What are the most significant challenges for Health Information Management (HIM) departments? One of the challenges in 2016 includes the disappearing HIM department; physical downsizing as well as workforce downsizing. With the workforce downsizing we see technology impacting traditional roles for transcriptionists, documentation specialists and coders. HIM professionals need to manage business, clinical and information systems. Some of the challenges have been prevalent for years but today can take on more risk and require varying expertise to manage that risk.
Operations
Operations in the HIM Department includes electronic health records (EHRs), documentation scanning, release of information and clerical functions. Although there are departments with a file room and hard copy medical records, the reliance on the paper documentation continues to decrease as the EHR evolves. Paper medical records are fewer and document scanning is the mode to transform these documents to a format that can then be assembled in a more accessible media. Keeping the HIM operation free from backlogs in scanning can be a challenge dependent upon the degree of automation, efficiency of the scanning equipment and staff expertise. Solid training programs for staff and quality audits of scanned documents is the foundation to an efficient revenue cycle and preserving reimbursement with payer audits. Although these functions may not appear to be the highest priority, they can quickly become the highest priority and risk area when coders are delayed in coding and auditors identify missing documentation that does not support reimbursement to the healthcare organization. An efficient HIM operation in support of the EHR is key to the revenue cycle and audit landscape.
Revenue Cycle
Coding and Clinical Documentation Improvement (CDI) remain on the forefront of priorities for financial viability. With ICD-10 implementation since October 2015, the key remains staff assessment for code accuracy and DRG assignment. At this point, the shift on the coder drill down may be more focused on detail code review and challenging cases. Strong CDI programs ensure accurate representation of services through complete and accurate reporting of diagnoses and procedures. Working with physician groups and specialties to educate providers on their role and the associated impact on quality is foundational to a strong CDI program. The Coding and CDI team collaboration to discuss physician queries as well as challenging documentation areas needs to be strong and consistently implemented as part of the revenue cycle. Physician documentation and coding impacts data analytics, value based purchasing and other payment reform. Actively reviewing the accuracy of hospital acquired conditions, mortality and patient safety indicators remain on the priority list for ensuring optimal reimbursement.
Compliance
Release of information in the world of EHRs can be more challenging than the days of photocopying a medical record. Today, releasing accurate documents, correct patient documents and compliance with multiple state and federal regulations in that release is a challenge for HIM staff. As we know, release of information is not only for continuing care but also for ensuring optimal reimbursement. The payer audits are increasing and staff expertise is required to understand the content of the release and which documents in the EHR must be provided to support the services. Staff with the expertise to understand coding and billing is becoming more crucial to efficiently respond to payer audits. Time and money is all consuming when the outcome of audits threatens original payment and then extensive appeals may be required. A strong audit team that understands payer requests, manages the audits and communicates with the auditor is becoming more critical in the compliance arena.
The HIM landscape is built by efficient Operations, can we accurately and efficiently manage documents in a time sensitive manner? Revenue Cycle, if we have accurate EHRs supported with complete scanned documents, can we accurately code the services to meet financial turnaround times? Compliance, if we accurately code for services in a timely manner, will the services sustain payer audits and ensure reimbursement is not diminished or denied? Although the physical HIM departments may be diminishing the skill set required to manage these operations is crucial to organization financial sustainability.
Laureen A. Rimmer, RHIA, CPHQ, CHC
Vice President, Department Management
