By: Carol Spencer, RHIA, CCS, CHDA and Jill Sell-Kruse, RHIA, CCS

ED. NOTE: This is the second of three series of articles designed to compare and contrast the "coding-state" coding manager's role;s and responsibilities of today in contrast to the "data-state" data manager's roles and responsibilities of tomorrow. The first article discussed integration of controls and safeguards. This article compares and contrasts coding quality measures for improper payment.

When evaluating coding, it is interesting that coding managers generally access quality based on accuracy rates whereas regulatory agencies, or those contracted by the Centers for Medicare & Medicaid Services (CMS) such as Recovery Audit Contractors (RACs), evaluate coding quality based on dollars or payment error rates.

ED. NOTE:

This is the first of a three-part series designed to compare and contrast the current and future states of coding and the coding manager's roles and responsibilities. The article below summarizes the movement from a retrospective review process to a prebill, concurrent review process that includes medical necessity, clinical documentation improvement (CDI), and coding.

Today's coding "world" tends to be focused on quality and productivity, based on audits of individual records and the number of records coded. The future promises a move from the traditional coding manager to an "integrated-state" data manager, with the goal being to reduce financial risk and increase data integrity.