Ways to Calculate Backlogs for Coding

Organizations giving critical care know that medical coding and billing are their lifeblood. To achieve their mission of saving lives, they need a good, steady cash-flow to maintain their medical facilities. Even though they sit quietly and deal only with paper, medical coders do critical work in a hospital. Coding backlogs are a hospital's organizational equivalent of arterial blockage. That's why when backlogs become serious, help is usually brought in to get caught up. However, to decide how to handle the problem, you have to know the extent of it.

Time

• One of the simplest ways to estimate a coding backlog is by looking at how long you've been behind. Use a billing system generated report to get your average total dollars billed per day, week or month. Then figure out exactly when the backlog began. How many days, weeks or months behind are you? If you know that you're one week behind in billing, and you bill an average of $2.5 million a week, then you can safely guess you're about $2.5 million behind in your coding and billing. Let's say you're five days behind and bill an average of $500,000 per day, then you would again be $2.5 million behind schedule. This is not precise, but until you code everything and get caught up, all you can do is estimate.

Files

• Sometimes all you have are stacks. If you're seriously backlogged and your organization's tracking systems are not what they should be, then you may never figure out just how far behind you are in your billing. All you can do is roll up your sleeves and get to work. In that case, a straight count of the number of medical files awaiting coding is probably your best course. Your billing system can tell you how many files on average you process per coder per day. That will help you estimate how long it will take you to get caught up or how many people to add to accelerate the catch-up.

  You can also run a report for your average daily billing. If you know that on average you process 100 files a person per day, and that you have two coders and you bill an average of $4 million a day, you can figure that each file is an average of $20,000 in billing. Multiply $20,000 by the number of backed-up files, and you have an approximate idea of the value of your coding backlog. Of course, this is a very crude estimate.

Quick Survey

• If your hospital uses computerized charting and medical billing, you can probably run reports to find out how many procedures of each type were performed in any given time period. For example, you can inventory the number of surgeries performed in a week. You can look at the average that was billed for every type of procedure and multiply it by how many of those procedures were performed in the time period of your backlog. This is fairly labor intensive, because you're looking up the average billing of every kind of procedure and surgery performed in your facility --- which is probably vast. In the end, this is not guaranteed to be any more accurate than other methods.