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ROI in the Business Office: Why HIM Should Keep a Watchful Eye – HIM Scene

Posted on August 16, 2017 I Written By

The following is a HIM Scene guest blog post by Lula Jensen, MBA, RHIA, CCS, Director of Product Management at MRO.  This is the second blog in a three-part sponsored blog post series focused on the relationship between HIM departments and third-party payers. Each month, a different MRO expert will share insights on how to reduce payer-provider abrasion, protect information privacy and streamline the medical record release process during health plan or third-party commercial payer audits and reviews.

According to most business office staff, pulling information and releasing medical record documentation to payers is a necessary evil to get claims paid and reduce accounts receivables. It is not their core competency.

Whether the request is unsolicited or solicited by the payer, time required to compile information and respond wreaks havoc on business office productivity. Also in efforts to meet payer deadlines and expedite claims, human mistakes can be made. Incorrect patient information might slip through the cracks.

Despite concerns, many business office directors prefer that payer disclosures be sent out by their own business staff—versus by the HIM department. If your organization follows that practice, this HIM Scene blog post is for you.

Two Types of Business Office Requests

There are two instances of business office Release of Information (ROI) to know: unsolicited and solicited requests. The unsolicited process takes place when medical documentation containing all the additional information pertinent to the service being billed is submitted proactively by the provider with the initial claim. The solicited process occurs when the original claim is sent without additional supporting medical record documentation and the payer subsequently (during the adjudication process) determines that additional information is needed. The payer then places a request for the additional documentation from the provider.

Unsolicited Releases During Claims Processing

The purpose of releasing information during claims processing is to expedite payment. In an effort to get the claim paid faster, medical records are sent proactively with the claim. This is especially true for high-dollar claims, payer policies, readmissions within 30 days and the published Office of Inspector General (OIG) Work Plan.

Sounds like a good intention with the organization’s best financial interests in mind. However, three concerns arise when business offices send medical record documentation to payers—versus having HIM professionals take charge.

  1. Business office staff may not know which parts of the medical record will be required to support the claim. Often, the entire chart is sent—a process that is not practical for high-dollar or long-length-of-stay cases.
  2. Sending the entire record is also not compliant with HIPAA’s Minimum Necessary Standard. By sending too much information, hospitals are at risk for HIPAA breach.
  3. Upon receipt of prepay documentation, the payer’s staff logs each record received, scans or otherwise digitizes the documents, and incorporates them into their own electronic systems. This creates a huge administrative burden on payers.

Similar challenges ensue with solicited payer medical record requests that occur during the adjudication process or retrospective reviews.

Business Office Disclosures for Payer Audits and Reviews

There has been significant uptick in payer audits and reviews, a topic that was covered by HIM Scene last month. This includes governmental and third-party commercial. According to one central business office director at an MRO client site, “The pull lists for payer audits and reviews keep getting longer and the piles of medical records to send keep getting higher.”

To reduce administrative burdens with payers, some organizations are allowing payers direct access to their EMRs and EHRs to obtain the required information during audits and reviews. While this process may lighten the load for billing personnel, it is laden with additional privacy risks.

Business office personnel complain about the travails of responding to all the various requests for records. However, a significant number of business office directors still insist on owning the ROI process for payer audits and reviews. When this is the case, there are several important steps for HIM directors to consider.

Three Steps for HIM: Educate, Track and Talk

For both types of business office disclosures, it is important to educate billing staff about the implications of a HIPAA breach and privacy risks listed above. Establish an organization-wide standard for ROI to keep PHI safe during all types of business office disclosures. Educating all personnel involved in business office ROI (whether for claims processing, audits or reviews) helps relieve frustration with the record release process.

Billers should also track which specific records, and what sections of each, were sent. By documenting and then reviewing this information, organizations gain valuable knowledge about payer trends—insights that can be used to prevent denials and negotiate more favorable terms for payer contracts.

Collaborate with privacy and the business office to determine which release information to track. Then establish a common database or software application to document each release to payers. Here are four ways to make the most of business office ROI tracking data:

  • Look for patterns in what payers are requesting. Any trends in payer request activity could offer opportunities for provider improvement.
  • Identify risk. Analytics can help business offices detect weaknesses in the revenue cycle, involving coding, documentation or other internal processes.
  • Educate coders, biller, collectors, physicians, etc. on payer trends and how collaboration can promote accurate, complete billing for services rendered and support a claim via medical record documentation.
  • Use data analysis. When payer contract negotiations arise, use payer trend statistics to your advantage in the next round of negotiations.

Talk with local payers and stay updated on policy changes related to claims processing, audits and retrospective reviews. Open communication with each payer is recommended to ensure records are sent in the most secure way possible. Communication with payers also reduces phone tag and minimizes payer-provider abrasion.

Finally, due to the importance of collecting medical record documentation, health plans are willing to pay for records. Business offices and HIM departments fulfilling these requests are encouraged to discuss and pursue reimbursement from payers.

About Lula Jensen

In her role as Director of Product Management for MRO, Jensen drives product enhancements and new product initiatives to ensure MRO’s suite of solutions enable the highest levels of client success and end-user satisfaction. She has more than 15 years of experience in healthcare, focusing on Health Information Management (HIM), Revenue Cycle Management, analytics, software development and consulting. In addition to holding product management roles at McKesson Health Solutions and CIOX Health, she also served as Revenue Cycle Manager at Fox Chase Cancer Center and taught a course on ICD-9 CM Coding and Reimbursement at Bucks County Community College. Jensen is an active member of the Healthcare Financial Management Association (HFMA), American Health Information Management Association (AHIMA) and Pennsylvania Health Information Management Association (PHIMA); she is a 2005 PHIMA Scholar Award recipient. Jensen holds a B.S. in HIM from Temple University and an M.B.A. in Health Care Administration from Holy Family University.

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

What’s Happening with HIM and Clinical Documentation Improvement (CDI) – HIM Scene

Posted on August 2, 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.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

The world of HIM is constantly changing. It’s important for every HIM professional to stay on top of trends happening in the industry. With this in mind, I was excited to interview Steve Robinson, MS-HSM, PA-O, RN, SSBB, CDIP, who is the VP of Clinical Revenue Integrity at RecordsOne and ask him the following questions:

  • What’s the most exciting thing you see happening in the HIM world?
  • What’s the scariest thing people aren’t paying enough attention to in HIM?
  • What’s been the impact of CDI on healthcare and what will it be in the future?
  • How do you see the role of HIM changing in the next 5-10 years?
  • Make a big 20 years from now prediction for healthcare

Check out the full video interview we did with Steve Robinson to learn more about Steve’s perspectives on What’s Happening with HIM and CDI:

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

Finding Civility in Payer Relationships: Audits, Reviews and HIM – HIM Scene

Posted on July 19, 2017 I Written By

The following is a HIM Scene guest blog post by Greg Ford, Director, Requester Relations and Receivables Administration at MRO.  This is the first blog in a three-part sponsored blog post series focused on the relationship between HIM departments and third-party payers. Each month, a different MRO expert will share insights on how to reduce payer-provider abrasion, protect information privacy and streamline the medical record release process during health plan or third-party commercial payer audits and reviews.

Civility is defined by Webster’s as courtesy and politeness. It is a mannerly act or expression between two parties. While civility in politics has waned, it appears to be on the rise in healthcare.

New opportunities for civility between payers and providers have emerged with the shift from fee-for-service to value-based reimbursement. Population health, quality payment programs and other alternative payment models (APMs) are opening the door to better collaboration and communications with payers. Optimal patient care is a mutual goal between payers and providers.

HIM professionals can also contribute to stronger payer-provider relationships. Our best opportunity to build civility with health plans and payers is during audits and reviews. HIM professionals who take the time to understand the differences will make notable strides toward a more polite and respectful healthcare experience.

Payer Audits vs. Payer Reviews: What’s the Difference?

It’s no secret to most HIM professionals that the volume of health plan medical record requests continues to increase significantly. In fact, between 2013 and 2016 the number of requests for HEDIS and Risk Adjustment reviews increased from one percent to 11 percent of the total Release of Information requests received by MRO.

The main difference between audits and reviews is the potential negative financial impact to providers. Payer audits include risk for revenue recoupment while payer reviews do not.

For example, audits conducted by third-party payers are intended to recoup funds on overpaid claims. The most common reason for a post-payment payer audit is to confirm correct coding and sequencing as billed on the claim to determine if payment was made to the provider correctly. In audits, the health plan’s intention is to recoup funds on overpaid claims.

Payer reviews do not carry financial risk to the provider. Instead, payer reviews deliver valuable insights providers can use to improve their relationships with health plans and patient populations.

The Upside of Payer Reviews

HEDIS and Risk Adjustment reviews are the most common types of payer reviews. Payer data submissions for HEDIS are due to the National Committee for Quality Assurance (NCQA) by June of every year. Medicare Risk Adjustment results are due in January and Commercial in May.

Since these payer reviews both overlap and occur simultaneously, HIM departments are deluged with medical record requests. Understanding the importance of these reviews improves communication between HIM, Release of Information staff and health plan requesters.

HEDIS Reviews

HEDIS reviews can benefit providers during contract negotiations because the HEDIS performance rankings can be used to gauge the quality and effectiveness of different health plans for potential participation with the facility.

Risk Adjustment Reviews

With these reviews, health plans are required to prove the needs of the population to CMS so they can continue to provide services for higher risk patients and pay providers for the care of this population.

In both cases, medical records are needed to provide the analysis, so HIM is involved.

HIM’s Role: Reimbursable Release of Information

In 2015, 85 percent of MRO’s audit and review requests came from third-party vendors representing health plans. Both post-payment audit and review requests are typically chargeable to the requesting party. Due to the importance of collecting medical record documentation, health plans and payers are willing to pay for records.

HIM professionals are encouraged to pursue reimbursement for payer requests. This is especially true if your HIM department is working diligently to accommodate the payer deadline for record receipt.

A provider’s Release of Information staff should be able to work directly with these requesters to ensure payment for the timely delivery of records. HIM professionals can reduce payer-provider abrasion and ultimately strengthen relationships to improve compliance. It’s the first step to increasing civility in healthcare.

Watch for our August HIM Scene post to learn more about how to secure patient privacy when sending records to payers and health plans.

About Greg Ford
In his role as Director of Requester Relations and Receivables Administration for MRO, Ford serves as a liaison between MRO’s healthcare provider clients and payers requesting large volumes of medical records for purposes of post-payment audits, as well as HEDIS and risk adjustment reviews. He oversees payer audit and review projects end-to-end, from educating and supporting clients on proper billing practices and procedural obligations, to streamlining processes that ensure timely delivery of medical documentation to the requesting payers. Prior to joining MRO, Ford worked as Director of Operations and Sales at ARC Document Solutions for 15 years. He received his B.A. from Delaware Valley University.

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

A Look at HIM and the Impact of ICD-10 – HIM Scene

Posted on July 6, 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.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

After all of the noise that was made around the move to ICD-10, I’m now talking to more and more people about what impact the switch to ICD-10 has had on their organizations.  The reality for many organizations is they don’t really know what the new normal is under ICD-10.  So, they’ve had a hard time evaluating if their ICD-10 work has been going well or not.

With this in mind, I was excited to talk with Eileen Dano Tkacik, Director of Operations & Information Technology at AVIANCE Suite Inc, about a survey they did that looked at ICD-10 accuracy and productivity.  Learn more about the results of this survey in the video below and review the full survey results. Also, check out their 2017 ICD-10 coding contest which includes $5000 in prizes and begins July 17, 2017.

Eileen is so right that the transition to ICD-10 definitely sucked up people’s time and the QA process suffered. I hope now that ICD-10 has been around for almost 2 years that more efforts will go back to QA. We’re going to need to given the ICD-10 accuracy results from their survey.

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

The Important Role of HIM in Healthcare Cybersecurity – HIM Scene

Posted on June 21, 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.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

Healthcare organizations that rely on their CSO (Chief Security Officer) to handle cybersecurity in their organizations always annoy me. Cybersecurity requires everyone at the organization to be involved in the effort. One person can have a large influence, but your healthcare organization will never be secure if you don’t have everyone working their best to ensure your organization is secure.

A great example of someone who’s often forgotten in healthcare cybersecurity efforts are HIM professionals. Organizations that do this, do so at their own peril. If you’re not involving your HIM professionals in your cybersecurity efforts, I exhort you to do so today.

One of the best reasons to involve HIM professionals in your security efforts is that they’re often experts on the patchwork of healthcare privacy and security laws. It’s not enough to just ensure you’re being HIPAA compliant. That’s essential, but not sufficient.

Healthcare privacy and security are so important, there are multiple layers of laws trying to protect your health information. Or maybe the laws just aren’t well planned and that’s why we have so many. I’ll let you decide. Either way, in your privacy and security efforts you’re going to need to know HIPAA, HITECH, MACRA, and of course don’t forget the state specific privacy and security laws. No doubt there are more and your HIM professionals are likely some of the people in your organization that knows these laws the best.

Beyond the fact that HIM professionals know the privacy and security laws, HIM professionals are usually well versed in ensuring the right access to the right information in your system. One of the biggest form of breaches is internal breaches from people who were given the wrong permissions on your IT systems.

Making sure someone is auditing and monitoring these permissions is a very important part of your cybersecurity efforts. Plus, don’t forget to have a solid process for removing users when they leave your organization as well. Those zombie user accounts are a ticking time bomb in your security efforts. When your employees verify that their records are in order before they leave with HIM, that might be a good time to remove their access.

Another place HIM professionals can help with healthcare cybersecurity efforts is around information governance. More specifically, HIM can help you properly manage your health data and legacy systems. HIM can ensure that your legacy systems are properly managed until their end of life. No doubt this will be done in tandem with your IT professionals who have to keep these legacy systems secure (not always an easy task). However, an HIM professional can assist with your information governance efforts that impact cybersecurity.

In what other ways can HIM be involved in healthcare cybersecurity?

Cybersecurity is always going to be a team effort. That’s why it’s shocking to me when healthcare organizations don’t involve every part of their team. HIM professionals should step up and make the case for why they should be involved in healthcare’s cybersecurity efforts. However, when they don’t, a great leader will make sure HIM is involved just the same.

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

A Look Into the Future of HIM with Rita Bowen – HIM Scene

Posted on June 14, 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.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

One of my favorite people in the HIM world is Rita Bowen. She is currently Vice President, Privacy, Compliance and HIM Policy at MRO, but she has a really impressive HIM resume previous to MRO and a deep understanding of the evolution of HIM and their role in healthcare.

With this experience in mind, I was excited to interview her on the current state of HIM and where HIM is heading in the future. Here are the list of questions I asked Rita if you want to skip to a specific question or you can just watch the full video interview embedded at the bottom of this post.

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

The Disconnect Between Patient Experience and Records Requests – HIM Scene

Posted on April 19, 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.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

This week I met with one of the digital marketing team at a children’s hospital. We had a great conversation about the hospital website and the way the hospital’s website represented the organization to the patient. Plus, we talked about how patients choose to interact with the hospital through their website. There are a wide variety of patient requests through the website, but one of those requests was a request for their patient record.

It wasn’t really a surprise that this digital marketer didn’t really know the details of what’s required for a patient to make an appropriate medical record request from his hospital. In his defense, he didn’t usually answer the questions, but just created the website that collected the questions. However, it was quite clear that the workflow for any medical records request was to send it to their HIM department and let them figure it out.

Most organization then have their HIM staff play phone tag with the patient to explain how to make a proper records request which will allow them to release the information to the patient. The progressive organizations might send the patient an email. However, many of them will then ask the patient to mail, drop off or fax in the official records request. If this sounds painful, I can assure you that it’s as painful as it sounds.

This illustrates the massive disconnect between creating a great patient experience and most organization’s current records request process. Please note that I’m not blaming the digital team at hospitals for the issue and I’m not blaming the HIM people for this problem. I’m blaming the disconnect between the two organizations because the only way to solve this problem is to have both organizations involved.

The best patient experience would actually be for the patient to go to their patient portal and download their whole record. Maybe we’ll get their one day, but there are hundreds of systems in a hospital where a patient’s data is stored. So, it’s going to take a while for us to reach the point where a patient can self-service their data requests.

Since I’m not holding my breath on this amount of data sharing happening between disparate systems, I’m more interested in making the current processes so it’s a seamless experience for the patient. If you can model a medical records request on paper, then you can do it digitally. To their credit, I’ve seen a few organizations working on this. In fact, their system is part education about records requests and part getting the information that’s needed to fulfill a records request.

It’s time that HIM and a hospital’s digital and tech teams come together to make the process for requesting records a seamless patient experience. And if you think using a fax machine is a seamless experience for patients, then you’re part of the problem.

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

A Look at the HIM World with Dr. Jon Elion from ChartWise Medical Systems – HIM Scene

Posted on April 5, 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.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

Healthcare Scene had a chance to interview Dr. Jon Elion, founder and president of ChartWise Medical Systems where we asked him about some of the big happenings in Health Information Management (HIM) and how world of HIM is evolving. Dr. Elion offers some really great insights into the HIM profession. You can watch the full video interview embedded at the bottom of this post or click on one of the questions below to hear Dr. Elion’s answer to that question.

Find more great Healthcare Scene Interviews.

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

HIM’s Role in Healthcare Security and Privacy – HIM Scene

Posted on November 30, 2016 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.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

One of my go-to experts on healthcare privacy and security is Mac McMillan, CEO and Co-Founder of CynergisTek. He’s built a really great company that focuses on privacy and security in healthcare and he’s a true expert.

While at AHIMA 2016, I talked with Mac about the role that HIM plays in healthcare privacy and security. We also talk about where healthcare privacy is heading and which part of healthcare privacy and security doesn’t get enough attention. I also asked Mac to make a big 20 year prediction on what will happen with privacy and security in healthcare.

Check out our interview with Mac McMillan, CEO and Co-Founder of CynergisTek:

We shot a number of other videos at AHIMA 2016 which we’ll be posting shortly. If you enjoyed this video, be sure to Subscribe to Healthcare Scene on YouTube and watch our full archive of Healthcare Scene interviews.

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

Will Medical Coders Be Needed in the Future? – HIM Scene

Posted on October 26, 2016 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.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

After spending time with so many HIM professionals at the AHIMA Annual conference, I’ve come back thinking about the future of medical coders. No doubt, many HIM professionals are moving well beyond medical coding into other areas such as healthcare analytics, clinical documentation improvement (CDI), EHR optimization, and much more. However, there’s still a massive need for high quality medical coding and the HIM professionals that provide that service.

As we look into the future, the techie in me feels like medical coding should be automated. Why are we paying people to do medical coding? Why can’t that be automated and be done by robots? It’s not like medical coding is a particularly fun job. I’m sure there are some times it’s fun working on unique cases, but it can be quite monotonous and tedious. Why not have a computer do it instead?

What I’ve learned over the years is that medical coding is more art than it is science. Certainly there are some clear cut cases where it’s basically science. However, a large part of what a coder does isn’t set in stone. There’s some artistic licence if you will, or at least some interpretation that has to happen in order to code a visit properly. Computers aren’t good at interpretation, but humans are.

The other reality is that doctors don’t produce perfect documentation. If they did, then we probably could code a robot to code a patient visit. Since there are nuances to every physician’s documentation, we’re going to need humans that interpret those nuances as part of the coding process. I don’t see this changing in our lifetimes.

One word of caution. Many people fall into the trap that we need automated robot coding to be perfect for it to accepted. That’s just not the case, because human coders aren’t perfect either. In fact, there’s some research that human coders aren’t as good as we thought they were at coding, but I digress. The reality is that automated coding just has to be better than humans, it doesn’t have to be perfect. Even with this said, I don’t see it happening for a while.

What we do see happening now is a collaboration between humans and computers: computer assisted coding. While we don’t have to worry about computers replacing humans in medical coding, we do need to focus on ways that technology can make the work humans do better. That’s a powerful concept that we’re starting to see happen already.

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