Why is 95% Proficiency in Coding Acceptable? (Part 1 of a 2 Part Series)

In a recently conducted study of a convenience sampling of hospitals, we identified that 95% of respondents claimed that their coding proficiency was 95% or higher (or a 5% error rate). Of those same respondents, about one-third claimed that their coding proficiency was closer to 97% (or a 3% error rate). The average annual revenues of the hospitals responding to the questions were 250 million dollars. A 3% error rate could represent a loss of almost eight million dollars a year, and a 5% error rate could represent a loss of almost 13 million dollars a year for these organizations. In a world where Six Sigma reigns and perfection and accuracy are constantly being sought after, why is 95% proficiency in coding acceptable? In this series of two articles, we explore the history of data quality in health care, the impact of Medicare fraud and abuse investigations, and the current lack of standardization in the measurement of coding proficiency, and we will touch on some of the practices that hospitals can engage in to improve their coding accuracy.

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