HIM 660 Module 5 Final Project Milestone Two Example

Final Project Milestone Two: From Gaps to Goals. Strategic Goals, Initiatives and a Balanced Scorecard for the Kanawha Ridge HIM Team

[Student Name]

Southern New Hampshire University

HIM 660: HIM Strategic Planning and Financial Management

Final Project Milestone Two

[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 Two: From Gaps to Goals. Strategic Goals, Initiatives and a Balanced Scorecard for the Kanawha Ridge HIM Team

Milestone One judged HIM at the composite Kanawha Ridge system in West Virginia accurate but slow and short of staff, with no program to review documentation while patients are in the hospital. It ranked four gaps: missing documentation review, a 6.8-day wait for final coding, contract labor driven by vacancies and a first-pass denial rate of 12.1%. This milestone converts those gaps into measurable goals, chooses the initiatives most likely to close them and sets out a balanced scorecard that the department and the chief financial officer will use to track progress. The financial case for each initiative follows in Milestone Three.

Strategic Goals

Each goal names a baseline, a target and a date, and each traces to a ranked gap. Goals run to the end of fiscal year 2028, two years from now, with interim checkpoints.

Goal 1 is to establish documentation review: a program in place by January 2027, reaching 12 queries per 100 inpatient discharges at the regional hospital and a physician response rate of at least 90% by June 2027. Goal 2 is to shorten the coding wait from 6.8 days to 4.0 days by June 2028, which would cut average unbilled accounts from $14.6 million to roughly $8.5 million. Goal 3 is to reduce contract coding spending from $1.08 million to $300,000 a year and vacancies from five to two or fewer by June 2028. Goal 4 is to lower the first-pass denial rate from 12.1% to 9% and denial write-offs by a quarter, from $2.9 million to about $2.2 million, by June 2028. Goal 5 protects current strengths: inpatient coding accuracy at or above 95% and release of information turnaround within five days throughout the period.

Two of these goals overlap. Documentation review should reduce clinical denials, so Goals 1 and 4 support each other. That overlap is deliberate, but it also means the department will need to separate their effects when it measures results.

Initiatives

Three initiatives were chosen from a longer list.

Initiative A is a clinical documentation improvement program at the regional hospital, staffed by four documentation specialists with nursing or coding backgrounds and a part-time physician advisor. Specialists review records of Medicare and Medicaid inpatients during the stay and query physicians when documentation is unclear or incomplete. When a trauma and teaching hospital placed documentation specialists with its surgeons, confirmed revenue gains passed two million dollars and the share of queries physicians answered climbed from under a fifth to nearly all once a structured process existed (Castaldi & McNelis, 2019). The program starts with medicine and cardiology, where clinical denials cluster.

Initiative B is a coder workforce plan: recruiting remotely across the region with a retention bonus, converting contract hours to employed positions and running a six-month trial of computer-assisted coding on outpatient records. Campbell and Giadresco (2020) found that computer-assisted coding can improve accuracy and quality but reshapes coders' work toward editing and requires careful change management, so the trial begins with willing volunteers and is measured before any wider rollout.

Initiative C is a denial prevention team shared with revenue cycle: two analysts who trace every denial to its root cause, build front-end edits for technical denials such as missing authorizations and send clinical denials back to the documentation program for education.

Two options were rejected. Outsourcing all inpatient coding would end vacancies but at a higher long-term cost and with loss of control over accuracy. A full computer-assisted coding rollout now would ask too much change at once from a team already short of people.

Balanced Scorecard

The department will track progress on a balanced scorecard, which pairs financial measures with indicators for the people served, the department's workflow and its staff's so that short-term savings do not come at the cost of quality or staff. Amer et al. (2022) pooled 20 evaluations of the scorecard approach in hospitals and health services and reported gains on patient satisfaction and financial performance, with less consistent evidence on staff satisfaction. Table 1 shows the scorecard, with a single owner for each measure.

Table 1. Balanced Scorecard for Health Information Management

Note. Measures are reviewed monthly by the department and quarterly with the chief financial officer.

Who Steers the Plan

During year one, the HIM director, the revenue cycle director, the physician advisor and a finance analyst will sit together monthly as the plan's steering group. It reviews the scorecard, removes obstacles and decides when an initiative needs to change course. Each initiative has a written charter with scope, owner and checkpoints. If a goal is clearly out of reach at its interim checkpoint, the group will revise the initiative before revising the target, so that targets are not quietly lowered.

Risks to the Goals

Three risks could undermine the goals. Physicians may ignore queries if they see them as billing pressure, so the documentation program will present queries as clinical clarification and share results with medical staff leaders. Remote recruiting may draw candidates who leave quickly for larger employers, which is why retention, not hiring alone, is measured. Finally, denial prevention depends on departments outside HIM, and the shared team only works if revenue cycle leaders own technical denials as firmly as HIM owns clinical ones.

Conclusion

The department now has five goals it can be held to, three initiatives tied to its largest gaps and a scorecard that will show monthly whether the plan is working. What remains is to show that the initiatives are worth their cost, which Milestone Three will test with return on investment, net present value and payback analysis.

References

Amer, F., Hammoud, S., Khatatbeh, H., Lohner, S., Boncz, I., & Endrei, D. (2022). The deployment of balanced scorecard in health care organizations: Is it beneficial? A systematic review. BMC Health Services Research, 22, Article 65. https://doi.org/10.1186/s12913-021-07452-7

Campbell, S., & Giadresco, K. (2020). Computer-assisted clinical coding: A narrative review of the literature on its benefits, limitations, implementation and impact on clinical coding professionals. Health Information Management Journal, 49(1), 5-18. https://doi.org/10.1177/1833358319851305

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