Coding, collaboration and revenue integrity matter in healthcare. These are consistent themes in reimbursement circles. And they topped conversation charts during the recent American Health Information Management Association (AHIMA) annual convention.
As a 22-year veteran of this event, I see AHIMA quickly moving forward to keep stride with their revenue cycle and health IT peers in three specific areas: healthcare industry partnerships, health information integrity and change management. Here’s how.
Revenue Cycle Oversight of Coding on the Rise
Bill Wagner, CHPS, CPCO, Chief Operations Officer & Co-Founder, KIWI-TEK, spoke with hundreds of coding professionals during the three-day event. He witnessed greater numbers of coding departments reporting directly to finance or revenue cycle instead of HIM. With revenue cycle’s increased responsibility comes greater focus on coding performance. Here are two trends to know.
Outpatient Coding Takes Spotlight
The volume of outpatient surgeries is growing by 6-7 percent a year with predictions of up to 27 million ambulatory procedures by 2021. Healthcare organizations of all types are keenly focused on ensuring proper billing and coding for their outpatient encounters. While the shift to outpatient bodes well for ambulatory surgery centers, “new coding accuracy and revenue integrity concerns emerge for hospitals and health systems”, according to Eileen Tkacik, Vice President, Information Technology, Pena4.
In Pena4’s fourth annual national coding contest, notable drops in outpatient coding accuracy were identified. The contest revealed a drop from 42.5 percent accuracy in 2018 to only 40.39 percent accuracy in 2019. Tkacik believes the drop reflects ongoing revenue integrity hurdles in outpatient coding:
- Multiple coding guideline changes create grey areas for coders
- Inadequate coder education and inconsistent processes occur in outpatient areas
- Frequent documentation gaps appear due to sheer volume of outpatient procedures
Single-Path Coding Rises in Popularity
Single-path coding refers to the ability for one coding professional to assign both facility and professional service codes to a case versus multiple coders touching the same encounter at varying points in the revenue cycle workflow. I believe single-path coding will become increasingly prevalent as organizations work to boost operational efficiency, reduce overlaps and address coding errors. It is also a pragmatic way to break down silos in the revenue cycle and improve revenue integrity across inpatient and outpatient services.
Health Information Integrity at Every Turn
Dozens of educational sessions during AHIMA’19 focused on health information integrity. More than just a pipe dream, HIM professionals are frontline support to ensure patient data is clean, accurate and accessible. Letha Stewart, MA, RHIA, director of customer relations at QuadraMed is an health information integrity expert and AHIMA’19 speaker. She details the negative downstream impacts of dirty data.
“Despite advanced EHRs and intelligent systems, patient mismatches still occur in high volumes at virtually every health system”, states Stewart. Mismatches and other patient information integrity errors cause inordinate challenges for patient safety and revenue recognition. Stewart recommends several steps revenue cycle leaders can take to mitigate their risks.
- Conduct an extensive enterprise master person index (EMPI) cleanup prior to any new system implementation or upgrade. This includes add-on applications to your EHR.
- Don’t rely solely on your EHR vendor to identify and report medical record mismatches. They have a vested interest in minimizing the risks and accurate patient identification is just one part of the product, not the focus.
- Duplicates in your archives and legacy applications are just as dangerous as duplicates in live systems.
- A combination of probabilistic and referential matching tools provides the best patient matching rates and outcomes.
Association, Organization and Interdepartmental Collaboration
The speaker lineup at AHIMA’19 demonstrated new levels of industry collaboration and partnership. The CEO of CHIME, Presidents of AMA, HHS’s Office for Civil Rights, and CMS were all guest speakers during the event. Education sessions covered a wide range of topics including revenue cycle, patient engagement, business associate management, artificial intelligence, clinical documentation, and consumer-driven health.
A nascent issue that requires strong interdepartmental collaboration is patient-directed medical record requests. During two standing-room-only sessions, Rita Bowen, MA, RHIA, CHPS, CHPC, SSGB and Vice President of Privacy, Compliance and HIM at MRO joined her MRO peer Danielle Wesley, Esq., Vice President and General Counsel, to dissect the legal, compliance, privacy and financial ramifications of attorney misuse of patient-directed requests for copies of medical records. This topic was also covered by Bowen in her December 2018 guest post on HITECH Answers.
Attorneys are taking advantage of patient’s right to designate a third party to receive records and styling the requests to make providers believe they are patient-directed requests subject to the limited fees. Multiple departments are impacted by this nefarious action:
- Health Information Management
- Risk Management
- In-House Legal Counsel
Bowen and Wesley encouraged attendees to take a leadership role in addressing the misuse of patient-directed requests through education, workflow and proactive outreach to the OCR. With this issue—and many more like it—attendees to the AHIMA’19 conference sought to embrace new leadership roles and responsibilities.
Key Leadership Moments
Keynote speakers, innovation leaders and industry panelists all shared the message of leadership in action. Get a running start, but also take time to plan when making big decisions. Balance plans, research and collaboration across departments and organizations. And finally, ask yourself “what do the people you are leading really need and want to meet their goals”? Sage advice for all of us in the healthcare industry today.