Project Implementation Phase:  Starting the reviews, ensuring quality, and staying on target.

  • Starting the Reviews:  We have lined up the Team, delineated the scope of the review, lined out the review approach and guidelines (as well as other necessary items).  We are now ready to start the Review.  All reviews must start with initial orientation and training of auditors to assure all are prepared to start the review and perform work consistently.  Work should be distributed based upon expected productivity.
  • Ensuring Quality: Quality Control (reviews) of audits performed should be done at initiation of work, and then on a regular basis. No auditors will consistently perform at 100%, a threshold of 95% is acceptable and sustainable. Quality Control logs should be maintained on each Auditor and plans in place for staff that fall below 95% (audit, educate, reaudit, etc.). Weekly reminders on quality matters supports a quality program.  Weekly or regular meetings with the Audit Team also contributes to improved overall quality and cohesiveness of the Audit Team. 
  • Staying on Target: Completing the Review on time is very important for many factors.  Leadership expectations of results, and reprocessing or submitting of data are the two major factors for completing reviews/audits on time.  Below are some best practices to ensure on-time completion:
    1. Team Oversight – A Project Manager will be assigned for overall Project success.  A “Team Lead” should be appointed that will monitor individual daily productivity (to ensure individuals hit expectations), individual quality review scores (to ensure individuals are performing at 95% or higher quality level).  This can be one individual or multiple “Team Leads” depending on the size of the project.  This individual will work with the Project Manager to solve problems related to quality and/or productivity. 
    2. Weekly Progress Reports (or Monthly) – Progress Reports showing various key performance indicators (KPI) are a quick snapshot as to where the Review is at, at any given time.  Examples of items to be included are as follows:
      • Number of Charts/Patients TOTAL to be Reviewed =Number of Charts/Patients Review Completed =
      • Number of Charts/Patients Not Reviewed =
      • Percentage Review Completed =
      • Overall Quality Score =
      • Overall Productivity =
      • Productivity Goal =
      • Estimated Cost to date =Original Cost to date =
      • Over/under Budget =
      • Estimated Completion Date =
      • Original Completion Date Goal=
      • Narrative addressing over/under budget; areas of concerns, issues encountered, etc.

Project Completion & Closing Phase:  Completing a project correctly, and tying up loose ends, evaluating the project, and lessons learned are useful for moving forward and will benefit future projects.

  • Completing a Project:  It is important, once a project is complete, to perform various quality checks of final reports assuring that all data abstracted is in a format requested, and consistently noted.  Summary Reports should be gathered to give all high level statistics, and data which can be impactful across the organization, including educational information as desired.  Patient records should be organized and stored in a retrievable format. If this data will be given to another organization or department, orientation to the reporting and formats is encouraged. 
  • Evaluating the Project: At the conclusion of the project, the Stakeholders and other key players, should be engaged to evaluate the overall success of the Project. This should be an objective look at the project in the early conception stages, through to the completion of the project.  Constructive criticism should be welcomed, as well as analyzing shortfalls, and issues or challenges that were encountered.
  • Lessons Learned:  At conclusion of the project, and preferably after the “Evaluating the Project” has been completed.  The Project Manager and the Team Leads should convene to review the entire project to decipher “Lessons Learned”. The lessons learned should outline the   issues encountered and how best to avoid in the future.  This is a pure “how can we do this better next time” endeavor, not a negative       experience.

Benjamin Franklin once said “If you fail to plan, you are planning to fail!”.  And Project Management is all about planning.  In Risk  Adjustment reviews – having a project management plan in place is key to success.  From the delineation of the goals of the review, to scope of the review, to having the appropriate staff, to assuring Auditor staff are provided tools needed to perform reviews, and down to the final reports, all are necessary for the project to be successful.

Written by Dott Campo, RHIT, CCS & Dana Brown, MBA, RHIA, CHC, CCDS, CRC

To read Part 1, CLICK HERE