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Word of Caution for Hospital CFOs

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Ignore HIM at Your Own Risk

CharlieSaponaro_6055Medical records are going electronic at record-breaking speed. Spurred by meaningful use incentives, EHRs are being rapidly installed and core HIM functions quickly automated. Many HIM functions are already outsourced and hospital leaders plan to offload even more HIM tasks in the year ahead.

For example, a recent survey of 650 hospital leaders by Black Book Rankings found that 47% plan to outsource their coding efforts by October 1, 2015, the new deadline for implementing ICD-10-CM/PCS. There is already a 21% national coder shortage according to industry estimates. ICD-10 will make the situation worse. But there’s more.

Look Beyond Coding

Savvy hospital CFOs must look beyond coding to uncover the full impact of HIM operations on their organizations’ overall productivity, efficiency and outcomes.

HIM departments are the “clean-up crew” for patient access and billing errors. They are the guardians of patient privacy. And they are the critical link between clinical documentation and revenue cycle.

While some HIM functions are purely tactical, others are strategic to revenue cycle improvement and quality care. Here are four numbers for hospital CFOs to know about HIM performance:

  • 40% of clinical documentation is not ready for ICD-10. The relationship between physicians, CDI and HIM must be strong.
  • 38% of healthcare organizations expect revenue to decrease during the first year of ICD-10.  HIM professionals should be part of your claims denial team.
  • Nationwide, HIM departments receive over 28 million requests for medical records from RACs, patients, attorneys, and other third parties annually—generating nearly 1.5 billion in electronic and paper pages. The process must be carefully managed to avoid becoming a HIPAA breach statistic. Your HIM department is at the helm.
  • $3 billion has been taken back by the RACs. 48% of hospitals report increased administrative costs due to RAC. HIM departments are usually the first to receive RAC and other auditor record requests. They are your first line of defense in preventing recoupments.

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The above statistics are included in this one-page infographicdescribing the relationship between HIM and revenue cycle. It’s a great starting point for deeper discussions with your hospital CFO.

 

The bottom line? You can’t afford to ignore your HIM department as it undergoes massive change. What are your thoughts?

 

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