Who you gonna call?! Ghostwriters!

I can’t tell you how many times I’ve talked to HIM subject matter experts who say the same thing: ‘I don’t have time to write, and I just can’t get motivated!’

Sound familiar?

If you’re working in the world of HIM (especially if you’ve established yourself as a thought leader), you’re probably bombarded with requests for content. Editors ask you to write articles for trade publications, the company for which you work asks you to write blogs, and your professional associations ask you to contribute articles to their journals. Regardless of the opportunity, all requests for content have one thing in common: They require time — the most precious commodity!

Even if you haven’t been asked to contribute content, there are many reasons to start looking for opportunities to author articles. For example, well-written content can open doors to new customers or potential employers who are impressed by what you have to say. It can also draw the attention of journalists looking for experts to interview. Content can also pave the path to speaking engagements or invitations to serve as a guest on a podcast. With good content, the possibilities are truly endless.

Some HIM subject matter experts love writing articles because it gives them a chance to step outside of their daily routines. They aren’t daunted by deadlines, grammar, outlines, etc. But many are just the opposite, and the idea of writing a 1,000-word article is as overwhelming as a massive documentation request from a Recovery Auditor during ICD-10 go-live. Is there any way to make the entire process less painful?

Yes. Enter the ghostwriter.

Ghostwriters are individuals who write content on behalf of others. Yes, you read that correctly — the ghostwriter does ALL of the writing. Their job is to articulate the author’s thoughts, ideas, and tone–all while adhering to pesky rules of grammar, word count restrictions, requirements for search engine optimization, a demand for hyperlinks, and more. Ghostwriters also often perform any background research necessary to supplement the topic, saving authors considerable time tracking down that one vital statistic to support an argument, for example. It’s a tall order, but completely do-able for a skilled ghostwriter.

The best part is that you get to share your awesome ideas — and put your best foot forward to potential customers (and peers) — without any of the hassle of writing. It also means that you get to spend more time doing what you do best: Focusing on HIM-related tasks and projects.

When I ghostwrite for clients, I often start by asking this question: What do you hope this content conveys? I try to keep this in mind as I’m writing and asking questions. I do compile questions in advance, but I also think it’s important to remain flexible as the conversation progresses. After all, it’s not my byline — it’s yours. The content needs to reflect your perspective, experience, and opinions.

As an HIM ghostwriter, my job is to translate your subject matter expertise into interesting and relatable content that captures readers’ attention. It’s a challenge that I enjoy, and I’m constantly humbled by the knowledge of the authors for whom I ghostwrite. Talk to me — and let me tell your story!





7 tips to make your case studies shine

Before we dive into what your case studies need, perhaps a more fitting question is: Have you created any? If not, well, what are you waiting for? Chances are, you’ve helped countless clients achieve stellar results over the years. Why not share some of your successes in narrative form? When well-written, case studies convey several key pieces of information to potential clients:

  1. Insider knowledge of the challenges that customers face on a daily basis
  2. Why your company is uniquely positioned to address these challenges
  3. The type of results that customers can expect when they work with you

Think of a case study as an in-depth testimonial. It’s an opportunity to highlight your customer’s hard work and success. It also showcases your ability to help solve a problem, address a challenge, or improve a process — all with quantifiable results.

Here are some tips to help you create a compelling case study:

Tip #1: Pick the right customer. Not every customer is willing (or able) to share their thoughts for a case study. For example, a customer may be open to the opportunity but prohibited by their HR department to speak about internal processes. Another customer might speak highly of your services but not yet have meaningful results to share. Pick someone who had a positive experience with your company, who achieved quantifiable results, who has been cleared for participation, and who is willing to spend the time necessary to answer questions and review content once it’s written.

Tip #2: Include an ‘at a glance’ summary. Not everyone will have the time (or interest) to read the case study in its entirety. That’s why it’s important to ‘call out’ certain key takeaway points in two short sidebars: Challenges and results. Be concise — 10 words or fewer for each challenge and result.

Tip #3: Describe the customer so readers have context. This also often works well as a short sidebar. For example, when featuring a hospital client, include the type of hospital, number of beds, and location. For physician practices, include the specialty, monthly patient volume, and location.

Tip #4: Include real results. I can’t stress this enough. Don’t just say that you helped reduce readmissions or increase revenue. Provide specific numbers or percentages. This makes the case study more credible and impactful.

Tip #5: Seek empathy from the start. The best way to engage readers is to strike a nerve in the first sentence. Connect with readers emotionally by diving into the customer’s challenge and the effect it had on his or her business. In some ways, this is no different from a good fictional novel. If the first sentence catches your eye, you’ll read the next one…and the next one, and so on. Chances are, most readers will relate to your customer’s challenge and want to continue reading to learn more about how you helped solve the problem.

Tip #6: Include quotes, but be selective. No case study is complete without honest and insightful quotes from your customer. Quotes bring the story to life and insert a human element into the narrative. Choose quotes that express opinions, emotions, or unique expressions. Stay away from quotes that recap facts or that don’t add a new dimension to the content you’ve already written.

Tip #7: Conclude with a call to action. Don’t forget to prompt readers to contact your company for more information. Include your phone number, email address, and website at the end of the case study.

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.



RIHIMA kicks off 2017 with practical education sessions


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?




RIHIMA annual meeting — a good mix of HIM topics

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.


A snapshot of the 24th annual AAPC conference

I was lucky enough to be able to attend the recent HEALTHCON conference sponsored by the American Academy of Professional Coders. The 24th annual event, held in Orlando April 9-13, drew nearly 2,700 attendees — many of them physician practice coders. More than 50 vendors also exhibited at the conference, providing the opportunity for networking and checking out the latest and greatest technology. Plus, there were many fun giveaways and prizes (I always enjoy grabbing some extra pens!).

The schedule was jam packed with sessions touching on EMRs, coding/billing compliance, HIPAA, productivity, practice management, telemedicine, value-based payments, and more. It was a coder’s dream — a smorgasbord of all things coding! Speakers included physicians, consultants, attorneys, and others. Every session I attended was held in a room filled with bright-eyed coders ready and willing to take notes, ask questions, and absorb information like a sponge.

Following are just a few of the noteworthy highlights:

  1. Coders and billers must learn the lingo of denials. Read the EOB carefully. Track and trend denial codes, and implement carrier-specific edits. -Yvonne Dailey
  2. 90%-93% of denials are preventable because they’re due to data entry errors. Design front-end processes that ensure accurate demographic and financial information. -Yvonne Dailey
  3. Physician practices need policies and procedures. Every practice should have these policies in place: Financial policy, bad debt/write offs, financial hardship, compliance, claim correction, refunds. -Yvonne Dailey
  4. Physicians must ensure that their personal mobile devices conform to enterprise-wide policies and procedures for HIPAA compliance. -Steve Spearman
  5. The biggest hurdle in terms of billing for transitional care management is being able to receive discharge notifications. Practices must develop relationships with hospitals to establish this workflow. -Stephen Canon
  6. Wearable devices will improve preventive medicine. That’s because these devices will continuously gather data in real-time, providing much richer health histories. What will this mean for HIM? There are many privacy implications. We’ll need new permission models that must be more sophisticated and perhaps even rely on time-limited boundaries. We’ll also need to be able to filter information based on the end user/recipient of that data. -Scott Klososky
  7. Auto-population in the EMR is risky business because it affects credibility. -Michael Miscoe
  8. Some Medicaid contractors and commercial payers are asking for the EMR audit trail. -Robert Pelaia
  9. When reporting time-based codes, coders need to question whether the payer is using CMS or AMA guidelines. -Michael Strong
  10. Data is becoming the new currency. By 2030, consumers will be able to shop for and compare physicians. We’ll also see more bundled payments, the expansion of telemedicine, and the consolidation of smaller practices into larger integrated practices. -Dan Schwebach
  11. Coders are salespeople — they must “sell” the importance of coding to physicians. -Stephanie Cecchini
  12. As soon as you feel comfortable, it’s time to learn something new. -Stephanie Cecchini
  13. Templates are a tool — not a “be all end all” when it comes to selecting a code. You still need to question/validate the code and ensure that documentation supports code assignment. -Angela Jordan
  14. Coding quality is just as important as coding productivity. -Ann Bina
  15. When setting productivity standards, consider these factors: Page count, access to coding tools, experience, handwritten vs. electronic notes, Internet speed, provider (resident vs. physician), non-coding duties, and more. -Ann Bina




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?

Finding inspiration in patients’ stories

As a healthcare writer, I tend to gravitate toward healthcare-related non-fiction. Atul Gawande is one of my favorite authors. I’ve read all of his books: Complications, Better, The Checklist Manifesto, and Being Mortal. I appreciate the insights he shares into the complexities of healthcare as well as art and science of medicine. I also appreciate his humility, self-awareness, and sensitivity to patients’ stories. These are admirable traits in any individual and especially in a clinician who — like many physicians — is inundated with regulatory requirements and other demands.

In his most recent book, Being Mortal, he examines end-of-life care, pointing out that we (as a society) seem to have gotten it wrong — i.e., that far too often, we assume that those at the end of their lives have essentially nothing left to give. Instead, he says, these individuals have much to contribute and that silencing them is both shameful and wrong.

In an article for the New Yorker, he wrote: “Medicine has forgotten how vital such matters are to people as they approach life’s end. People want to share memories, pass on wisdoms and keepsakes, connect with loved ones, and to make some last contributions to the world. These moments are among life’s most important, for both the dying and those left behind. And the way we in medicine deny people these moments, out of obtuseness and neglect, should be cause for our unending shame.”

I couldn’t agree more. We need to shift the way in which we think about end-of-life care. People don’t stop living simply because they’ve reached this final stage in life. They still have stories to share, hobbies to pursue, and connections to make. They are alive, and they don’t want to be treated as if they’ve already passed on.

We also need to be more comfortable talking about death — something I, myself, find challenging. Having watched my own grandmother trudge through the final phase in her life — and ultimately pass on a few years ago — I know how difficult it is to finally let go. At the very end of her life, I think the times she felt most understood were the times I simply held her hand and told her I was happy that she’d finally reached the point at which she felt she could leave this life and move toward whatever comes next. She didn’t want me to mourn. She wanted me to rejoice in her decision.

As a healthcare writer, I spend a lot of time sifting through complicated healthcare regulations. But at the end of the day, patients’ stories are what are ultimately what drives and moves me to write in this space. Atul Gawande gets it. He understands that healthcare is more than just words on a page, medical codes on a claim, or diagnoses out of a textbook. Patient stories matter, and all patients matter — including those at the end of their journeys.


Reflections on ICD-10

So far, ICD-10 seems to be going so much more smoothly than many expected. Are we to believe that smooth operations will continue indefinitely? Based on conversations I’ve had, people seem to be waiting for one significantly potential driver of change:

Insurer refinement of ICD-10 claims processing

Will insurers demand the level of specificity inherent in ICD-10? What exactly will audits look like? And how might reimbursement change in the future?

I think providers need to continue to remain alert and ready for whatever comes next.