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RCM Tips And Tricks: To Collect More From Patients, Educate And Engage Them

Posted on November 1, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Hospitals face particularly difficult challenges when trying to collect on patient bills. When you mix complex pricing structures, varied contracts with health insurers and dizzying administrative issues, it’s hard to let patients know what they’re going to owe, much less collect it.

Luckily, RCM leaders can make major progress with patient collections if they adopt some established (but often neglected) strategies. In short, to collect more from patients you need to educate them about healthcare financial issues, develop a trusted relationship with them and make it easy for them to pay that bill.

As a thought exercise, let’s assume that most patients want to pay their bills, but may need encouragement. While nobody can collect money from consumers that refuse to pay, you can help the willing ones prepare for the bills they’ll get. You can teach them to understand their coverage. In some cases, you can collect balances ahead of time. Toss in some smart patient engagement strategies and you could be golden.

What will that look like in practice? Check out this list of steps hospitals can take to improve RCM results directly, courtesy of a survey of hospital execs by Becker’s Hospital Review:

  • Sixty-five percent suggested that telling patients the amount due before they come to an appointment would be helpful.
  • Fifty-two percent believe that having more data on patients’ likelihood to pay could improve patient collections results
  • Forty-seven percent said that speaking to clients in different ways depending on the state of the finances would help improve patient collections.
  • Forty-two percent said that offering customers payment plans would be valuable.

Of course, you won’t be doing this in a vacuum, and some of the trends affecting patient financial responsibility are beyond your control. For example, unless something changes dramatically, many patients will continue to struggle with high-deductible health coverage. Nobody – except the health insurers – likes this state of affairs, but it’s a fact of life.

Also, it’s worth noting that boosting patient engagement can be complicated and labor-intensive. To connect with patients effectively, hospitals will need to fight a war on many fronts. That means not only speaking to patients in ways they understand, but also offering well-thought-out hospital-branded mobile apps, an effective online presence and more. You’ll want to do whatever it takes to foster patient loyalty and trust. Though this may sound intimidating, you’ll like the results you get.

However, there are a few strategies that hospitals can implement relatively quickly. In fact, the Becker’s survey results suggest that hospitals already know what they need to do — but haven’t gotten around to it.

For example, 87% of hospital respondents said they had a problem with collecting co-pays before appointments, 85% said knowing how much patients can pay was important, and 76% of respondents said that simplifying bills was a problem for them. While it may be harder than it looks to execute on these strategies, it certainly isn’t impossible.

When Hospitals Leak Money

Posted on October 20, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A couple of weeks ago I was skimming healthcare business headlines and stumbled across this guaranteed showstopper: You’re probably leaving $22 million on the table. That headline is from a column by Jim Lazarus, who works in the Advisory Board’s Revenue Cycle Solutions division. In his column, he named four ways in which hospitals could recapture some of this lost revenue.

In the article, Lazarus notes that hospitals aren’t following best practices in four key areas, namely denial write-offs, bad debt, cost to collect and contract yield.  Unsurprisingly, Advisory Board benchmarks also demonstrate that median performing organizations are having trouble reducing net days in accounts receivable. The Advisory Board has also found that the overall average cost to collect has worsened by 70 points of net patient revenue from 2011 to 2015.

To turn the stats around, he suggests, hospitals should focus on four critical issues in revenue cycle management. They include:

  • Preventing denials rather than responding to them. “Hospitals are losing, on average, five percentage points of their margin to underpayments, denials and suboptimal contract negotiations,” Lazarus writes.
  • Collecting more from patients by improving their financial experience. According to Lazarus, between 2008 and 2015 the portion of patient obligations being written off as bad debt has climbed from 0.9% to 4.4%. To boost patient collections, hospitals must offer price estimates, convenient payment methods and a positive care encounter, he says.
  • Being sure not to take a hit on MACRA compliance. See that doctors, including those coming on board as employed physicians, get up to speed on documentation performance standards as quickly as possible.
  • Building the value of merged RCM departments. If multiple RCM organizations are being integrated as part of consolidation, look at ways to improve the value they deliver collectively. One approach is to create a shared services organization providing a common business intelligence platform across entities and service lines systemwide.

If you’re an IT leader reading this, it’s probably pretty clear that you have a substantial role in meeting these goals.

For example, if your hospital wants to lower its rate of claims denials, having the right applications in place to assist is critical. Do your coding and billing managers have the visibility they need into these processes? Does senior management?

Also, if the hospital wants to improve patient payment experiences, it takes far more than offering a credit card processing interface to make things work. You’ll want to create a payment system which includes multiple consumer touch points and financing options, which is integrated with other data to offer sophisticated analyses of patient payment patterns.

Of course, the ideas shared by Lazarus are just the beginning. While all organizations leave some money on the table, they have their own quirks as to why this happens. The important thing is to identify them. Regardless, whether you are in RCM, operations or IT, it never hurts to assume you’re losing money and work backward from there.

Predictive Analytics with Andy Bartley from Intel

Posted on September 20, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

#Paid content sponsored by Intel.

In the latest Healthcare Scene video interview, I talk with Andy Bartley, Senior Solutions Architect in the Health and Life Sciences Group at Intel. Andy and I talk about the benefits of and challenges to using predictive analytics in healthcare.

Andy offers some great insights on the subject, having had a long and varied career in the industry. Before joining Intel, he served in multiple healthcare organizations, including nurse communication and scheduling application startup NurseGrid, primary care practice One Medical Group and medical device manufacturer Stryker.

In my interview, he provides a perspective on what hospitals and health systems should be doing to leverage predictive analytics to improve care and outcomes, even if they don’t have a massive budget. Plus, he talks about predictive analytics that are already happening today.

Here are the list of questions I asked him if you’d like to skip to a specific topic in the video. Otherwise, you can watch the full video interview in the embedded video at the bottom of this post:

What are your thoughts on predictive analytics? How is it changing healthcare as we know it? What examples have you seen of effective predictive analytics? We look forward to seeing your thoughts in the comments and on social media.

Health IT Preserves Idaho Hospital’s Independence

Posted on February 1, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Most of the time, when I write about hospital IT adoption, I end up explaining why a well-capitalized organization is going into the red to implement its EMR. But I recently found a story in RevCycle Intelligence in which a struggling hospital actually seems to have benefitted financially from investing in IT infrastructure. According to the story, a 14-bed critical access hospital in Idaho recently managed to stave off a forced merger or even closure by rolling out an updated EMR and current revenue cycle management technology.

Only a few years ago, Arco, Idaho-based Lost Rivers Medical Center was facing serious financial hurdles, and its technology was very outdated. In particular, it was using an EMR from 1993, which was proving so inflexible that the claims stayed in accounts receivable for an average of 108 days. “We didn’t have wifi,” CEO Brad Huerta told the site. “We didn’t have fiber. We literally had copper wires for our phone system…we had an EMR in a technical sense, but nobody was using it. It was a proverbial paperweight.”

Not only was the cost of paying for upgrades daunting, the hospital’s location was as well. Arco is a “frontier” location, making it hard to recruit IT staffers to implement and maintain infrastructure, staff and servers, the story notes. Though “fiercely independent,” as Huerta put it, it was getting hard for Lost Rivers to succeed without merging with a larger organization.

That being said, Huerta and his team decided to stick it out. They feared diluting their impact, or losing the ability to offer services like trauma care and tele-pharmacy, if they were to merge with a bigger organization.

Instead of conceding defeat, Huerta decided to focus on improving the hospital’s revenue cycle performance, which would call for installing an up-to-date EMR and more advanced medical billing tools. After the hospital finished putting in fiber in its area, Lost Rivers invested in athenahealth’s cloud-based EMR and medical billing tools.

Once the hospital put its new systems in place, it was able to turn things around on the revenue cycle front. Total cash flow climbed rapidly, and days in accounts receivable fell from 108 to 52 days.

According to Huerta, part of the reason the hospital was able to make such significant improvements was that the new systems improved workflow. In the past, he told RevCycle Intelligence, providers and staff often failed to code services correctly or bill patients appropriately, which led to financial losses.

Now, doctors chart on laptops, tablets or even phones while at the patients’ bedside. Not only did this improve coding accuracy, it cut down on the amount of time doctors spend in administrative work, giving them time to generate revenue by seeing additional patients.

What’s more, the new system has given Lost Rivers access to some of the advantages of merging with other facilities without having to actually do so. According to the story, the system now connects the critical access hospital with larger health systems, as the athenahealth system captures rule changes made by the other organization and effectively shares the improvements with Lost Rivers. This means the coding proposed by the system gradually gets more accurate, without forcing Lost Rivers to spend big bucks on coding training, Huertas said.

While the story doesn’t say so specifically, I’m sure that Lost Rivers is spending a lot on its spiffy new EMR and billing tech, which must have been painful at least at first. But it’s always good to see the gamble pay off.

Value Based Reimbursement: Another Challenge for HIM Professionals

Posted on August 3, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin’s latest HIM Scene posts here.

How many times have you heard something along these lines: “HIM professionals must stay relevant and current with the continuous healthcare changes.” I must sound like a broken record to my team but it is absolutely true! HIM professionals provide the bridge between clinical data and reimbursement methodologies through CDI, coding, documentation integrity, and health data analytics to name a few. It has been proven time and time again that these HIM skills are vital to healthcare organizations but these skills must also be adapted and be put to good use each time a new guideline or rule is introduced.

Value-Based Reimbursement is an area that continues to grow with the push for quality patient outcomes and healthcare savings with potential penalties for excessive costs and poor quality of care. Reimbursement incentives that are tied to quality of care make perfect sense and HIM professionals need to take the plunge into these initiatives. By marrying departments and cross-functioning teams, we are able to generate proactive data and improve performance.

At my facility, I oversee the HIM department as well as the Quality department because we work closely together and will continue to have an even closer relationship throughout healthcare reform. This is becoming very common in the industry.

In this roundtable article for the Journal of AHIMA, we each outlined how we are bringing HIM to the table for Value Based Reimbursement initiatives and maximizing the tried and true skills of HIM professionals.

I have said it before and I will continue to say it: Always keep your finger on the pulse of healthcare and stay relevant by taking on these new challenges!

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Healthcare Price Transparency Driving Choice – Just The Wrong Direction

Posted on July 25, 2016 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last month, the Healthcare Financial Management Association held their annual conference – #HFMA16ANI. The topics covered in the sessions and discussed in the aisles of the exhibit hall were wide-ranging. Financial patient experience, scoring based on propensity to pay, patient loans, financing options and price transparency were on the lips of many attendees.

The discussions on price transparency were particularly interesting. Attendees were not talking about transparency as the silver-bullet for reducing costs in healthcare like they were last year. Instead, attendees were talking about it as being just the first step in a long journey to a truly open market in healthcare.

Just a few years ago, price transparency was touted as the necessary catalyst for true consumer/patient choice in healthcare. It was believed that with detailed price information patients would be able to “shop around” for their care using price as a determining factor. Having this choice would mean healthcare organizations would have to become more price competitive – thus driving overall costs lower.

Check out this excellent post from Dan Munro @danmunro back in 2013 that captures the hope of price transparency at that time.

I believe that all the work around price transparency in the past few years has indeed pushed patients to make choices in their healthcare – just not the choices that we want.

This tweet from Annette McKinnon @anetto, a patient advocate from Toronto, during a recent #hcldr tweetchat perfectly illustrates the choices patients are making when they know the price of care:

Armed with price information, patients are not choosing to shop around for more affordable options, instead they are making the choice between forgoing care vs getting treatment. A Gallop poll found that in the US, 33% of families have put off medical treatment because of cost. That same poll shows that 22% of Americans have put off medical treatment for a “very” or “somewhat serious” condition.

So why aren’t patients taking the pricing information they receive and shopping around for cheaper alternatives? The biggest reason in my opinion is that patients do not have value transparency.

To me, value transparency is a state where patients purchasing healthcare services have a clear understanding of the expected outcomes, health benefits, disadvantages, risks and costs associated with it. In addition, patients would know how those services will be delivered (the workflow) and who is doing it. When a patient has access to this type of information and has the knowledge to interpret it, that’s when they have value transparency.

So what do we need to get to this state of value transparency in healthcare? Members of the #hcldr community had some interesting suggestions:

I believe that one day we will have value transparency in healthcare. Price transparency is an important first step. However, price in and of itself is not sufficient information to spur most patients to choose between different providers of care. In its current form, price transparency may be doing more harm than good for patients with chronic conditions that get worse without treatment – they may choose to forgo care due to cost only to end up in a more critical situation later because of the delay in treatment.

My hope is that someone will take today’s healthcare pricing tools and merge them with standardized quality metrics, crowdsourced patient experience data and provider histories to create a value transparency tool. In the meantime, the current crop of price transparency tools can at least help to reduce the fear of the unknown medical bill.

Are We Outgrowing HIM Systems?

Posted on July 15, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin’s latest HIM Scene posts here.

We have changed and adapted to a rapid influx of electronic medical records and data over the last several years and it’s no surprise that some systems have struggled to keep the pace. Electronic medical records (EMRs) are in a state of constant revision to make sure patient care, clinical functionality, and data security measures are keeping up with our needs. It seems there are software application solutions or enhancements to almost every task we do in healthcare and these systems are also constantly evolving.

I don’t know of any healthcare application system or workflow that has remained static year over year and because of this, it is important for us to stay on top of vendors and keep an eye on current and future needs of HIM workflows. Clinical Documentation Improvement (CDI) is one of those areas that has been evolving since it first came on the scene and it is currently undergoing yet another face-lift. We realized there were many revenue opportunities hiding within inpatient clinical documentation and found that we could maximize reimbursement with a little detective work and physician education along with sophisticated software tools. Many are exploring the idea of CDI for outpatient levels of care. This means we will need software applications, interfaces, and expanded CDI workflows to extend these opportunities to outpatient documentation. Have you thought about what you will need from your vendors to adapt or upgrade current systems and how much will need to be budgeted for?

As we work to implement computer assisted coding (CAC) programs, we see opportunities to increase coder and CDI productivity and capture even more quality documentation by using discrete EMR data to our advantage. But are these CAC systems ready to be pushed to the limits to enter unchartered waters? I personally do not have a CAC success story to tell as of yet, but I am exploring the options and hoping that these systems have matured more than when we first explored them a few years ago.

That’s the beauty of technology in healthcare; if a product does not meet your needs, there may be other options already on the market or rapidly developing new technologies on the horizon. A vast amount of data may be held hostage in our systems if we do not maximize our EMRs and applications and set our standards high in a quest for knowledge. We can’t rely 100% on technology to dictate what we do which is why we need to be the visionaries and demand more from our systems in order to accomplish new and exciting things in HIM.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Avoiding Revenue Crunches During EMR Transitions

Posted on May 23, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Most healthcare leaders know, well before their EMR rollouts, that clinical productivity and billings may fall for a while as the implementation proceeds. That being said, it seems a surprising number are caught off guard by the extent to which payments can be lost or delayed due to technical issues during the transition. This is particularly alarming as more and more hospitals are looking at switching EHR.

Far too often, those responsible for revenue cycle issues live in a silo that doesn’t communicate well with hospital IT leadership, and the results can be devastating financially. For example, consider the case of Maine Medical Center, which took a major loss after it launched its Epic EMR in 2012, due in part to substantial problems with billing for services.

But according to McKesson execs, there’s a few steps health systems and hospitals can take to reduce the impact this transition has in your revenue cycle. Their recommendations include the following:

  • Involve revenue cycle managers in your EMR migration. Doing so can help integrate RCM and EMR technologies successfully.
  • Create a revenue cycle EMR team. The team should include the CFO, revenue cycle leaders from patient access and reimbursement, vendor reps and someone familiar with revenue cycle systems. Once this team is assembled, establish a meeting schedule, team roles and goals for participants. It’s particularly important to designate a project manager for the revenue cycle portion of your EMR rollout.
  • Before the implementation, research how RCM processes will be affected by the by the rollout, particularly how the new EMR will impact claims management workflow, speed of payment and staff workloads. Check out how the implementation will affect processes such as eligibility verification, registration data quality assurance, preauthorization and medical necessity management, pre-claim editing and remittance management.
  • Pay close attention to key performance indicators throughout the transition. These include service-to-payment velocity, Days Not Final Billed, charge trends and denial rates.

The article also recommends bringing on consultants to help with the transition. Being that McKesson is a health IT vendor, I’m not at all surprised that this is the case. But there’s something to the idea nonetheless. Self-serving though such a recommendation may be, it may help to bring in a consultant who has an outside view of these issues and is not blinkered by departmental loyalties.

That being said, over the longer term healthcare leaders need to think about ways to help RCM and IT execs see eye to eye. It’s all well and good to create temporary teams to smooth the transition to EMR use. But my guess is that these teams will dissolve quickly once the worst of the rollout is over. After all, while IT and revenue cycle management departments have common interests, their jobs differ significantly.

The bottom line is that to avoid needless RCM issues, the IT department and revenue cycle leaders need to be aligned in their larger goals. This can be fostered by financial rewards, common performance goals, cultural expectations and more, but regardless of how it happens, these departments need to be interested in working together. However, unless rewards and expectations change, they have little incentive to do so. It’s about time hospital and health system leaders address problem directly.

ICD-10 Check-Up

Posted on May 13, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin’s latest HIM Scene posts here.

It’s hard to believe it has been seven months since we implemented ICD-10 in the US. We talked about this subject and planned for so many years and now it feels like second nature. Looking back, I would label the implementation mostly successful and smooth. Would you say the same?

If you’re like me, you have forgotten some or most ICD-9 codes and have a nice repertoire of ICD-10 diagnosis codes swimming around in your head daily. At least memorizing the beginning of a code is helpful when you only need to search the encoder for the fourth through seventh digits of the code to further specify laterality and detail.

Conducting an external audit on ICD-10 coded accounts at this point is a good idea to make sure coders are accurate with the new code set. It’s important to watch for any trends in DRG shifts that may be attributable to ICD-10. If claims data for the past seven months have not been reconciled with expected reimbursement, now is a good time to be reviewing for coding and billing accuracy.

We were promised more specificity with ICD-10 and I believe we have somewhat achieved that. There are still opportunities to improve physician documentation and gather more detail in order to assign the correct codes. For the most part, I believe physicians have been affected by HIM teams bringing awareness to specific documentation and education on what is needed for ICD-10 coding and billing. ICD-10 has not turned out to be the burden that everyone was initially so reluctant to; at least from my experience.

In the blog post I wrote soon after ICD-10 implementation, I mentioned that coder productivity was a big issue to watch for with ICD-10. With sophisticated coding tools, thorough training, and skilled coders, the productivity impact has been real but not nearly to the extent some HIM managers were bracing for. We are starting to see coder productivity come to a manageable level that will probably be the norm for the foreseeable future.

I’m happy to report that I feel confident in ICD-10 as our designated code set and based on peer input, I think others will agree. The specificity was much needed after many years of vague or catch-all codes. This paves the way for better data reporting and thus more quality information resulting in better disease management. Accurate reimbursement is an obvious bonus as well.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Can HIM Professionals Become Clinical Documentation Improvement Specialists?

Posted on April 21, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin’s latest HIM Scene posts here.

Most acute care hospitals have implemented a clinical documentation improvement (CDI) program to drive appropriate reimbursement and clarification of documentation. These roles typically live (and should live) within the HIM department. Clinical Documentation Specialists (CDS) work closely with the medical staff and coders to ensure proper documentation and must have an understanding of coding and reimbursement methodologies along with clinical knowledge.

Certain aspects of the CDI or CDS role require in-depth clinical knowledge and experience to read and understand what documentation is already in the chart and find what is missing. Some diagnoses may be hiding in ambiguous documentation and it is up to the CDS to gather consensus from the medical staff to clarify through front-end queries. There are many tools available to assist in this process by creating worklists and documentation suggestions based on diagnosis criteria and best practices. The focus of CDI is not entirely on reimbursement, although it is a nice reward to receive appropriate reimbursement for the treatment provided while obtaining compliant documentation for regulatory purposes.

Determining or changing the potential DRG prior to discharging a patient provides a secondary data source for many healthcare functions such as case management, the plan of care, decision support, and alternative payment models. For these reasons, a CDS must know the coding guidelines for selecting a principal diagnosis that will ultimately determine the DRG.

Inpatient coders also have the foundational skills to perform this role. Coders and HIM professionals are required to have advanced knowledge of anatomy and physiology, pharmacology, and clinical documentation. Therefore, to answer my original question “Can HIM professionals become Clinical Documentation Improvement Specialists?”, the answer is absolutely. But I will say that it depends on the organization as to whether nursing licensure and clinical experience is required in the job description.

Some organizations have mixed CDI teams consisting of coders and nurses while others may allow only nurses to qualify for this role. The impact of who performs the CDS role in the CDI program all lies in the understanding of the documentation, knowledge of coding guidelines, and detective work to remedy missing or conflicting documentation.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.