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Footprints Newsletter
February 2017


Inside This Issue:

President’s Message


Hello North Carolina Members. I hope you had a wonderful Valentine’s Day and you spent some quality time with friends and loved ones. As we age, grow, and mature, we continually realize how important those times are. From a HIM standpoint, we learn how vital our career is and how we can impact the revenue cycle as we grow and become more seasoned in our profession. HIM is an important element in maintaining a healthy revenue cycle and regulatory climate.

The Publications team has selected regulatory as one of the themes for this month. Throughout my career, I am continually impressed with the unique contributions HIM professionals make to this area of healthcare. Many of you are compliance officers, audit and coding team members and leaders, privacy and security officers, involved in quality, or release of information specialists to name a few. These areas and many more, encompass some piece of regulatory awareness/adherence. To continue to sculpt your career, take advantage of the wonderful resources that are available to you to strengthen your regulatory knowledge. Below is only a small sample of some free resources available to you to stay abreast of regulatory changes. Stayed tuned as Pamela Lail, President-Elect, and other team members offer more information on these areas in coming issues.



As we focus on regulatory awareness, did you know CMS has awarded RAC contracts nationwide? The RAC for North Carolina, Region 3 is Cotiviti. The Medicare Administrative Contractors (MAC) is holding sessions with the RACs. The session for Cotiviti was February 2, 2017 but the recording should be available soon. Visit the Cotiviti and Palmetto website for the recording which should be posted per Cotiviti. This presentation will offer more insight to the process.

We have heard your request for more interactive, hands-on sessions and have been able to begin that transition with the Data Analytics Workshop offered in January and will be doing more of the same at the Winter Workshop. ICD-10 PCS continues to offer challenges to many of us. Join us to spend some time on some challenging coding areas (don’t forget your current ICD-10-CM and PCS code books, online or paper is acceptable the choice is yours).

As many of you are aware, AHIMA is experiencing difficulties with the transition to a new association management website. Continue to monitor your email and AHIMA website for updates on continuing education credits, membership, and myAHIMA portal. Details as of Feb 15th are posted here.

The NCHIMA elections will be opening soon. Look for correspondence from the Nominating Committee as voting opens. Please participate and exercise your voice when the ballot is posted.
As a reminder, the NCHIMA Giving Campaign for student’s scholarships is here at the AHIMA Foundation.

I hope to see you at the Annual Meeting in Concord, NC. Don’t forget to get your registration in early. The Program Committee is working diligently to bring exceptional speakers, topics, and the best products and services from our sponsors. Thank you for all your efforts Program Committee.

Take charge of your future…

By: Sharon Easterling, MHA, RHIA, CCS, CDIP, FAHIMA
NCHIMA President 2016-2017

NCHIMA 2017 Keynote Presentations


Don’t miss out on these great keynote presentations at our 2017 NCHIMA Annual Meeting & Exhibit.
To learn more about the agenda and to register, please click here.
 
Wednesday, May 4, 2017
8:00 am - 9:00 am


The 4 Phases of Attitude


Stephen Morgan | Vice President, New Directions of the Future

Stephen




Experience the levels of emotion and attitude change that we all go through in each and every project and relationship we enter. Learn how to identify and monitor these attitudes in ourselves and those around us.

1:15 pm - 2:15 pm

Changing Physician Behavior: The Holy Grail of HealthCare Management

Daniel Murrey, MD, MPP | CEO of Transformant Healthcare Solutions
 
The vast majority of dollars spent in healthcare are the result of physician decisions on behalf of their patients. In order to shift from volume to value in our healthcare system, doctors will have to lead the transformation. Changing physician behavior and decision-making is challenging but will be necessary to bend the cost curve.
 

Highlights


We are looking forward to our Annual Meeting this year! The program committee has been hard at work planning and have come up with some great ideas to change things up a bit this year. Here are a few highlights to look forward to:
  • Magic Tuesday - Come enjoy some mind-bending magic with Dr. Brett Senor at our reception on Tuesday evening.
  • Show your Team Spirit - Many of us dress up every day for work.  Enjoy a dress down day, if you would like, on Wednesday with work appropriate jeans and show your team pride by wearing your favorite sporting team on a shirt or jersey. This could be a great networking opportunity and conversation starter!
  • Did someone say Murder? - Come out to our reception on Wednesday after dinner to enjoy some dessert and a little Murder Mystery with The Charlotte Murder Mystery Company.  Can you figure out who did it?
We can’t wait to see you there!

The NCHIMA Mentorship Program


INTRODUCING: The new Mentorship Program! We have created the program to help NCHIMA members in all stages of their development as Health Information Management professionals. 


Stuck? Need Help? Follow us to
career and academic success!

We are invested in your success!

MENTOR LEADERSHIP NEEDED:  We need experienced professionals to mentor others!   If you want to learn more about the program, please click here or e-mail us at: membership@nchima.org.

Fitting Coding and CDI into MACRA


Back in 2014, I wrote an article called “Holistic Collaborative Documentation,” published in RACMonitor.  The thought behind that article was about not only how important physician documentation is within any setting but also about the need for coders and CDI (Clinical Documentation Improvement) professionals to assist in the appropriate reporting and capture of this information. Providers have had a long-standing history of minimizing diagnosis coding in the Part B revenue cycle. A key difference in Part A and Part B coding is the laissez faire approach providers take for reporting Part B diagnoses. The only times these diagnoses become of concern is when the need to justify the test for medical necessity arises and payment becomes of utmost importance due to denial or non-coverage. As I stated in that article 2 years ago, the need has come for us to better reflect what is occurring within the clinic setting and providers need to take a “holistic” approach to documentation. Medicare Access and CHIP Reauthorization Act (MACRA) is here and providers are yet another step closer to reaching the (Centers for Medicare and Medicaid Services (CMS), “Triple Aim”.


You may ask, “What does MACRA have to do with coding and CDI…MACRA is only a Quality Payment Program (QPP) that replaces the Sustainable Growth Rate (SGR) methodology? It is only financial and is another way to measure quality of care, incentivize providers, and profile clinicians.” Well, all those things are true but it goes a step further. Programs within the QPP are risk-adjusted for severity. This means that a patient’s diagnosis is utilized to categorize the patient based on how sick they are; diagnoses. This measure of diagnoses adequately shows you and the payer the true costs of treating the patient.

Here is an example. Many providers have been participating in Accountable Care Organizations (ACOs) for years. ACOs provide care to a population of patients. Primary care physicians, specialists and hospitals manage patients as a group. The participating physicians and hospitals jointly take responsibility for the cost and quality of patient care, and they function under a various risk-sharing arrangements. There are many types of ACOs which are Alternate Payment Models (APMs) and now, in some cases, under MACRA Advanced Alternate Payment Models. Historically ACOs have had many challenges. There have been some successes and some failures. One potential problem could be the inability to adequately project benchmarks for cost of caring for the patient due to an inadequate picture of the patient from a diagnosis perspective. However, keep in mind, there are other factors that also come into play such as age, sex, socioeconomic status, and geographic location.

“The benchmark is a surrogate measure of what the Medicare Fee-For-Service Parts A and B expenditures would otherwise have been in the absence of the ACO. The initial benchmark is risk adjusted using the CMS Hierarchical Condition Categories (HCC) risk adjustment model that was originally developed in conjunction with the Medicare managed care (Medicare Advantage) program, also known as Medicare Part C. The HCC risk adjustment model is used to calculate expected expenditures for a population of Medicare beneficiaries. Although costs for an individual beneficiary may be higher or lower than expected, these variations are likely to balance each other across a population of beneficiaries. To minimize variation from catastrophically large claims, CMS truncates an assigned beneficiary’s total annual Parts A and B Fee-For-Service per capita expenditures at the 99th percentile of national Medicare Fee-For-Service expenditures as determined for each benchmark year. (“Methodology for Determining Shared Savings and Losses under the Medicare Shared Savings Program Fact Sheet”.  DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) Centers for Medicare & Medicaid Services).
“Properly implementing a risk-adjustment mechanism is critical to intelligently assigning budget responsibility to an ACO.” (American Academy of Actuaries, Risk Assessment and Risk Adjustment, May 2010 issue brief: http://www.actuary.org/pdf/health/Risk_Adjustment_Issue_Brief_Final_5-26-10.pdf.) It is important to ascertain the ACO payment with the actual budget.

This is only an example of one type of APM/Advanced APM that is risk adjusted for diagnosis. The two models of risk adjustment utilized most often is CMS HCC Model utilized widely in Medicare Advantage plans and the HHS HCC Model which is mostly utilized within patient populations that are more diverse such as with the DHHS Healthcare Market Place. It is important for providers to become accustomed to these models and how to utilize HCCs properly.

Example APMs/Advanced APMs risk-adjusted utilizing HCCs:
The payment shift to increased quality through MACRA is another step toward providers needing documentation that is “holistic” and adequately reflects the population of patients served. This concept is crucial as providers are profiled and data is made more publicly available. Oh yeah, did I mention HCC also has impact on PQRS and Value Modifier? It’s only the beginning.
 
Sharon Easterling, FAHIMA, MHA, RHIA, CCS, CDIP, FAHIMA
sharon@recoveryanalyticsllc.com
704-826-7497

Bachelors In Health Information Management Coming Back To North Carolina!!


East Carolina University
We will be having a floating Open House session for the Bachelor of Science in Health Information Management program at East Carolina University on Thursday, 2/16/17, 6:00pm-8:00pm, in CAHS room 1410. This session is for people interested in the Bachelor of Science in Health Information Management. Information about the course of study will be available. A brief overview of the application process, funding, scholarship and financial aid will be provided. We plan to have a live stream online and also a recorded session available for those cannot attend in person. If you plan to attend, watch the live stream or recording, please complete the registration form at:  There will be signs on the doors directing you to room 1410 and parking passes will be available for you.
 If you have any questions, please contact Dr. Susie Harris (harrissus@ecu.edu).

Spotlight on Scolarships

Would you like to contribute to the future of a student?  NCHIMA is proud to partner with the AHIMA Foundation to administer our dollars for scholarship opportunities for those attending a Commission on Accreditation for Health Informatics and Information Management Education (CAHIM) accredited program.  Consider making a donation to help change the life of a student

Member Spotlight

 
Anita Jones, RHIT
Durham Women’s Clinic, Coder/Biller

1. What initially drew you to this particular profession?
The healthcare industry is fast growing, and I wanted to be a part of it.  However, I knew that I did not have what it takes to be on the clinical side.  Also, the fact that I could eventually work from home was very alluring.

2. What are your future plans?
I would like to earn a Bachelor’s of Science in Health Information Management.  I am in the process of preparing for the CPC exam.  Also, I would like to earn the COBGC from AAPC as well as a CCS or CCS-A from AHIMA.

3. How did you decide this field was good for you?
I enjoy the detective aspect of finding why a claim was denied as well as determining if the right code was used.  I get to be a part of a growing industry and help people.

4. What advice would you present to those considering entering the HIM profession?
My advice would be to keep persevering even through frustrations.  Eventually, you will complete your education and find a job in the industry.  Do not let a failed exam or a rejection determine your future.  Also, continue striving for a better understanding by using the resources available to you such as the mentoring program as well as maintaining and earning other credentials.

5. How has the mentorship program impacted me?
I feel that my mentor Leola Burke is a person that provides safety and resources for me. I feel comfortable asking my mentor questions and for explanations, because most have expectations that I am already an expert in this field due to my credential. Also, my mentor has provided me with different opportunities to further my career development that I did not realize existed. It is important to have someone that you can lean on while you are on your way at becoming an expert in the industry.

The clarification that I have received from Ms. Burke has had a positive impact with my daily work responsibilities. I would recommend the mentoring program to anyone that is beginning their career as well as to the experienced mentor. Both individuals can benefit from this program.

Student Member Spotlight


Debbie Rogers Hodges
Graduate Student in the Health Information Management Certificate program at East Carolina University-December 2017
Health Information Management Operation Specialist I
Vidant Beaufort
                                                                                                  
1.  What initially drew you to this particular profession?
I wanted to pursue a Master's Degree. I actually looked up the Master's programs at ECU in the allied health science field.  I looked in the HIM Certificate program in hopes of getting into the Master's in Health information and Informatics.  Also, I looked to see if I had to take any classes to get into the Masters program, which I didn't because I had got my Bachelor's degree in Health Services Management, and a lot of the courses I had.

2.  What are your future plans?
-Does it include further education or certifications in the Health Information Management (HIM) field? 

My future plans-I actually got a position in the Health Information department in October 2016. I am a Health Information Management Operation Specialist I with Vidant Beaufort. I am
currently working on finishing my Health Information Management Graduate Certificate (hopes of graduating in December 2017). I plan to take the RHIA exam after graduation. I will still work in my current position.  And, I am still considering finishing my Master's Degree in Health Information and Informatics.

3.  How did you decide this field was a good fit for you? 
I believe it was luck that I found my field. I had been working as a unit secretary at the Marion L. Shepard Cancer Center. I actually have had a lot of positions in health care-I have been an admitting clerk, a certified pharmacy technician, and unit secretary until I landed my position in HIMS. One of my coworkers, Catherine, actually saw a posting on our intranet page, and encouraged me to apply for the position. I had experience in doing release of information at the cancer center. Since being in my career, I truly enjoy what I do! I mainly do release of information, and help create birth certificates for new babies born at our hospital.  My job is neat - I don't do the same release every day; they are all different and I enjoy meeting new families with their new bundle of joy! I also enjoy meeting people that come in and I get to help them release their medical records that they are requesting. It’s a rewarding job! 
 
4.  What advice would you present to those considering entering the HIM profession?
 
I went to an information session regarding the HIMS program. Dr. Paul Bell interested me, in that he spoke about this program, and he stated that he enjoyed the health care, but was not a person that could tolerate blood, and direct patient care. I couldn't agree with him more! I love the medical field. Its changing every day; it’s rewarding. I would tell anyone going into the program, that if they like a challenge, if they enjoy working with the public; if they want to do something in the medical field, but can't tolerate direct patient care, then to give HIMS a chance. We found out that it is definitely a growing field. Also, to tell them, don't give up!  Have determination, and take a chance! This program has made me "think outside of the box."  Go at your own pace. I am a mother of two young girls (6 and 3), married, and work full time. I like that you can go full time or part time and pursue it online, or on campus! 

I want to give recognition to all the professors at ECU in the HIMS/Health Services Management programs!  They are dedicated to what they do; are very helpful; they want you to succeed! I am fortunate to have such a wonderful program close to home to me. ECU is an all-around great campus to attend; and one of more affordable universities to attend. I just like the fact that a lot of my professors I had for my undergraduate are still there, and teach some of the graduate courses.

GO PIRATES!
 
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