Revenue integrity, HIM advocacy discussed at RIHIMA

0207141454.jpg

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.

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?

 

 

 

Effective communication starts with YOU

As a freelance writer, I spend the majority of my time “heads down” writing healthcare content. However, I also spend a good chunk of my day interviewing subject matter experts and chatting with potential clients. Either way, I need to be able to “cut to the chase” in as few words as possible. This is not unlike HIM directors who must often convey information quickly and effectively –particularly when speaking with members of the c-suite. These meetings tend to address a variety of topics/questions — Should we move CDI specialists offsite? Can we afford to hire another FTE coder? What’s the strategy to engage patients in portal technology? How can we get outpatient physicians on board with clinical documentation improvement? The list goes on!

Here are three tips I’ve learned over the years that could help HIM directors — or anyone for that matter — speak their case with ease:

  1. Less is more. Keep it relatively brief and to the point. Encourage questions so you can tailor your content accordingly, but always be mindful of others’ time/schedules.
  2. Do your homework. When I’m preparing for an interview, I research the topic and prepare at least 5 questions in advance. When preparing for a meeting, plot out your overall agenda and specific goals for the conversation. What information do you need to convey? What are the next steps that must be accomplished after the conclusion of the meeting? Compile any necessary statistics/data in advance so you can make decisions most efficiently.
  3. Think “what does the audience want?” In my case, the audience may be an interviewee or potential client. What do they feel they need to tell me about the topic? Or what are they looking for specifically in terms of content management/production? When preparing to speak with the c-suite, for example, what’s the best approach that will solicit buy-in? For example, when approving an FTE coding position, executives don’t want to know all of the details related to new ICD-10 codes effective October 1. They simply want to know trends in productivity and quality — and why this necessitates the need for an additional coder.

What strategies are most effective for you in your own organization?

5 traits that HIM directors and freelance writers have in common

I was listening to a webinar the other day that was geared toward freelance writers. As the speaker discussed various aspects of running a successful freelance writing business, it struck me that there are many overlaps with running an efficient HIM department. Following are 5 commonalities between HIM directors and freelance writers:

  1. HIM directors and freelance writers wear many hats. A good freelance writer is also a marketer, salesperson, quality control manager, bookkeeper, maintenance worker, IT providers, and customer service representative. Likewise, a savvy HIM director is also a project manager, patient advocate, and process improvement specialist.
  2. HIM directors and freelance writers must be flexible. As directors of one of the most critical departments in an organization, HIM professionals must be able to adapt daily — and sometimes by the minute — to whatever circumstances come their way. This is no different for freelance writers.
  3. HIM directors and freelance writers must focus on customer service at all times. For a freelance writer, customer service is paramount — and it keeps clients coming back for more content. In healthcare, customers are the patients who frequent the organization. HIM directors must always put patients first — responding professionally to requests for information, questions about privacy/security, questions about billing, and more.
  4. HIM directors and freelance writers may sometimes have self-limiting beliefs. Even despite a well-honed skillset, some freelance writers may doubt their abilities to make a living as a writer. HIM directors are no different. Despite their vast knowledge of coding, HIPAA, release of information, clinical documentation, and more, many fear that they aren’t qualified to take a seat at the decision-making table. [I’m here to say that the seat is available — take it!]
  5. HIM directors and freelance writers must view themselves as problem solvers. A successful freelance writer has the ability to identify clients’ problems and offer solutions (via content) that are address those problems. HIM directors are also problem-solvers within their organizations. They can help researchers and physicians interpret clinical data; improve data integrity; and explain patterns in morbidity, mortality, readmissions, and more.

As an HIM professional, how else might your career be similar to mine?  Where are the overlaps? If you could switch with me for a day, would you do it? 🙂