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Coding Counts

Coding Counts. Jane Dimond Vicki Nicolaou SLHD 2 nd September 2011. BACKGROUND. 2007/8 Casemix pressure reignited SSWAHS – Identified and supported need for increased Clinical Coding workforce. INITIATIVES . Clinical Coder Trainee Program – Three to-date

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Coding Counts

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  1. Coding Counts Jane Dimond Vicki Nicolaou SLHD 2nd September 2011

  2. BACKGROUND • 2007/8 • Casemix pressure reignited • SSWAHS – Identified and supported need for increased Clinical Coding workforce

  3. INITIATIVES • Clinical Coder Trainee Program – Three to-date • Standardised SSWAHS Coding Auditing Program • SSWAHS Documentation Guidelines published on the intranet • Clinician Buy-In

  4. CLINICAL CODER TRAINEE PROGRAM • Three programs run to-date • PROGRAM 1 • Advertised internally – no experience necessary • PROGRAM 2 • Advertised internally only – working towards qualifications • PROGRAM 3 • Advertised internally and externally – working towards qualifications

  5. PROS AND CONS +VE • Increased workforce • Familiarisation to our practical coding • Networking (trainers and trainees) • Trainees able to fill vacant positions -VE • Loss of investment – trainees moved on • Cost / Time - course / trainer’s time / non-productive time • The right fit – What makes a good coder??? • Different learning styles – formal program didn’t fit • Individual vs Group training • No Area Trainer

  6. CODING AUDITING PROGRAM • Standardised program across all SSWAHS Facilities • Designed to fit all facilities • Weekly / Monthly / Quarterly / Bi-Annual • Types of Audits • Individual Clinical Coder Audit • Random 5% of one months discharges • Error DRGs • Adjacent DRGs • Outliers • Coder Education • Clinicians presenting to coders • Coders watching procedures • Internet Access for self teaching

  7. PROS AND CONS +VE • Benchmarking across facilities • Identification of training needs • Identification of documentation issues • Development of Documentation guidelines (specialty cheat sheets in some facilities) • Correction of errors – hopefully for gains in funding • Coders Self Checking - mandatory highlighting of patient’s LOS against ALOS/DRG -VE • Time restraints • Staffing restraints • Internet access

  8. DOCUMENTATION GUIDELINES • Published documentation per specialty on the intranet • Endorsed by SSWAHS Executive • Memo to GMs from CEO • Copies in JMOs offices on wards, • Laminated copy for bedside • Sent to Clinical Training Schools / Facility

  9. PROS AND CONS +VE • Standardised information across SSWAHS • Education by Specialty • Accessibility via intranet -VE • “Not one shoe fits all” • “Cheat Sheets” or tick a diagnosis/procedure – not always documented in the record as well as the cheat sheet – therefore can’t code = waste of time

  10. CLINICIAN BUY-IN • Revved up education in past few years • Heads of Department meetings • Ward Rounds • JMO Orientation • Specialty meetings (Adopt a HIM or Adopt a Clinician) • Individual Clinician • Patient Flow • Casemix reports

  11. PROS AND CONS +VE • Education for Clinicians at all levels • Education by Specialty • Lifts the HIM’s and Coder’s profile -VE • Jaded Senior Clinicians • Availability of HIM to educate • Time consuming • Lack of Casemix HIM specialists • Coders – under the spotlight

  12. MOVING FORWARD • Surgical Targets • Introduction of Local Health Districts • Workforce issues • Education • Maintaining HIM profile • Driving Efficiency and Change

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