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Tag Archives: holiday

‘Tis the Season: ICD-10 Holiday Coding Guide

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The holiday season is upon us — a time to deck the halls, indulge in tasty treats, and gather with loved ones. With all the hustle and bustle of this time of year, it’s no surprise that all the season’s festive activities bring with them the risk of accidents, injuries, and illnesses. As everyone celebrates […]

The post ‘Tis the Season: ICD-10 Holiday Coding Guide appeared first on AAPC Knowledge Center.

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An HIM director’s holiday wish list

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By Dom Nicastro
 
The last month of the year can be a bit stressful. Closing out the books on the prior year. Making sure you leave time for all the holiday get-togethers. The traffic. The lines. The people.
 
It adds up.
 
If you’re an HIM director, it can be hectic in your healthcare facility, too. Not that it’s smooth sailing the first 11 months of the year.
 
Either way, you deserve a few treats yourself this holiday season. Make a few wishes, and who knows?
In fact, we gave an HIM director just that – the platform to make a few wishes this holiday season.
 
So, the floor is yours, Marianne Durling, MHA, RHIA, CDIP, CCS, CPC, CIC, director of Health Information Management and privacy officer at Granville Health System in Oxford, North Carolina. What do you wish for?
 
I wish contract companies would quit poaching my coders.
Most contract companies allow remote work. They pay more than small, county-owned facilities like Durling’s can afford, she says.
 
“Most coders soon find out it isn’t what they expected and the work isn’t always guaranteed, but by then their job has been filled,” Durling adds. “As a manager, I feel bad when I can’t let an employee come back. Some also limit the notification time they will allow staff to give, which can make them ineligible for rehire.”
 
I wish I could implement a full CDI program.
What are the struggles here for HIM directors? What gets in the way of realizing a full program, and what can HIM directors do in light of not being able to have a full program? First, you must decide where CDI fits into your organization’s tree. Does it come under HIM and its coders or does it come under the revenue cycle and work with the utilization review/case management team?
 
“If leaders can’t agree on this aspect then they can’t agree on how to champion for the position,” Durling says. “I think CFOs don’t understand the role and the benefit to the organization and thus won’t approve the necessary funding for an experienced CDI specialist. Since this role is new, I see a lot of leaders making due with coders or clinical staff minimally trained in coding, which means you may be missing some important skills.”
 
I wish the CMS website was more user friendly.
Use professional organization websites and references relative to what you are reviewing, Durling says. When CMS releases a new regulation that will impact family practice physicians, wait a few days or a week then check the American Academy of Family Physicians website.
 
“They get their experts to review the new rulings and regulations,” Durling says, “and then they boil it down in terms that their members can understand and apply to daily practice. This usually works for any specialty. I also find that state Medicaid websites and some [Medicare Administrative Contractor] sites have more user-friendly search features to find what you need than the CMS website.”
 
I wish my staff knew how hard I champion for them with administration.
A good leader needs to spend their time educating the C-suite on what their department does and how it impacts the organization and community. Durling takes this seriously.
 
“While we all know HIM is responsible for producing the claims that brings in the money we are widely considered a non-revenue producing department,” she says. “I’ve worked to find ways to be innovative to cut costs and actually bring in some revenue. By doing this, it keeps HIM in the eye of the administration, and they can see the importance we play in all aspects of the daily operations and how we can be a valued community partner.”
 
I wish payers reimbursed more realistically so our salaries could be more competitive.
Coder salaries are often not truly competitive, and managers can be underpaid–and even overpaid at times. Some get lucky. They avoid the day-to-day operational work because they have other managers under them for each service area they supervise, while others are underpaid if they must do everything because they don’t have the same supervisors or managers.
 
“This is because smaller hospitals still have the same work requirements, but no funding to support extra staff,” Durling says. “If payers paid more realistically, I think it would greatly impact compliance and hospital care.”
 
I wish Santa would come and work for me a day!
“Since Dad is usually Santa, I think in our environment Santa would be the CEO,” Durling says. “I would have him do just what I do every day: on a day of back-to-back meetings, juggle a staff member calling out sick, and some ‘crisis’ from another hospital area, all while dealing with staff drama or conflict.” HIM can be the “forgotten department that everyone knows exists, but no one could tell you exactly what we do,” she says.
 
I wish more hiring managers thought outside the box when it comes to hiring coders instead of just focusing on the credentials.
What should hospitals focus on when hiring coders? Work experience, skills, and personality are far more important than focusing just on the credentials.
 
“I also think that some managers think one credential is better than another, when in reality you are going to train them to do things the way you want them to do it, regardless of their credentials,” Durling says. “I have been around since before coding credentials even existed and sometimes we forget that good policies, procedures, and training can allow anyone with some aptitude and a willingness to learn to be a great coder.”
 
Oftentimes, you’ll see a coder who has a long list of credentials who can’t do the day-to-day job. What does that tell Durling? Maybe they are good at taking tests or memorizing material, but not good at applying the material.
 
“I just think too many managers take the easy way out and think the credentials alone can allow them to find a successful coder, or because they had luck in the past with one type of credential they will only hire those with that same credential, which severely limits their pool of candidates,” she says. “Step outside your comfort zone and you may find a whole world of great employees you never saw before.”
 
I wish we could offer more services to help our patients be better stewards of their personal health information and healthcare in general.
Durling says she’d like to work with her marketing department to educate their community on the importance of accurate health information and why it’s important to protect that information. She would like to help educate local providers that are not fully complaint with HIPAA learn to be compliant, so everyone can provide the same protections. She’d liked to help create a database of verified patients where patients who don’t have any picture ID can be easily verified so they have alternative methods to service their needs and protect their information.
 
I wish I could pay my coders what I know they deserve.
Durling says her staff members multitask, but they are not being compensated for all those other duties.
“We lose good staff members to larger hospitals just because of the higher pay,” she says. “The other problem is location. Because we are rural, we have a smaller local pool of qualified candidates, which means that jobs are harder to fill. We also don’t have the ability to offer remote coding because the high cost of [electronic health record] integration causes us remain a hybrid record system with a lot of paper chart elements.”
 
Smaller hospitals struggle with a smaller candidate pool, broader job duties hybrid systems, and lower salaries.
 
“This is why so many small rural hospitals are merging with larger facilities or corporate healthcare agencies,” Durling says, “but if we lose that community attachment, will it truly benefit the community in the end?”
 
I wish I could win the lottery and afford to revamp and update my department like I want.
“I would do a major remodel to our work area to make it more user friendly for the way we work today, as well as upgrade equipment to reflect our changing tasks,” Durling says. “I would spend the necessary money to back scan all our old records and integrate all our service areas so we could truly be a fully electronic medical record.”
 
“I would also use some funding to create a group to champion for smaller, rural hospitals at the government level,” Durling adds.
 
I wish the hospital staff and community realized just how much HIM really does for the hospital, the community, and patients.
Often board members, like the hospital staff in general, don’t know exactly what HIM does.
 
“I would like to speak to them at each new board installation to talk about what we do and how we serve the facility, providers, and the community,” Durling says. “I would also wish to be able to talk to them about significant changes such as things like ICD-10, HIPAA, or even issues that impact our department such as identity theft. I normally don’t get asked to present to them on these types of topics, but I believe they need to know what to expect and the impact it will/could have on our facility and our community in order to make appropriate decisions moving forward.”

 

Email your questions to editor Steven Andrews at [email protected].

HCPro.com – JustCoding News: Inpatient

Keep These ICD-10 Codes Handy for Holiday Mishaps

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Besides being a time for giving and promoting peace on earth, December is the month of holiday preparation, gathering with loved ones, and celebrating. With so many festivities and too much holiday hustle and bustle, accidents happen. here are some ICD-10 codes you may see this season. Christmas Preparation Accidents These codes are useful if you fall while […]

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AAPC Knowledge Center

Medical Tourism Company – cost effective treatment with free holiday package

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In the dynamic world of international health care medical tourism is a growing trend. It offers an excellent prospect of getting world-class medical treatments in the lap of foreign hospitality. Going for a change to improve health is an age-old practice among people in different parts of the world. Medical tourism can be considered as an evolved form of this age old habit of humanity. The cost for medical treatments has become the major consideration for most of us today. All people do not have the same ability to get treatments for ailments that really costs a lot. So for those people thinking of getting treatments for diseases like cancer, bone marrow treatments and many other treatments can cost huge amount of money. This is where medical tourism can make a big difference. Through national medical tourism a leading medical tourism company one can get the best treatments under experienced and knowledgeable professional doctors as well as caring nurses. The most essential point is treatments in India would cost them cheaper than treatments for different ailments in countries like Canada, England, and other European nations. medical tourism packages offered by national medical tourism India provide many advantageous, a few among them are like: – Reduced waiting periods for your treatments. – At times of needs you can initiate the process through contacting healthcare professionals. – Facility to travel exotic destinations of the land. – Prior fixing of appointments with the doctors. – Booking of hotels before your arrival for treatments. It is generally found that most of the hospitals in US or U.K have lengthy waiting lists and necessitate wait for substantially for a longer period of time. So do you want to get a major expensive treatment or do you want a treatment at a low and affordable price, the thing is you have to decide whether you want a treatment at a low price or do you want treatments for various ailments at an affordable price in the lap of foreign hospitality. Previously India was regarded as underdeveloped with regards to medical treatments. But today the scenario has completely changed. Medical tourism in India is fast developing concept whereby patients from all over the world are visiting India for the purpose of medical and surgical care. Medical tourism india costs: The appeal for medical tourism is a low-cost treatment. Of course you can get huge reduction in your cost of investment for treatment in India but medical tourists can enjoy holiday package. India today has become a preferred destination for medical treatments. Today, tourism company India facilities treatments for different procedures like bone marrow transplantation, brain surgery, cardiac procedures cosmetic surgery, kidney transplant, neurosurgery and other treatments. Are you suffering from the disease like kidney problem then the best option is to get treatment through tourism company India that can help you to get the best treatment from experienced as well as professional doctors. The medical tourism services offered by India medical tourism are outstanding. Low cost treatment that you can afford. So you can save your money and time now. You can receive at the same time world class treatments for various types of ailments like cancer therapy, cosmetic surgery and many more at a cost effective price affordable by all. For more info visit: http://www.nationalmedicaltourism.com/

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A holiday checklist for HIM managers

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By Dom Nicastro
 
Some say the holidays are a time for joy. Others find stress and chaos in the last six weeks of the year.
What do your coders feel as we wind down the year? It’s a good time to check their pulse if you’re an HIM manager or director—especially in light of ICD-10 implementation.
 
“Change is stressful on staffing,” says Darice Grzybowski, MA, RHIA, FAHIMA, president of HIM best practice consultancy HIMentors, based in Westchester, Illinois. “Many organizations lost key HIM coding staff prior to the ICD-10 go-live. Recruitment and retention strategies are key to maintaining a healthy revenue cycle process.”
 
Ask yourself if you have put in place specialized retention, recruitment, or incentive plans to keep coding and CDI staff happy and productive, Grzybowski adds.
 
HIM managers and directors can add these to-do items to their closing-out-2015 laundry list. How else can you tidy up the HIM ship as the end of the year nears? Coding experts told JustCoding that HIM directors and managers should also run a gap analysis of the ICD-10 early stages.
 
Are your coders happy?
This year is as good as any to recognize your coders’ hard work. They just underwent perhaps the most significant transition in their professional careers, ending a long journey of training, preparation, uncertainty, fear, and doubt. And that’s on top of their regular workload.
 
They want to feel appreciated more than ever, says Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC, vice president of training and education for Salt Lake City-based AAPC.
 
“You’ll want to reward your employees for the good work they’ve done throughout the year,” Jimenez says, “whether it’s a bonus or a personal gift from their manager. It’s good for them to know their manager took time to think of them, especially with the year they’ve had with ICD-10.”
 
Tell them you recognize the work it took on their part—the coordination, the training—to transition to ICD-10.
 
“Some people respond well to a handwritten thank-you note specific to them,” says Jimenez. “If everyone gets the same message, they may think this is one of those canned things. But if you do something unique for that individual, it goes a long way saying specifically what they did that year that you appreciated.”
 
ICD-10 has upped the stress levels significantly, Grzybowski says. Allow adequate time off—versus months of continuously mandated “overtime”—to reduce burnout. 
 
“Salaries aren’t the only reason for change,” she says, “but not having regular feedback meetings, not having good equipment/resources, and not feeling involved in decisions plays a part. Of course, money and benefits and a flexible work schedule is important.”
 
Grzybowski works with hospitals to set up incentive coding plans and tiered coding career ladders to ensure diversity of work and bonuses for not only productivity, but also quality of work. 
 
“Coders are the heart of hospital reimbursement,” she says, “and it’s critical to keep coders happy, educated, and productive members of the HIM team.”
 
ICD-10 checkpoint
Now is a good time to run an ICD-10 gap analysis, says Jimenez. Coding staffs went through a good amount of preparation for ICD-10. Revisit budgetary items. Did all your requests and expectations come to fruition?
 
“Now that we have implemented ICD-10, see if those plans are really meeting your business needs at this time,” Jimenez says.
 
Did you bring in additional staff? If not, will you need more now that you’ve got a good idea what it takes to get codes out in a typical week under ICD-10? If you’re managing an outpatient coding team, HCPCS and CPT® code changes will be important.
 
“Some HIM managers will be involved in reimbursement and billing,” Jimenez says. “They’ll have a general understanding and accounting of how codes impact revenue. Or it may be something that only the revenue cycle management team deals with. Depending on how involved with that you are, it’s important for managers to understand the (OPPS and IPPS) final rules and how it impacts facilities.”
 
HIM directors and managers can now see payments coming in from ICD-10 and recognize where the problem areas are.
 
“Everyone was preparing for doomsday,” Jimenez says, “and we’ve seen ICD-10’s not been as problematic as we were all led to believe. It didn’t live up to its hype. But it’s good to evaluate your wins and misses and quickly make up your misses.”
 
Something missing?
Grzybowski already does see some issues with ICD-10 coding in terms of data integrity, especially in physician or clinic billing.
 
Although ICD-10 codes were just implemented October 1, she agrees it’s not too early to audit and see how accurately you are assigning and capturing the correct codes.
 
Grzybowski says she’s seen a lot of missed opportunities—though they may be invisible because the codes still get paid and processed without error. However, they’re highly inaccurate due to omissions and lack of specificity in coding. This is especially true, she says, in the physician clinic area. 
 
“Ask yourself if you have a trusted coding/[clinical documentation improvement] audit partner in place who can work with you to help educate staff and physicians and get to the root cause of problems in coding workflow,” Grzybowski says.
 
Were these problems already evident in ICD-9-CM?
 
Not really, Grzybowski says, because “the specificity wasn’t there.”
 
“Now,” she adds, “you can identify, for instance, whether this was an initial treatment for a specific diagnosis, or a subsequent visit, or dealing with the sequelae by a doctor. If the physician’s office is not taking care to include the seventh character correctly, this can impact insurance coverage for injuries or rehab care, etc.”
 
Another example is using incorrect coding guidelines. A doctor orders an MRI because the patient had a dizzy spell and facial numbness. The correct diagnoses on the initial visit are the dizziness and facial numbness (symptom codes). The doctor may have ordered the MRI to rule out a stroke.
 
“However if the billing service codes ‘stroke’ as the diagnosis—as opposed to the symptoms of the dizziness and numbness—and then the MRI is negative, there could be a medical necessity denial problem,” Grzybowski says. “Symptom codes are always to be billed for outpatient care unless the diagnosis is definitive.”
 
Educate—then educate some more
It’s up to HIM directors and managers to take the lead on this through education and auditing. A doctor’s office may be the facility at the most risk compliance-wise, Grzybowski says, if they have hired a billing/coding service that is not following guidelines. 
 
“The scariest thing I hear is when coders or a billing company say, ‘We just code what the doctor tell us to or whatever is on the report that comes out of the [electronic medical record],’” Grzybowski says. “It is evident that poorly designed crosswalks are putting out inappropriate codes that do not distinguish symptoms from rule-out conditions and are using erroneous codes due to misinterpretation of coding guidelines.” 
 
She predicts we’ll see more cases audited, problematic insurance company reimbursement, or post-payment takebacks because of this issue. 
 
“So when people say it’s ‘calm’ post-ICD-10,” Grzybowski says, “I don’t think we have even started to see some of this fallout, and may not for a good number of months, or even a year from now. The important thing is to audit and then educate, and make change happen for compliance.”
 
Email your questions to editor Steven Andrews at [email protected].

 

HCPro.com – JustCoding News: Inpatient