7 tips for working from home during COVID-19

As a freelance healthcare writer, I’ve worked from home for the last decade. I love it. I work at an antique roll top desk surrounded by objects that inspire me. I light my favorite candle—a holiday bayberry scent from Yankee Candle—to put me in the ‘writing mood.’ I even have an ergonomic footstool and a laptop stand for added comfort. However, this ideal work setting isn’t a reality for so many people who suddenly find themselves in a makeshift home office due to COVID-19. With that said, working from home during the pandemic is hard for all of us. I conduct most interviews against the backdrop of two screaming 17-month-old twins who are normally at daycare five days a week. I’m cramming 40 hours’ worth of work into three days so my wife and I can both continue to make money. I’m exhausted and running purely on adrenaline most days. I get it. If you truly want to be productive while working from home during COVID-19 (or any time for that matter), you need to be mindful about it. Here are seven tips to ease the transition:

  1. Set your alarm. Working from home does not mean you can wake up whenever you want. If you normally start your day at 9am, start your day at 9am. Structure is key during this time.
  2. Create a to-do list. Write down specific daily goals. Then consider working in blocks of time on each of those projects, and don’t forget to make time for lunch. For example, I’ll spend an hour from 9 to 10 working on story A, an hour from 10 to 11 working on story B, lunch from 11 to 11:30, conduct interviews from 11:30 to 3, and then respond to emails from 3 to 5. (Note: My day usually isn’t this straightforward, but the idea is to be deliberate with your time and how you’re spending it.)
  3. Use a white noise machine. If you’re like me, your kids are probably making a bunch of noise in the background as you try to work. A white noise machine, space heater, or even a small fan can help block that out to help keep you productive.
  4. Rethink your workspace. Luckily for me, I have a dedicated office space in a room where I can close the door. However, not everyone is that fortunate. If you need quiet while you work (which most of us do), you may need to consider setting up a space in your basement, walk-in closet, garage, back deck, front porch, or even in your car. It’s not ideal, but nothing about our current situation is ideal.
  5. Take breaks. I definitely need to take my own advice on this. I’m guilty of working through the entire day without every getting up from my desk. However, it’s a good mental break to walk around the house for a bit or go for a short walk outside. Even stepping out to get the mail or put laundry in the washer/dryer counts.
  6. Set boundaries. It’s okay to chat or go out to lunch with family and friends once in a while during your workday, but try not to make a habit of it. Your workday is your day of work, so the fewer interruptions, the better.
  7. Drink lots of coffee. You’re going to need it. It will keep you energized, awake, and focused on your work so you don’t feel tempted to go take a nap or binge on Netflix.

Stay healthy out there—both mentally and physically. One day down, many more to go.

RIHIMA kicks off 2020 with lively discussions of HIM ‘hot topics’

By Lisa A. Eramo, MA

Presenters touched on a variety of hot topics at the most recent RIHIMA meeting: Data mining, patient matching, and evaluation and management (E/M) coding. Approximately 40 people attended the event held in Warwick, Rhode Island on January 17, 2020.

Data management skills a ‘must’ for HIM

Lolita M. Jones, MSHS, RHIA, CCS, healthcare data mining consultant at iquerydata.com encouraged attendees to gain data management skills so they can continue to add value in an increasingly artificial intelligence-driven healthcare environment. In the not-so-distant future, Jones said HIM professionals will be charged with auditing large data sets, identifying patterns, and recommending physician education. They’ll no longer manually assign codes and perform audits with limited sample sizes. Those with data management skills will be able to weather the storms of change and prevail, she added.

HIM professionals with data management skills, for example, can convert official coding guidelines into database queries to identify potential coding problems proactively—before payers and Recovery Audit Contractors do, said Jones. Why is it critical for HIM to write these queries? They possess the subject matter expertise to identify all of the diagnosis and procedure codes that apply to each query, said Jones. They can also help decision makers draw accurate conclusions and glean actionable insights from the data, she added.

How does one obtain data management knowledge without obtaining a master’s degree? Grassroots education at local and regional AHIMA meetings, said Jones. HIM professionals can also attend data management-related tracks at the annual AHIMA conference or take a variety of courses online.

Patient matching is more critical today than ever before

Letha E. Steward, MA, RHIA, director of customer relations at Quadramed gave an informative presentation on patient matching in the context of mergers, acquisitions, and health information exchange. A duplicate record doesn’t just affect one hospital—it affects many providers in real-time, said Steward. “As soon as you create a duplicate, the patient’s medical record is fragmented,” she added.

When hospitals and physician practice merge onto a single EHR platform, they must have a process in place to identify and resolve duplicates, said Steward. She encouraged organizations to use referential data because it’s updated as life events occur, and it can enhance automated matching. She also encouraged attendees to think about using cell phone numbers as unique identifiers because they don’t change often.

E/M documentation problems persist

Oby Egbunike, CPC, COC, CPC-I, CCS-P, director of professional coding at Lahey Health Care System, Burlington, MA spoke about the importance of the chief complaint—a detail that’s often omitted from E/M documentation. “This is the driver for whatever else the physician is going to do,” she said.

When documenting the exam, Egbunike said physicians should consider this question: Is the exam for the purpose of diagnosing and treating the patient or for coding? For example, a full organ system exam isn’t necessary for an ear infection, she added.

 

Targeted probe and educate audits coming to a provider near you

“When Medicare claims are submitted correctly, everyone benefits.” That’s what CMS says verbatim on its website about the newly-launched targeted probe and educate audits that are designed to reduce denials and appeals through one-on-one education.

During an AAPC chapter meeting on February 13 in Providence, Rhode Island, Lori Langevin, education consultant at National Government Services (NGS), walked attendees through the process. NGS is the Medicare Administrative Contractor (MAC) for jurisdictions 6 and K.

“It’s all about lessening the burden on providers,” she said.

Here’s how it works: MACs use data analysis to identify providers/suppliers with high error rates or unusual billing practices. Common claim errors include an omitted physician signature, lack of medical necessity, or incomplete certification. The initial probe includes a review of 20-40 claims. Practices have 45 days to respond to the request for documentation, though Langevin says 30 days is best practice. A lack of response equates to an error, she added.

After the review, providers receive a letter detailing the results. They’ll also have an option to receive one-on-one education via teleconference or webinar. During these sessions, providers will have the opportunity to ask questions and learn about the specific CMS policies that apply to each claim.

Langevin was unable to provide a concrete definition of what constitutes a high error rate, though she did say that she anticipates E/M codes and prolonged services will be targeted due to the high error typically associated with these services. Other targets will likely include topics that have surfaced during CERT and RAC audits, she added.

The overarching goal of these audits is to reduce the administrative burden on providers and MACs, said Langevin. Not only is it costly for providers to appeal denials, but it’s also costly for MACs to review the appeals and potentially overturn the denials. The probe and educate audits will hopefully drive process improvement, she said.

To learn more about targeted probe and educate audits, view this FAQ.

 

 

Can HIM and technology be friends?

Let’s face it. Technology changes every industry. This is especially true in HIM as it continues to revolutionize the way in which providers release health information, document in the medical record, assign codes, and more. How can HIM professionals keep up, and what must they do to stay current? These are two of the many questions that arose during the recent RIHIMA meeting on February 9 in Warwick. Approximately 50 people attended the event.

The future of HIM

Now that the hurdle of ICD-10 implementation has passed, AHIMA has set its sights on data analytics and information governance, both of which require a new level of training at the master’s or doctorate levels, said Donna Corbani, CCS. Corbani attended the 2017 AHIMA House of Delegates meeting in October and reported on several AHIMA initiatives. “We have to embrace technology to be relevant,” she added. “Automation is coming.”

Specific EHR certifications are helpful, said Corbani. “You’re golden when you have this and a background in HIM,” she added.

HIM must convey to executives that no technology is 100% accurate and that coders must validate coded data, said Corbani. One attendee voiced concerns about computer-assisted coding, stating that HIM must educate senior leaders about its limitations and flaws. Another attendee said HIM needs to be at the table as EMRs are developed and implemented because they can shed light on the flaws inherent in many products, preventing executives from having false hope that the technology will be a panacea.

HIM and IT also need to work together to develop best practices for EHR use and maintenance. Requiring users to ‘open a help ticket’ isn’t efficient in a rapidly-changing patient care environment, said one attendee.

Managing health information for transgender patients

Angela Carr, partner at Barton Gilman, LLP, provided an informative session on how healthcare providers can manage electronic health information most effectively for transgender patients by developing a policy for release of information, name changes, and more.

“The more we learn and talk about it, the better we’re going to be at providing care. The ultimate goal is to provide better care for this population,” said Carr. HIM can help by developing a policy to address the following:

*Data capture — Help providers explain to patients why they collect information about gender identity and preferred pronouns (e.g., for continuity of care, preventive care, etc.).

*HIPAA authorizations — Explain how and why providers may share information about gender identity and sexual orientation when it relates to treatment. This requires an explanation of uses and disclosures for treatment, payment, and healthcare operations, said Carr. Patient education must happen long before records are completed. This would help avoid conflict when sensitive information in the discharge summary is auto-faxed to the patient’s primary care physician, she added.

*Names/name changes —  Explain how the provider handles patient name and any subsequent name changes. For example, the medical record includes the individual’s legal name as it appears on their insurance card, but the provider uses an ‘aka’ when communicating directly with the patient.

Carr suggested conducting focus groups with transgender patients to see what they want and need. “The best way to learn is to talk to the people you’re trying to protect,” she said. “Be honest, and have a dialogue with people.” She also directed attendees to the World Professional Association for Transgender Health.

Reducing cancer in Rhode Island

David Rousseau, chair of the Partnership to Reduce Cancer in Rhode Island, talked about the importance of data in cancer research. Approximately 6,700 people in Rhode Island are diagnosed with cancer annually, and approximately 43,000 residents are living with cancer already.

Rousseau’s team is at the forefront of prevention. His team examined more than 500 people at various skin cancer screening events throughout 2017, helping individuals who couldn’t get a timely appointment with a dermatologist. This year, Rousseau said the partnership will be looking more closely at the large number of individuals who have insurance but don’t undergo preventive colonoscopies. Approximately 650 Rhode Islanders are diagnosed with colon and rectal cancers annually.

What’s at the heart of this research? Coded data.

 

 

 

What HIM can expect in 2018 and beyond

The list of topics covered at the recent RIHIMA meeting truly ran the gamut: Medicare payment reform, Office for Civil Rights (OCR) enforcements, the 21st Century Cures Act, FY 2018 ICD-10-CM coding changes, and more. The meeting, which drew approximately 50 people, was held in Warwick on October 20. The theme? Looking ahead to 2018 and beyond.

Health IT updates

Jennifer L. Cox of Cox and Osowiecki, LLC kicked off the morning with an update on health IT, the future of which she said is unclear in light of unprecedented budget cuts to infrastructure. What can HIM professionals expect during the next year and beyond? Cox told attendees to keep their eyes open for the 21st Century Cures Act, which she said is one of the most significant regulations that will affect the HIM profession. The legislation, which was enacted in December 2016, includes a section on health IT interoperability that requires data sharing and prohibits data blocking. A first set of draft rules is due by March 2018.

“This is going to be bigger than HIPAA and Meaningful Use–it will be the biggest thing in our careers that will shift how we use health information,” said Cox.

Cox also touched on the federal government’s efforts to remove Social Security Numbers (SSN) from Medicare cards by 2019. Although this may reduce identity theft, she said it creates an inability for HIM professionals to verify patient identity using this unique identifier. HIM may eventually need to create consistent verification standards in lieu of having access to the SSN, she added. They may also need to retrospectively sanitize records to remove the SSN. Cox encouraged attendees to make a list of all the ways in which they currently rely on the SSN so they can work collaboratively with the legal/compliance department to develop a strategy for how they’ll handle these scenarios once the SSN is no longer available.

Cox also warned of increasing OCR activity, stating that high-dollar settlements have increased over the last year and a half. She encouraged attendees to monitor the OCR’s running list of resolution agreements because she said it’s often a roadmap for potential vulnerabilities. “Learn from your colleagues’ misfortune,” she said. “This is what [the OCR] cares about, and what they care about, we should care about.”

Risk assessments should be a top priority, she said, adding that many independent physician practices are failing Meaningful Use audits because they didn’t conduct an assessment during the year of attestation. Also remember to fix any problems discovered during the assessment, she added.

Staff education is equally as important, said Cox. For example, employees should notify their IT department when a computer is particularly slow, as this could signal an impending cyber attack. “These are very sophisticated attacks,” she added. “It takes minutes–not hours–to infect the entire system.”

FY 2018 coding updates

Mary Beth York, senior associate at Barry Libman, Inc. discussed several important ICD-10-CM coding changes that took effect October 1, 2017. She encouraged attendees to review the FY 2018 ICD-10-CM coding guidelines as well as the 2018 Addendum. When coders rely entirely on the encoder–and don’t review all of the additions, deletions, and revisions–they aren’t as aware of these oftentimes subtle changes, she said.

Third-party release of information

Amy Derlink and Laureen Rimmer, both of MRA Health Information Services, gave an informative presentation on ROI best practices.

Derlink encouraged attendees to create a third-party audit record review policy that addresses these and other questions: Will you ask to see the business associate agreement between the health plan and third-party auditor before releasing information? Will you allow the third-party auditor onsite? What access will you provide to the third-party auditor? Will it include remote access? How will you comply with HIPAA’s minimum necessary requirements? “We need to protect privacy,” she said. “That’s our number one obligation.”

Don’t let auditors bypass HIPAA to access protected health information, said Derlink. Quality audits (e.g., HEDIS) are not included in uses and disclosures for treatment, payment, and operations, she added.

Rimmer said HIM must leverage technology and tap into data analytics to identify compliance risk and prepare for audits. “Understand your data, and know what’s going on so you can be proactive with your own internal audits,” she said. “As you see themes, you need to drill down.”

Embracing leadership qualities

Karen A. Benz of Benz Strategic Group gave an interesting presentation on leading vs. managing. “Management is doing. Leadership is being,” she said. “As a leader, you set the culture and tone of your department.” She described managers as productivity-oriented implementers, and she identified leaders as open-minded agents of transformational change. Managers ask people to follow, but when you’re a leader, people will follow naturally, she explained.

She challenged attendees to embrace leadership qualities and not succumb to negativity. Doing so improves employee retention and satisfaction. And when employees are happy, they’re often willing to go the extra mile for patients as well.

 

 

 

 

The *perks* of working from home

For many of us, the idea of working from home conjures up images of individuals hanging out in pajamas and slippers past noon, taking long breaks to watch game shows and soap operas — or perhaps not even ‘working’ at all. I’ve always found this to be an odd assumption considering I’ve worked far more diligently since establishing my home office than I ever did while working onsite. As a self-employed freelance writer, I put my nose to the grindstone daily, though I must admit I do it while wearing orthotic leopard-patterned slippers.

Can you blame me?

Still, working remotely wasn’t something offered to me at the onset of my writing career. I worked for several years in a cubicle —  constantly distracted by others’ conversations (and drama). When my previous employer eventually told me I would have my own private office, I had to pinch myself. Was it a dream or reality? Luckily, it was reality, and once settled in, I could shut the door, dim the lights, and get my work done in half the time it would have taken me to do so before. It wasn’t until nearly five years later (when I relocated to a different state) that this same employer offered me the option to work remotely from home. Of course, I said yes — and even turned down another job offer because of it.

Once I got a taste of working from home, I knew there would be no going back.

Why? First off, I’m happier. There’s more space, and it’s my space. Second, the quality of my writing improved because I was able to focus. Third, I could accomplish more work in an average 8-hour workday even despite the fact that it didn’t feel as though I was over-extending myself.

I’d like to think that the same holds true for medical coders who work from home. Medical coding is a profession that has increasingly embraced remote work arrangements in an age of electronic health records (EHR). Remote coders with whom I’ve spoken love working from home, and many view it as an ideal scenario.

Still, remote work isn’t for everyone. I’ve interviewed many coding managers and HIM directors who say it’s not even possible in some circumstances. Following are some questions to consider before allowing an employee to work from home:

  1. Does the employee have sufficient Internet access and speed to support remote access to the EHR?
  2. Does the employee have a quiet working environment and dedicated work/office space at home?
  3. Is the employee self-motivated? If so, how has he or she demonstrated this?
  4. Has the employee already met productivity and accuracy standards?
  5. Will working from home improve the employee’s job satisfaction?

While you ponder these questions, I’m going to go pour another cup of coffee and get started on my next article…all from the comfort of my home office with my only co-worker (my cat) by my side.

 

 

Revenue integrity, HIM advocacy discussed at RIHIMA

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Social media in healthcare, revenue integrity, HIM advocacy, and 2017 CPT updates were among the many topics discussed at the Rhode Island chapter of AHIMA’s winter meeting held January 20 in Warwick. Approximately 30 people attended the four-hour event.

2017 CPT updates take effect
Barbara Japhet, BS, CCS, manager of coding education and health information manager at Rhode Island Hospital, kicked off the meeting with an overview of CPT changes for 2017, including the nearly 500 code revisions primarily due to the unbundling of conscious sedation.

Though Japhet focused mostly on hospital-based CPT codes, she did highlight several changes that may be of interest to ambulatory-based providers. Two examples included the following:

  1. A new code for cognitive impairment assessment and testing (G0505). She said that physicians may bill this code in addition to chronic care management and transitional care management when certain requirements are met.
  2. The addition of low-, moderate-, or high-complexity descriptors for physical therapy and occupational therapy evaluation codes. More detailed codes will help CMS examine utilization more closely, she added.

Social media and healthcare: Can the two coexist?
Angela Carr, JD, partner at Barton Gilman, gave a very interesting presentation about the impact of social media on healthcare privacy and security. In particular, she said hospitals increasing rely on social media for the following purposes:

  1. Attract and engage patients
  2. Improve Google hits
  3. Recruit patients for clinical trials
  4. Attract employees

However, she urged organizations to think about the implications of social media on patient privacy, adding that an internal social media policy for employees is paramount. Such a policy should include the following components, she said:

  1. Definition of social media (including websites that fall under this category)
  2. Who can access social media, and why
  3. Fines for violating HIPAA
  4. Examples of what is considered a HIPAA breach
  5. Specific consequences for non-compliance
  6. Contact information of someone who can answer questions about the policy and its application

Note: Massachusetts General Hospital provides an employee social media policy that you can view here. Carr cited this policy as an example to which other organizations can refer when developing their own guidelines.

Provide an in-service to explain the policy, and apply it consistently to all employees, she added. Remind employees that even the most well-intentioned individuals can inadvertently breach confidential patient information. She provided this example: An employee takes a picture of herself eating birthday cake at her desk and posts it on Facebook. The employee doesn’t realize that five patient records are visible on her desk. This ‘background information’ is what many people fail to think about, she says.

She also urged organizations to create a social media policy for external users. This policy basically sets the ground rules for interacting with the organization’s social media sites. It should include clear terms of participation, the purpose of the organization’s social media presence, the prohibition of abusive terms, and more. Click here to view an example of Massachusetts General Hospital’s social  media guidelines for individuals who wish to interact with the hospital through social media.

Creating a revenue integrity program
Bettyann Carroll, director of revenue integrity (RI) at South Shore Hospital, spoke about how she created an RI program from the ground up commensurate with the hospital’s new EHR and billing system. She said those working on the RI team have tackled many projects, a few of which include the following, :

  • Incorporating clinical providers into the process for obtaining ABNs
  • Performing chargemaster review and validation in each hospital department
  • Creating consistent processes to ensure revenue and documentation integrity when new service lines are added

“You don’t want to be reactive–you want to be proactive in revenue integrity,” she added.

Raising awareness of HIM
Michele Mahan-Smith, RHIA, CCS, director of inpatient/observation coding at Rhode Island Hospital, and Kelly Doyle, RHIA, manager of HIM operations at Rhode Island Hospital, both reiterated the importance of promoting HIM internally as well as within the community.

For example, if you haven’t done so already, consider developing an HIM elevator speech. Also refer to the AHIMA website for more tips and tools to help raise awareness of the HIM profession–a profession that continues to grow and expand in an electronic environment.

Inspiration, innovation key themes at the 2016 annual AHIMA convention

20161018_211108“Inspire big thinking to launch our future” was the theme of the 88th annual AHIMA convention held October 16-19 in Baltimore, MD. And wow, did it inspire. I imagine that most HIM professionals walked away from the event feeling incredibly energized about the role they’ll play in this new era of big data and patient engagement.

In my opinion, the most powerful presentation was that of Dr. Bennet Omalu, the first doctor to diagnose chronic brain damage in NFL athletes. He also inspired the movie “Concussion” starring Will Smith. Dr. Omalu received frequent applause as he shared his personal journey–one in which he overcame insurmountable odds in war-torn Nigeria to not only attend medical school at the age of 15 but also to ultimately make a discovery that revolutionized neuroscience and sports medicine/safety. I had goosebumps just listening to him. As I watched and listened in awe, I was reminded that with hard work, passion, and a little luck, anything is possible. This is an important lesson for everyone, including HIM professionals working tirelessly to improve compliance and data integrity within their organizations.

Retired American astronaut and U.S. Navy Captain Mark Kelly continued the theme of inspiration as he spoke about his career flying 39 combat missions over Iraq and Kuwait during the first Gulf War. He also described in vivid detail what it felt like to blast off in a rocket when he served as the commander of space shuttle “Endeavor” on its final flight. His talk then turned personal as he spoke about the day his wife, former congresswoman Gabrielle Giffords, was severely wounded after being shot in the head at near point-blank range. Giffords joined him on stage at the conclusion of the talk and received a standing ovation.

Many of the sessions throughout the duration of the conference focused on thinking ‘outside the box’ of traditional HIM roles.

For example, ONC Chief Medical Information Officer Andrew Gettinger, MD, encouraged HIM professionals to help their organizations integrate patient-generated data into the EHR–especially as medical care continues to move outside of a hospital’s four walls. He said HIM is also well-suited to help organizations “harvest digital dividends” from EHRs–that is, use the technology (and big data) to solve operational challenges and problems.

During a panel discussion about the future of healthcare, AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA, encouraged attendees to imagine the HIM jobs of the future–and take steps now to prepare. Is higher education warranted? A specialty credential? She said to embrace industry changes–not simply react to them.

Panelists identified these healthcare trends that will continue to shape HIM in the years to come:

  • Push for transparency around healthcare costs
  • Integration of patient-generated data for a 360 degree holistic view of one’s health
  • Increased interoperability to meet patients’ demands and coordinate care more effectively
  • Best practices to educate patients about their health information
  • Best-of-breed strategic partnerships
  • Availability of clinical information at the point of care

Others spoke about new and emerging roles in HIM, including data scientist and healthcare data quality manager. Michelle Basco, RHIA, of Children’s Medical Center spoke about her own journey to become a personal health record coordinator. HIM professionals are uniquely qualified to engage and educate patients. “They need to learn, and they need us by the side,” she said.

Various speakers also talked about the importance of developing an HIM workforce to meet the job demands of the future. Apprenticeship programs are critical, said Bill Rudman, PhD, RHIA, executive director of the AHIMA Foundation. “We’re evolving so quickly with technology. On-the-job experience is so necessary,” he added.

Marci Wilhelm, of MedPartners, said apprentices with whom she’s worked achieved a 95% coding accuracy rate in only 90 days. Debra Boppre, MSM, RHIA, CCS, CCS-P, FAHIMA, of Trinity Health recounted a similar experience with apprentices who helped address coding backlogs at their facility.

Boppre encouraged other HIM professionals consider serving as mentors. “You owe it to these HIM professionals,” she said. “Invest the time, and you will see the return on investment over and over again.”

Information governance was also a hot topic. During a panel discussion, panelist Sally Beahan, RHIA, MHA, director of HIM at UW Medicine said to start small by identifying the ways in which HIM is already striving to enhance data integrity. Others shared their journeys toward information governance and encouraged HIM professionals to champion the effort within their organizations.

Did you attend the AHIMA convention? If so, what did you take away from it? What inspired you the most?

 

 

 

OCR audits, risk-adjustment coding discussed at RIHIMA

OCR audits, FY2017 coding updates, and risk-adjustment coding were among the many topics covered during the most recent RIHIMA meeting on October 7 in Warwick, RI. These meetings provide an affordable opportunity to stay abreast of industry changes and network with peers. Another perk: Free coffee and donuts. 🙂

HIPAA branding, OCR audits

Norma Chitvanni, RHIT, CHPS, privacy officer and director of privacy and confidentiality at Beth Israel Deaconess Medical Center, spoke about her efforts to lead an awareness campaign to help employees understand the importance of HIPAA. She reminded attendees that employees are an organization’s biggest vulnerability, and she urged others to consider creative ways to brand an internal privacy and security program.

For example, Chitvanni worked with the hospital’s communications department to create an educational video in which members of a patient/family advisory group spoke about the importance of keeping information private (KIP). She and her team also:

  • Created a padlock logo for the program
  • Identified internal KIP coaches to help educate staff
  • Put KIP labels on salad contains and food wrappers in the cafeteria
  • Created a staff portal with resources about how to secure laptops
  • Handed out promotional materials about KIP (e.g., pens, phone wipes)

Chitvanni also urged attendees to prepare for upcoming OCR audits. She provided these tips:

  • Provide HIPAA education to all staff. Ensure that you have some way to monitor and assess staff member’s understanding along the way (e.g., test-your-knowledge questions or a final exam).
  • Use the OCR audit tool as a foundation for compliance. Do your policies and educational materials support each of the 109 elements included in the tool?
  • Compile information for your business associates in advance. HHS provides a complete list of necessary information.
  • Use technology to monitor and mitigate risk. For example, some applications can identify and flag unencrypted emails that include medical record numbers, patient information, or medical codes.

FY 2017 coding updates

Mary Beth York, CCS, CCS-P, CIC, senior associate at Barry Libman Inc., provided a helpful overview of important coding changes that took effect October 1. She encouraged attendees to review the updated ICD-10-CM guidelines and also pointed out several surprises, including:

  • 1.A.19: The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists.  The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis.

“I think we have to see how this is going to play out,” she said, adding that it remains unclear as to how insurance companies and Recovery Auditors will handle this guideline when a condition doesn’t meet clinical criteria.

  • 1.C.12.a(6): If a patient is admitted with a pressure ulcer at one stage and it progresses to a higher stage, two separate codes should be assigned: one code for the site and stage of the ulcer on admission and a second code for the same ulcer site and the highest stage reported during the stay.

She urged HIM professionals to work with members of the quality team to raise awareness of this new guideline.

Risk-adjustment coding

Gerry Petratos, MD, MS, CEO of Hiteks Solutions, Inc. said HCC coding is becoming the “gold standard” in healthcare because of its ability to capture clinical complexity and predict costs.

Many organizations are already using HCC modeling in the outpatient arena, necessitating the need for documentation improvement, he said. “Ambulatory CDI will be the biggest growth area in which there are the fewest people to do the work,” he added.

Accountable Care Organizations can also use HCC data to segment populations and target preventive care.

Why HIM professionals hold the keys to patient satisfaction

I started writing about medical coding and health information back in 2005. When I stop and think about how many changes HIM professionals have been through during that decade, it’s mind-boggling! First it was MS-DRGs and the dawn of clinical documentation improvement, then the Affordable Care Act and the push for electronic health records, then ICD-10, and now a transition to value-based payments.

As medical records have evolved, HIM professionals’ skills have evolved as well. With their intimate knowledge of data — particularly how data is created, modified, stored, and shared — they bring such value to the table. The sky is the limit when HIM and IT collaborate effectively. Add a hospital executive to the mix, and you’ve got a powerful trio of intelligent minds that can propel process improvement forward. What an exciting thought!

Unfortunately, it’s sometimes difficult to find common ground. And it’s easy to lose valuable ideas in translation. The good news is that everyone seems to speak the language of ‘patient satisfaction.’ Organizations nationwide  continue to focus on the patient experience — especially in light of the important role that both of these plays in CMS’ latest hospital quality star ratings.

This is an opportunity for HIM. Take it.

Meet with a C-suite executive and explain how HIM can engage patients. Here are a few examples:

  1. Portal navigation. Who is most qualified to convey the value of portals and educate patients how to use them? HIM.
  2. Health coverage education. Who is most knowledgeable of complex insurance policies (including copayments, deductibles, coinsurance, etc.) and can thus help patients understand these concepts? HIM.
  3. Digital forms. Who can help digitize forms, integrate EHR data into those forms, reduce duplication, and create opportunities for e-signatures on mobile devices? HIM.
  4. Advocacy for privacy and security. Who can help patients understand their rights to obtain copies of their own medical records? HIM.
  5. Protection against medical identity theft. Who can implement policies and procedures to thwart identity theft and protect patient information? HIM.
  6. EHR best practices. Who can help physicians integrate the EHR into the exam room so it doesn’t disrupt communication? HIM.

In what other ways do you, as an HIM professional, strive to improve the patient experience daily?