Coder Productivity Benchmarks - HCPro
Transcript of Coder Productivity Benchmarks - HCPro
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
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
usin
ess
offic
e/pa
tient
fina
ncia
l ser
vice
s
Ans
wer
ing
calls
/que
stio
ns fr
om p
hysi
cian
offi
ces
Ans
wer
ing
codi
ng q
uest
ions
from
util
izat
ion
revi
ew/c
ase
man
agem
ent
Abs
trac
ting
(can
cer
regi
stry
)
Abs
trac
ting/
colle
ctin
g oc
curr
ence
dat
a
Abs
trac
ting
(cor
e m
easu
res)
Abs
trac
ting
for
the
oper
atin
g ro
om (
bloo
d lo
ss, a
nest
hesi
a ty
pe, e
tc .)
Que
ryin
g ph
ysic
ians
to
clar
ify in
form
atio
n fo
r m
ore
spec
ific
codi
ng
Serv
ing
as d
irect
or/m
anag
er o
f the
dep
artm
ent
Abs
trac
ting
(per
form
ance
impr
ovem
ent
data
)
Prov
idin
g an
alys
is (
defic
ienc
ies)
App
ealin
g de
nial
s
Resp
ondi
ng t
o re
cove
ry a
udit
cont
ract
or r
eque
sts
Reco
rdin
g re
trie
val/
filin
g (in
clud
ing
inse
rtin
g lo
ose
mat
eria
ls)
Ass
istin
g w
ith r
ecor
d as
sem
bly
Obt
aini
ng in
form
atio
n to
sup
port
med
ical
nec
essi
ty
Han
dlin
g in
com
plet
e re
cord
s m
anag
emen
t
Filin
g co
ded
reco
rds
Perf
orm
ing
clin
ical
doc
umen
tatio
n im
prov
emen
t ac
tiviti
es
Ass
istin
g w
ith o
r pe
rfor
min
g tr
ansc
riptio
n
Ass
istin
g w
ith o
r pe
rfor
min
g re
leas
e of
info
rmat
ion
Ass
igni
ng w
orki
ng D
RGs
Ass
igni
ng P
OA
indi
cato
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
Coder Productivity Benchmarks: A Special Report6
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
We don’t have a standard: 21%
Greater than 8:
6%
Fewer than 4:
9%
6: 9%
5: 17%
4: 10%
8:
4%
7:
3%
We don’t code this
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%
We don’t have a standard: 20%
Clinic visit reports per hour
Fewer than 8:
3%
8:
5%
9: 1%
Greater than 12:
17%
We don’t code this
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%
We don’t code this
record type: 28%
(Non-interventional) (Interventional)
We don’t have a standard: 20%
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 .
Coder Productivity Benchmarks: A Special Report88
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)
Number of bedsFewer than 8 8 9 10 11 12
Greater than 12
Not applicable (we don’t have a standard or performance expectation)
Not applicable (we don’t code this record type)
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 applicable (we don’t have a standard or performance expectation)
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
Not applicable (we don’t have a standard or performance expectation)
Not applicable (we don’t code this record type)
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
Coder Productivity Benchmarks: A Special Report10
Establish benchmarks: Know the factors that affect coder productivity (cont.)
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)
Not applicable (we don’t code this record type)
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)
Number of bedsFewer than 4 4 5 6 7 8
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
Establish benchmarks: Know the factors that affect coder productivity (cont.)
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
code this record type)
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)
Not applicable (we don’t code this record type)
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)
Record typeFewer than 8 8 9 10 11 12
Greater than 12
Not applicable (we don’t have a standard or
performance expectation)
Not applicable (we don’t code this record type)
The entire record is online 50% 40% 50% 46% 0% 0% 35% 14% 26%
Most transcribed reports and lab data are online and/or some docu-
ments are scanned
0% 10% 50% 8% 50% 14% 14% 19% 6%
The entire record is paper-based 17% 0% 0% 0% 50% 14% 16% 28% 24%
The record is partially online and partially paper-based
33% 50% 0% 46% 0% 71% 35% 40% 43%
> continued on p. 12
Coder Productivity Benchmarks: A Special Report12
Establish benchmarks: Know the factors that affect coder productivity (cont.)
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)
Not applicable (we don’t code this record type)
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%
The record is partially online and partially paper-based
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
Not applicable (we don’t have a standard or
performance expectation)Not applicable (we don’t
code this record type)
The entire record is online 56% 32% 35% 28% 12% 22%
Most transcribed reports and lab data are online and/or some docu-
ments are scanned
11% 12% 12% 7% 19% 7%
The entire record is paper-based 0% 10% 15% 28% 23% 31%
The record is partially online and partially paper-based
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 have a standard or performance expectation)
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%
Most transcribed reports and lab data are online and/or some docu-
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%
The record is partially online and partially paper-based
25% 25% 20% 43% 25% 44% 50% 60% 43% 46% 35%
Ambulatory surgery records 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)
Not applicable (we don’t code this record type)
The entire record is online 70% 39% 31% 34% 30% 15% 20% 6% 25%
Most transcribed reports and lab data are online and/or some docu-
ments are scanned
10% 8% 11% 18% 0% 8% 13% 14% 8%
The entire record is paper-based 10% 8% 11% 8% 15% 23% 33% 29% 39%
The record is partially online and partially paper-based
10% 46% 46% 40% 55% 54% 33% 51% 28%
July 2009 13
Establish benchmarks: Know the factors that affect coder productivity (cont.)
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 have a standard or
performance expectation)
Not applicable (we don’t code this
record type)
The entire record is online 44% 27% 50% 24% 33% 6% 13%
Most transcribed reports and lab data are online and/or some docu-
ments are scanned
12% 6% 10% 10% 8% 18% 17%
The entire record is paper-based 20% 14% 10% 19% 17% 30% 37%
The record is partially online and partially paper-based
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?
> continued on p. 14
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?
Coder Productivity Benchmarks: A Special Report14
Establish benchmarks: Know the factors that affect coder productivity (cont.)
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%
> continued on p. 16
Coder Productivity Benchmarks: A Special Report16
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 ____________________________________________________