HIM 660 Module 3 Final Project Milestone One Example

Final Project Milestone One: Where We Stand. A Strategic Assessment of the Kanawha Ridge Health Record and Coding Department

[Student Name]

Southern New Hampshire University

HIM 660: HIM Strategic Planning and Financial Management

Final Project Milestone One

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Final Project Milestone One: Where We Stand. A Strategic Assessment of the Kanawha Ridge Health Record and Coding Department

The health information department at Kanawha Ridge Health, a composite system of a 260-bed regional hospital and a 70-bed community hospital in West Virginia, has never had a written strategic plan. This milestone establishes the baseline for one. It proposes a mission and vision tied to the system's own plan, measures the department's performance on ten indicators, records what key stakeholders expect of the department and ranks the gaps that the plan should address. Begun and Kaissi (2005), interviewing leaders in 20 health care organizations, found that planners valued plans that were updated continuously and connected to the organization's other plans. This assessment is written with both in mind: it is meant to be refreshed each quarter and to plug into the system plan rather than sit beside it.

Mission and Vision

The system's mission is to give Kanawha Valley families good care without a long drive. The proposed department mission follows from it: to keep a complete and accurate record of that care and turn it, quickly and correctly, into the information the system needs to be paid, to measure quality and to serve patients. The proposed vision is that by 2029 every discharged account will be coded within three days, every record will tell the full clinical story and the department will be the system's trusted source of coded data. Both statements were reviewed with the chief financial officer, who asked that the vision include a time frame, and with the coding team, who asked that accuracy appear alongside speed.

Approach

The assessment followed four steps over six weeks. First, the writer pulled twelve months of data from the encoder, the billing system and finance reports and checked each measure against a second source where one existed; unbilled dollars, for example, were reconciled with the finance department's month-end report. Second, eight stakeholders were interviewed for about forty minutes each using the same five questions about what the department does well, what it should do differently and what they would measure. Third, the draft mission and vision were circulated for comment. Fourth, a small committee ranked the gaps. The approach has limits. Benchmarks for some measures are internal targets rather than published norms, the interviews favored leaders over front-line staff and one year of data cannot show whether a trend is new or longstanding. These limits are noted so later milestones can test the findings rather than assume them.

Performance Measures

Table 1 reports ten measures for the fiscal year that ended in June 2026, with the benchmark or internal target used for comparison. Measures were drawn from the encoder, the billing system, the release-of-information vendor's portal and finance reports.

Table 1. Department Performance, Fiscal Year 2026

Note. Prepared by the author from system reports. Targets are internal unless stated.

What Stakeholders Expect

Interviews with eight stakeholders added context the numbers cannot. The chief financial officer cares most about cash: every day an account waits for coding delays payment on roughly $2 million of charges, and she wants the department to explain how it will reduce the wait without raising costs. The revenue cycle director traced most clinical denials to documentation that did not support the diagnosis billed, such as sepsis or acute respiratory failure without clinical indicators in the note, and asked whether HIM would lead a documentation review program. Two hospitalists said they receive no feedback on documentation until a denial arrives months later. Coders described working from incomplete records and spending time hunting for information that should already be there.

Those views connect to cost evidence. Tseng et al. (2018) estimated that billing and insurance activities for a general medicine inpatient stay took 73 minutes and cost about $124 at an academic system, so every denied and reworked inpatient claim repeats part of that cost. Castaldi and McNelis (2019) reported that adding documentation specialists on a surgical service produced more than $2.2 million in validated revenue and raised physicians' query response rate from 17% to nearly 95%, which suggests that the gap here is an opportunity as well as a weakness.

Ranked Gaps

Four gaps stand out. They were ranked by the committee of the chief financial officer, the revenue cycle director and the writer, weighing financial effect, effect on patients and staff, and the department's ability to act.

First is the documentation gap: no program reviews records during the stay, which drives clinical denials and incomplete accountable care data. Second is the coding wait, which ties up about $14.6 million in unbilled accounts on an average day. Third is contract labor, driven by five vacancies, which costs far more per hour than employed coders and adds no lasting capacity. Fourth is the denial rate itself, which overlaps with the first gap but also includes technical denials such as missing authorizations. Accuracy and release of information, both meeting targets, are strengths to protect rather than gaps.

Each gap also has a natural owner. Documentation review would sit with HIM in partnership with the hospitalists, the coding wait and contract labor with HIM alone and technical denials with patient access and the revenue cycle team, which matters for deciding what this department's plan can promise on its own.

Conclusion

The department is accurate but slow, understaffed and missing a documentation program that its environment now requires. The mission and vision give it a direction tied to the system's own, and the four ranked gaps give the plan its agenda. Milestone Two will turn those gaps into goals with targets and the initiatives meant to reach them.

References

Begun, J. W., & Kaissi, A. A. (2005). An exploratory study of healthcare strategic planning in two metropolitan areas. Journal of Healthcare Management, 50(4), 264-274. https://doi.org/10.1097/00115514-200507000-00009

Castaldi, M., & McNelis, J. (2019). Introducing a clinical documentation specialist to improve coding and collectability on a surgical service. Journal for Healthcare Quality, 41(3), e21-e29. https://doi.org/10.1097/JHQ.0000000000000146

Tseng, P., Kaplan, R. S., Richman, B. D., Shah, M. A., & Schulman, K. A. (2018). Administrative costs associated with physician billing and insurance-related activities at an academic health care system. JAMA, 319(7), 691-697. https://doi.org/10.1001/jama.2017.19148