6. Evaluating Claim Production Data (Level 5-Evaluating) As a leader and manager, the health information administrator is responsible for monitoring and evaluating the performance of processes. This responsibility requires the manager to determine key performance indicators to be included in the monitoring and evaluation process. You are the HIM director at Memorial Hospital. You are a member of the revenue cycle department and are charged with monitoring and evaluating key HIM RC processes that impact the stability and health of the facility's revenue cycle. During the claims production process claims are scrubbed and modified to ensure that a clean claim is submitted to the payer. Memorial Hospital tracks claims through this process so that inefficiencies in the RC can be addressed. Below is the claims production data for April through June. The HIM coding unit's clean claim metric standard is 95 percent. Prepare a summary statement about the coding unit's quarterly performance. Create a graphic display that summarizes the coding unit's performance in relation to their standard. Is the unit performing as expected, or is there need for a root cause analysis and process improvement? If there is room for improvement, brainstorm some ways the coding manager could educate the staff. Claim Production Quarterly Report-Memorial Hospital Claim Issue Number of Claims Requiring Rework Prior to Submission Identified by April May June Scrubber 5,500 claims 6,200 claims 5,850 claims processed processed processed Claim failed patient 115 213 137 identifier edits Claim failed 12 5 21 provider identifier edits Claim failed 220 196 351 coding modifier edits Claim failed date of 10 25 14 service edits Over the second quarter, the HIM coding unit was able to process many claims, but still needs improvement when handling and editing them. The staff showed decent numbers in terms of processing clean claims, however, the unit failed to meet the clean claim metric standard. The month of April showed a 94% clean claim metric; May showed 88%; and June had 916; all of which show the unit failing to meet the performance standard of 95%. The unit certainly needs improvement, especially since the standard of 95% was not met for the whole quarter and growth was not consistent. Providing proper training of correct claims processing is necessary and will provide many benefits to the organization. In this case, training can help the employees and the organization, especially when it comes to growth. It would have been better if their clean matric percentages gradually improved month to month, but that was not the case. Based on the percentages in the answer, the unit struggles more when a larger