Coder Quality Assessment Program

This Program was developed in 1992, to establish a systematic process to assess the accuracy and quality of professional and technical charge submission performed by the Patient Record Abstractor (PRA) at the University of California, Davis Health System (UCDHS).

This Program is responsible for performing coding assessments as part of an ongoing quality improvement process as established in UCDHS P&P 1921, Professional Fee Billing Compliance Plan, and P&P 1922, Compliance Monitoring, Auditing, Review and Reporting Standards.

Expectations for PRA III & PRA IV shall be to pass each coding assessment at 90% or above in all categories (CPT, Modifiers, Procedures, ICD-9, Pharmaceuticals, and APCs) on a semi-annual basis. If the PRA achieves less than 90% accuracy in any coding category, the PRA shall be placed into a biweekly assessment cycle and given educational feedback by HIM that will outline their deficiencies to assist in achieving a 90% or better accuracy on their next coding assessment.
Expectations for PRA II shall be to pass each coding assessment at 90% or above in ICD-9 and Modifiers.  If less than 90%, the employee shall be placed into a biweekly assessment cycle and given educational feedback by HIM that will outline their deficiencies to assist in achieving a 90% or better accuracy on their next coding assessment. 
The timing and frequency for coding assessments may vary depending on the results and outcome of the previous assessment however at a minimum the PRA will be assessed semiannually. The cycles are as follows:

1. Initial Assessment
a. 20 Encounters
b. Within 60 days of hire
c. Pass (90% or above in all categories) = placed on quarterly cycle
d. Fail (less than 90% in one or more category) = placed on biweekly cycle

2. Quarterly Assessment
 a. 20 Encounters
 b. Pass (90% or above in all categories) = continue on quarterly cycle
 c. Pass 2 consecutive quarterly assessments = placed on semiannual cycle
 d. Fail (less than 90% in one or more category) = placed on biweekly cycle

3. Biweekly Assessment
a. 10 Encounters
b. Pass (90% or above in all categories) =  placed on quarterly cycle
c. Pass 2 consecutive assessments (1 biweekly and 1 quarterly) = placed back on semiannual  (twice a year) cycle
d. Fail (less than 90% in one or more category) = continue on biweekly cycle

4. Semiannual (twice a year) Assessment
a. 20 Encounters
b. Pass (90% or above in all categories) = continue on semiannual cycle
c. Fail (less than 90% in one or more category) = placed on biweekly cycle