Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

The Challenge of Medical Records Requests in the Healthcare Business Office – HIM Scene

Posted on July 10, 2018 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.

While at the HFMA Annual Conference (Formerly known as ANI), Healthcare Scene was able to sit down with Kim Charland, BA, RHIT, CCS, Director of Revenue Cycle Services at MRO, to talk about some unique issues with Release of Information (ROI) coming out of the healthcare business office.

This was an issue I hadn’t thought much about previously, but it makes a lot of sense that medical billing professionals probably aren’t the best people to be handling release of information to insurance companies. Billing professionals’ goal is to get paid, not ensure that they’re doing a proper release of information to payers. Plus, most of them have billing expertise, not ROI expertise. It makes a lot of sense for the business office to involve HIM professionals with release of information expertise into the process.

To learn more about this topic and what MRO is doing to help healthcare organizations address this compliance issue, watch the video interview below with Kim Charland:

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

Lessons Learned from the 2017 AHIMA Information Governance Survey – HIM Scene

Posted on May 16, 2018 I Written By

The following is a guest blog post by Stephanie Crabb, Co-Founder and Principal at Immersive as part of the HIM Scene series of blog posts.

The American Health Information Management Association (AHIMA) 2017 Information Governance (IG) survey follows previous surveys administered in 2014 and 2015 to identify trends and offer insights associated with the healthcare industry’s understanding and adoption of IG. The good news from the 2017 survey is that awareness of IG, at least among the 1500+ survey respondents, is high with 84.6 percent reporting that they are familiar with IG. The bad news from the survey is that 51.6 percent of those same respondents report that lack of awareness or misunderstanding of IG is a barrier (the most significant barrier reported) to IG adoption in their organizations.

Who participated?

While the 2017 survey garnered more participation from outside the health information management professional community than previous efforts, it is important to note that the majority of respondents identified themselves as health information managers (HIM-ers). AHIMA’s work to raise IG awareness and educate the healthcare industry since 2012 has been significant and is to be commended. The body of knowledge created and published and the work completed is extraordinary; it has certainly paid off with its own constituents. Perhaps the survey demonstrates that there is still work to be done with additional stakeholders or that we need to do more to demonstrate the knowledge and capabilities that HIM-ers possess to support IG efforts.

IG Adoption, Drivers and Benefits

Based on what we see, read and experience, in every sector of the industry information and the data from which it is created are at the center of nearly every strategic and tactical activity. So why the disconnect, or the slow pace of formal IG adoption? Why did only 14.8 percent of respondents report an “initiated” IG program as illustrated below? Further, why did percent of respondents report that IG is not considered a priority in their organizations?

A closer look at what respondents had to say about the barriers to IG adoption is useful. The survey offered respondents a list of commonly-cited barriers to IG adoption across all industries and asked them to select their top three, resulting in the following:

For many, the term “governance” implies bureaucracy, expense, complexity, misplaced power and control, among other negative connotations. This may offer some context for these survey results and explain, in part, the top responses.

IG is a complex discipline, no doubt. However, everyone can identify IG or IG-like work that is getting done in their organization every day; it is just not formalized, organized or recognized as such. Sadly, much of that work is buried or siloed, in part, because it is not connected to a strategic imperative where it might gain greater visibility and appreciation as an IG effort.

The data around low IG adoption are even more confusing when we look at what respondents had to say about what they think does or should drive IG efforts. The survey demonstrates that there is no shortage of compelling and meaningful drivers to spur action. While the survey did not provide respondents with the same response choice options for “drivers” and “benefits” there was a connection and association reflected in the responses to these two questions.


These responses reflect an impressive number of business units, departments and individuals–workforce and patients—that can truly be served by and through IG.

What’s Changed from 2014 to 2017?

In 2014, 43% of respondents reported that a formal IG program had been initiated compared to 14.8% of respondents in 2017. What contributes to this dramatic change? Does it reflect organization abandonment of previously initiated IG efforts? Does it reflect that respondents are more educated today so what they labeled as IG in 2014 was not really IG? This area may warrant further exploration in future survey efforts.

In 2014, respondents cited “strong agreement” with regulatory compliance (80 percent), improvement in patient care and safety (73 percent) and the need to manage and contain costs (61 percent) as the top three drivers for IG, followed by analytics and business intelligence (53 percent). Interestingly, trust and confidence in data was the lowest rated driver. In 2017, data quality and trust ranked second. Analytics and business intelligence tops the list of drivers, patient safety falls to the middle and regulatory compliance is at the very bottom of the list.

The most promising insight from the 2017 survey is that data governance (DG) is a growing priority and reality in healthcare. Thirty percent of respondents reported a “formal structure” for DG in their organization. There is still a bit of confusion between IG and DG as disciplines. DG is one of the competencies in AHIMA’s IG Adoption Model and often referenced as a sub-domain of IG in other reference models. Simply stated, data are the building blocks of information, so DG is requisite to IG. One takeaway from the survey is that healthcare organizations are progressing along a path that positions DG as a precursor to IG, rather than a component of IG.

Conclusion

While the drivers for IG seem to have shifted over the time that AHIMA has spent surveying the industry, there is a universality to the vision and expectation that healthcare wants and needs to put its data and information to work to accomplish its ambitious and complex mission. Much of AHIMA’s and its IG partners’ work to document the experiences of IG pioneers is available at IGIQ.org.

Have ideas about how we can better study the topic of IG and deliver meaningful insights to you? Please share your comments.

About Stephanie Crabb
Stephanie is Co-Founder and Principal at Immersive, a healthcare data lifecycle management company where she leads program and solution development, knowledge management and customer success. Stephanie brings 25 years of experience in the healthcare industry where she has served in program/solution development, client service and business development roles for leading firms including The Advisory Board Company, WebMD, CTG Health Solutions and CynergisTek. She has led a number of program and product launches with an emphasis on competitive differentiation, rapid adoption, client satisfaction, and strategic portfolio management.

Prior to her work at these firms Stephanie worked for a large Maternal and Child Health Bureau grantee working on the national Bright Futures and Healthy Start initiatives to develop and document best practices in the care continuum for pediatrics and infant mortality, and to inform federal and state health policy initiatives in these areas.

Stephanie holds her A.B. and A.M. from the University of Chicago. Stephanie serves as the Scholarship Chair of CNFLHIMSS, on AHIMA’s Data Analytics Practice Council and recently completed a two-year term on the Advisory Board of the Association for Executives in Healthcare Information Security (AEHIS) of CHIME.

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

Coding Accuracy: Study Reveals Differences Between Domestic and Offshore Coding – HIM Scene

Posted on March 23, 2018 I Written By

The following is a guest blog post by Bill Wagner, CHPS, Chief Operating Officer, KIWI-TEK.

In January 2015 the ICD-10-preparation frenzy was at its peak. Healthcare provider organizations were scrambling to find coding support during the implementation and transition phases of the quickly approaching ICD-10 implementation deadline. KIWI-TEK was one of those outsourced coding companies being asked to supply experienced, qualified coders.

KIWI-TEK was valiantly trying to keep up with the burgeoning client requests for coding support. And although they had been actively recruiting for months, their coding bench was empty. For the first time in company history, KIWI-TEK decided to augment their team with additional coding resources by contracting with several offshore coding services.

By April 2016, the crunch for additional coding support was all but over. However, the appeal of lower coding costs via offshore coding support drives many healthcare executives to contract with international outsourced coding support. Interest in offshore coding remains even to this day as evidenced by Partners Healthcare recent decision to outsource medical record coding to India.

But what about coding accuracy? This question remains and HIM Directors deserve a data-driven answer.

The Study

Until now, the only information available for providers to compare outsourced domestic coding quality with offshore coding performance was anecdotal. Specific quality data had not been produced or shared. Amidst rampant questions and red flags, KIWI-TEK partnered with six hospitals and health systems to answer the coding industry’s toughest question: “Who delivers higher coding accuracy, domestic or offshore outsourced coding services?” (Be sure to check out the full study results for a more detailed answer to this question).

Each of the six participants had experience with both domestic and offshore coders for at least one year. The same onboarding, auditing, and training procedures were applied equally to all.

Code Accuracy Lower with Offshore

Across all six organizations, code accuracy was lower for the outsourced offshore coding service versus the domestic coding companies by an average of 6.5 percentage points.

Poor coding quality also increased payer denials with additional management time required to onboard, train and audit the outsourced offshore coders.

And What About the Cost?

The final results showed that, despite what seems to be a much lower hourly rate for offshore coders, the total cost is much higher when all factors are taken into consideration. These factors include:

Auditing – Offshore coders required an average of 6 more hours per coder per month of auditing due to poor accuracy results.

Denied claims – Offshore coders averaged 10 more denied claims on Inpatient and Same Day Surgery encounters per week than domestic coders. Reworking of denied claims on these patient types takes 40 minutes for each claim.

The Final Answer

Yes, there is a difference. Offshore coding is less accurate, and in the long-term, may also be more expensive.

To read detailed findings of the study, download the KIWI-TEK White Paper entitled “Is Offshore Coding Really Saving You Money”.

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.  KIWI-TEK is a proud sponsor of Healthcare Scene.

An HIM Perspective of What Was Shared at #HIMSS18 – HIM Scene

Posted on March 9, 2018 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.

Today is the final day of the HIMSS 2018 Annual Conference. While there are nearly 44k attendees at the conference and 1350 vendors, I didn’t meet a single HIM professional. I certainly didn’t meet all 44k attendees, but it’s safe to say that the HIM community wasn’t well represented at the HIMSS conference. It’s unfortunate because healthcare IT initiatives can really benefit from the HIM perspective.

Since many HIM professionals weren’t in attendance, I thought it would be beneficial to share some insights into trends I saw at HIMSS 2018 that could be beneficial to HIM professionals.

AI (Artificial Intelligence)
AI was the hottest topic at HIMSS 2018. It seemed like every vendor was saying that they were doing some sort of AI. Of course, many used the AI term very broadly. It included everything from simple analytics to advanced AI. In some ways, that’s corrupted the term AI, but what’s clear is that lots of companies are using data to provide insights and to automate a wide variety of healthcare work.

Another great insight I heard was that revenue cycle management and other financial areas are a great place to start with AI because they’re seen as less risky. When you’re applying AI to clinical use cases, you have to worry a lot more about being wrong. However, the consequences aren’t nearly as damaging when you’re talking about the financial side of healthcare.

Information Governance and Clean Data
At HIMSS 2018 I heard over and over the importance of having clean data. If AI was the hottest topic at HIMSS 2018, none of that AI will really matter or provide the value it should provide if the data is inaccurate and not trusted. This is why the work that HIM professionals do to ensure effective information governance is so important. It’s almost cliche to say bad data in leads to bad insights out. However, it’s cliche because it’s true. HIM needs to play an important role in making sure we have accurate data that can be trusted by AI applications and therefore the providers that receive those insights.

Texting Patients Is Not a HIPAA Violation
No doubt this will feel like news for many of you. It may even scare many HIM professionals. However, OCR Director Severino made it clear that Texting Patients is Ok. I won’t dive into the details here, but read the article by Mike Semel which outlines what was said at HIMSS 2018 in regards to texing patients.

Healthcare Chatbots
I didn’t see any healthcare chatbots that are solving HIM’s problems. However, when you look at the various healthcare chatbots out there, there’s no reason why a healthcare chatbot couldn’t do amazing things for HIM professionals. Here’s a framework for healthcare chatbots that companies should consider. What mundane tasks are well defined that could be automated by a healthcare chatbot? When you ask this question, you’ll see how chatbots are something HIM professionals should embrace. There’s a lot of mundane HIM work that could be done by a chatbot which frees them to work on the more challenging HIM issues.

Patient Access to Medical Records Is No Longer Controversial
While some specific individuals have fears related to access to medical records, it’s been proven across every type of healthcare organization that providing patients’ access to their medical records is right thing to do. The fears people have are unfounded and that patients find this extremely valuable. I heard one person say that they no longer will do visits with doctors who will not give them access to their records.

Those were some high level insights from a HIM perspective. Lots of exciting things when it comes to technology and HIM. What do you think of these changes, announcements, and trends? We’d love to hear your thoughts and perspectives in the comments.

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

The Full Spectrum of Information Governance – HIM Scene

Posted on February 7, 2018 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.

Information governance is such an important topic across so many areas of healthcare. It impacts almost every organization and quite frankly takes the full organization to buy in to ensure proper information governance. Doing it right is going to be essential for any healthcare organization to work efficiently and effectively in the future.

While information governance impacts everyone in healthcare, I have to give credit to AHIMA and their HIM professional community for leading the way on the topic of information governance. A great illustration of this leadership is in the AHIMA Information Governance Adoption Model Competencies (IGAM):


*Thanks to HIM professional, Katherine Downing for sharing it on Twitter.

I think a lot of people that work in a hospital and healthcare system don’t recognize a lot of these areas of information governance. At least they don’t look at them from that lens.

My favorite part of this model is that it starts with creating the right information governance structure and the strategic alignment. If you don’t get the right people assigned as part of their job to work on information governance, it will never happen. Plus, if you don’t realize how information governance aligns with the organizations priorities, then you’ll fall short as well.

How far along are you in your information governance efforts? Have you incorporated all of the above elements into your information governance strategy? We’d love to hear your experiences, insights, and perspectives in the comments.

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

An HIM Twitter Roundup – HIM Scene

Posted on December 13, 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.

For those that aren’t participating on Twitter, you’re missing out. The amount of knowledge and information that’s shared on Twitter is astounding. The problem is that many people think that Twitter is where you go to talk about yourself. Certainly, that’s an option if you want to do that, but I find that consuming information that people share on Twitter is extremely valuable.

If you’ve never done Twitter before, sign up (it’s free) and then you need to go in and follow about 50 HIM professionals and other healthcare influencers. You can start by following @healthcarescene. HIM professionals are easy to find. Just search for the term AHIMA or ICD-10 and you’ll find a lot of them to follow.

Ok, enough of the Twitter lesson. Just to show you some of the value of Twitter, here’s a quick roundup of HIM related tweets. Plus, I’ll add a little commentary of my own after each tweet.


This is becoming such an important role for HIM professionals in a healthcare organization. HIM staff can do an amazing work ensuring that the data that’s stored in an EHR or other clinical system is accurate. If the data’s wrong, then all these new data based decisions are going to be wrong.


I think upcoding stories are like an accident on the freeway. When you see one you just have to look.


I’m still chewing on this one. Looks like a lot of deep thoughts at the AHIMA Data Summit in Orlando.


The opioid epidemic is such an issue. We need everyone involved to solve it. So, it’s great to see HIM can help with the problem as well. I agree that proper documentation and EHR interoperability is a major problem that could help the opioid epidemic. It won’t solve everything, but proper EHR documentation is one important part.


This is an illustration of where healthcare is heading. So far we’ve mostly focused on data collection. Time to turn the corner and start using that data in decision making.

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.

Heard at #AHIMACon17: Lessons Learned for HIM – HIM Scene

Posted on October 18, 2017 I Written By

The following is a HIM Scene guest blog post by Rita Bowen, MA, RHIA, CHPS, CHPC, SSGB, Vice President, Privacy, Compliance and HIM Policy, at MRO.  

The American Health Information Management Association (AHIMA) held its annual convention and exhibit in Los Angeles last week. Beginning with preconvention meetings and symposia, this year’s event delivered a renewed focus on the profession’s stalwart responsibility to protect and govern patient information. Updates for privacy, security, interoperability and information governance were provided. Here is a quick overview of my lessons learned at AHIMACon17.

Privacy and Security Institute

The 11th anniversary of AHIMA’s Privacy and Security Institute didn’t disappoint. Speakers from the HHS Office for Civil Rights (OCR), Federal Bureau of Investigations (FBI) and HITRUST joined privacy and HIM consultants for an information-packed two-day symposium. The most important information for HIM professionals and privacy officers came from the nation’s capital.

Cutbacks underway—Recent defunding of the Chief Privacy Officer (CPO) position by ONC makes practical sense for the healthcare industry and the national budget. The position has been vacant for the past year, and during this time Deven McGraw successfully served as acting CPO and deputy director for health information privacy. Her imminent departure along with other cutbacks will have a trickle-down impact for privacy compliance in 2018.

Onsite audits cease—Yun-kyung (Peggy) Lee, Deputy Regional Manager, OCR, informed attendees that onsite HIPAA audits would no longer be conducted for covered entities or business associates due to staffing cutbacks in Washington, D.C. The concern here is that whatever doesn’t get regulatory attention, may not get done.

To ensure a continued focus on privacy monitoring, HIM and privacy professionals must remain diligent at the organizational, regional, state and national levels to:

  • Maintain internal privacy audit activities
  • Review any patterns in privacy issues and address through corrective action
  • Use environmental scanning to assess resolution agreement results
  • Review published privacy complaints to determine how to handle similar situations
  • Compare your state of readiness to known complaints

Interoperability advances HIPAA—The national push for greater interoperability is an absolute necessity to improve healthcare delivery. However, 30 years of new technology and communication capabilities must be incorporated into HIPAA rules. Old guidelines block us from addressing new goals. We expect more fine-tuning of HIPAA in 2018 to achieve the greater good of patient access and health information exchange.

Luminary Healthcare Panel

Tuesday’s keynote session was the second most relevant discussion for my role as vice president of privacy, compliance and HIM policy at MRO. Panelists provided a glimpse into the future of healthcare while reiterating HIM’s destiny—data integrity and information governance.

HIM’s role extends beyond ensuring correctly coded data for revenue cycle performance. It also includes the provision of correct and complete data for the entire healthcare enterprise and patient care continuum under value-based reimbursement. The need for stronger data integrity and overall information governance was threaded through every conversation during this session.

Final Takeaway

Make no doubt about it! HIM’s role is expanding. We have the underlying knowledge of the importance of data and the information it yields. More technology leads to more data and an increased need for sophisticated health information management and governance. Our history of protecting patient information opens the door to our future in the healthcare industry.

About Rita Bowen
In her role as Vice President of Privacy, Compliance and HIM Policy for MRO, Bowen serves as the company’s Privacy and Compliance Officer (PCO), oversees the company’s compliance with HIPAA, and ensures new and existing client HIM policies and procedures are to code. She has more than 40 years of experience in Health Information Management (HIM), holding a variety of HIM director and consulting roles. Prior to joining MRO, she was Senior Vice President and Privacy Officer for HealthPort, Inc., now known as CIOX Health. Bowen is an active member of the American Health Information Management Association (AHIMA), having served as its President and Board Chair, as a member of the Board of Directors, and of the Council on Certification. Additionally, Bowen is the chair for the AHIMA Foundation. She has been honored with AHIMA’s Triumph Award in the mentor category; she is also the recipient of the Distinguished Member Award from the Tennessee Health Information Management Association (THIMA). Bowen is an established author and speaker on HIM topics and has taught HIM studies at Chattanooga State and the University of Tennessee Memphis. Bowen holds a Bachelor of Medical Science degree with a focus in medical record administration and a Master’s degree in Health Information/ Informatics Management Technology.

MRO is a proud sponsor of HIM Scene.  If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

How to Balance Privacy, Security and Quality with Offshore Coding: Three Critical Caveats for HIM – HIM Scene

Posted on October 4, 2017 I Written By

The following is a guest blog post by Sarah Humbert, RHIA, ICD-10 AHIMA Certified Trainer, Coding and Compliance Manager, KIWI-TEK. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

Prior to ICD-10 there was a shortage of domestic coders, making offshore services a necessity for many organizations. But in a post ICD-10 environment, experienced U.S. coders are more readily available and accessible. Domestic coding services are still considered best practice by most HIM professionals. In fact, 72 percent of hospital respondents outsource more than half of their coding needs according Black Book’s October 2016 Outsourced HIM Report.

While acceptance of offshore coding services has grown there are important caveats for HIM professionals to know according to the Black Book report. Price isn’t everything when it comes to protecting your patient’s privacy and your organization’s financial performance. Additional offshore concerns continue to be reported by U.S. hospitals and health systems:

  • Increased audit costs
  • Higher denial rates
  • Missed procedure codes

As Black Book states, it is imperative for offshore coding companies to tighten processes in three key areas: privacy, security and quality. With ransomware on the rise, hospitals, health systems and medical groups have greater levels of responsibility to fully assess their business associates—especially those using protected health information (PHI) offshore.

Because of these concerns and those mentioned above, HIM professionals must carefully explore, vet and secure detailed service level agreements prior to even considering the offshore option. This month’s blog lays out three critical caveats to consider and weigh against the proven value of domestic coding services.

Verify and Test Privacy and Security for Offshore Coding

The first step for HIM professionals is to understand the annual attestation requirements. Originally required by CMS for Medicare Advantage (MA) plans, the following annual attestations have become best practice for healthcare provider organizations and other covered entities (CEs) working to protect PHI.

  1. Provide notice to CMS—30 days prior to beginning the contractual relationship—that offshore contractors will be used, providing CMS an opportunity to review and raise an objection if warranted.
  2. Sign an annual attestation to accurately report to CMS the use of any offshore contractors.

For example, if a hospital wants to use a coding or billing company with personnel located offshore, it must submit the initial notification, receive no objections from CMS, and then annually attest that protections are in place with the offshore vendor.

Beyond the two-step attestation process, HIM professionals must take the following five precautionary steps with all offshore HIM services vendors.

  • Discuss any offshore contacts with your legal counsel and the vendor prior to signing.
  • Include language to indicate that onshore vendors will not subcontract with offshore vendors or coders.
  • Make sure your vendors are aware of attestation rules and take precautions to safeguard PHI.
  • Obtain cybersecurity insurance that includes coverage for potential breaches of offshore data.
  • Identify any other clinical services that may be provided offshore, such as coding audits, and consult your legal counsel to determine if that service should be identified in the attestation.

Rigorous due diligence of offshore coding vendor privacy and security safeguards ensures HIM professionals are doing their part in reducing PHI breaches and ransomware attacks in healthcare. Six states went a step further by prohibiting Medicaid members from sending any PHI offshore: Arizona, Ohio, Missouri, Arkansas, Wisconsin and New Jersey. If your state provides healthcare services in any of these states, additional review by legal counsel is mandatory.

Watch Offshore Coding Quality

The second area for concern with offshore medical record coding services is accuracy.

Offshore coders are mostly former nurses or other well-educated candidates. Although global coding staff speak English and are highly competent, they may not be well trained in self-directed chart interpretation.

Our clients often report international coding accuracy concerns and the need for additional audits, higher denials and missed procedure codes—especially as global coders expand beyond relatively simple and repetitive ancillary testing and radiology cases. In fact, 22 percent of HIM executives continue to shy away from a non-U.S. workforce, according to Black Book.

When it comes to coding quality, here are five recommendations to measure, monitor and manage accuracy prior to engaging an offshore coder.

  • Confirm who is actually doing your coding initially, and after each month into the services engagement.
  • Know global coders’ credentials, testing results and accuracy scores.
  • Verify that less experienced coders aren’t engaged following the initial work assignment.
  • Conduct a minimum of monthly coding audits to quickly identify and correct any negative trend or patterns.
  • Refuse to accept lower quality standards for offshore coding.

Re-evaluate Your Options

The medical record coding industry has shifted. Now is the time to re-evaluate the risks and returns of offshore coding services—keeping privacy, security and quality top of mind.

About Sarah Humbert
Sarah serves as the manager of coding and compliance at KIWI-TEK, a 100% domestic coding and audit services company. She is responsible for coding quality control—accuracy, turnaround time and compliance.

Sarah oversees all coding processes, including coders’ performance, credentials and recurrent testing. She is a member of AHIMA, IHIMA, CHIMA, and she is also a Certified ICD-10 AHIMA trainer. Sarah has worked in a variety of health information management positions for Health Care Excel, MedFocus and St. Vincent Health System.

KIWI-TEK is a proud sponsor of Healthcare Scene. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

Preview of #AHIMACon17 – HIM Scene

Posted on September 7, 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.

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

I thought it might be interesting to check out the #AHIMACon17 conference hashtag for the AHIMA Annual Convention to get an idea of what the hot topics were going to be going into the annual convention. Unfortunately, there wasn’t much conversation happening on the hashtag yet. Here’s a sample of a few things I found and some of my commentary about each.


I’m excited to hear Viola Davis as well. I’m sure she has some amazing stories. It’s not clear to me her connection to healthcare, but I’m all about hearing the stories of successful people. I hope they let her tell her story and not try to have her be a healthcare speaker. Ironically, the MGMA Annual Conference is happening at the same time as the AHIMA Annual Convention about 45 minutes away. Viola Davis is keynoting both. I’m not sure if they planned this together or if it’s just coincidence. Either way, I guess I get 2 chances to hear Viola, but trying to manage both events is hard.


This tweet from Ciox made me laugh. There’s a lot of things in healthcare that are still stuck in the 80s. As Mr. H from HIStalk likes to say, Healthcare is where old technology goes to die. There’s certainly some modernization that could happen at about every healthcare organization.


This tweet is ironic after the above tweet talking about the need to modernize. I wonder how many in the AHIMA community are familiar with NLP based technology. For those not familiar, NLP stands for natural language processing. It can be used in a variety of ways, but in the AHIMA world it’s most commonly used to analyze medical records and assess if the documentation matches the coding. It’s pretty amazing technology. I also love seeing NLP used on narrative sections of a note to identify granular data elements that could be used to better inform clinical decision support tools. Do many HIM professionals care about this technology? Are they using it? I think I’ll ask when I’m at the event.


I think security will be an extremely hot topic this year. Given HIM’s role in doing release of information (ROI), it’s always had an important role. In fact, they have a pre-conference Privacy & Security Institute that I’ve heard a lot of great things about. I’m hoping to go this year if they let press attend.

Will you be at #AHIMACon17? What do you expect to be the hot topics? Are there sessions you absolutely must attend? Who’s going to throw the best party? I hope to see many of you at the conference!

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