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Opening the Door to Data Analytics in Medical Coding – HIM Scene

Posted on November 15, 2017 I Written By

The following is a HIM Scene guest blog post by Julia Hammerman, RHIA, CPHQ, is Director of Education and Compliance, himagine solutions.

Data analytics has moved from IT and finance to the majority of business functions—including clinical coding. However, most healthcare organizations admit they could do more with analytics. This month’s HIM Scene blog explores the importance of analyzing clinical coding data to improve quality, productivity, and compliance.

Coding Data in ICD-10: Where We Are Today

HIM leaders are implementing coding data analytics to continually monitor their coding teams and cost-justify ongoing educational investments. Coding data analytics isn’t a once-and-done endeavor. It is a long-term commitment to improving coding performance in two key areas: productivity and accuracy.

A Look at Productivity Data

Elements that impact coding productivity data include: the type of electronic health record (EHR) used, the number of systems accessed during the coding process, clinical documentation improvement (CDI) initiatives, turnaround time for physician queries, and the volume of non-coding tasks assigned to coding teams.

Once any coding delays caused by these issues are corrected, coding productivity is best managed with the help of data analytics. For optimal productivity monitoring, the following data must be tracked, entered, and analyzed:

  • Begin and end times for each record—by coder and chart type
  • Average number of charts coded per hour by coder
  • Percentage of charts that take more than the standard minutes to code—typically charts with long lengths of stay (LOS), high dollar or high case mix index (CMI)
  • Types of cases each coder is processing every day

A Look at Accuracy Data

Accuracy should never be compromised for productivity. Otherwise, the results include denied claims, payer scrutiny, reimbursement issues, and other negative financial impacts.

Instead, a careful balance between coding productivity and accuracy is considered best practice.

Both data sets must be assessed simultaneously. The most common way to collect coding accuracy data is through coding audits and a thorough analysis of coding denials.

  • Conduct routine coding accuracy audits
  • Analyze audit data to target training, education and other corrective action
  • Record data so that back-end analysis is supported
  • Assess results for individual coders and the collective team

Using Your Results

Results of data analysis are important to drive improvements at the individual level and across entire coding teams. For individuals, look for specific errors and provide coaching based on the results of every audit. Include tips, recommendations, and resources to improve. If the coding professional’s accuracy continues to trend downward, targeted instruction and refresher coursework are warranted with focused re-audits to assure improvement over time.

HIM and coding managers can analyze coding audit data across an entire team to identify patterns and trends in miscoding. Team data pinpoints where multiple coders may be struggling. Coding hotlines or question queues are particularly helpful for large coding teams working remotely and from different geographic areas. Common questions can be aggregated for knowledge sharing across the team.

Analytics Technology and Support: What’s Needed

While spreadsheets are still used as the primary tool for much data analysis in healthcare, this option will not suffice in the expanded world of ICD-10. Greater technology investments are necessary to equip HIM and coding leaders with the coding data analytics technology they need.

The following technology guidelines can help evaluate new coding systems and level-up data analytics staff:

  • Data analytics programs with drill-down capabilities are imperative. These systems are used to effectively manage and prevent denials.
  • Customized workflow management software allows HIM and coding leaders to assign coding queues based on skillset.
  • Discharged not final coded and discharged not final billed analytics tools are important to manage each piece of accounts receivables daily and provide continual reporting.
  • Systems should have the ability to build rules to automatically send cases to an audit queue based on specific factors, such as diagnosis, trend, problematic DRGs.
  • Capabilities to export and manipulate the data within other systems, such as Excel, while also trending data are critical.
  • Staff will need training on advanced manipulation of data, such as pivot charts.
  • Every HIM department should have a copy of the newly revised AHIMA Health Data Analysis Toolkit, free of charge for AHIMA members.

HIM directors already collect much of the coding data required for improved performance and better decision-making. By adding data analytics software, organizations ensure information is available for bottom-line survival and future growth.

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

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.

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.

What is the CCA Credential?

Posted on January 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.

There comes a point in an aspiring coder’s life when they are ready to earn a credential but might not have coding experience yet. This is when the Certified Coding Associate (CCA) credential comes in to play to provide the opportunity to prove the credential holder’s coding knowledge and competencies. The CCA credentialing exam is administered by the American Health Information Management Association (AHIMA) and is one of three specific coding credentials offered by AHIMA. The other coding credentials through AHIMA are the Certified Coding Specialist (CCS) and the Certified Coding Specialist- Physician based (CCS-P).

The CCA exam is offered to anyone with at least a high school diploma interested in coding. The content of the exam includes clinical classification systems, reimbursement methodologies, health records and data content, compliance, information technologies, and confidentiality and privacy (source: AHIMA). The largest portion of  questions on the exam covers the clinical classification systems which includes assigning codes and applying coding guidelines. Candidates prove they are able to apply coding methodologies for all levels of care including inpatient hospitals and physician offices.

The CCA credential is ideal for HIM and Coding students or new HIM professionals who are eager to earn a credential to add to their resume. While this credential proves competencies in the key coding domains, someone with this credential may not be qualified for a seasoned coder job posting which will typically require years of coding experience. However, the benefit of having this credential is that it shows the hiring manager that the applicant has had enough education and exposure to coding to be able to pass a thorough credentialing exam on the subject. Many students take this exam while completing coursework for HIM and Coding degrees to prepare themselves for the job market.

Medical coding is a career in high demand and has been recognized as a very important role in healthcare. Anyone interested in launching a career in coding will have to learn the ropes from the ground up. It is appropriate for CCA credentialed coders to look for entry level coding positions that will develop their coding skills and potentially lead to further specialization in the HIM field.

For more information on the CCA credential, see the AHIMA website.

Access additional resources for HIM credentials here: CCS, RHIA, RHIT.

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

Why Should Medical Coders Have the CCS Credential?

Posted on November 18, 2015 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.

In continuation of my posts on the value of HIM credentials, one very important credential is the Certified Coding Specialist (CCS). This tried-and-true credential shows current and potential employers that you are skilled in all of the domains of medical coding. The CCS exam is designed for experienced inpatient and outpatient coders to show competency in all of the potential functions a coder will be required to perform on the job. Disclaimer: this credential is not ideal for new graduates who have no prior experience in medical coding at some level although they may meet eligibility.

For those not familiar, medical coding involves reviewing clinical documentation in a medical record, assigning the appropriate ICD or CPT codes using established coding guidelines, and grouping the codes to determine a Diagnosis Related Group (DRG) for reimbursement. Some coders may be required to analyze DRG usage and report on documentation trends as part of their job roles. The codes and DRGs that are selected by the medical coders are used for a variety of data uses including tracking the prevalence of diseases, monitoring procedure and treatment outcomes, public reporting of quality measures, and the most critical function is to determine a healthcare organization’s reimbursement rate based on the treatment provided.

Coders must be educated on medical terminology and clinical documentation in order to effectively and accurately assign codes and DRGs. The CCS exam tests each applicant on his or her ability to understand the coding guidelines and assign codes properly. Candidates taking the CCS exam should have a working knowledge of both ICD coding guidelines and CPT guidelines. There are also questions on regulatory guidelines and information technology to make sure CCS credentialed professionals are well versed in healthcare operations.

The American Health Information Management Association (AHIMA) administers the CCS exam to those with the following qualifications:

Candidates must meet one of the following eligibility requirements:

  • By Credential: RHIA®, RHIT®, or CCS-P® OR
  • By Education: Completion of a coding training program that includes anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced ICD diagnostic/procedural and CPT coding; OR
  • By Experience: Minimum of two (2) years of related coding experience directly applying codes; OR
  • By Credential with Experience: CCA® plus one (1) year of coding experience directly applying codes; OR
  • Other Coding credential from other certifying organization plus one (1) year coding experience directly applying codes.

Source: AHIMA.org/certification/CCS

It is important to note that a majority of CCS credential holders also have either the RHIA or RHIT credentials (according to the 2012 AHIMA job analysis). This is because the RHIA and RHIT credentials cover all of the many different HIM job tasks and domains while the CCS is a specialty credential for coding. HIM management positions may be looking for RHIA or RHIT credentials while coding specific positions frequently require the CCS.

With the recent change to ICD-10 in the US, medical coders have become a hot commodity. As a side note, the CCS exam is also offered to some additional countries internationally yet the test covers US coding practices. Many organizations are experiencing a decrease in coder productivity therefore additional coders may need to be hired or contracted. While it is a great time to be a coder, we must also take into account that the role of a coder has changed over the years and will continue to change with new technologies and tools. Continuing education credits are required for all CCS credential holders to keep coding competencies up as well as educate coders on other hot topics and changes in healthcare.

For more information on HIM Credentials visit: RHIT, RHIA, CCS

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

The Challenge Outside Coding Companies Face Working with Hospital IT

Posted on November 19, 2013 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.

One of the really interesting stories I found at the AHIMA annual conference was the challenge that outside coding companies face when working with the hospital IT support. I think this is a challenge that could be dealt with by hospital organizations across the country who deal with outside coding companies. The reason this is important is because if your coding company can’t work properly, then your revenue won’t be flowing properly either.

I interviewed Abby Coplan, Director of Client Services at HRS, to discuss some of the challenges they face when accessing a client system. It really struck me when she talked about how hard it is for them as an outside organization to get a response from the internal hospital IT. It really points to the need of a single point of contact that is familiar with these outside organizations. Otherwise, the workflow really breaks down. Abby also brings up an interesting point about the number of client systems they have to access to do their coding work. Not a simple task.

Learn more about these challenges from Abby Coplan in the video interview below:

Doctors Fear EMRs Will Mess Up E&M Coding

Posted on July 25, 2012 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.

Here’s one more example of technology clashing with habit. Apparently, even when EMRs are ready to code for doctors, Medicare physicians often hand-code anyway, according to the HHS Office of the Inspector General.

The OIG study, which was requested by ONC, looked at how Medicare docs use EMRs to assign and document codes for evaluation and management services. According to the study, 57 percent of Medicare physicians use an EMR, and of those, 90 percent use their systems to document E&M services.

The rub is that most of that 90 percent assign codes manually, rather than letting the system do the work, the report notes. That’s not surprising, however, given that doctors are on the hook if HHS finds fraudulent upcoding whether it’s the software’s fault or not.

How can the industry cope with this issue? I liked the suggestion made by Susan Fenton, PhD, assistant professor at the College of Health Professions at Texas State University.

In an interview with American Medical News, she argues that HHS and the Department of Justice should get together to certify coding capabilities of given EMRs.  She also recommends that the two agencies should agree that physicians not be held liable if something was coded wrong, as long as the practice didn’t alter the software.  (The American Medical Association has made similar recommendations.)

Honestly, I think the compulsion to do hand-coding goes deeper than a fear of getting slapped by the DoJ or HHS.  If you don’t feel comfortable with an EMR, you’re likely to do as much of your work as you can in “the old way.”  Heck, I know I would. But the very reasonable fear of government sanctions makes the situation much worse. Certifying bodies, start your engines.