Coder Productivity Benchmarks - · PDF file2 Coder Productivity Benchmarks: A Special Report Dear reader, Establishing coder productivity standards can be difficult because you must

An HCPro Publication

Coder Productivity Benchmarks

A Special Report

Coder Productivity Benchmarks: A Special Report2 Coder Productivity Benchmarks: A Special Report2

Dear reader,

Establishing coder productivity standards can be difficult because you must take various factors into account,

and there are no apple-to-apple comparisons on which you can base your own requirements. Do your current

full-time equivalent (FTE) employees keep your hospital or physician practice running efficiently? Are you

looking for ways to justify additional FTEs? How can you establish fair productivity standards that accurately

reflect your coders’ workload?

HIM directors and physician practice managers can develop coder productivity standards by learning from

their peers, as well as taking into account data that drill down into the factors that affect productivity.

This special report includes selected results from HCPro’s April 2009 coder productivity survey that polled

215 readers in the following settings:

➤ Acute care community hospital (nonteaching): 45% ➤ Acute care teaching hospital: 26%

➤ Clinic/physician office: 12% ➤ Critical access hospital: 7%

➤ Freestanding ambulatory surgery center: 5% ➤ Freestanding rehab: 2%

➤ Freestanding skilled nursing facility: 1% ➤ Long-term acute care hospital: 2%

The report provides a detailed breakdown of coder productivity according to bed size and record type.

In addition, we’ll take a look at how working remotely affects productivity.

We hope the report will serve as a useful benchmarking tool for you and your organization.

Sincerely,

Lisa A. Eramo, CPC

Senior Managing Editor

781/639-1872, Ext. 3923

[email protected]

Ensure accurate inpatient coder productivity benchmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Noncoding duties that affect coder productivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Set the bar with outpatient coder productivity standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Outpatient coder productivity standards according to record type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Establish benchmarks: Know the factors that affect coder productivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

– Factor #1: Bed size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8– Factor #2: Record format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11– Factor #3: Remote coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Use a time ladder and work distribution chart to take a closer look at coder productivity . . . . . . . . . . . . . . . . . 15

Table of contents

July 2009 3

The results of HCPro’s April 2009 coder productivity

survey highlight two common themes among coding

managers and professionals:

➤ Productivity should never be the sole focus; hospitals

must also address quality concerns

➤ The nuances of each facility make assessing produc-

tivity difficult

The survey found that 23% of the 215 respondents

have not established a quality baseline. CMS’ continued

reduction in reimbursement along with an increase in

federal and commercial payer oversight and auditing ac-

tivity mean that HIM departments must establish a qual-

ity expectation and mechanisms to monitor it, says Rose

T. Dunn, RHIA, CPA, FACHE, chief operating officer

at First Class Solutions, Inc., in St. Louis.

More than 50% of respondents said they undergo ex-

ternal coding quality audits at least annually or as often

as quarterly. Reimbursement changes and an increase

in uninsured patients make accurate coding imperative

for healthcare providers if they hope to receive the reim-

bursement to which they are entitled, Dunn adds.

The survey also found that 37% of respondents

whose facilities have a quality baseline said their expec-

tation is 95%–96%. These providers should conduct an

internal or external coding quality review to determine

the gap between current performance and this expecta-

tion, Dunn says.

Assessing the nuances of each facility presents unique

challenges, especially when considering coders’ noncod-

ing responsibilities. Remember that extra tasks should

not distract coders from their primary function (i.e., accu-

rately and completely coding the record), Dunn says.

See “Noncoding duties that affect coder productivity”

on p. 4 for a summary of the survey findings.

These extra tasks, as well as other regulatory changes,

affect coder productivity. For example, one respon-

dent from a New York acute care hospital wrote that

MS-DRGs increase the amount of time it takes to code

a record, thereby decreasing coder productivity. Four

respondents laid the blame on present-on-admission

(POA) indicators.

The lack of national productivity standards, coupled

with high productivity expectations, breeds the great-

est amount of frustration, according to many survey

participants.

“Coding productivity needs to be reestablished to in-

clude expectations for POA indicators reporting, the

query process, and abstracting functions,” wrote one

respondent from a medium-size Texas teaching hospital.

Another respondent from a large teaching hospital in

Florida added, “Across the nation, there does not seem

to be an apples-to-apples number for productivity.”

Coding practices

Although there are no national productivity stan-

dards, it is possible to establish standards within your

facility by looking at how you stack up against other

hospitals. To start, use the following statistics from the

survey for inpa tient records coded per hour:

➤ Fewer than 3: 12%

➤ 3: 29%

➤ 3.5–3.75: 14%

➤ 4: 10%

➤ Greater than 4: 6%

➤ Not applicable (we don’t have a standard): 15%

➤ Not applicable (we don’t code this record type): 14%

For those who think working remotely breeds lower

productivity, think again. Of the 83 respondents who al-

low a remote option for coders, 43% reported those re-

mote workers have a higher productivity because of the

arrangement. Eleven percent reported remote workers

had a lower productivity due to reasons such as a slow In-

ternet connection or lack of interaction with coworkers.

“There is much to consider in coding a record—the

time to search a subject or getting the little details done,”

wrote one respondent from an Illinois acute care teach-

ing hospital. n

Ensure accurate inpatient coder productivity benchmarks

Coder Productivity Benchmarks: A Special Report4

0%

10%

20%

30%

40%

50%

60%

70%

80%

64%

49%

58%

20%

12%

18%

13%

20% 20%

60%

39%

11%

7%

28%

18%

14%

34%

12%

17%

21%

11%

78%

10%

Noncoding duties that affect coder productivity

Ans

wer

ing

calls

/que

stio

ns fr

om t

he b

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ng q

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ase

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)

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a

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(cor

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for

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om (

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ss, a

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ify in

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n fo

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ore

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ng

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irect

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ting

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)

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Ass

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rs

Source: HCPro’s April 2009 coder productivity benchmarking survey.

July 2009 5

Set the bar with outpatient coder productivity standardsEstablishing coder productivity standards is a neces-

sary and challenging part of running an efficient HIM

department. Without standards, coders don’t know what

directors and managers expect of them and they don’t

have a productivity goal to which they can aspire.

Seventy-three percent of the 215 respondents to

HCPro’s April 2009 coder productivity survey reported

having established a general coding productivity standard.

Although having standards is important, the one

area in which directors or managers sometimes fail is

in monitoring those standards, says Glenn Krauss,

RHIA, CCS, CCS-P, CPUR, senior consultant at

QHR in Brentwood, TN. Outpatient standards, in particu-

lar, aren’t monitored as closely because inpatient cases

tend to bring in more money, Krauss says.

Not revisiting outpatient productivity standards on a

weekly or monthly basis for each coder could be a big

mistake, he says, adding that if a coder is not performing

up to par, it’s better to recognize that early on and set re-

alistic goals rather than to realize it during a six-month

or annual evaluation.

What’s challenging about productivity standards is

that there’s no one-size-fits-all solution, says Joe Rivet,

CCS-P, CPC, CEMC, CICA, regulatory specialist at

HCPro, Inc., in Livonia, MI.

“The problem is that people are looking for something

that doesn’t exist,” Rivet says. “Every facility is unique.

Facilities should really be looking at their operations,

flows, and processes to create their own benchmarks

for productivity.”

When monitoring outpatient coding productivity

standards, directors and managers should routinely

ask the following questions to ensure accurate and fair

expectations:

Do outpatient coders also code inpatient

services?

Inpatient and outpatient coding require two different

skill sets, says Rivet.

“The rules between inpatient and outpatient are very

different. Outpatient rules are unique, and you use CPT

far more than you would on the inpatient side,” he says.

Because of these differences, productivity standards vary

greatly between the two.

In smaller facilities, coders typically code both types of

records, Rivet says. But larger facilities may have more

full-time equivalents, allowing for specialization.

One advantage of separating coders according to re-

cord type is that it could increase productivity.

“If you do something all the time, you’re going to

get to know the types of diseases and procedures that

represent the product line and can move more quickly

through the encoder or book,” Rivet says.

A disadvantage is that coders who code only one re-

cord type may become bored with the task and yearn for

more variety, Krauss says.

It’s important to distinguish whether coders code in-

patient records, outpatient records, or both because each

record type has its own challenges. For example, inpatient

coders must scour records in search of complications and

comorbidities (CC) or major CCs. They must also assign

the present-on-admission indicator and follow up with

physicians regarding queries for added specificity.

On the outpatient side, coders struggle with medically

unlikely edits, NCCI edits, modifiers, and verifying medi-

cal necessity, Krauss says. All of these factors affect coding

productivity.

What type of outpatient records do coders

code?

Outpatient productivity standards could vary greatly

depending on the record type.

“[Interventional radiology] cases or any other type of

invasive procedure is more complex than a straightfor-

ward ER or clinic visit,” Rivet says.

See “Outpatient coding productivity standards ac-

cording to record type” on p. 6 for specific standards for

ambulatory surgery, ED, outpatient testing reports (non-

interventional), interventional outpatient testing reports

(e.g., cardiac catheterizations and angiographies), clinic

visits, and observation.

> continued on p. 7


Outpatient coder productivity standards according to record type

Source: HCPro’s April 2009 coder

productivity benchmarking survey.

Ambulatory surgery records per hour

Fewer than 4:

5%4: 6%

6: 18%

5: 16%

7: 9%

We don’t have a standard: 16%

Greater than 8:

7%

8: 6%

We don’t code this

record type: 17%

Observation cases per hour


Greater than 8:

6%

Fewer than 4:

9%

6: 9%

5: 17%

4: 10%

8:

4%

7:

3%


record type: 21%

ED records per hour

We don’t code this record type: 23%

We don’t have a

standard:16%

Greater than 12: 29%

Fewer than 6: 2%

12: 7%

11: 1%

10: 13%

9: 2%

6: 2% 7: 2%


Clinic visit reports per hour

Fewer than 8:

3%

8:

5%

9: 1%

Greater than 12:

17%


record type: 44%

10: 6%11: 1%

12: 3%

Outpatient testing reports per hour

Fewer than 20:

8%

20–25:

19%

26–31:

12%We don’t have a standard: 20%

Greater than 31:

13%


record type: 28%

(Non-interventional) (Interventional)


Fewer than 4:

4%4: 6%

6: 8%

5: 12%

7: 6%We don’t have a standard: 18%

Greater than 10:

9%

10:

5%

We don’t code this record type: 27%

8: 4%

9: 1%

July 2009 7

What other noncoding duties do outpatient

coders perform?

Noncoding duties can greatly affect coding productiv-

ity, and you should take them into account when estab-

lishing standards, Rivet says.

For example, outpatient coders often perform data

entry and loose filing, answer phones, order supplies,

and retrieve records.

Of those respondents who reported that coders code

outpatient records only, nearly 63% said they also an-

swer calls and questions from the business office and

patient financial services.

Fifty-six percent said outpatient-only coders obtain

information to support medical necessity. Thirty-eight

percent said they respond to recovery audit contractor

requests, and another 38% said they answer calls and

questions from physician offices.

Coders who code for labs, x-rays, or other ancillary

departments may need to go to the department to pick

up the record, Rivet says. Often, they may need to al-

phabetize the records as well, and each of these tasks

takes time.

For which omissions do outpatient coders

check?

Omissions, such as a missing operative note or pa-

thology report, are perhaps the biggest barrier to an

outpatient coder meeting productivity expectations,

says Krauss.

Of those respondents who reported that coders code

outpatient records only, nearly 63% reported that these

coders also check for omissions in ambulatory surgery/

outpatient records.

Twenty-five percent said they check for omissions in

ED records, and another 25% said they check for omis-

sions in outpatient testing records.

“Is it missing, or did the physician not perform it?

If it’s not documented, then it didn’t happen,” Rivet

says, adding that outpatient coders must frequently

track down missing signatures or attestations for teach-

ing hospitals.

Set the bar < continued from p. 5

What ED services do coders code?

In some facilities, coders only code facility ED services,

whereas in others, they code facility and professional ser-

vices, Rivet says. When coders code both, adjust produc-

tivity standards accordingly.

Twenty-seven percent of respondents reported that

coders assign diagnoses on the physician’s bill, 20% said

they assign procedures on the physician’s bill, and 27%

said they assign the physician E/M level.

What is the skill level of the individual coder?

When setting productivity goals, take coders’ skill sets

into account, particularly when the coder is new to the

organization, Rivet says. “Even if the person is seasoned

but new to the organization, there should be some ramp

up,” he says. “Set goals for one month, two months,

three months, etc., into the employment.”

Although it’s important to consider a coder’s skill set

when determining whether he or she can reasonably

meet predetermined standards, directors and managers

shouldn’t set standards solely based on skills, Krauss says.

“If you have too many standards, it defeats the purpose

and is not a standard anymore,” he adds. “If someone is

not meeting the standard, figure out what you can do to

help that person get where he or she needs to be.” n

One-stop shop for HIM resources

To help increase the efficiency of your HIM department,

consider adding these HCPro resources to your toolbox:

➤ Coding Productivity: Tapping Your Team’s Talents to

Improve Quality and Reduce Accounts Receivable

➤ The HIM Director’s Handbook

➤ More With Less: Best Practices for HIM Directors,

Second Edition

To learn more about the results of HCPro’s April 2009 coder

productivity survey, purchase a copy of HCPro’s audio confer-

ence “Benchmark Coder Productivity to Improve and Justify

FTEs .” For more information about any of these products,

call HCPro’s customer service department at 877/727-1728 .


Establish benchmarks: Know the factors that affect coder productivity

Observation

cases Productivity standards (records coded per hour)

Number of bedsFewer than 4 4 5 6 7 8

Greater than 8

Not applicable (we don’t have a standard or performance expectation)

Not applicable (we don’t code this record type)

Fewer than 75 26% 14% 17% 37% 0% 11% 8% 33% 35%

75–150 11% 19% 17% 5% 14% 11% 23% 17% 20%

151–226 32% 19% 14% 0% 14% 11% 15% 7% 2%

227–302 16% 10% 6% 16% 0% 11% 8% 2% 2%

303–378 16% 10% 6% 16% 0% 11% 0% 4% 2%

379–454 0% 0% 11% 0% 14% 22% 8% 2% 4%

455–530 0% 10% 3% 5% 14% 0% 8% 2% 2%

531–606 0% 0% 3% 0% 14% 11% 0% 0% 4%

607–682 0% 0% 14% 0% 0% 0% 0% 2% 0%

683–758 0% 5% 0% 5% 0% 0% 0% 4% 0%

759–834 0% 5% 0% 0% 14% 0% 8% 0% 0%

835–910 0% 0% 0% 5% 0% 0% 8% 0% 4%

911–986 0% 0% 0% 0% 14% 0% 0% 0% 0%

Greater than 986 0% 10% 6% 5% 0% 11% 0% 7% 0%

Not applicable 0% 0% 3% 5% 0% 0% 15% 20% 24%

Clinic visits Productivity standards (records coded per hour)


Greater than 12



Fewer than 75 17% 20% 0% 15% 0% 29% 16% 21% 34%

75–150 0% 30% 0% 23% 0% 14% 22% 19% 13%

151–226 17% 20% 0% 15% 0% 0% 5% 9% 13%

227–302 17% 0% 50% 8% 0% 14% 5% 5% 6%

303–378 33% 10% 50% 15% 50% 14% 3% 0% 5%

379–454 0% 0% 0% 0% 0% 14% 8% 2% 6%

455–530 0% 0% 0% 0% 0% 0% 11% 2% 3%

531–606 0% 10% 0% 0% 0% 0% 0% 0% 4%

607–682 0% 0% 0% 15% 50% 0% 3% 0% 2%

683–758 0% 0% 0% 8% 0% 0% 0% 5% 1%

759–834 0% 10% 0% 0% 0% 0% 0% 0% 2%

835–910 0% 0% 0% 0% 0% 0% 3% 0% 3%

911–986 0% 0% 0% 0% 0% 0% 0% 0% 1%

Greater than 986 0% 0% 0% 0% 0% 0% 11% 5% 3%

Not applicable 17% 0% 0% 0% 0% 14% 14% 33% 3%

Bed size, record format, and remote coding can greatly affect inpatient and outpatient coder productivity . Below are

graphic representations of findings from HCPro’s April 2009 coder productivity benchmarking survey .

Factor #1: Bed size

July 2009 9

Establish benchmarks: Know the factors that affect coder productivity (cont.)

Interventional

outpatient test-

ing reports (e.g.,

cardiac caths and

angiographies) Productivity standards (records coded per hour)

Number of beds

Fewer

than 4 4 5 6 7 8 9 10Greater than 10


Not appli-cable (we don’t code this record

type)

Fewer than 75 13% 8% 16% 11% 0% 13% 0% 30% 47% 24% 38%

75–150 13% 8% 12% 11% 17% 25% 50% 20% 5% 22% 18%

151–226 13% 33% 16% 17% 8% 0% 0% 10% 5% 5% 10%

227–302 13% 0% 8% 6% 17% 0% 0% 10% 11% 5% 5%

303–378 13% 8% 4% 17% 17% 0% 0% 0% 11% 5% 3%

379–454 0% 8% 16% 11% 8% 0% 0% 0% 11% 2% 0%

455–530 13% 8% 4% 6% 8% 0% 0% 0% 5% 2% 2%

531–606 0% 0% 8% 0% 8% 13% 0% 0% 0% 0% 2%

607–682 0% 8% 8% 0% 0% 25% 0% 10% 0% 0% 0%

683–758 0% 0% 0% 6% 0% 13% 0% 0% 0% 2% 2%

759–834 0% 0% 0% 0% 8% 13% 0% 0% 0% 0% 2%

835–910 0% 0% 0% 6% 0% 0% 0% 10% 0% 0% 3%

911–986 0% 0% 0% 0% 8% 0% 0% 0% 0% 0% 0%

Greater than 986 13% 17% 4% 6% 0% 0% 50% 0% 0% 5% 2%

Not applicable 13% 0% 4% 6% 0% 0% 0% 10% 5% 27% 13%

Outpatient

testing reports

(non-interventional) Productivity standards (records coded per hour)

Number of bedsFewer

than 20 20–25 26–31Greater than 31



Fewer than 75 22% 20% 8% 28% 35% 29%

75–150 11% 10% 35% 24% 16% 10%

151–226 17% 22% 8% 10% 7% 5%

227–302 11% 5% 8% 10% 5% 5%

303–378 11% 15% 8% 3% 0% 5%

379–454 6% 2% 8% 14% 2% 3%

455–530 6% 2% 12% 3% 2% 2%

531–606 6% 0% 0% 0% 0% 7%

607–682 6% 7% 0% 0% 2% 2%

683–758 0% 0% 4% 0% 2% 3%

759–834 0% 2% 0% 0% 0% 3%

835–910 0% 2% 0% 0% 0% 5%

911–986 0% 2% 0% 0% 0% 0%

Greater than 986 6% 2% 8% 3% 5% 3%

Not applicable 0% 7% 4% 3% 23% 16%

> continued on p. 10



ED records Productivity standards (records coded per hour)

Number of bedsFewer than 6 6 7 8 9 10 11 12

Greater than 12

Not applicable (we don’t have a stan-

dard or performance expectation)


Fewer than 75 25% 50% 20% 0% 25% 19% 50% 20% 14% 40% 35%

75–150 0% 0% 0% 43% 0% 7% 0% 40% 21% 11% 14%

151–226 25% 0% 20% 43% 25% 7% 0% 13% 14% 9% 2%

227–302 0% 0% 20% 0% 0% 7% 50% 0% 11% 3% 4%

303–378 25% 25% 20% 0% 25% 4% 0% 20% 10% 0% 0%

379–454 0% 0% 0% 0% 0% 19% 0% 7% 6% 0% 2%

455–530 0% 0% 0% 0% 25% 0% 0% 0% 6% 3% 4%

531–606 0% 0% 0% 0% 0% 7% 0% 0% 2% 0% 4%

607–682 0% 0% 20% 0% 0% 15% 0% 0% 2% 0% 0%

683–758 0% 0% 0% 0% 0% 4% 0% 0% 3% 3% 0%

759–834 0% 25% 0% 0% 0% 0% 0% 0% 0% 0% 4%

835–910 0% 0% 0% 0% 0% 4% 0% 0% 2% 0% 4%

911–986 0% 0% 0% 0% 0% 0% 0% 0% 2% 0% 0%

Greater than 986 0% 0% 0% 14% 0% 7% 0% 0% 3% 9% 2%

Not applicable 25% 0% 0% 0% 0% 0% 0% 0% 5% 23% 25%

Ambulatory surgery records Productivity standards (records coded per hour)


Greater than 8

Not applicable (we don’t have a standard or perfor-

mance expectation)Not applicable (we don’t

code this record type)

Fewer than 75 20% 23% 11% 21% 10% 23% 27% 43% 36%

75–150 10% 23% 20% 8% 15% 23% 20% 14% 19%

151–226 30% 23% 11% 13% 15% 0% 20% 6% 0%

227–302 0% 0% 11% 8% 15% 8% 0% 3% 6%

303–378 20% 8% 6% 11% 10% 8% 7% 0% 3%

379–454 0% 0% 14% 11% 0% 15% 0% 0% 0%

455–530 0% 15% 0% 5% 10% 0% 7% 3% 0%

531–606 0% 0% 6% 0% 5% 8% 0% 0% 3%

607–682 0% 8% 6% 3% 10% 0% 0% 0% 0%

683–758 10% 0% 3% 5% 0% 0% 0% 0% 0%

759–834 0% 0% 0% 3% 5% 0% 0% 0% 3%

835–910 0% 0% 0% 3% 0% 0% 7% 0% 6%

911–986 0% 0% 0% 0% 5% 0% 0% 0% 0%

Greater than 986 0% 0% 9% 5% 0% 8% 0% 6% 3%

Not applicable 10% 0% 3% 5% 0% 8% 13% 26% 22%

July 2009 11


Inpatient records Productivity standards (records coded per hour)

Number of bedsFewer than 3 3 3 .5–3 .75 3 .76–4

Greater than 4

Not applicable (we don’t have a standard or perfor-

mance expectation)Not applicable (we don’t


Fewer than 75 20% 20% 3% 38% 8% 46% 37%

75–150 12% 14% 20% 19% 17% 18% 17%

151–226 16% 13% 17% 10% 17% 6% 0%

227–302 8% 9% 17% 5% 0% 0% 0%

303–378 4% 9% 10% 14% 8% 0% 0%

379–454 4% 11% 7% 5% 0% 0% 0%

455–530 0% 6% 3% 0% 8% 3% 3%

531–606 0% 6% 0% 0% 0% 0% 3%

607–682 4% 3% 7% 5% 0% 0% 0%

683–758 8% 2% 0% 0% 8% 0% 0%

759–834 0% 2% 3% 0% 8% 0% 0%

835–910 8% 2% 3% 0% 0% 0% 0%

911–986 4% 0% 0% 0% 0% 0% 0%

Greater than 986 8% 2% 10% 0% 8% 6% 0%

Not applicable 4% 2% 0% 5% 17% 21% 40%

Factor #2: Record format

Observation cases Productivity standards (records coded per hour)

Record typeFewer than 4 4 5 6 7 8

Greater than 8

Not applicable (we don’t have a standard or

performance expectation)


The entire record is online 53% 48% 31% 42% 14% 22% 31% 13% 13%

Most transcribed reports and lab data are online and/or some docu-

ments are scanned

0% 10% 14% 16% 0% 0% 8% 15% 13%

The entire record is paper-based 16% 10% 11% 11% 0% 33% 15% 20% 41%

The record is partially online and partially paper-based

32% 33% 43% 32% 86% 44% 46% 52% 33%

Clinic visits Productivity standards (records coded per hour)


Greater than 12






ments are scanned

0% 10% 50% 8% 50% 14% 14% 19% 6%



33% 50% 0% 46% 0% 71% 35% 40% 43%




Interventional outpatient testing reports (e.g., cardiac

caths and angiographies) Productivity standards (records coded per hour)

Record typeFewer than 4 4 5 6 7 8 9 10

Greater than 10

Not applicable (we don’t have a

standard or perfor-mance expectation)


The entire record is online 50% 50% 40% 50% 25% 50% 50% 20% 16% 10% 20%

Most transcribed reports and lab data are online and/or some

documents are scanned

0% 8% 8% 11% 17% 0% 0% 20% 11% 24% 5%

The entire record is paper-based 13% 0% 16% 11% 17% 13% 0% 0% 21% 22% 35%


38% 42% 36% 28% 42% 38% 50% 60% 53% 44% 40%

Outpatient testing reports (non-interventional) Productivity standards (records coded per hour)

Record typeFewer

than 20 20-25 26-31Greater than 31


performance expectation)Not applicable (we don’t


The entire record is online 56% 32% 35% 28% 12% 22%


ments are scanned

11% 12% 12% 7% 19% 7%

The entire record is paper-based 0% 10% 15% 28% 23% 31%


33% 46% 39% 38% 47% 40%

ED records Productivity standards (records coded per hour)

Record typeFewer than 6 6 7 8 9 10 11 12

Greater than 12


Not applicable (we don’t code this

record type)

The entire record is online 50% 50% 20% 43% 50% 44% 50% 27% 27% 11% 20%


ments are scanned

0% 25% 40% 0% 25% 7% 0% 0% 11% 17% 10%

The entire record is paper-based 25% 0% 20% 14% 0% 4% 0% 13% 19% 26% 35%


25% 25% 20% 43% 25% 44% 50% 60% 43% 46% 35%

Ambulatory surgery records Productivity standards (records coded per hour)


Greater than 8

Not applicable (we don’t have a standard

or performance expectation)




ments are scanned

10% 8% 11% 18% 0% 8% 13% 14% 8%



10% 46% 46% 40% 55% 54% 33% 51% 28%

July 2009 13


Inpatient records Productivity standards (records coded per hour)

Record typeFewer than 3 3 3 .5–3 .75 3 .76–4

Greater than 4



Not applicable (we don’t code this

record type)

The entire record is online 44% 27% 50% 24% 33% 6% 13%


ments are scanned

12% 6% 10% 10% 8% 18% 17%

The entire record is paper-based 20% 14% 10% 19% 17% 30% 37%


24% 53% 30% 48% 42% 46% 33%

Factor #3: Remote coding

1 . Do you offer a remote (at home) coding option for

your employed coders?


53%

No, and we don’t

have any plans to do

so in the near future

13% No, but we’re

planning on

implementing

one in the next

12 months

34%

Yes

43%

Yes, they have

a higher

productivity

11% Yes, they

have a lower

productivity

46% No, their

productivity has

remained the same

2 . If you do have a remote coding program, have you

noticed any differences in productivity for your remote staff

members?



3 . If your remote coders have a lower productivity, which of the following have you noticed? Please check all that apply .

Coders have battled slow Internet connections

Coders have encountered disconnects and other connectivity issues

Some coders have lacked motivation/self-discipline

Some coders have experienced home interferences (e .g ., children and spouses)

Some coders have complained about the lack of coworker interaction, particularly when they have coding-related questions

Source: HCPro’s April 2009 coder productivity benchmarking survey.

0%

10%

20%

30%

40%

50%

38%

6%

25%

38%

50%

July 2009 15

Use a time ladder and work distribution chart to take a closer look at coder productivity

HIM directors may need to capture data to identify activities

that are time-wasters for coders and that can be done more

cost-effectively by other staff members . One tool that is helpful

in capturing such data is the time ladder (see p . 16) .

The employee completes the time ladder throughout the

day at given intervals . At the end of a given period, usually

not less than 10 working days, the manager compiles the

ladders to determine the amount of time spent on the given

activities and whether it is appropriate to assign some activi-

ties to other employees .

Once the reassignment is made, the proportionate amount

of time is “returned” to the individual to perform his or her

designated duties . To view the distribution of work (based on

one day’s input from the time ladder), see “Distribution of

work time by function” below .

From the time ladder example, you can see that Carolyn

Coder has several duties that qualify for evaluation, such as

covering the phone for the receptionist and filing records .

If the manager reassigned the receptionist and filing duties

to others, Carolyn would capture 113 minutes in this day, or

nearly two hours, to do coding . Additionally, unless Carolyn’s

extended lunch is authorized by the organization, the man-

ager may wish to speak to Carolyn about it .

However, HIM recognizes that there are activities that need

the input of professional coders, such as:

➤ Charge master maintenance

➤ Documentation improvement

➤ Quality Improvement Organization (formerly known as

the professional review organization) findings or third-

party payer coding–related denials

The time away from coding can be significant, but it is a

necessity in many organizations . And in many instances, cod-

ers who enjoy variety in their days may find it rewarding to be

involved in such activities . Forbidding their involvement may

cause job dissatisfaction and result in the loss of quality cod-

ing professionals to another organization .

Therefore, the HIM manager must balance the need for

high and accurate coding production with the need to main-

tain employee satisfaction .

Distribution of work time by function

Function Time spent Percent of total time

Coding 240 minutes 240/480 = 50%

Covering for the receptionist 45 minutes 45/480 = 9 .4%

Filing records/documentation 68 minutes 68/480 = 14 .2%

Searching for documentation 45 minutes 45/480 = 9 .4%

Business-related calls 15 minutes 15/480 = 3 .1%

Breaks 37 minutes 37/480 = 7 .7%

Other (printing) 30 minutes 30/480 = 6 .2%

Total 480 minutes

Productive time 428/480 minutes 89 .2%



This special report is published by HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945. • Copyright 2009 HCPro, Inc. All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, Inc., or the Copyright Clearance Center at 978/750-8400. Please notify us immediately if you have received an unauthorized copy. • For editorial comments or questions, call 781/639-1872 or fax 781/639-2982. • Opinions expressed are not necessarily those of the editors. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. HCPro, Inc., is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks.

07/09 SR4309

Use a time ladder and work distribution chart to take a closer look at coder productivity (cont.)

Source: Coder Productivity: Tapping Your Team’s Talents to Improve Quality and Reduce Accounts Receivable, published by HCPro, Inc.

Time ladder

Time ladder for employee: Time ladder for employee: Carolyn Coder

7:00 _____________________________________________________7:15 _____________________________________________________7:30 _____________________________________________________7:45 _____________________________________________________8:00 _____________________________________________________8:15 _____________________________________________________8:30 _____________________________________________________8:45 _____________________________________________________9:00 _____________________________________________________9:15 _____________________________________________________9:30 _____________________________________________________9:45 _____________________________________________________10:00 ____________________________________________________10:15 ____________________________________________________10:30 ____________________________________________________10:45 ____________________________________________________11:00 ____________________________________________________11:15 ____________________________________________________11:30 ____________________________________________________11:45 ____________________________________________________12:00 ____________________________________________________12:15 ____________________________________________________12:30 ____________________________________________________12:45 ____________________________________________________1:00 _____________________________________________________1:15 _____________________________________________________1:30 _____________________________________________________1:45 _____________________________________________________2:00 _____________________________________________________2:15 _____________________________________________________2:30 _____________________________________________________2:45 _____________________________________________________3:00 _____________________________________________________3:15 _____________________________________________________3:30 _____________________________________________________3:45 _____________________________________________________4:00 _____________________________________________________4:15 _____________________________________________________

7:00 _______ Inpt charts _________________________________7:15 _______ Inpt charts _________________________________7:30 _______ Searching for missing cases __________________7:45 _______ Call from business office _____________________8:00 _______ Inpt charts _________________________________8:15 _______ Ambi surg _________________________________8:30 _______ Ambi surg _________________________________8:45 _______ Ambi surg _________________________________9:00 _______ Ambi surg _________________________________9:15 _______ Break _____________________________________9:30 _______ Inpt charts _________________________________9:45 _______ Inpt charts _________________________________10:00 ______ Inpt charts _________________________________10:15 ______ Restroom __________________________________10:30 ______ Inpt charts _________________________________10:45 ______ Inpt charts _________________________________11:00 ______ Inpt charts _________________________________11:15 ______ Inpt charts _________________________________11:30 ______ Lunch _____________________________________11:45 ______ Lunch _____________________________________12:00 ______ Lunch _____________________________________12:15 ______ Searching for path reports ___________________12:30 ______ Searching for path reports ___________________12:45 ______ Printing dictated report _____________________1:00 _______ Covering phone for receptionist ______________1:15 _______ Covering phone for receptionist ______________1:30 _______ Covering phone for receptionist ______________1:45 _______ Inserting paths and dictated reports ___________2:00 _______ Inserting paths and dictated reports ___________2:15 _______ Ambi surg _________________________________2:30 _______ Ambi surg _________________________________2:45 _______ Restroom/filing records in incomplete _________3:00 _______ Filing records in incomplete __________________3:15 _______ Filing records in incomplete __________________3:30 ____________________________________________________3:45 ____________________________________________________4:00 ____________________________________________________4:15 ____________________________________________________

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