SCENE ONE: The Vice President of Clinical Services reviewed a  report from radiology and noticed a decrease in the volume of  mammography studies performed over the past 9 months. She wants to learn  what may be contributing to the decrease, so she arranges to meet with  the Radiology Performance Improvement Team (R-PIT) which monitors the  performance of the radiology department and works on improving services.

 

1. As the lead on R-PIT, you begin by completing the R-PIT Plan of  Action which will be presented to the VP of Clinical Services for  approval. Copy the R-PIT table below into a Word Document and complete  it for submission.

 R-PIT Plan of Action
      Complete the four boxes in the right   column for presentation to the VP. VP will review for approval and roll-out.    Identify   the issue – record it for reference.
      Identify a   quality measure to determine cause of the issue.
      Identify   the category of data on the measure identified in  (b) above. (Tangible vs.   intangible, structure, outcome, process  measures).
      Explain   the rationale for using the quality measure identified in (b) above.
     
    Approval given by VP:   __________________________________ on date ___________________________.  

SCENE TWO: Six months later (after the R-PIT was approved,  quality measure researched and radiology quality improvement action has  been completed) you request a new data report to validate mammography  improvements. The new data report demonstrates a new problem,  unfortunately, and this problem is outside of the radiology department.  You find that of the 1800 mammograms completed in radiology over the  last 3 months, only 27% of them have been coded and therefore have not  been billed. This leaves a little over 1300 mammograms unbilled which is  likely why multiple patients have called recently asking why they have  not been billed. 
 

You went to high school with the coding manager, Charmaine, and head  over to her office to share this information. Charmaine asks you about  the Process Improvement Team and you offer to assist with the newly  discovered Coding Delay Issue. Charmaine is committed to HIM best  practices for her entire coding team, including the outpatient clinic  coding group.

 

1. Complete the HIM Plan of Action which will be presented to the VP  of Financial Services for approval. Copy the table below into a Word  Document and complete it for submission.

 HIM Plan of Action
      Complete the four boxes in the right   column for presentation to the VP. VP will review for approval and roll-out.    Identify   the issue – record it for reference.
      Identify a   quality measure to determine cause of the issue.
      Identify   the category of data on the measure identified in  (b) above. (Tangible vs.   intangible, structure, outcome, process  measures).
      Explain   the rationale for using the quality measure identified in (b) above.
     
    Approval given by VP:   __________________________________ on date ___________________________.  

  3.    Consider Charmaine's intention of functioning with Best  Practices. Create a Best Practices Coding Statement for Charmaine to use  for her own Performance Improvement Team in HIM. Best Practice  considerations should include at a minimum – patient satisfaction,  financial well-being of the facility and chart completion requirements  by regulating agencies such as CMS (Centers for Medicaid and Medicare  Services). 

SCENE ONE: The Vice President of Clinical Services reviewed a  report from radiology and noticed a decrease in the volume of  mammography studies performed over the past 9 months. She wants to learn  what may be contributing to the decrease, so she arranges to meet with  the Radiology Performance Improvement Team (R-PIT) which monitors the  performance of the radiology department and works on improving services.

 

1. As the lead on R-PIT, you begin by completing the R-PIT Plan of  Action which will be presented to the VP of Clinical Services for  approval. Copy the R-PIT table below into a Word Document and complete  it for submission.

 R-PIT Plan of Action
      Complete the four boxes in the right   column for presentation to the VP. VP will review for approval and roll-out.    Identify   the issue – record it for reference.
      Identify a   quality measure to determine cause of the issue.
      Identify   the category of data on the measure identified in  (b) above. (Tangible vs.   intangible, structure, outcome, process  measures).
      Explain   the rationale for using the quality measure identified in (b) above.
     
    Approval given by VP:   __________________________________ on date ___________________________.  

SCENE TWO: Six months later (after the R-PIT was approved,  quality measure researched and radiology quality improvement action has  been completed) you request a new data report to validate mammography  improvements. The new data report demonstrates a new problem,  unfortunately, and this problem is outside of the radiology department.  You find that of the 1800 mammograms completed in radiology over the  last 3 months, only 27% of them have been coded and therefore have not  been billed. This leaves a little over 1300 mammograms unbilled which is  likely why multiple patients have called recently asking why they have  not been billed. 
 

You went to high school with the coding manager, Charmaine, and head  over to her office to share this information. Charmaine asks you about  the Process Improvement Team and you offer to assist with the newly  discovered Coding Delay Issue. Charmaine is committed to HIM best  practices for her entire coding team, including the outpatient clinic  coding group.

 

1. Complete the HIM Plan of Action which will be presented to the VP  of Financial Services for approval. Copy the table below into a Word  Document and complete it for submission.

 HIM Plan of Action
      Complete the four boxes in the right   column for presentation to the VP. VP will review for approval and roll-out.    Identify   the issue – record it for reference.
      Identify a   quality measure to determine cause of the issue.
      Identify   the category of data on the measure identified in  (b) above. (Tangible vs.   intangible, structure, outcome, process  measures).
      Explain   the rationale for using the quality measure identified in (b) above.
     
    Approval given by VP:   __________________________________ on date ___________________________.  

  3.    Consider Charmaine's intention of functioning with Best  Practices. Create a Best Practices Coding Statement for Charmaine to use  for her own Performance Improvement Team in HIM. Best Practice  considerations should include at a minimum – patient satisfaction,  financial well-being of the facility and chart completion requirements  by regulating agencies such as CMS (Centers for Medicaid and Medicare  Services).