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Rise of the Super Coder: HIM Professionals in Clinical Documentation Improvement

Posted by Pamela Hess on Jun 27, 2016 10:10:00 AM

RISE_OF_THE_SUPER_CODER.pngIn today’s shifting healthcare landscape, the evolving disciplines of HIM, clinical documentation improvement and healthcare informatics are merging.  The recent implementation of ICD-10 offers additional opportunities to further specify the patient’s condition that enhances provider communication as well as accurate reimbursement.  As risk base insurance models increase, many organizations are in the process of expanding their clinical documentation improvement efforts in order to drive optimized revenue and compliance.

What does this mean for HIM professionals industry-wide?  It means there is increasingly more opportunities, and more demand, to develop the skills needed to become a CDI specialist.  And what does it mean for providers?  It means HIM Professionals with the ability to perform in a clinical documentation improvement role are in more demand than ever.  With the employment marketplace becoming increasingly competitive, quality CDI resources are becoming more difficult to find and when available relatively more expensive when compared with traditional coding resources.  Do providers have another option?  We believe they do via a segment of the coding market we have coined “super coders”.

“Super coder” is an unofficial term we’ve developed to refer to HIM professionals that can perform the majority of functions of CDS at a lower cost.  We believe inpatient and outpatient coders are poised to participate in best in class CDI programs because many of them possess the key skills required to perform in a CDI role.  AHIMA suggests that the key skill sets required for CDI roles include:

  • Knowledge of coding concepts and guidelines and clinical terminology
  • Ability to read and analyze all information in a patient’s health record
  • Clinical knowledge (anatomy and physiology, pathophysiology, and pharmacology)
  • Ability to establish and maintain strong verbal and written communication with providers and other clinicians
  • Knowledge of healthcare regulations, including reimbursement and documentation requirements (AHIMA, 2016 2)

In addition to the requirements set forth by AHIMA, super coders will have been trained in the case review process looking for clinical indicators that might prompt a query because test results or clinical signs and symptoms can point to an underlying condition/diagnosis that was not documented.  They would have been trained in the “art” of physician communication so that there is a higher query response.  The would already have the skill sets required for accurate DRG assignment and how to compare reimbursement/DRG weights when there is a choice between two principal diagnoses.  They would have an in depth understanding of principal diagnosis assignment that results in an accurate DRG assignment with less chance of denial by the payer for incorrect DRG assignment.  Finally, they would also be trained in the review of DRG analytics for monitoring the program success and sustainability as well as identification of focused DRGs and root cause analysis to determine reason for lower DRG/service line performance.

The great news is that providers may already have the coding talent needed to perform clinical documentation improvement.  In order to find out, it is important that providers assess their programs to determine how best to optimize the resources they have on hand.  This is where we can assist.  We work with providers every day to perform program assessments.  Want to learn more about assessing your clinical documentation program and optimizing your coding resources?  Feel free to reach out to me at [email protected]. I’m always glad to have a conversation.

What are your thoughts on super coders?  Do you feel inpatient and outpatient coders are a viable solution to the need for clinical documentation professionals?  I value your input.  Leave your comments below. 

References:

Guidance for Clinical Documentation Improvement Programs (AHIMA 2016) http://www.ahima.org/about/aboutahima AHIMA 2016 1

AHIMA Our Story our History, (AHIMA 2016) http://www.ahima.org/about/aboutahima

(CAHIIM, 2016) http://www.cahiim.org/

E Gardner, A Big Data ACO Effort (Health Data Management) HealthCatalyst, March 3, 2014, https://www.healthcatalyst.com/news/a-big-data-aco-effort-health-data-management/

E King, 2014) ICD10 Monitor, What You Need to Know About Hierarchical Condition Categories and ICD-10, Nov 2013 http://www.icd10monitor.com/enews/item/1072-what-you-need-to-know-about-hierarchical-condition-categories-and-icd-10

Topics: ICD-10, Coding, CDI