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June 30, 2021

Inside this Issue:

President’s Message

As I transition out as your president and the very awesome Jeanette Taylor enters stage right, I get to leave you with one final word.  Many speakers during our annual conference spoke on leadership, especially that of a servant leader.  I have heard this term before, but it is becoming a common descriptor for what organizations and followers look for in their leaders.  It is also a descriptor that individuals are using to describe themselves, especially as it relates to job satisfaction.  In an article by Patricia DeVoy, PhD, EdS, LPN, RHIA, CPC, CPPM, she conducted research on “the application of Servant Leadership Theory to job satisfaction through globally applicable and transferable leadership behavior.”  She applies her findings to the diverse group of HIM professionals which illustrated a link between job satisfaction and servant leadership within a global mindset of leadership.  The foundation of our profession is rooted in serving others and I see that characteristic in almost everyone I meet in this industry. 
Our annual conference was full of wonderful content and it has been my pleasure in serving you as the MSHIMA president this year.  If you did not have an opportunity to participate live, you can still access all of the content from the state meeting after paying the nominal fee.  Registration details are still on our website and you will earn 20 CEUs!  As I step down, I am so excited to see so many new faces volunteering from within our state.
DeVoy, P. (2021, Spring).  An Exploration of Global Leadership and Job Satisfaction in Health Information Management.  Perspectives in Health Information Management.  An Exploration of Global Leadership Behavior and Job Satisfaction in Health Information Management | Perspectives (

Congratulations to Our Newly-Elected 2021-2022 Officers!

Look below to see your 2021-2022 officers:
    Jeanette Taylor, RHIT, CPC
    Ashley Stanford, RHIT
    Kory Hudson, RHIA
    Constance Walley, RHIA, MPH, RHIA
    Jude Haney, PhD
    Ashley Stanford, RHIT
    Mallory Pennington, RHIA
    Michelle Hoover, RHIA, CCS
    April Callahan, CCS, CPC, CPC-I
    Alicia Harris, MBA, RHIA
    Denise Reese, CCS-P
    Stephen Dilatush

MSHIMA Award Recipients

Distinguished Member Award

Cheryl Cooper, RHIA

Educator Award

Jude Haney, PhD

Rising Star Award

Mallory Pennington

Champion Award

Trinity Farr

Mentor Award

LeAnn Bohl    

2021 Scholarship Recipients

Haylie Kent
Itawamba Community College

Haley Black
Itawamba Community College 

Jade Hayes
William Carey University

Dionne Grant
The University of Mississippi Medical Center

Save the Date

2022 MSHIMA Annual Conference

June 2022

Jackson, MS
This event will be held in-person with more details to come.

2021 CCS Bootcamp

September 18, 2021

More details to come!

Successful 2021 Annual Conference

Last Friday concluded our 2021 Annual Conference! Thanks to all of the speakers, board members, and participants for your part in making this conference a success. As a recap, we learned about AI in healthcare, HIPPA updates and policy, where HIM is going, how documentation impacts your bottom line, cybersecurity, and more.
We also want to recognize our sponsors for their commitment to supporting MSHIMA:

Be Sure to “Like” Us on Facebook

If you have not already had the opportunity to ‘Like’ the MSHIMA Facebook page, we encourage you to do so.  We often post engaging content and links to articles and events that may be of interest to you.

Latest FPM Supplement Examines Innovative Care Delivery

Resource Focuses on Behavioral Health Integration, Home-based Primary Care

May 27, 2021, 4:08 p.m. News Staff ― The latest installment in the FPM journal’s supplement series on value-based payment ― “Innovative Care Delivery: Behavioral Health Integration and Home-based Primary Care” ― draws a direct line between VBP’s focus on increasing physician engagement in risk-based payment models to achieve the “quadruple aim” (i.e., better patient population health, better patient satisfaction, lower cost of care and greater primary care team satisfaction) and reliance on flexible care delivery models to provide what the AAFP calls the “quadruple right” (i.e., delivering the right care to the right patient at the right time in the right location).

“To achieve the quadruple right, the goals of VBP should be inherently aligned and rely on implementing innovative care solutions,” the supplement notes, pointing to behavioral health integration and home-based primary care as two examples of such solutions.

Behavioral Health Integration

Statistics from the National Institute of Mental Health reveal that the prevalence of mental illness among U.S. adults in 2019 was nearly one in five, and evidence suggests that up to 70% of primary care visits in the United States are related to behavioral health needs.

Moreover, according to a recent blog post from the American Psychiatric Association, “as many as 40% of all patients seen in primary care settings have a mental illness, and the presence of psychiatric comorbidities translates not only into suffering due to the psychiatric illness, but also worsens outcomes for the other illnesses afflicting the patient.”

Clearly the ability to integrate behavioral health services into primary care can greatly benefit patients. But given the accompanying need for adequate financial support, resources, time and staff, that’s not always a good fit in a fee-for-service practice setting. Fortunately, the move toward VBP can allow primary care practices to leverage the care delivery and payment flexibilities available to them through alternative payment arrangements.

Indeed, flexibility is the key to successful BHI. Essentially a patient-centered approach in which primary care and behavioral health physicians and other clinicians collaborate with patients and their caregivers to improve patients’ physical and mental health, BHI is highly individualized from practice to practice and evolves to meet patient and practice needs.

The supplement lays out a BHI spectrum that comprises three distinct categories:
  • Coordinated care entails minimal and/or basic collaboration rendered from a distance. Primary care and behavioral health clinicians work in separate facilities, communicating information about shared patients to facilitate care.
  • Co-located care requires that the primary care team and behavioral health specialist be located in close physical proximity to each other (i.e., in the same facility, but not necessarily in the same office). It enables discussion about patient care through various modalities — including in person — and begins to build a larger team-based approach to care.
  • Integrated care demands practice change to create a systematic approach to care, with close and/or full collaboration among patients, caregivers and the integrated health care team.
Most BHI is currently supported through FFS, the supplement notes, although as primary care practices move along the VBP continuum, opportunities for them to further integrate care will likely open up as they are able to take on VBP contracts with aligned payments and increased flexibility in care delivery.

Ideally, alignment of BHI with primary care VBP models would include prospective payment arrangements sufficient to support BHI at a level commensurate to the patient’s needs, as well as much-needed administrative simplification.

Home-based Primary Care

According to Blue Cross Blue Shield Association statistics, the total annual cost of health care in the United States tops $3 trillion, with medical care accounting for 90% of that total. The cost of care is especially high at the end of life; about 25% of Medicare payments occur in beneficiaries’ final year.

Moreover, between the aging of the American population and the rising prevalence of chronic health conditions among patients of all ages, a growing number of patients face mobility issues. Given that a 2015 report from the National Academy of Medicine found that adults with both chronic conditions and functional limitations accounted for 56% of total U.S. health care expenditures in 2011, such an increase promises to hike overall health care costs.

Fortunately, the types of innovative delivery models with payment incentives to address rising costs that characterize VBP offer a way forward. Home-based primary care has been suggested as one such possible solution.

Roughly defined as primary and palliative care provided in the home to high-risk or medically vulnerable patients, preventive services offered in an HBPC setting (i.e., in-home monitoring, care management and proactive interventions) are intended to avoid unnecessary emergency department utilization and hospital admissions.

Ultimately, HBPC permits identification of patients who would most benefit from home-based integrated care and provides the right set of services to meet patient needs.

Hierarchical Condition Category Coding

Given that one of the goals of VBP is to keep health care costs in check, being able to accurately predict those costs is key. CMS implemented hierarchical condition category coding in 2004 to respond to that need.

Originally designed as a risk-adjustment model that would allow the agency to estimate future costs for Medicare Advantage plan beneficiaries, HCC coding has drawn renewed attention as interest in VBP has risen.

As a reminder, a previous AAFP News story that discussed HCC coding and risk adjustment noted physicians use ICD-10 codes to report specific diagnoses. Certain types of ICD-10 codes, in turn, map to an HCC.

Each HCC is assigned a weight/score proportional to the relative costs associated with its constituent diagnoses. Patient demographic factors are also assigned individual scores. The HCC and demographic scores are added together to calculate the patient’s risk-adjustment factor score. Finally, insurers use algorithms to predict health care costs based on the patient’s RAF score.

Visit the AAFP’s Hierarchical Condition Category Coding webpage for more on this topic, including examples of how to calculate RAF scores.

Because that RAF score is instrumental in calculating a patient’s total expected annual health expenditures, it has a keen effect on establishing capitation rates for MA plans as well as benchmarks for certain shared savings programs. That translates to major financial implications for physicians and practices.

In the AAFP’s newest Practice Hack video, Kansas AFP President-elect Jennifer Bacani McKenney, M.D., of Fredonia, Kan., explores using team-based strategies to optimize risk adjustment and ensure success in VBP. Here are four strategies she recommends.
  1. Risk adjustment is everyone’s business. It’s important to foster a culture of autonomy and ownership among every member of the care team, from clinicians to front-office staff, so that everyone understands what the team is trying to accomplish and how they can participate.
  2. Code with specificity and appropriate supporting documentation. Most physicians have been trained to code for evaluation and management services, but few have received much information about HCC coding and the thousands of ICD-10 codes assigned an HCC weight. Although only physicians and certain other clinicians can make a diagnosis, with the right knowledge and tools other care team members can help ensure that diagnosis is appropriately documented.
  3. Use the data available. Each practice’s EHR contains information about patients’ diagnoses and conditions that should be periodically reviewed. It’s essential to find ways to ensure that long-term diagnoses such as lower-limb amputation or cancer are documented annually for every patient because they do not carry over from year to year, meaning revenue could potentially be lost.
  4. Every patient every time. Whenever a patient comes in for care, whether for an annual wellness visit, upper respiratory infection or other reason, check to see whether the patient is due for any preventive services or has a diagnosis that needs to be addressed. Even if it can’t be worked into that day’s visit and requires rescheduling, this practice enables the physician to stay on top of the patient’s care needs.

UnitedHealthcare Delays Controversial ER Policy Following Backlash

Dive Brief:

  • UnitedHealthcare, the biggest private payer in the U.S., is delaying a controversial policy that could retroactively deny emergency room bills it deems non-emergent — potentially saddling patients with costly medical bills — following intense backlash from patient advocates and hospital groups.
  • "Based on feedback from our provider partners and discussions with medical societies, we have decided to delay the implementation of our emergency department policy until at least the end of the national public health emergency period," UnitedHealthcare tweeted on Thursday.
  • UnitedHealthcare said it planned to use the time to "educate consumers, customers and providers on the new policy and help ensure that people visit an appropriate site of service for non-emergency care needs." Hospital lobbies cheered the payer's decision to defer the policy, which UnitedHealthcare has estimated could lead to as many as one in every 10 claims being rejected.

Dive Insight:

Earlier this month, insurance giant UnitedHealthcare informed its hospital networks it would be retroactively assessing ER claims to determine if the visit was medically necessary, beginning July 1. If the claim is determined to be non-emergent, such as a visit for pink eye, it would be subject to limited or no coverage based on a patient's specific insurance plan.

That could potentially leave patients on the hook for some of the most expensive medical bills in American healthcare today.

In the notice to hospitals, UnitedHealthcare said claims would be assessed based on a patient's presenting problem, the acuity of services performed and other complicating factors. There would have been a process in place for providers to contest the claim denial, by submitting evidence to UnitedHealthcare that the visit met the prudent layperson standard, a federal policy requiring payers to cover ER care based on presenting symptoms and not the final diagnosis.

But many provider groups, including the American Hospital Association and the American College of Emergency Physicians, came out publicly against the policy change, arguing it would jeopardize patient's physical and financial health and could actually be illegal under the prudent layperson standard.

It also comes at a time when providers continue to face the loss of ER visits, which have remained depressed during the COVID-19 pandemic, even as other volumes recover. 

AHA and ACEP said the policy could result in patients avoiding the ER, worried about unexpected medical bills.

"Patients are not medical experts and should not be expected to self-diagnose during what they believe is a medical emergency," AHA CEO Rick Pollack wrote in a letter to UnitedHealthcare. "Threatening patients with a financial penalty for making the wrong decision could have a chilling effect on seeking emergency care."

Patients turning to the pricey ER setting for minor health needs is long-standing problem in healthcare. Though only about 6% of ER visits annually are actually nonemergent, misuse of emergency departments for minor ailments costs the nation's healthcare system $32 billion a year, according to a previous report from UnitedHealth.

It's not the first time payers have targeted stemming ER claims as a way to drive down medical costs. Indianapolis-based Anthem adopted a similar policy in 2018, but ultimately scaled the changes back after the move attracted ire from legislators and doctors.

Prior to Thursday's delay, the new policy would have applied to UnitedHealthcare's commercially insured patients in employer-sponsored plans. Currently, the payer has more than 26 million commercial members.

Patients covered by Medicare Advantage or in contracted Medicaid plans would have been unaffected.

Provider groups on Thursday applauded the policy's deferral, with AHA's Pollack calling it a "temporary reprieve for patients." However, both AHA and the Federation of American Hospitals called on UnitedHealthcare to permanently shelve the changes.

"While the delay is appreciated, this temporary pause does not address the underlying policy that poses harmful and unnecessary risk to patients, regardless of its date of implementation," FAH CEO Chip Kahn said in a statement.

"There is no justification for these restrictions now or after the public health emergency," Pollack said.

MSHIMA Job Board

The MSHIMA website contains a job board available for those seeking employment and those looking to hire qualified HIM professionals in Mississippi.  The job board is free to use for all MSHIMA members.  Click here to access this great membership tool.

MSHIMA Legal Manual

The MSHIMA Legal Manual is available for purchase and download. This manual includes state and federal guidelines and policies for health information management.  Stay up-to-date on the latest updates on policy and download your copy today!
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