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!

Looking Forward to #AHIMACon18 – HIM Scene

Posted on September 19, 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.

This weekend is the start of the AHIMA Annual Convention happening in Miami, Florida. For those not familiar with the AHIMA organization, it brings together HIM professionals from across the country. Something that I think makes AHIMA unique is that around the HIM conference are multiple days of training and certifications for HIM professionals. I’m always amazed at how much work HIM professionals have to put in to keep up with their certifications and to stay up with things like the ever-changing world of medical coding. HIM definitely doesn’t get the credit they deserve in this regard.

As I think what topics will be hot at this year’s AHIMA Annual convention, I’m most interested to hear what the HIM crowd thinks about the changes to the Physician Fee Schedule and E&M Coding. This is going to be a big deal for healthcare and medical coders are going to be the ones charged with dealing with the changes. Sure, doctors will have to change how they are documenting as well, but verifying that it was documented correctly and making sure the medical coding matches that documentation is mostly done by HIM professionals.

I’m really interested to hear what HIM professionals think about these medical coding changes. What do you think of the new time based coding options? Does this make life easier or not? Let us know what you think and what you’re hearing in the comments. The obvious part to me is that in the short term it’s not going to make medical coders’ lives easier at all. It’s just one more code they’re going to have to deal with and it doesn’t have a history of practices to support what’s acceptable or not. It’s not like these new codes are doing away with the old codes. At least I don’t think that’s how most practices are going to handle these new codes, but we’ll see. Let us know your thoughts in the comments.

Another big change that could impact HIM professionals, particularly medical coders, are the new remote monitoring and digital care coordination codes. I’ve heard a lot of people saying that these codes show some promise. However, I’m starting to hear overtures that the codes aren’t going to live up to their billing (excuse the pun). What are you seeing when it comes to the new coding for telemedicine, remote monitoring, and digital care coordination?

Outside of these two big topics, I’ll be interested to hear how HIM professionals are looking at security and privacy. It’s become a huge topic in the CIO and healthcare IT world. I wonder how much it will impact the HIM world. There’s always an interesting dance when a breach happens. The HIM world is great at understanding disclosures and HIPAA violations, but breaches often bring out a lot of different people. The reality is that when a breach occurs it needs to be all hands on deck. However, my guess is that many HIM professionals aren’t part of the discussion when a breach occurs. How’s your experience been in this regard? If you haven’t had a breach (lucky you), you should still have some policies and some drills in place to make sure you’re ready. So, you should have an idea of what HIM’s role would be in a breach.

Another trend I’ve been watching for a number of years is the push for more and more HIM professionals to be involved in things like healthcare analytics. This was highlighted by a recently published article in the Journal of AHIMA that makes the argument that all healthcare professionals need to learn data analytics. I argued something similar in this article on how HIM professionals can use Information Governance to ensure they’re heard. These are important messages that I think many in HIM are largely ignoring. It will be interesting to see how this shakes out. Those that embrace the changes will be well positioned for the future.

What other things should we be watching for from an HIM perspective? What’s keeping you up at night? What’s getting you most excited about your job? Let us know in the comments or on Twitter @HealthcareScene.

Centralizing HIM Operations: An Enterprise Approach

Posted on August 15, 2018 I Written By

The following is a guest blog post by Patty Sheridan, MBA, RHIA, FAHIMA; SVP, Life Sciences at Ciox.

Technological advances, policy changes and organizational restructures are continuously bringing trends to the healthcare industry, specifically impacting healthcare facilities. Centralization of operations is one of those trends. Driven by a value-based model, the centralization of health information management (HIM) aims to streamline operations, standardize processes, reduce costs and improve quality of care and patient satisfaction.

Oftentimes, HIM departments operate with disparate processes due to legacy standard processes and acquisitions of new entities and are unable to efficiently integrate and access information when it is derived from multiple sources. This causes inconsistencies in processes and procedures, as well as incompleteness of information and unavoidable redundancies. Furthermore, decentralization can result in risks such as ineffective information management, inaccurate coding and breaches.

Silos of information hinder standardization, and as a result create compartmentalized pockets of information from sources, slowing down communication and making change more difficult. However, through the use of electronic HIM technology, secure information can be shared and processed across various departments and facilities at a quicker pace than ever before. Taking these efficiencies one step further, instead of siloes of information, many organizations are moving to a centralized model that can reduce operational costs by streamlining organizational performance, establishing consistent processes through standardization and eliminating redundancies.

Patient health information must be linked across the healthcare continuum to provide the best quality of care. Additionally, sources of information must be linked to electronic health records (EHRs) to support centralization and enhance patient care. To connect silos and reduce risks, healthcare facilities must centralize HIM operations to create standardization and improve coordination across the continuum of care.

Benefits of Centralization

Healthcare facilities can greatly benefit from incorporating the centralization of HIM operations into their long-term organizational plans. In fact, the benefits are greater than any hurdles encountered during the transition. Benefits include:

  1. Improves operational efficiency: Moving from a fragmented system to a model that streamlines operations improves efficiency and decreases administrative and operational costs.
  2. Eliminates redundancies and reduces errors: Helps to standardize processes, procedures and forms across a healthcare system to ensure they are the same throughout facilities.
  3. Improves financial performance: Restructuring improves productivity and efficiency as resources are centrally located, which positively impacts the bottom line.
  4. Fosters collaboration: Eliminates silos of communication that cause a stagger in the flow of information – improving communications and optimizing patient outcomes.
  5. Increases accessibility: Provides the benefit of system-wide accessibility to patient information for release purposes, such as billing and coding.
  6. Optimizes workflow: Allows opportunities to reexamine workflows for optimal efficiencies across the HIM continuum, bringing business value.

Driving Transition Towards Centralization

When an organization transitions to centralized HIM operations, it’s important that the journey be completed with the right preparation and execution. HIM professionals must establish processes that foster opportunities for consolidation and standardization that then result in reduced cost, mitigation of risk and overall improved patient care.

Prior to implementing a centralized model, HIM professionals must take certain steps into consideration:

  • Acquire an executive sponsorship to provide direction, support, budget and resolution to potential problems that may arise during the transition.
  • Establish a multidisciplinary steering committee to address centralization and your organization’s information policy, aligning resources with strategy.
  • Identify challenges, gaps, risks and opportunities while working with collaborators to achieve goals for improvements.
  • Define and establish standards, processes and procedures.

Centralization: The Decision is Yours

It is important for HIM professionals to be proactive when determining his or her organization’s vulnerabilities and address them immediately, as breaking down barriers that add risk ultimately drives down costs and improves efficiencies.

Additionally, everyone in an organization may not support the transition. However, executive sponsorship and collaboration between staff, departments and facilities is essential. To gain consensus, HIM professionals must understand the culture of the departments involved and how to leverage their individual technological capabilities.

The work of healthcare professionals is being reshaped by the centralization of HIM operations. If you’re looking to succeed during this ambiguity of change, transforming HIM to a centralized model throughout an enterprise provides healthcare facilities with a competitive advantage, as the integration of emerging technology continues to become a crucial step towards efficient, successful operations.

About Ciox
Ciox is a health technology company working to solve the clinical data illiquidity challenge by providing transparency across the healthcare ecosystem and helping clients manage disparate medical records and is a proud sponsor of Healthcare Scene. When stakeholders do not have timely access to the complete clinical picture of patients, critical decisions about patient care, medical outcomes research, disease prevention, reimbursement, and payments are sub-optimized. Ciox’s scale, expertise, expansive provider network and industry leading technology platform make it the most reliable clinical data company in the US. Through its standards based technology platform, HealthSource, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability.  Learn more about Ciox’s technology and solutions by visiting www.ciox.com

HCCs: An Operational Perspective – HIM Scene

Posted on August 8, 2018 I Written By

The following is a guest blog post by Cathy Brownfield, MSHI, RHIA, CCS, Chief Operating Officer, TrustHCS.

Hierarchical Condition Categories (HCCs) were mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997. In 2003 HCCs were selected as a risk adjustment model to be used to determine reimbursement for Medicare Advantage Plans.  They describe chronic condition diagnoses for patients and are determined from other codes assigned during physician encounters—including ICD-10 codes, CPT codes and medication codes.

The HCC framework is progressively being applied to numerous healthcare reimbursement reform initiatives. As the shift from volume to value advances, so does the importance of accurate HCC coding. This month’s blog explains the correlation between HCC coding and value- based reimbursement.

Two HCC models prevail

There are two HCC models in use by the federal government: CMS-HCC and HHS-HCC. Both models employ a risk adjustment score to predict future healthcare costs for plan enrollees. They operate within a hierarchical structure in which the more complex diagnoses absorb and incorporate less complex, chronic conditions.

The CMS-HCC model addresses a predominantly elderly population (65 years and over) and includes more than 9,000 ICD-10 codes that map to 79 HCC codes; these numbers do change and will increase slightly in FY 2019.

The Department of Health and Human Services (HSS) maintains the HHS-HCC model, which addresses commercial payer populations and covers all ages. This system incorporates CPT and medication codes and is currently comprised of 128 HCC codes.

Relationship to risk adjusted payment programs

The following are some of the risk adjusted payment programs currently using HCCs to determine reimbursement:

  • MA – Medicare Advantage Plan
  • MSSP – Medicare Shared Savings Program (ACO)
  • CPC+ – Comprehensive Primary Care Plus (Medical Home Model)
  • Commercial – Mainly the ACA

Each of the models primarily use ICD-10 codes taken from claims data to identify individuals with serious or chronic illnesses and assign a risk factor score to each enrollee based upon a combination of the individual’s health conditions and demographic details. Each HCC has a risk factor, an individual can have multiple HCC’s and those factors add up to their overall risk adjustment factor.

According to the CMS website, “risk adjustment allows CMS to pay plans for the risk of the beneficiaries they enroll, instead of an average amount for Medicare beneficiaries. By risk adjusting plan payments, CMS is able to make appropriate and accurate payments for enrollees with differences in expected costs. Risk adjustment is used to adjust bidding and payment based on the health status and demographic characteristics of an enrollee. Risk scores measure individual beneficiaries’ relative risk and risk scores are used to adjust payments for each beneficiary’s expected expenditures. By risk adjusting plan bids, CMS is able to use standardized bids as base payments to plans.”

How to operationalize accurate HCC coding

The risk-adjustment data for these programs is based on active diagnoses. In order to ensure the information is accurate, providers must conduct face-to-face encounters with their patients and all pertinent diagnoses must be documented in the medical record on an annual basis. Accurate documentation and coding is paramount to proper reimbursement under risk adjusted programs that use HCCs.  Beyond accurate HCC coding, it is important for HIM professionals to be aware of CMS reporting and data collection methodologies when operationalizing HCCs.

Reporting considerations to know

In 2012, CMS began transitioning the Medicare Advantage Organizations (MAOs) data collection method from its original format to an Encounter Data Payment System (EDS). The data collected under the EDS is unfiltered and more detailed than EDS’s predecessor, Risk Adjustment Payment System (RAPS). While CMS has gone back and forth on which algorithm to use, a blend of 85 percent RAPS and 15 percent EDS scores is currently in place for 2018.

Data is submitted directly to CMS where filtering logic is applied to extract the valid diagnosis codes from the data. The codes are then used in the risk score calculation process. With this process, MAOs must verify the completeness and accuracy of the data submitted to CMS to ensure that all appropriate diagnosis codes have been accepted for risk adjustment by CMS.

The RAPS/EDS blend will return to a 75/25 split in 2019. Additionally, CMS is proposing to calculate the EDS risk scores amended with RAPS inpatient diagnoses. Other 2019 changes are listed below.

2019 CMS-HCC Model Changes

  • Behavioral Health Conditions
    • HCC 55 Drug/Alcohol Dependence: Add opioid (and other substances) overdose ICD-10 diagnosis codes to HCC 55
    • Add HCC 56 Drug Abuse, Uncomplicated, Excluding Cannabis, includes opioid dependence diagnoses (among other narcotics)
  • Mental Health and Substance Abuse Disorders
    • Add HCC 59 Reactive and Unspecified Psychosis
    • Add HCC 60 Personality Disorders
  • Add HCC 138, Chronic Kidney Disease Stage 3 (Moderate Only)

Role of HIM and where to learn more about HCCs

In the new frontier of value-based payment, HIM is the purveyor of accurate coding and HCC assignment for organizations and providers. Savvy HIM leaders ensure they have the most up-to-date information by monitoring the following websites and information sources:

About Cathy Brownfield
Cathy Brownfield is the Chief Operating Officer of TrustHCS. She holds over 17 years of operations, auditing and coding experience. Prior to TrustHCS, Cathy served as the Operations Director for HealthPort’s Coding Operations division overseeing scheduling, billing, and quality assurance efforts.

Cathy holds her Master of Science in Health Informatics from Arkansas Tech University. She received her Bachelor of Science in Health Information Management from the same university. Cathy is a Registered Health Information Administrator and a Certified Coding Specialist. As a member of the American Health Information Management Association she volunteers on the Coding Community Council and also the PPE work group.

Medical Coding, Revenue Cycle Management and the EHR – HIM Scene

Posted on July 31, 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.

It’s unfortunate, but true that very few healthcare organizations thought about the impact the EHR selection and implementation would have on things like medical coding and revenue cycle management. The later has gotten more attention after hospitals implement an EHR and then run into cash flow problems when they realize their collections have started piling up after the EHR implementation. However, it’s surprising how many coding and revenue cycle management challenges exist post EHR go live.

With this in mind, Healthcare Scene recently talked with Susan Gatehouse, CEO of Axea Solutions, at the HFMA Annual conference about how EHR impacts medical coding and revenue cycle management. She shares some great insights into the topic and some practical ideas for those dealing with these challenges. Plus, we ask Susan what thing stood out to her at the HFMA annual conference.

Check out our interview with Susan Gatehouse:

*Note: This video was originally live streamed to Facebook, so please excuse the poorer quality video and audio.

Be sure to check out all of the Healthcare Scene interviews on YouTube. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

Remote Release of Information: The Next Step in Secure and Compliant Exchange of Patient Health Information

Posted on July 18, 2018 I Written By

The following is a guest blog post by Patty Sheridan, MBA, RHIA, FAHIMA; SVP, Life Sciences at Ciox & Tarun Kabaria; Executive VP, Provider Operations at Ciox.

Across the industry, there is an influx of health information management (HIM) departments and medical groups moving their HIM operations from hospital main campuses and individual physician practices to centralized, offsite locations to gain efficiencies and make better use of valuable square footage in their facilities. For many organizations, this move began decades ago with the implementation of remote coding and/or the need to free up space for patient care.

These ‘virtual HIM” departments can be located at a separate facility, home-based office or remote vendor locations, and result from the continued adoption of electronic health records (EHR) and pressure to manage costs, offering HIM directors and practice administrators the opportunity to reorganize and form more efficient spaces and processes. Outsourcing functions, such as release of information (ROI), allows HIM staff to focus on other priorities of data governance while maximizing available space.

From a financial perspective, costs associated with regulations, staffing, printing, mailing and square footage are increasing; and in some instances, volumes of requests are increasing due to health plans, lawsuits and the portability of healthcare. Furthermore, allowable fees for releasing medical records are decreasing in some states. As a result of these rising financial pressures, healthcare providers are finding it more difficult to make ROI a profit center in their organizations.

HIM departments are experiencing additional pressures from rising health plan request volumes, requiring flexible operational solutions in order to meet the increasing demand. In a typical year, the volume of health plan requests tends to increase to the order of 20-30 percent, and this year those numbers are expected to triple. With such an influx of requests, moving to a virtual model allows for the onsite staff to be augmented with the remote team, fulfilling these large volume requests without impacting the core ROI and patient requests.

Another prevalent challenge is timeliness. With the advent of rebranding the Meaningful Use program to focus on promoting interoperability and the increase in various governmental and payor audits, timeliness of response to requests for medical records is critical and penalties for non-compliance are steep. As such, healthcare providers are reaching the point of diminishing returns in regards to managing the ROI function on their own, and in some cases, will not be able to meet the time deadlines imposed upon them to gain incentives, avoid penalties and takebacks.

These new industry influences create the need for even faster, more efficient, error-free fulfillment of medical record requests and pave the way for a new approach designed to help your organization meet this demand: Remote ROI.

The Remote ROI Process

The ROI process is a time-consuming administrative challenge for HIM professionals, requiring compliance expertise, secure and efficient technology, and a trained and knowledgeable staff. The Remote ROI process starts at your healthcare facility when requests for release of health information are received. From there, your chosen third party vendor, such as Ciox, receives the request from the hospital or practice via a mutually agreed upon, secure mechanism. Securely connected and able to access the hospital or practice EHR, an offsite ROI Specialist then reviews the requests for proper authorizations, identifies and captures the records to be released, and transmits the medical records from your facility’s EHR in an encrypted electronic format to the third party vendor’s ROI centralized processing center. The release is delivered to the requestor through an automatic print and mail process or electronically via a secured delivery method. Ciox’s process is computer-assisted using artificial intelligence and natural language processing thereby reducing turnaround time, improving patient satisfaction and ROI outcomes.

When creating your Remote ROI process, follow these three fundamental steps to ensure its success:

1. Determine the method of access to the Request Letter/Authorization received by the hospital or physician practice.

There are several mechanisms by which requests and authorizations are securely made available to Remote ROI Specialists for ROI processing. The most common methods include:

  • Requests/Authorizations are scanned into the EHR – Staff at the facility scans the requests/authorizations into the EHR. The Remote ROI Specialist accesses the EHR to view the information and begin the process.
  • Requests/Authorizations are faxed – Staff at the facility faxes the requests/authorizations to a fax-in queue provided by the third party vendor. The Remote ROI Specialist accesses the fax-in queue to view the information.
  • Requests/Authorizations are scanned and placed in a shared folder – Staff at your facility scans the requests/authorizations into a shared folder accessible by the Remote ROI Specialist at the third party vendor’s secure Remote ROI Processing Center.
  • Requests/Authorizations are automatically received via health data exchange or health information exchange.

2. Establish connectivity to the EHR to validate the authorization, review the medical records and process the request.

An acceptable baseline for securing the connection to your EHR system(s) must be established for Remote ROI. The appropriate connectivity scenario depends on the underlying technologies at your facility. When understanding which technologies are at your disposal and establishing connectivity, remember that security is key in this part of the process. Keep that in mind when selecting a third party vendor, as it’s paramount to select a company that makes the security of the exchange of protected health information a top priority. Furthermore, it’s of critical importance to select a vendor that has earned certified status for information security by the Health Information Trust (HITRUST) Alliance. The HITRUST CSF Certified Status ensures that key healthcare regulations and requirements for protecting and securing sensitive private healthcare information are met.

3. Ensure compliance standards to track when and who accessed protected health information.

As an added security effort, it’s crucial to follow compliance standards that allow insight as to who accessed patient health information and when it was accessed. To ensure maximum security, computers located at the third party’s Remote ROI processing facility should be secured utilizing encryption, anti-virus protection and web filters.

Passwords should be provided by the facility for access to their specific EHR and stored in an electronic password vault. The password vault should be linked to the third party’s directory that is only accessible by the ROI Specialist using their directory account. Third parties should provide complete audit trail capabilities to track personnel accessing the EHR and processing medical record requests from your applications.

By moving some or all of the onsite ROI functions to a Remote operation, you can streamline the ROI workflow, reclaim square footage for other purposes and have additional capacity available for request volume fluctuation. As an added benefit, the immediate access to requests and authorizations speeds turnaround times on processing requests, which is particularly important when considering tight timelines for meeting Meaningful Use and audit-related releases.

If you’re looking to make HIM operations more efficient and cost effective, Remote ROI can open the doors to achieving those goals.

About Ciox
Ciox is a health technology company working to solve the clinical data illiquidity challenge by providing transparency across the healthcare ecosystem and helping clients manage disparate medical records and a proud sponsor of Healthcare Scene. When stakeholders do not have timely access to the complete clinical picture of patients, critical decisions about patient care, medical outcomes research, disease prevention, reimbursement, and payments are sub-optimized. Ciox’s scale, expertise, expansive provider network and industry leading technology platform make it the most reliable clinical data company in the US. Through its standards based technology platform, HealthSource, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability.  Learn more about Ciox’s technology and solutions by visiting www.ciox.com

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.

Workers’ Comp ROI – Disclosures For Workers’ Compensation Purposes – HIM Scene

Posted on April 10, 2018 I Written By

The following is a HIM Scene guest blog post by Don Hardwick, Vice President, Client Relations and Account Management at MRO.

Even under the best of circumstances—excellent staff, streamlined workflows, the latest technology— Release of Information (ROI) is a precarious process. Specific rules apply to different categories of requests. One area of complexity and confusion is the disclosure of Protected Health Information (PHI) for workers’ compensation purposes. While the ROI process for workers’ comp requests is similar to the process for “regular” requests, the type of information allowable for disclosure is different unless the request is accompanied by a patient authorization.

According to HHS guidelines, “The HIPAA Privacy Rule does not apply to entities that are either workers’ compensation insurers, workers’ compensation administrative agencies, or employers, except to the extent they may otherwise be covered entities.” However, the rule recognizes the legitimate need of these entities involved in workers’ compensation cases to access PHI according to state or other laws. Due to variability among such laws, the Privacy Rule permits disclosures of PHI for workers’ compensation purposes in different ways.

Disclosures without individual/client authorization. In most cases, an employer or insurance carrier is permitted to request and receive information pertaining to the injury—on behalf of the company or on behalf of the client—without an authorization. So employers, insurance companies or their attorneys can obtain information on behalf of the insurance company or on behalf of the client. Typically an attorney would get an authorization from the client. However, the employer, the payer or an attorney representing the payer can generally request those records without individual authorization.

Disclosures with individual authorization. The Privacy Rule permits covered entities to disclose PHI to workers’ compensation insurers and others involved in workers’ compensation systems if the individual (patient/client) has provided an authorization for the Release of Information to the entity. The authorization must meet specific Privacy Rule requirements.

When considering a workers’ comp claim, we can only disclose PHI pertaining to the event that initiated that particular claim. For example, suppose a patient had five admissions in 2017, and was injured January 2018. The employer may want to determine if the patient had preexisting injuries or conditions where the most recent injury occurred. If the January 2018 injury was secondary to a problem that already existed with this patient, the requester generally cannot obtain prior information without a HIPAA valid authorization.

The main point is that rules and regulations pertaining to workers’ compensation claims differ depending on the type of request for information and the type of requester.

About Don Hardwick
As Vice President of Client Relations and Account Management, Hardwick oversees all client relations initiatives including implementation and account management. Prior to joining MRO, he was CEO and President of Record Enterprises Inc., a Health Information Management (HIM) company that provided hospitals with an outsourcing program for patient release of information, medical coding and medical/confidential record storage. Previously, he was CEO and president of MedRecs Law Inc., a record acquisition company. Additionally, he was a manager in the healthcare consulting division of Ernst & Young and worked as the Director of HIM at Saint Margaret Hospital in Montgomery, AL and Southampton Memorial Hospital in Franklin, VA. Hardwick is a past President of the Virginia Health Information Management Association (VHIMA) and the recipient of East Carolina’s Allied Health Sciences Distinguished Alumni Award. He holds a B.S. in Health Information Management.

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.