Category: HIM management

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

On By Lisa A. EramoIn AHIMA, Audits, Data analytics, EMR and EHR, HIM management, Uncategorized

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.

 

What HIM can expect in 2018 and beyond

On By Lisa A. EramoIn AHIMA, Audits, EMR and EHR, HIM management, HIPAA, ICD-10, medical coding, Revenue integrity, Uncategorized

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

On By Lisa A. EramoIn HIM management, medical coding, Remote coding, Uncategorized

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

On By Lisa A. EramoIn AHIMA, CPT, Freelance writing, Healthcare writing, HIM advocacy, HIM management, HIPAA, Revenue integrity, Social media, Uncategorized

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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.

OCR audits, risk-adjustment coding discussed at RIHIMA

On By Lisa A. EramoIn AHIMA, Clinical documentation improvement, HIM management, HIPAA, ICD-10, Physician practices, Risk adjustment

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

On By Lisa A. EramoIn AHIMA, Communication, EMR and EHR, Freelance writing, Healthcare writing, HIM management, ICD-10, Patient advocacy, Patient engagement, Patient portals, Patient satisfaction, Uncategorized

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?

 

 

 

Information governance, cybersecurity discussed at RIHIMA

On By Lisa A. EramoIn AHIMA, HIM management, ICD-10, medical coding, Uncategorized

Last week, I attended the annual meeting of the Rhode Island chapter of AHIMA. The event, held in Warwick, drew 70+ people as well as several vendors. It was a day filled with a wide variety of presentations, a delicious breakfast and lunch, and many opportunities for networking. The best part was that I only needed to travel 10 minutes from my home!

The day began with an overview of AHIMA’s strategic goals and initiatives. Tim J. Keough, MPA, RHIA, FAHIMA, of the AHIMA board of directors, spoke about the importance of data in healthcare — and why HIM is well-suited for the role of data analyst. He urged HIM professionals to lead the charge in the current data revolution — that is, to look for ways in which their organizations can turn data into health intelligence that can mitigate risk and improve outcomes.

Keough also talked about information governance through data transparency, data protection, and data integrity. As the industry continues to tap into big data for precision medicine, he said HIM should be at the forefront managing, using, and improving this data.

Cybersecurity expert, John H. Rogers, CISSP, gave a great presentation on the growing risk that hackers pose to health information privacy and security. “Healthcare information is more valuable than any other information on the market,” he said.

HIM professionals must make cybersecurity a core mission of the organization. This requires ongoing staff education, virus protection/patch updates, and social engineering testing. “It’s not just about the technology. Situational awareness is your power,” he said.

On the coding side, Barry Libman, MS, RHIA, CDIP, CCS, CCS-P, CIC, provided a helpful overview of important ICD-10-CM/PCS changes that will go into effect for FY 2017 on October 1, 2016. In particular, there are 3,651 new PCS codes (many of which are cardio-related) and 1,943 new CM codes, including a new code for the Zika virus (A92.5).

Attorney Jennifer Cox, JD gave an update on the ever-evolving Meaningful Use (MU) program, urging attendees to perform a security risk analysis if they haven’t done so already. Cox said this analysis is the number one reason providers fail to meet MU criteria.

David L. Rousseau, director of cancer information systems at the Hospital Association of Rhode Island, talked about the importance of cancer registries and why this is a good fit for HIM.

Perhaps the most riveting presentation was given by Michael G. Cooley, executive director of Nalari Health. Cooley shared his personal journey to overcome many challenges and hardships to ultimately find success both personally and professionally. His story, which also serves as the basis for his memoir “Rock Bottom: From the Streets To Success,” was extremely inspirational and unexpected. It also serves as a reminder of the strength of the human spirit — a good lesson for all of us.

 

Effective communication starts with YOU

On By Lisa A. EramoIn Communication, Freelance writing, Healthcare writing, HIM management, Uncategorized

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

On By Lisa A. EramoIn Freelance writing, Healthcare writing, HIM management

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? 🙂