Incentive Program

Incentive Program


By Cindy Copeland, ART

Three years ago, as the DRG coordinator at Provena St. Mary’s Hospital in Kankakee, IL, I implemented a coding incentive program to reward the coding staff for their productivity and quality. The program was also instituted to aid in the recruitment of new coders. Because we are located so close to many Chicago hospitals, we needed to devise a method of drawing coders to our suburb.

I am now currently pursuing the implementation of this incentive program at another hospital within our corporation–Provena St. Joseph Medical Center, Joliet, IL. However, I will be adjusting the coding standards here to reflect an overall higher level of coding experience, as well as to incorporate more complex coding such as CABG, PTCA and trauma surgeries. The individual number of charts coded for each monetary step will be increased from what was utilized at St. Mary’s.

The program is tied to monthly coding quality reviews, as well as monthly productivity of the total number of charts coded by each coder. There are two bonus programs in place. One rewards the coder on an individual basis and reflects the average number of records coded that month. The other program rewards the coder as part of a team. This portion is contingent upon the team being able to meet their accounts receivable (AR) days. Those coders within the group who meet both individual productivity standards and the group threshold turnaround times for AR days would be eligible for two separate bonus amounts.

Each month, I designate a chart type (Medicare/public aid, commercial insurance, ambulatory surgery/observation, emergency records with procedures, etc.). Six records per coder are selected from a computer-generated report that lists all charts coded each month by an individual coder. Some months I select a particular procedure, such as with ambulatory surgery cases (i.e. sinusotomies, diskectomies, etc). Other months, as with inpatient charts, I select the charts based on principal diagnosis (PDX). I try to select the same PDX from each coder and use several different PDXs for that month.

The coders perform quality peer reviews on the six records selected. They document their findings/questions and recommendations on individual quality assurance (QA) worksheets that I review and tally. If a discrepancy arises, I will discuss the findings with the coder and render a final decision. The current error rate threshold is 10 percent. If a coder exceeds this threshold, she is not eligible for an individual bonus.

The minimum number of charts coded that enable a coder to participate in the individual coding bonus is 30. This number is taken from weekly productivity sheets. The total number of charts coded in a given month is used as the denominator. The actual number of coding hours is then calculated. All time spent on non-coding functions is excluded. Only coding hours are calculated based on an eight-hour coding day.

For example, 340 total charts coded in January/92 actual coding hours = 11.5 coding days; 11.5 coding days/340 charts=29.5 average number of charts coded in January.

I rounded off the number so this would equal an average number of 30 charts coded. This meets the minimum standard so the coder would then be eligible to receive a $100 individual coding incentive.

All of our coders are able to code all work types. They all code every work type available, depending upon their previous experience or current individual training program.

The individual monetary range is: 30 charts coded = $100; 35 charts coded = $200; 40 charts coded = $300; and 45+ charts coded = $400.

The group incentive range is based on work type for that month: Medicare/public aid records = $500; commercial insurance rec-ords = $250; and ambulatory surgery/obv/ER = $250.

So, theoretically, if a coder codes an average number of 35 records for January, the individual QA error rate falls below 10 percent and the group threshold for AR days is met, the coder would be eligible for a coding incentive bonus of $200 (individual) and a portion of the work type amount for that given month. *

Cindy Copeland is the coding supervisor at Provena St. Joseph Medical Center in Joliet, IL. She can be reached at genecopeland