Developing a Coding Quality Plan

You have just been promoted to coding supervisor at a 300-physician clinic. The previous supervisor was terminated for incompetence. The coding section is a disaster. There is no coding quality program in place. There are no coding standards for either quality or productivity. There is a high denial rate due to the coding problems. Your job is to resolve the coding section deficiencies. Since you have been promoted from within the facility, you are already aware of many of the problems. Your facility is in serious trouble with the Quality Improvement Organization (QIO), and you fear that the OIG will show up on your doorstep soon. Although not all of the financial difficulties the physician practice is having can be related to coding, many can, as the facility is not receiving proper reimbursement.

1. What should you do to resolve the problems with quality of coding?

2. What should you do to reduce the denial rate?

3. What standard for quality of coding will you recommend?

4. What standard(s) for productivity will you recommend?

Support your statements with examples