2016 HIM roles and responsibilities survey

HIM professionals report on their expansive role in the revenue cycle

For approximately 10 years, HIMB has been gathering data about the HIM profession through its annual salary survey. This survey often gives us a glimpse into the responsibilities of HIM professionals, but focuses primarily on the education, experience, and salary of those in the HIM field.

Time and again, the salary survey reveals that HIM directors and managers are wearing many hats and asked to oversee an increasing number of tasks. In an effort to dig a bit deeper into HIM departments, HIMB conducted its first HIM roles and responsibilities survey.

More than half of respondents were HIM directors (26%) or managers (25%), whereas the remaining 49% held other revenue cycle positions. Of the latter group, 50% were coders and 29% were CDI specialists. Responses also came in from transcriptionists, privacy officers, compliance officers, revenue integrity professionals, and consultants.

HIM demographics

The plurality of respondents work in acute care hospitals (55%) and critical access hospitals (17%) or have a corporate position at a multi-system hospital (8%). Other settings represented in the survey include long-term acute care hospitals, psychiatric/behavioral health hospitals, skilled nursing facilities, ambulatory surgery centers, and physician practices.

On average, most respondents appear to be working in a hospital with 100?199 beds, with approximately 20% of respondents selecting this option. Nearly 18% work in hospitals with fewer than 25 beds, and 15% work in hospitals with 500 or more beds.

HIM reporting structure

Nearly half of respondents (48%) report that more than 20 staff members report to the HIM director and/or manager at their facility. Nearly one-quarter (22%) of respondents reported that 0?5 staff members report to the HIM director/manager at their facility. The remaining 30% of respondents said the number of employees reporting to HIM is more than five but less than 20.

The majority of HIM departments represented in the survey (78%) report to their facility’s chief financial officer. Others tend to report to the chief executive officer (13%) or chief information officer (9%). Some respondents wrote in to clarify their reporting structure after selecting one of the aforementioned broader options. Write-in responses indicate HIM may also report up to:

• Vice president of finance
• Vice president of health data support services
• Vice president of revenue management
• Vice president of revenue cycle
• Vice president of quality management
• Chief quality officer
• Chief medical information officer
• Chief revenue officer

Similarly, HIMB asked respondents which roles report to the HIM director/manager. The top three roles reporting to HIM include release of information staff (90%), coders (89%), and transcriptionists (76%). Less than half of CDI specialists (45%) and privacy officers (42%) report to HIM. And less than one-quarter of information governance (22%), compliance (16%), security (14%), and revenue integrity (12%) staff report to HIM directors/managers. A lesser percentage of risk management (5%) and case management (4%) professionals fall under HIM.

Some respondents wrote in to note that HIM is often responsible for overseeing registration, billing, collections, record management, and patient access.

Respondents indicated that transcription is the most frequently outsourced role in HIM, with 61% indicating their facility outsources this function. "It is very convenient, as transcribers are situated throughout the states and reports are transcribed timely for late night physician dictations," one respondent said.

More than one-third of facilities surveyed (34%) have also opted to outsource release of information (ROI) functions. "We have a one-person department. ROI is outsourced only as it applies to requests from lawyers, courts, and disability agencies. HIM handles requests from hospitals, doctors, and patients," one respondent said.

Other functions frequently outsourced include archives/warehouse storage (33%) and inpatient (28%) and outpatient (24%) coding. (See the figure on p. 3 for more information about outsourcing.) One respondent noted that his or her coding and transcription is only partially outsourced.

"Our outsourced outpatient coding position is for only 20 hours a week. She codes clinical accounts as well as observation and outpatient surgery cases," a survey respondent said.

Respondents seemed to be split on whether outsourcing was the best option. While some respondents noted that outsourcing was helpful in terms of managing costs, others stated that it was expensive. However, for facilities with limited resources and space, it seems to be a viable option.

"Coding is outsourced due to the limited resources we had available at our facility, such as qualified coding candidates in our geographic area as well as competitive compensations with surrounding areas," one respondent said.

While some facilities reported outsourcing functions due to lack of resources, others are simply using it for backfill and vacation coverage or simply to ensure coverage after hours and on weekends for certain functions. "The services outsourced above are mainly outsourced because of the lack of resources to hire qualified personnel who can do the job. In a recent analysis it was also shown that the price we pay for outsourcing coding was low compared to the price it would cost to have it in house," one respondent said.

Notably, one HIM director stated that his or her function is entirely outsourced. This seems like it may present a challenge given that HIM directors and managers are involved in so many projects.

HIM responsibilities

According to survey respondents, HIM directors/managers are actively responsible for the following functions (see the figure on p. 3 for more information):

• Prepping, scanning, and quality checks for medical records (96%)
• Record retrieval, assembly, and analysis (93%)
• Delinquency management (88%)
• Transcription (79%)
• Enterprise master person index/master person index (56%)
• Archives/warehouse management (51%)
• Patient identity management (46%)

When asked to expand upon their roles in HIM, respondents described their responsibilities in various ways, backing up what we have long seen in the HIM director and manager salary survey about HIM playing many roles.

One HIM manager responding to the survey stated that he or she supervises coder education and training, "providing orientation and initial job training for coders, ongoing and new software/processes training for coders and CDI, including all ICD-10-CM and ICD-10-PCS training as job-required."

An HIM director responding to the survey stated that he or she is "responsible for direction and overall performance of all chart assembly, analysis, and coding." This respondent also noted involvement in "ROI functions and all internal and external audit reviews." As if that doesn’t sound like enough to keep one HIM director busy, this particular respondent also noted involvement in the following:

• Quality improvement
• Utilization review
• Chart delinquencies and CMS reporting requirements
• Working with CDI and physicians on chart requirements and timely documentation

See the sidebar on p. 5 for specific information about responsibilities of various titles within the HIM department.

Despite everything HIM directors/managers have on their plates, most respondents chimed in when we asked which committees HIM should play a role in. Respondents wrote in that HIM should participate in committees related to the following:

• EMR/EHR
• UR
• Billing
• Quality
• Finance
• Compliance
• HIPAA
• Credentialing
• Forms creation
• Population health
• Patient services
• CDI
• Medical executive
• Nursing
• Appeals and denials
• Revenue integrity
• Information governance

If it seems like we just listed off the majority of hospital departments, that’s because we did. Despite an ever-growing list of demands, HIM managers and directors are well suited to take a seat at the table with any of the above departments/committees and are often eager to do so.

"HIM participates in information governance, and quality meetings. I would suggest that our HIM department also participate in medical executive meetings and also ambulatory care meetings," one respondent said.

While some respondents were specific about which committees HIM should be a part of, others simply stated that HIM had earned a seat on any committee that was related to the revenue cycle. "I think HIM should participate in any and all committees needed, as the HIM department touches every piece of PHI that enters the hospital, whether that be on paper or electronic. HIM representation at meetings, I believe, is very important," said an HIM director.

Challenges facing HIM today

We asked survey respondents a variety of open-ended questions about the HIM department at their facility. When asked to identify challenges facing HIM, respondents said the following:

• "HIM professionals are rarely acknowledged for their impact and knowledge they have that benefits the facilities they work at. Most leaders and other departments have no idea what we do and typically will call us ‘glorified paper pushers.’ Because of this, compensation is not where it should be."
• "Movement to an EMR. Dealing with issues with copy and paste functions within an EMR. Acquiring accurate information on admission with an accurate MPI. Being included in meetings and decision-making that affects the HIM function."
• "Lack of staffing. Not all facility staff are aware of all the HIM tasks, so they think we only put papers together all day and nothing else."
• "Building a coding department. Ensuring accurate coding and impact to patient safety indicators. Accurate physician documentation."
• "Competing salaries with outsource companies for coders and coders wanting remote work only."
• "It seems that most HIM jobs are outsourced and that we are having to pick a specialty (CDI, Privacy/Security, coding, EHR, etc.) to keep a foothold in our business. It’s not the old HIM department as we knew it!"
• "Our greatest challenge is the hybrid medical record. Know what is electronic and where it is located in the HIS system and what is still paper. Some physicians still will not electronically sign. Along with EMR is the multiple systems that interfaces must be built for information to be shared which adds to cost."
• "For us I believe that is trying to get us that last 5% totally electronic. Overall, I would say support of providers to use the electronic system, so that we can get away from pushing around so much paper. We have gone from a department of eight to a department of five in my five years here; we, as well as many other departments, are being asked to do more with less. That is a challenge."

Inside the HIM department

Ever wonder what the inside of another facility’s HIM department looks like? Of course you do. To satisfy our curiosity, we asked respondents to describe the makeup and location of the HIM department within their facility:

• "HIM is on the main level of the hospital. We are located on a separate wing by ourselves away from main traffic of the hospital. It would be beneficial to be more centrally located so that patients can better find us when they need records. The coding department is across the hall from us in a separate office."
• "Ground floor next to administration, away from the physician lounge. Would be better being closer to the physicians to get records completed. One in-house coder for ancillary coding. All staff in area for ROI, birth certificates, assembly and analysis, scanning, but file room is located across the hall."
• "HIM at my facility is on the ground level. In fact, I think we are in the perfect location for patient access because we are right inside the door. From the HIM department we only have HIM personnel working alongside each other. Coding works at home and at our affiliate site. Transcription is outsourced. We do share space with another department, not HIM related."
• "We are located on the first floor of the hospital. Our coding and transcription functions have been regionalized and are managed off-site. The majority of our coders work from home."
• "Ground level. Coding, scanning, and records review share a large office. Transcription and CDI are in different areas of the hospital."
• "All of HIM, except for CDI, are all located together in a medical office building on campus. A CDI [specialist] is assigned to a specific floor/unit and works from there."
• "The HIM department is on the patient floor with coding being done on-site and remotely. Transcription is contracted out and performed remotely and HIM clerical personnel on-site at each building."
• "HIM located within the core of the patient care area. Four of five HIM staff share the office with the manager."
• "Basement of hospital for scanning, chart completion, data integrity. Off-site for HIM at rehab, skilled, homecare. Coding is in a separate building off campus."
• "We have a separate building from the hospital for all non-clinical employees. Most of our coders work from home. All of HIM is in one big area of the second floor."
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Survey respondents weigh in on roles and responsibilities

To understand the intricacies of the HIM role, we asked survey respondents a variety of open-ended questions about the HIM department at their facility. When asked to describe their role and responsibilities as they relate to HIM, respondents said the following (the title that follows each quote was selected by the respondent regardless of the scope of responsibilities described):

• "My role is inpatient coder and involved in DRG appeals sending out letters of redetermination to insurance companies?HIM department separated from coding/CDI department." ?Coder
• "I manage the coding and CDI functions within the HIM department. I make sure the coding service is up to date on any facility changes and monitor that they are meeting service agreements." ?HIM manager.
• "I am a coder and credentialing coordinator by title, however, I perform every single task in HIM department?transcription filing to chart assembly and analysis, denial follow-up cases due to documentation or coding issue, physician delinquent rates, subpoenas and other ROIs, etc." ?Coder.
• "Only employee?coder, data entry, chart completion, analysis, physician visits, medical staff, release of information." ?Non-director/manager in HIM.
• "Revenue cycle director, HIM director, privacy officer. I wear several hats to coordinate the areas of admitting, scheduling, switchboard, business office, and medical records." ?HIM director.
• "My role and responsibilities as the HIM director and privacy officer include education on HIPAA privacy and breach reporting, maintaining the department, conducting and reporting on closed chart reviews, coding quality and quantity, transcription quality and quantity, and other personnel’s productivity. I also play a very active role in educating physicians on using the EHR and completing their records; track delinquency rates; and assist IT in managing information." ?HIM director.
• "I am an outpatient coder coding some clinical accounts but primarily outpatient surgery and observation accounts. In addition to coding, I check charges on each account to make sure we have a revenue code to link the CPT code to and have charges for any implants/devices that were used. Each account finalized is then sent to billing so the more we code, the faster the billing department can send the bills." ?Coder.
• "We share/rotate responsibilities in our small department between outpatient ancillary coding, transcription, ROI, prepping charts for scanning our hybrid record, quality controlling scanned documents. I’m in training to take over for my director when she retires in two years. I’m also the module coordinator for our Meditech computer system, working with our IT lady on issues affecting our department." ?Transcriptionist.
• "I am the HIM coordinator who wears many hats. Coding/privacy officer/quality improvement/core measure reporting/chargemaster/credentialing." ?HIM manager.
• "Manage coding staff, perform compliance audits, provide education to coders, CDI specialists, and physicians. Support management of budget, supplies, etc. Participate in revenue cycle meetings and work closely to develop and submit appeals/address denials." ?Coding supervisor.

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