Footprints Newsletter - February 2015
Inside This Issue:
Hello my fellow NCHIMA colleagues! We hope that you all have enjoyed the new NCHIMA website which went live on November 15th! Working with the team at KnowledgeConnex has been a positive experience, and they have assisted us in making a smooth transition. We now work with this one vendor for all NCHIMA on line activities!
NCHIMA will be sending two Delegates to the AHIMA Leadership and Hill Day event in Washington DC on March 23 and 24th. Hill Day provides members the opportunity to interact and advocate for HIM with their Congressmen, which will certainly include the continued support for ICD-10! It is not too late to contact your Representative regarding I10; just click here and submit a letter through the AHIMA Advocacy page!
The 65th NCHIMA Annual Meeting is right around the corner and the Program Committee has been working diligently on an excellent agenda and speakers from across the country! We will be returning to the Sheraton in Greensboro in April. The meeting registration is now open and it’s easy to register. Just go to our website and the annual meeting link is on the home page! Please note that the hotel reservation discount code is also available and is located on the website. Please make your reservations as soon as possible.
The Call for Board Nominations will be coming out this month, so please submit fellow members (or yourself) as possible candidates to serve on the NCHIMA Governance Team for the next fiscal year! It just takes a few minutes to review each candidate and cast your VOTE!!!!!!
Stay warm, and I look forward to seeing you all in Greensboro in the spring!
Jolene Jarrell, RHIA, CCS
NCHIMA President 2014-2105
Audits and Appeals: 3 Hot Tips for Denials
Isn’t it great to get information you can operationalize right away. Well, NCHIMA wants to be an ongoing resource for you and your team and supply you with tools you can use. Take these tips and tighten up your audit and appeal processes today.
These types of denials can be time consuming to defend but you can succeed. Remember to keep the application of coding guidelines such as selection of the principal and secondary diagnosis as well as coding clinic in your back pocket as you will utilize them.
- Clinical validation denials can be appealed and won.
However, this is all about justifying clinical significance of the condition being treated and interaction or not with other signs, symptoms, and disease processes. You may need to grab your physician champion or a CDI to assist with that. Utilize the treatments and interventions provided for the condition and how those resources impacted and justified the diagnosis.
Another huge piece of this is clinical support via internal guidance such as practice guidelines or medical resources. If you and the auditor do not understand the disease process it could result in another denial. Remember to make it is as elementary and easy to understand for the layman. Most judges are not clinical and some auditors need better understanding as well.
We are embarking on new times in which a service denied in the hospital can be denied for the physician performing the service as well; Transmittal 541. This is a “double-whammy”, so to speak, in some cases.
- Justification of Medical Necessity can be obtained for that service or procedure.
Develop a process at your facility in which you have a check-off list for patient documentation to justify the service per the LCD/NCD. Some providers may not like it but it could save you in the long run and you won’t have to spend time on the back-end justifying a denial by getting records and praying everything is there.
I have seen automated denials overturned, but not always, as sometimes the billing guideline or CPT is limited and not clear. At times however, there are internal fixes needed, such as updating the chargemaster when code/unit changes occur, new staff is hired, or a new rule slipped through on you. When these denials happen they can be time consuming to identify and develop an argument to support a successful appeal. Obtaining the remit attached to the N469 Remit advice remark code can assist you in identifying the specific code with the error and any unit corrections associated with it. Ask PFS (your billing department) to create one for you to identify denials and assist with the why.
- Automated denial reason can be easily identified and you can fix your processes.
Hope these tips help. Good luck on your journey to combat denials.
Sharon Easterling, MHA, RHIA, CCS, CDIP, CPHM
M - 704-779-8095
Claim/Service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)
Pub 100-08 Medicare Program Integrity
Health Information Professionals Week
Health Information Professionals (HIP) Week will be held March 22-28, 2015. The theme for this year’s HIP Week is “Reliable Information Responsible Care”. Health Information Professionals Week is a showcase for the thousands of health information (HIM) professionals who perform their duties masterfully throughout the year.
Health information management (HIM) is an allied health profession responsible for ensuring the availability, accuracy, and protection of the clinical information needed to provide healthcare-related decisions. Health information professionals work in a variety of settings, including hospitals, clinics, physician offices, and many other organizations. They play a key role in the effective management of health data and medical records needed to deliver quality healthcare to the public. The work HIM professionals do to ensure the integrity of health information is imperative to clinical and administrative decision making. Access to reliable information helps everyone make important decisions and leads to a healthy society.
Managers - Are you looking for gift ideas for your employees as a token of appreciation for their hard work for HIP Week?
Members - Would you like to exhibit your pride as a health information professional?
Well look no further - NCHIMA has just what you need!
You can see the available items by accessing our NCHIMA Products. Click here to place your order today!
NC HIMSS Liaison Update
Like NCHIMA, The North Carolina Chapter of the Healthcare Information and Management Systems Society [NC HIMSS] has been advocating for the Health Information Exchange [HIE] initiative this year.
Health information technology is a pressing issue for this session of the North Carolina General Assembly. HIE is moving from the drawing board to execution here in North Carolina. With this comes concerns over cost, funding, patient rights, and privacy. Now, more than ever, we have an opportunity to shape the future of technology and how it affects healthcare.
NC HIMSS has reached out to their members to join them in an effort to lead and direct healthcare legislative, regulatory, and policy initiatives in North Carolina. This is the time for them to try to make a difference and have their voices heard.
Stay tuned for upcoming NC HIMSS HIT Advocacy initiatives.
Providers and fellow members of the healthcare IT community are advocating to improve healthcare outcomes by utilizing information technology.
Nathan White, CIO, Appalachian Healthcare and Past-President of NC HIMSS, will be a guest speaker at the NCHIMA Annual Conference in Greensboro on April 22, 2015, providing our membership with further updates. Be sure to plan to attend!
- February 12, 2015, 3:00 – 5:00 p.m. – NC HIMSS Workshop, Reception and Winter Dinner, Concord, NC.
- June 8 - 9, 2015 – NC HIMSS 2015 Annual Conference, Wilmington, NC
- April 12 – 16, 2015 – HIMSS National Conference, Chicago, IL.
By Kozie V. Phibbs, MS, RHIA
2014-2015 NC HIMSS Liaison
New Member Spotlight - Marc S. Thomas
Marc S. Thomas is a new member of the HIM community, bringing many years of successful experience in leadership, management, and administration in the finance and retail arenas.
What initially drew you to this particular profession and what are your future plans?
Basically, I grew up in NC and soon after college I moved to NYC where I lived for almost 20 years. I have an extensive career in retail as well as in office administration as an executive assistant. After my experience in NYC I decided it was time for a career change and I wanted to work in a growing industry and something in healthcare.
Even though my mother and some of my siblings were nurses I did not feel that was the correct choice for me. After some investigation and research, I decided I wanted a career in the HIM profession and started pursuing that at our local community college. It has been a great fit for me. After receiving my RHIT, I would like to pursue my RHIA and possibly a Master's degree in Heath Informatics and Information.
You have stated that a career in Health Informatics is a possible path. How did you decide this was a good fit for you?
I have always had an interest in healthcare but I knew nursing was not for me. I come from a family of nurses. I wanted something I could use my background and education within the healthcare industry. I went to my local community college open house after speaking with a college advisor. I met the Chair of the Department, Crystal Smith. The way she described various HIM career paths and potential careers and that it was a growing industry really peaked my interest. After speaking with her after the meeting I went home and did my own research. That is when I discovered the AHIMA website. I read the article “Why Choose a Career in Health Information?” I already had experience and education in management and leadership and all I needed was the health information and law. I was sold. I started taking classes that I needed for the HIT curriculum and once in school I applied to the program.
Share with us your perspective on the transition from retail to healthcare. In other words, what pieces and parts, if you will, helped make the shift smoother and what was surprising or unexpected?
My leadership, management, and finance background made the transition smooth. I knew and practiced the theories and styles in previous positions as well as my current job. What surprised me the most was the amount of anatomy and physiology that is required. And after completing ICD coding and CPT I feel I know a new language.
What advice would you present to those considering the HIM profession?
In 2009 I had an accident that left me blind. After many procedures and time, my vision is slowly returning. I am still blind in one eye. I have not let my disability stop me. If anything it has motivated me to strive even harder and with assistive technology I have been successful in my college classes and volunteer opportunities. I wanted to prove to myself and to others that you do not have to be limited due to a disability. You can still be an active and contributing member of society.
Go for it! If you have an interest in healthcare without dealing with patients, the HIM profession can offer you diverse opportunities. Get involved with HIM. You have the opportunity as a student to shape the future of the profession alongside seasoned professionals.
NCHIMA Newly Credentialed Professionals: Nov-Dec 2014 and Jan 2015
Sue Ellen Marsh
Maria Eileen Schaapveld