How Coding Accuracy Impacts Premier Quality and Utilization Benchmarks

Premier benchmarking is widely used by hospitals across the United States to evaluate quality, efficiency, and resource utilization against peer organizations. While not every Premier measure is driven by coding, inaccurate or inconsistent code assignment can quietly distort severity adjustment, utilization patterns, and outcome comparisons. This article outlines five practical strategies coding teams can use to support accurate Premier benchmarking, align with quality and CDI teams, and ensure reported data reflects true clinical complexity rather than documentation or coding variation.

Premier data is widely used by hospitals to benchmark quality, efficiency, and resource utilization against peer organizations. While not every Premier metric is directly influenced by coding, the integrity of coded data plays a critical role in how performance is reflected, particularly for severity adjustment, utilization patterns, and outcome-based comparisons.

Incomplete or inconsistent coding can unintentionally distort benchmarking results—making it difficult for organizations to accurately evaluate performance or identify true improvement opportunities. A strategic approach to coding helps ensure Premier data reflects clinical reality rather than variation in documentation or code assignment.

Here are five proven strategies to help coding teams support accurate and meaningful Premier benchmarking.

1. Identify Premier Measures Influenced by Coding

Premier aggregates clinical, financial, and administrative data, but certain benchmarks rely heavily on claims-based inputs such as diagnoses, procedures, and utilization patterns.

• Strategy: Work with quality and analytics teams to identify which Premier measures incorporate coded data. Focus coding reviews on mortality, complications, length of stay, and resource utilization metrics rather than process measures outside coding’s influence.

2. Strengthen Severity Capture Beyond CC and MCC Assignment

Severity adjustment within Premier benchmarking depends on more than CC and MCC capture alone. Principal diagnosis selection, procedure coding, and complete secondary diagnosis reporting all contribute to how patient complexity is represented.

• Strategy: Audit high-impact DRGs to ensure the principal diagnosis accurately reflects the reason for admission and that clinically supported comorbidities are consistently captured. Educate coders on documentation indicators that affect severity and expected resource use.

3. Reduce Utilization Variability Through Consistent Coding Practices

Premier utilization benchmarks are sensitive to variation in how similar cases are coded across departments, coders, or service lines.

• Strategy: Review coding patterns for high-volume DRGs and procedures to identify inconsistencies. Standardize internal coding guidance and provide focused education where variation may be inflating or suppressing utilization metrics.

4. Align Coding and CDI to Support Benchmark Accuracy

Documentation gaps often limit accurate code assignment, which can impact Premier comparisons related to severity, complications, and efficiency.

• Strategy: Encourage regular collaboration between coding and CDI teams for Premier-sensitive cases. Joint reviews help align principal diagnosis selection, clarify documentation expectations, and ensure severity is fully supported.

5. Use Premier Data to Drive Continuous Improvement

Premier benchmarking is most valuable when used as an ongoing performance tool rather than a retrospective report.

• Strategy: Leverage internal dashboards, audit findings, and Premier reports to monitor trends over time. Identify patterns where coding or documentation may be suppressing performance metrics and address them through targeted education and review before benchmarking periods close.

Final Thoughts

Premier benchmarking provides valuable insight—but only when the underlying data is accurate and consistent. While coding does not control every measure, coding and documentation integrity are foundational to fair and reliable comparisons. By proactively reviewing high-impact areas and aligning teams around data accuracy, organizations can ensure Premier results reflect the true complexity and quality of care delivered.

Need help reviewing coding practices tied to Premier benchmarking? Health Information Associates offers targeted reviews and coding support services to help organizations validate their data and strengthen benchmarking confidence.

FAQ

Since 1992, HIA has been the leading provider of compliance audits, coding support services and clinical documentation audit services for hospitals, ambulatory surgery centers, physician groups and other healthcare entities. HIA offers PRN support as well as total outsource support.

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.