Journal of the American Health Information Management Association (JAHIMA) recently published a case study authored by myself and Karen Frosch, CCS, CCDS, CRC, CPHQ, CDI Project Manager at Christiana Care on their newly implemented Outpatient CDI program.
With 60% of the Merit-Based Incentive System (MIPS) score for providers coming from risk adjusted quality and resource use scores, it is critically important to accurately reflect the acuity of your patient population. Doing so will allow your quality and cost scores to accurately reflect the care provided by your physicians.
CMS has provided eligible clinicians with a relatively flexible process for engaging in MACRA in 2017. However, in 2018 practices will need to participate more fully in MIPS if they are not participating in an advanced APM. As an HIM leader, does your department have a clear strategy for assisting the affiliated physician groups within your facility or system? Perhaps you are even uncertain what HIM's role should be? Here are 3 key areas where you can contribute.
"Outsourced coders are too expensive", "My internal coding resources are much less expensive than external coders" are statements I hear frequently from HIM leaders. Having worked on both sides of the fence as a HIM department lead on the provider side and now as Chief Operating Officer for himagine it struck me; has this cost gap between internal and external coders ever been quantified or is this more of a perception?
Topics: Coding Services
Most short term acute care providers have a formal inpatient Clinical Documentation Improvement (CDI) program in place as part of their overall coding process. Do you have insight on whether your program is optimally performing? There are 3 key areas I recommend you focus on to best answer that question.
In her blog post, "2 Things HIM Leaders Wish Their Revenue Cycle Peers Knew," Andrea Romero, SVP of HIM Operations at himagine solutions, challenged HIM leaders to become more visible within the revenue cycle function to help improve awareness of the importance and challenges associated with the HIM department. This prompted me to reflect on some of the feedback I receive from clients who are interested in utilizing companies like himagine for audit services. In many cases the client has a desire to go beyond a traditional and episodic compliance audit by developing a more comprehensive approach that addresses individual coder performance on an ongoing basis. Inevitably, this desire is tempered by the fact the HIM department does not have the funds budgeted to initiate such a program and the thought of achieving approval from the senior levels of the revenue cycle organization for this funding seems overwhelming.
Working in a variety of provider settings, ranging from a large, multi-facility health system to a county-owned, short-term acute hospital, has given me a unique point of view on the engagement between HIM and the revenue cycle function. Even in cases where HIM reported directly to the vice president of revenue cycle and ultimately the chief financial officer, I typically felt that awareness of the challenges the HIM Director faced on a day-to-day basis was lacking.
Are you in compliance with your offshore coding vendor? Please read my recently published article in HCPro's "HIM Briefings" (page 8) to better understand where your potential risks are and what you can do to address them.