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

ED. NOTE: This is the third in a three-part series designed to compare and contrast the “coding-state” manager’s roles andresponsibilities of today with the “data-state” manager’s roles and responsibilities of tomorrow. The first article discussed integration of controls and safeguards. The second article presented information on quality measures for improper payment. This article proposes measuring productivity in relationship to unbilled charges. The formula for each measurement is defined and the benefits of measuring productivity by unbilled charges are explained. All efforts related to the data manager are geared toward reducing financial risk and increasing data integrity.

Primary Measurements In evaluating coder productivity in the “coding state,” the primary measurement is the chart— the number coded per day, per week or per pay period. Charts per day are converted to the number of hours coded and divided by productive hours for a productivity percentage. The goal is 95 percent productivity.

In evaluating coder productivity in the “data-state,” the primary measurement is unbilled dollars—how many pending dollars on the unbilled report per day, per week or per pay period. Unbilled dollars coded per day are converted to hours coded and divided by productive hours for a productivity percentage. The goal is 95 percent productivity.

Coder Productivity Formula Measured by Charts Coded

There are variations to the formula used to determine coder productivity. The general one presented here uses two key components: charts and productive hours. Usually, a time period is defined as either a week or two weeks in order to allow enough charts to be coded and reduce variation that could occur on a daily basis. This example will demonstrate coder productivity for one week (40 hours).

Non-productive hours are subtracted daily based on 13 percent for personal, fatigue, and delay (PFD) time, which leaves seven hours of productive time daily. Personal time includes two 15-minute breaks. Thirty minutes for worker fatigue include personal downtime as well as computer delays, downtime, or other process delays. Productive hours for one week total 35, additional non-productive hours are subtracted. The denominator is always 35 hours to calculate weekly productivity unless meeting time, continuing education units (CEU) time, or additional allotted time for high-dollar charts is subtracted from 35 hours for the adjusted productive hours. To calculate the numerator, take the following steps.

Define your hospital’s minimum “meets requirements” coding standard. If the minimum is 22 records per day, then calculate the minimum standard “earned coder credit” or number of charts per hour. Divide 22 records by 7 (for a seven-hour productive day), which equals 3.14 earned coder credits or 3.14 charts per hour. (If a hospital’s minimum standard is 25 records per day, then divide by 7 (for a seven-hour productive day), which equals 3.57 earned coder credits.

Take the total number of charts coded for the week and divide by 3.14 (standard earned coding credit) and the answer is the numerator.

For example, let’s evaluate the productivity for Coder A and Coder B. Both coders had no additional non-productive hours, so each denominator is 35 hours. For the numerator, Coder A coded 100 charts for the week. Divide 100 by 3.14 to determine Coder A’s earned coder credit of 31.8 and divide it by 35 productive hours, which equals 90.9 percent productivity.

Coder B coded 112 charts for the week. Divide 112 by 3.14 to determine Coder B’s earned coder credit of 35.7 and divide it by 35 productive hours, which equals 102 percent productivity. Again, this is based on a minimum standard; therefore, nothing less than 100 percent is acceptable.

Coder Productivity Formula Measured by Unbilled Charges

Let’s take this same theory and transfer the formula to unbilled dollars. The first task for the coding manager is to find out (from the hospital’s finance department) the average charges for an inpatient discharge.

Let’s use $29,000 as the average charges for an inpatient discharge. The formula presented here to calculate coder productivity is based on unbilled charges (rather than charts) and productive hours. Again, the time period may be a week or two weeks to allow enough unbilled charges and avoid variation that could occur if productivity monitoring occurred on a daily basis.

This example will demonstrate coder productivity for one week (40 hours). Non-productive hours are subtracted daily based on a 13 percent deduction for personal, fatigue, and delay (PFD) time, which leaves seven hours of productive time daily. Personal time includes two 15-minute breaks. Thirty minutes for fatigue time includes personal downtime as well as computer delays, downtime, or other process delays. Productive hours for one week total 35, additional non-productive hours are subtracted for meeting time or CEU time. There is no need to subtract non-productive time for high-dollar charts since the unbilled charges are a key component of the productivity formula.