Missed Claims Submissions

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Team ID: 
College / Administrative Unit: 
Student Affairs
Date Started: 
October 2011
To identify claims not submitted to student healthcare insurance for student and non-student accounts due to late enrollments to the Penn State student health insurance plan.

Expected Results:

The goal is to have 100% of student and non-student claims sent to student insurance with 100% accuracy (Zero Tolerance Policy).

Team Update

Record code matches audit code in 38% (n=69) of encounters. This is 52% point variance from the goal of 90%. Each clinician will be given their audit score sheets to review. A question and answer session in medical staff meetings will be conducted. The results of the first data review will be submitted to the E&M coding group for discussion and future planning for additional education opportunities regarding E&M coding for medical staff.

Monthly data will be collected and reported to Clinical Services in Dec 2011 and Mar 2012.
The performance goal is that over the next year, we will reach a score of 90% accuracy of E&M coding.
Record code matches audit code in 33.5% (n=75) of encounters. This measurement is 56.5 % point variance from the goal of 90%.

The most recent data shows a -4.5% (n=75/224 vs 69/182) trend away from the goal.
Clinical services will drill-down into the data to identify any trends relating to specific types of encounters and determine corrective actions based on that analysis.

June 8, 2012

Contact Person: 
Nancy Lambert
  • Karen Kline, Leader
  • Barbara Virgil, Member