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SIPOC templates

SIPOC — Clinical Coding to Invoice

Written in the terse s/i/p/o/c dialect, this map scopes hospital activity from discharge summary to commissioner invoice and exposes a 26-day coding lag behind a 92% first-pass invoice rate target.

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Clinical coding to commissioner invoiceScope · From discharge summary signed to invoice raised with the commissionerProcess ownerHead of clinical coding …Days from discharge to coded26target 10 · +16 daysFirst-pass invoice acceptance78%target 92% · -14%Coding audit accuracy89%target 95% · -6%SSuppliers4IInputs5PProcess7OOutputs5CCustomers4Ward medical teamsTheatre systemsPathology and imagingPatient administrationsystemDischarge summaryCTQSigned within 24 hours andnames every comorbidity treatedOperation noteRecords laterality and anyunplanned return to theatreDiagnostic reportsPatient administrationrecordNational tariff fileCoded episodeCTQPrimary diagnosis coded tofour characters with a depthof at least threeHealthcare resource groupPriced activity lineCommissioner invoiceRaised inside the contract's30-day activity reportingwindowCoding query listCommissionersFinance business partnersService line managersNational data collections1Receive the signeddischarge summary2Retrieve the casenotes3Abstract diagnosesand procedures4Assign ICD-10 andOPCS codes5Group tohealthcareresource group6Price against thenational tariff7Raise the invoice4 suppliers · 5 inputs · 7 process steps · 5 outputs · 4 customers3 of 5 inputs have no stated requirement: “Diagnostic reports”, “Patient administration record”, “National tariff file”.3 of 5 outputs have no stated requirement: “Healthcare resource group”, “Priced activity line”, “Coding query list”.Scope starts at “discharge summary signed”, matching step 1 “Receive the signed discharge summary”.Scope ends at “invoice raised with the commissioner”, matching the last step “Raise the invoice”.Metric “Days from discharge to coded” misses target: 26 against 10, a gap of 16 days.Metric “First-pass invoice acceptance” misses target: 78% against 92%, a gap of 14 %.Metric “Coding audit accuracy” misses target: 89% against 95%, a gap of 6 %.

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title "Clinical coding to commissioner invoice"
scope "From discharge summary signed to invoice raised with the commissioner"
owner "Head of clinical coding and costing"
metric "Days from discharge to coded" target: 10 actual: 26 unit: days
metric "First-pass invoice acceptance" target: 92% actual: 78% better: higher
metric "Coding audit accuracy" target: 95% actual: 89% better: higher

s: Ward medical teams, Theatre systems, Pathology and imaging, Patient administration system
i: Discharge summary, Operation note, Diagnostic reports, Patient administration record, National tariff file
p: Receive the signed discharge summary -> Retrieve the case notes -> Abstract diagnoses and procedures
   -> Assign ICD-10 and OPCS codes
   -> Group to healthcare resource group -> Price against the national tariff -> Raise the invoice
o: Coded episode, Healthcare resource group, Priced activity line, Commissioner invoice, Coding query list
c: Commissioners, Finance business partners, Service line managers, National data collections

requirement input "Discharge summary": "Signed within 24 hours and names every comorbidity treated" (CTQ)
requirement input "Operation note": "Records laterality and any unplanned return to theatre"
requirement output "Coded episode": "Primary diagnosis coded to four characters with a depth of at least three" (CTQ)
requirement output "Commissioner invoice": "Raised inside the contract's 30-day activity reporting window"