Question

Instructions: For each of the following scenarios, categorize each part of the HIM process being described. In each scenario, identify: • Process • External benchmark (not found in every case) • Internal benchmark (not found in every case) • Process measure • Outcome measure (may be a datum point) Scenario 1: The coding supervisor at Louisville General Hospital has a problem. Her “Discharged Not Final Billed” (DNFB) report is staying over the limit that upper management desires. She needs to determine what needs to be done to bring her DNFB down and still maintain coding quality. The information in the table below describes some of the data available for this process. Your task is to use the data/information in the table to identify all the categories listed above. Current DNFB $1.2 million Desired DNFB $600,000 Age of DNFB 1-3 days old 35% 4-10 days old 20% 11-21 days old 15% 22-30 days old 15% >30 days old 15%

Answer 1

Health information management (HIM) is information management applied to health and health care. It is the practice of acquiring, analyzing and protecting digital and traditional medical information vital to providing quality patient care

Healthcare benchmarking is taking a given organization’s performance metrics and comparing those to a standard developed using data from other similar organizations.

Internal Benchmarking: Internal benchmarking takes place between departments, divisions, or offices within the same hospital or clinic. This is particularly important because many healthcare organizations have many locations and want to examine a particular set of measures across those locations.

External Benchmarking: External benchmarking takes place in the same market and provide a direct comparison of products or services. Conducting external benchmarking enables organizations to discover what is possible externally in the industry. Some studies actually include details on “best practices” of the top performing participating organizations.

Process measures:
It indicate what a health organization does to maintain or improve health, either for healthy people or for those diagnosed with a health care condition. These measures typically reflect generally accepted recommendations for clinical practice. For example:
1.The percentage of people receiving preventive services (such as mammograms or immunizations).  
2.The percentage of people with diabetes who had their blood sugar tested and controlled.
Process measures can inform consumers about medical care they may expect to receive for a given condition or disease, and can contribute toward improving health outcomes. The majority of health care quality measures used for public reporting are process measures.

Outcome Measures:
Outcome measures reflect the impact of the health care service or intervention on the health status of patients. For example:
1.The percentage of patients who died as a result of surgery (surgical mortality rates).
2.The rate of surgical complications or hospital-acquired infections.

Discharged Not Final Billed (DNFD): It means - every account held for billing for some reason. Some hospitals refer to it as AR (accounts receivable) or simply "the unbilled". The reasons for unbilled accounts are generally categorized into 3 major categories:

1.Accounts within suspense (bill hold) is a facility-defined number of days in which an account will be held from billing so charges can be entered after the patient is discharged from the hospital. Any charges added after the suspense period, which typically ranges from 3-5 days, are considered late.
2.Accounts outside of suspense and not coded - charts awaiting coding before bill drop.
3.Accounts outside of suspense and not billed - charts that have been coded but are being held by billing until issues are resolved (e.g., awaiting late charges)