Inaccuracies

The case study organization presents several inaccuracies in practice and policy, including reduced coding productivity and accuracy, high discharged not final billed (DNFB) cases, and poor physician documentation. This hinders the facility’s ultimate goal of advancing its reimbursement, coding processes, and establishing effective medical documentation policy and procedures per the national benchmarks for coding compliance. For instance, despite the Healthy Health Center having nine inpatient coders, the facility still averages approximately $4.5 million in DNFB, among other poor financial performance challenges. Based on the case study, the challenge of reduced coding productivity and accuracy rates emerges from insufficient physician documentation, which inhibits the ability of the coders to select an appropriate diagnosis code at the highest level of specificity.