The following is a guest article by Bill Wagner, CHPS, CPCO, Chief Operating and Security Officer from KIWI-TEK.
Short Term Impact on HIM
Revenue cycle executives have talked about process improvements for years, but the lack of budget, resources and urgency stalled many projects.
Then the pandemic came along and the realization that quick implementation of projects that remained on the backburner was the only way to succeed and survive. The ability to work remotely, embrace telehealth, create a cross-trained flexible workforce, capture the documentation of telemedicine visits and integrate telemedicine into the EHR and chargemaster had become revenue cycle priorities.
While the major focus was, and still is, on delivering patient care and stopping the spread of COVID-19, little attention was paid to the impact on HIM departments. Processes, software applications, staffing strategies, quality standards and best practices that had been in place for years were no longer suitable. New COVID-19 patient encounters and tests had no existing codes. Rapidly increasing telemedicine encounters created new problems due to expanded use in new patient encounters and the challenge of conducting the visit in a HIPAA-compliant manner. Many of those encounters were not set up to be documented in the EHR or coded in the chargemaster. Billing systems failed to recognize new encounters and created large numbers of edits that had to be reworked. Every week, CMS and the AMA released new coding guidelines that had to be adopted and incorporated into the coding process. Payors experienced the same issues, resulting in huge numbers of denied claims. All of these issues fell on the shoulders of the HIM staff.
Let’s look at some of the larger challenges and how they were handled and resolved.
Challenge #1: Creating a remote workforce
While many HIM departments already had all or some of their coders working remotely, others did not. Due to the sensitivity of accessing PHI remotely, IT resources were brought in to ensure secure connections and configure the equipment. Human Resources became involved to modify workplace rules. This is one of numerous examples of disparate departments quickly working together to create a new environment.
Challenge #2: Capturing documentation for new types of patient visits
Providers were not trained on or familiar with the information needed in the patient record to properly code telemedicine. Both the EHR and the chargemaster had to be updated to accept the documentation of new types of encounters. HIM professionals quickly led the effort to educate clinicians on the documentation requirements. EHR vendors, with complex and limited service contractual agreements in place, were brought in and encouraged to make the necessary system changes and upgrades.
Challenge #3: Incorporating new coding guidelines
Training and education on coding changes and updates had always been done quarterly or annually. Now training had to accommodate weekly changes on coding guidance from CMS and the AMA. Guidance given last week would be different this week. Accepted telemedicine codes went from 103 to 238 different codes. This required a realignment of staff to increase resources for training and auditing, to maintain quality and accuracy standards.
Challenge #4: Changes in patient type and patient volume
In an effort to control the spread of the pandemic and to focus on COVID-19 patients, providers were directed in March to cancel elective surgeries and all other non-urgent patient visits. Prior to that time, patient volume by type of visit was fairly predictable, which helped with staff planning, as well as forecasting revenue cycle metrics. Very quickly, patient volumes for same-day surgeries, ED visits and other outpatient services were drastically reduced. Coding professionals who coded those patient types for years suddenly had no work. At the same time, a flood of telemedicine encounters came to HIM, with no one trained to code them. In a matter of weeks, HIM management reorganized and cross-trained their staff to not only code telemedicine visits, but also become a trainer on the new codes, assume a CDI role for the new documentation challenges, or become an auditor to monitor the new coding guidance.
Challenge #5: HIM volunteer work and COVID-19
The HIM community is committed to volunteer work that enhances the education and professionalism of their industry—a passion that is often overlooked. Outside of their challenging professional position, most spend many hours contributing time to support their regional, state or national organizations to help with funding, education, annual meetings and conventions. A large share of this effort involves face-to-face events that require help to organize the agenda, schedule venues, recruit speakers and arrange housing. The pandemic has forced many of these events to be rescheduled or to go virtual. These changes have required extensive time and effort from HIM volunteers. For example, of the 41 events that KIWI-TEK had planned to attend as an exhibitor, 13 have been cancelled, 7 are now planning a virtual event, 13 have been postponed and 8 are undecided.
It’s been said that it took a pandemic to prove that the American healthcare system was overdue in updating how and where they treat patient needs. As health systems and hospitals adjust their workflows to deal with the pandemic, they have learned valuable lessons about the best use current health technology to improve patient care—now and in the future.
The same holds true for healthcare revenue cycle departments. Faced with overwhelming new challenges and obstacles to capturing, documenting and coding accurate data, HIM professionals quickly broke down cross-departmental silos, reinvented workflow processes, forced IT upgrades and realigned staffing priorities. All HIM and revenue cycle leaders should take pride in their responsiveness and creativity to handle the current challenges presented by the pandemic, as well as their actions to prepare their teams for the new normal.
Now that we are beyond crisis-management mode, we must prepare for the new normal. What does the future hold? Here are five COVID-19 driven trends that will continue.
- Telemedicine will be expanded for patient encounters.
- Many health systems will also be looking in the other direction, in the hospital setting.
- Remote staffing will be utilized more than before.
- Organizational silos are gone or no longer recognized.
- Social determinants of health will generate renewed passion and support.
We will dig into each of the challenges mentioned above in our blog series COVID-19’s legacy and the impact on HIM. If you’re not on our mailing list, please be sure to sign up here to get posts delivered to your inbox.