I was wondering if any other critical access hospitals are dealing with insurance companies changing the level of care for a patient. Example is an observation patient, transferred to acute care and the insurance company stating it will only pay if the patient’s stay is ALL observation. If anyone has any information on this topic, I would appreciate some input.
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Tag Archives: Thoughts
Peripheral thoughts
Would this be 37225-LT, 75710-26-59-LT I73.9?
Also, does can anyone recommend any good resources/tools/mentors for learning more about peripheral coding/coding interventions similar to these? I want/need to understand these better!
Thank you in advance!
PROCEDURES PERFORMED:
Right common femoral artery access catheter placement and contralateral
popliteal arthrectomy of the left SFA, PTA of the left SFA, and above
knee POP.
COMPLICATIONS:
None.
ESTIMATED BLOOD LOSS:
Less than 5 mL.
INDICATION FOR PROCEDURE:
Recurrent claudication, lifestyle limiting symptomatology.
COMORBID FACTORS:
Coronary artery disease, end-stage renal disease on peritoneal dialysis.
CONSCIOUS SEDATION TIME:
One hour.
DESCRIPTION OF PROCEDURE:
After informed consent, discussion of risks and benefits, a 5-French
sheath was placed under ultrasound guidance in the right common femoral
artery. A catheter was placed up and over, aortography was done, selective
angiography was done. There were no complications.
ANGIOGRAPHIC FINDINGS:
Right common femoral artery, diffuse calcium. Common iliacs bilaterally,
mild disease. External iliacs bilaterally, mild disease. Left common
femoral, mild disease. Left SFA, heavy calcification from the ostium
all the way to the popliteal with multiple 90% stenosis. Runoff is
via the posterior tibial, the peroneal terminates at the ankle and reconstitutes
at the dorsalis pedis.
INTERVENTION OF PROCEDURE:
Given the diffuse nature of the disease and the extensive calcification,
we did have a Vascular Surgery consult for possible femoral-popliteal,
and they recommended endovascular therapy as well. The patient was
anticoagulated to a therapeutic ACT. A 6-French sheath was placed up
and over. We got across where the ChoICE PT wire, which was exchanged
for a stiff Viper wire. Atherectomy was done with a 2.0 classic diamondback
at low and medium speeds throughout the SFA. Balloon angioplasty was
done with a 5.0 x 150 drug balloon. The same balloon was used to treat
the proximal SFA. Final angiography showed non-flow limiting dissection
with good flow. Runoff was confirmed to be unchanged. There were no
complications. The 6-French sheath was exchanged for a short 6-French
sheath and will be pulled manually. The patient was given 600 mg of
Plavix. There were no complications. The patient does have significant
SFA and popliteal disease on the right as well, which is amenable to
endovascular intervention.
Auditing suggestions or thoughts
We are a hospital based clinic, Article 28 billing behavioral health services in NY. We are looking into doing internal audits on the charge capture, coding and billing of these services; does anyone have a process they would like to share or audit documents they would like to share that may be helpful as we start this new process?
If anyone has specific payer insight or situations you have encountered with payers I would love to hear about them as well.
If anyone has specific payer insight or situations you have encountered with payers I would love to hear about them as well.
Thanks!
Peripheral Thoughts
Could someone check my codes…I think I’m finally starting to get these with all the feedback and help I’ve been provided here but still need some guidance. Thank you in advance and to anyone who has helped (Jim P. especially!)
37225-LT, 37228-LT, 75710-26,59, 75625-26, 99152
PROCEDURES PERFORMED:
Right common femoral artery access, catheter placement, and contralateral
posterior tibial angioplasty of posterior tibial into the plantar arch,
angioplasty, arthrectomy of the left SFA, and balloon angioplasty of
the left SFA.
CONSCIOUS SEDATION TIME:
1-1/2 hours.
Intra-Service Start Time: 1037
Intra-Service End Time: 1219
COMPLICATIONS:
No reflow of the posterior tibial, which was treated with the intra-arterial
nitroglycerin adenosine and balloon angioplasty. Final pictures showed
excellent flow.
INDICATION FOR PROCEDURE:
Gangrene threatened lower extremity.
DESCRIPTION OF PROCEDURE:
After informed consent, discussion of risks and benefits, a 5-French
sheath was placed on the right common femoral artery. Catheter was
placed up and over. Angiography was performed.
ANGIOGRAPHIC FINDINGS:
Abdominal aorta bilateral common and external iliac free of significant
disease. Left common femoral free of significant disease. Left SFA
has a 99% occlusion in the midportion, followed by 4 tandem 90% stenosis.
The popliteal has a diffuse 30% to 40% stenosis. Runoff is via the
posterior tibial, the anterior tibial terminates at the ankle and then
collateralizes to the foot.
INTERVENTION PROCEDURE:
A 6-French sheath was placed up and over. The patient was anticoagulated
to a therapeutic ACT. CSI atherectomy was performed at low medium and
high speeds. Following that, balloon angioplasty was done with 2 inflations
with a 5.0 x 150 drug-coated balloon. There was significant improvement
in the lesion. Angiography did show no reflow on the posterior tibial.
We then put a catheter and wire down into the posterior tibial, got
into the plantar arch, did a balloon angioplasty of the plantar arch
with a 1.5 balloon. Balloon angioplasty of the posterior tibial with
a 2.0 balloon. The patient was given about 1000 mcg of intra-arterial
adenosine and 600 mcg of nitroglycerin. Flow improved. The patient
was stable at the time of case completion
with good flow into the foot. The sheath will be pulled manually. The
patient was given 600 mg of Plavix. Closing ACT was 308.
DA/12287980/MODL
Staying Positive – Some Thoughts For Job Seekers (And Also, Employers)
I began applying for jobs in August, right before I started training. Based on advice from my friends in the medical field, and experienced coders, I’ve applied for every entry level, "foot in the door" position I could find. Jobs like document scanning, data entry, reception desk, phone switchboard, and even housekeeping. Positions that specifically stated in their postings, "no experience necessary" or "at least one year of customer service", "must have working knowledge of computers", etc. Basic jobs. Between then and now (my training has been complete for about a month) I have applied to nearly 60 different positions, with a strong resume, cover letter, references, and a clear objective. Out of all of those jobs, I have received maybe 40 responses, with some variation of "You are not qualified" or no response at all. I even pushed back the date of my CPC exam, to focus on trying to lock down entry level work. I have posted in the forum before, about how I have two decades of retail management experience. And, anyone who has ever been in that particular field can tell you, you have your hands in everything. From banking, to dealing with sensitive information, HR, taxes and payroll, hiring/training personnel, doing paperwork, taking meetings, scheduling, running office equipment, using every computer software program known to man, answering phones. And, complicated things, like supervising packed stores, dealing with hostile customers, assisting large numbers of people at once, managing a staff of 20+ people sometimes, alone. And yes – housekeeping. It’s a role that always kept me on my toes. A role where customer service was always the biggest component, thus, the main priority. Yet, in the eyes of hiring reps for healthcare jobs, at least in my area, I am not qualified to answer a phone, process a payment, file papers/records, or deal with clients/patients in a customer service related position. As I prepare to finally sit for my CPC exam – which I am very confident about – I do remain concerned about my chances in the job market. I’ve heard horror stories from people with 30 years in billing, who couldn’t find coding work. And, I’ve heard horror stories from people like myself and others on this forum, who are new, and genuinely wanted to make a career change, but were not being considered for one reason or another. I’m trying to fight through the doubt and remain optimistic. The bottom line is, you can’t get that 3-5 years of experience that most employers are looking for, unless someone gives you a chance. And everyone deserves that chance. Especially if they are serious and legitimately care about being in this industry. And, I’d say 99% of us are! I spent nearly 20 years interviewing, hiring, and training people, and while I took their resumes into consideration, I also looked at their potential. I understood that if someone was applying to work for me, it was because they wanted to, and felt as if they had something to contribute. I always hired people who were motivated, willing to learn, and ready to jump in with both feet, no matter how new or scary it may have been for them. More importantly, I always had respect for people who were trying to make a positive change in their lives, by taking on a new challenge. I hope that anyone in my position, who is struggling, certified yet or not, will keep pushing. Knock on doors, apply to everything, until someone finally says "Yes." And, for anyone looking to hire new coders – be it for actual coding, or for an entry level, "foot in the door" job (because we WANT to work, we WILL take it if it’s the right fit!), don’t judge them solely on their background. Look at their experiences, see where they’ve been, where they want to go, and what they could bring to the table. You might come to find out that an ex retail manager, a stay at home mom, or a McDonald’s cashier could be a great addition to your team. Newbies, don’t ever lose sight of the fact that we have all worked hard to train and earn our certifications. Keep going!
Survey respondents share their thoughts on HIM roles and compensation
2016 HIM director and manager salary survey
More HIM professionals needed to manage an increasing workload, responsibilities
When compared to data from past surveys, HCPro’s 2016 HIM director and manager salary survey revealed a harsh truth that many HIM professionals already know: There has been little movement in HIM manager and director salaries over the years.
This year, the highest percentage of respondents indicated earning between $ 60,000 and $ 89,999 annually, an amount that has not budged much since 2013 (see the figure on p. 3). The percentage of respondents earning less than $ 40,000 decreased from 7% in 2013 to 4% in 2016, and the percentage of those earning $ 150,000 or more increased from just 3% in 2013 to 6% in 2016?but this is happening during a time when the HIM department is often tasked with doing more work with fewer resources.
"As budgets get tighter, we get more responsibility with the increase in pay," one respondent said.
Another respondent echoed those sentiments: "It is not so much the pay as the ever-increasing workload. We need more bodies throughout HIM, not necessarily more money."
Despite the fact that average salaries have remained fairly consistent since this survey was first conducted, 78% of 2016 respondents received a raise in the past year. One-third of respondents (33%) received a 3% raise, and approximately one-quarter (26%) received a 2% raise.
While 56% of respondents feel they are fairly compensated for the work they do, 62% do not believe HIM directors and managers overall are sufficiently compensated for their work.
Statistics
More than half (53%) of this year’s respondents work as HIM directors, and 29% work as HIM managers. The majority (93%) of respondents are female. One respondent noted the ties between gender and salary in the workplace.
"There is still gender disparity?females are not paid the same as male counterparts for same/similar work," the respondent said. "There are other healthcare professionals with less responsibility/scope earning more. HIM professionals tend to have a wider scope of responsibility with multiple specialized functions."
Half of the respondents work at acute care hospitals, and 15% work in critical access hospitals. The plurality of those working in a hospital setting are in hospitals with fewer than 199 beds (42%), whereas more than one-quarter (26%) work at hospitals with 200?599 beds and 18% work at 600+ bed hospitals. The remainder of respondents do not work in hospital settings.
Experience, education, and certification
The percentage of respondents whose highest level of education is a bachelor’s degree remained steady at 42% from 2015 to 2016, which is an increase from the 30% of respondents with a bachelor’s degree in 2014. Similarly, the percentage of respondents whose highest level of education is an associate’s degree decreased from 22% in 2015 to 20% in 2015, indicating that a baccalaureate-level education is becoming the standard in the HIM profession. Although 21% reported earning a master’s degree, none had a doctoral-level education.
More than half of those whose highest level of education is an associate’s degree earn $ 50,000?$ 69,999 annually (54%), whereas most respondents with a bachelor’s degree earn $ 60,000?$ 89,999 annually (44%). (See p. 4 for more information.)
The majority of respondents are aged 40?59. The plurality of respondents (20%) have 21?29 years of HIM experience, a figure that has remained relatively steady since the 2015 survey. Just 13% have 3?5 years’ experience, and just 7% have 6?10 years, while 16% have been in the profession 30?39 years, indicating that HIM may need some fresh faces as directors and managers near retirement age.
The plurality of respondents with 16?20 years’ experience earn $ 70,000?$ 89,000 annually, whereas the plurality of those in the profession 21?29 years earn $ 80,000?$ 89,000 annually (23%). However, 30% of those with 30?39 years’ experience earn $ 150,000 or more.
Nearly half of this year’s respondents (43%) are certified as registered health information administrators (RHIA), compared to 53% in 2015. The percentage of respondents certified as registered health information technicians (RHIT) increased from 28% last year to 31% this year. The percentage of respondents who are certified coding specialists (CCS) increased from 16% in 2015 to 25% in 2016.
The percentage of respondents with an RHIT certification whose highest level of education is an associate’s degree continues to climb?78% in 2015 compared to 82% in 2016. These respondents appear motivated to earn certifications, with 32% holding a CCS certification this year compared to 19% in 2015.
In general, HIM directors and managers are obtaining CCS certifications. Among respondents whose highest level of education is a bachelor’s degree, one-quarter are CCS certified this year compared to 12% in 2015. However, the percentage of respondents with this level of education who are RHIA certified dropped from 68% in 2015 to 56% in 2016, while the percentage of those with an RHIT certification increased from 17% in 2015 to 22% this year.
RHIA certification also declined among respondents whose highest level of education is a master’s degree?84% in 2015 to 70% in 2016. The percentage of respondents in this group who are RHIT certified increased at a rate similar to respondents in other educational categories, more than doubling from 6% in 2015 to 13% in 2016.
Benefits and overtime
The percentage of respondents who work 42?50 hours weekly continues to increase, with 55% in 2014 compared to 58% in 2015 and 60% in 2016. However, 76% of 2016 respondents indicated that they are not compensated for overtime. Those who are compensated receive one and a half times their regular pay (9%) or time off in lieu of additional pay (2%).
Despite an increasing workload and a growth in the number of hours many respondents work, few have seen an increase in their benefits, including health coverage, retirement plan matching, pension plans, travel budget, vacation and holiday time, tuition reimbursement, continuing education budget, and the ability to accrue time off.
One respondent indicated that he or she does not receive any bonuses or perks, yet is still expected to take on more work. "I was given clinical documentation improvement [CDI] responsibilities in the last year with no salary increase. I am the inpatient coder and I do CDI by myself. I am also over privacy. When my salary is determined, privacy, CDI, and coding are not taken into consideration in the calculation?only the salaries of HIM department managers in the immediate area are considered."
Respondents were split on whether overall HIM salary, benefits, bonuses, and job perks keep up with the cost of living, with 56% stating these benefits have not kept pace throughout the industry. "It is similar to most industries?more work is added and cost of living rises and companies are able to keep up with rising costs," one respondent said.
Similarly, respondents were asked if their personal salary, benefits, bonuses, and perks keep up with the cost of living; more than half (51%) said no.
HIM responsibilities
In years past, respondents listed release of information as their top responsibility, with 76% responsible for this function in 2014. This figure remained steady, at 72% in both 2015 and 2016.
However, in the wake of ICD-10 implementation, the percentage of respondents working on coding increased from 70% in 2014 to 72% in 2015 and 77% in 2016. Other responsibilities appeared to dip slightly as coding took center stage, although the percentage of HIM directors and managers responsible for CDI increased from 45% in 2015 to 56% in 2016, which is not surprising as this function often goes hand-in-hand with coding.
Other responsibilities include the following:
- Document imaging, including preparation, scanning, indexing, and verification (65% in 2016, 2015, and 2014)
- Transcription, including report processing, interface failures, corrections, and distribution (53% in 2016, 57% in 2015, and 55% in 2014)
- Privacy (43% in 2016, 52% in 2015, and 51% in 2014)
- Recovery Audit program (33% in 2016, 30% in 2015, and 37% in 2014, which may be attributed to the temporary hold on these audits)
- Compliance (30% in 2016, 27% in 2015, and 32% in 2014)
- Birth certificates (33% in 2016, 31% in 2015, and 26% in 2014)
- Tumor registry (21% in 2016, 24% in 2015, and 20% in 2014)
- Security (15% in 2016 and 2015, 18% in 2014)
- Utilization review (5% in 2016, 6% in 2015, and 12% in 2014, which may indicate that this function is moving to other departments such as nursing or case management)
- Case management (2% in 2016 and 2015, 4% in 2014)
Survey respondents share their thoughts on HIM roles and compensation
HCPro’s HIM Briefings asked 2016 HIM director and manager salary survey respondents about their satisfaction with their roles, compensation, and benefits. They said:
"I think that the revenue the HIM departments generate and are required to ensure/validate compliance the salaries are way off in comparison to job requirements!"
"I suspect that people don’t realize the location has a lot to do with salary/compensation. Salaries for these positions in smaller communities is generally less."
"Some of my colleagues have not kept current with trends in the EMR, permitting IT staff to take control. I think this has lessened HIM’s role in some institutions. We have fought to get to the discussion table and have shown how our experience has a great value in implementing systems."
"Sometimes, we are branded one of the ‘non-revenue producing’ departments so we are an afterthought."
"The amount of work and knowledge needed in the role is comparable to information systems roles and the salaries are not comparable."
"HIM work is not understood nor appreciated. We are a critical member of the team."
SAFER in practice; Thoughts on Joint Commission’s new scoring matrix
There’s been much ado about The Joint Commission’s new scoring system, the Survey Analysis for Evaluating Risk (SAFER) matrix. But, unless you happened to be one of the facilities surveyed in the last four months, it means that you still haven’t seen SAFER in practice. So what are people saying about the new system? Is it better or worse than the one that came before?
Victoria Fennel, PhD, RN-BC, CPHQ, director of accreditation and clinical compliance at Compass Clinical Consulting, says Compass has heard from clients who’ve experienced the matrix and most of the feedback has been very positive.