Customer story: HIA consultant brings fresh perspective
Partnering with HIA for Interim Auditing services provides immediate solutions to fill the gap in your Health Information Leadership team so you can maintain productivity and performance. How? Read Diana’s story below.
“Oh, I was concerned,” said Diana, Director – HIM Coding at one of the largest pediatric medical centers.
“I can almost laugh about it now that we are on the other side of it.”
Two years ago, Diana was at a crossroads: her coders lacked coding confidence and her bosses were frustrated with lack of production. This, matched with the implementation of ICD-10, created the perfect storm.
To navigate the changes, and to hopefully increase support for the coding staff, Diana knew she had to implement a plan and soon.
“Our intention was to increase our coder’s professional development by performing ongoing audits throughout their training process,” she said. “We wanted to be able to provide constructive feedback when the coders made errors so they could learn and improve.”
Long story short, the education was not taking root quick enough for her staff.
“Not only did we find the same errors in their coding repeatedly,” said Diana. “the coders began to doubt themselves.”
Diana says coders started to turn to other coders for help rather than following the proper protocols. “That’s when we knew it was time to look at other options and bring a fresh perspective to my team” she laughed.
Diana already had a relationship with the team at HIA and reached out for help.
“Together, we developed the interim auditor position that is now in place today,” she said.
Until it Clicks
Heidi, HIA’s Coding Consultant, has been working with Diana and her team for only a short period of time and the success of the partnership is already evident in more than just increased production.
“When they ask a question, Heidi not only provides feedback, but she will walk them through the process – she works with them until they understand,” said Diana. “Our coders are learning how to use the coding guidelines to apply to other principles – and they have more confidence in doing so.”
For Heidi, communication is key when working with coders and mutual respect is crucial in an interim auditing scenario.
“It takes an immense amount of work to reach a conclusion when coding and, if it isn’t correct, that can be defeating,” said Heidi. “What I love about our team – HIA’s, that is – is that if something is incorrect, we don’t just tell them what the code is and be done with it. That helps no one.”
Instead, Heidi says she works directly with each coder to understand their thought process in reaching the first conclusion.
“If I understand their thought process, I can start to understand how their mind works and how I can provide the proper response and education so that they truly understand it – and, more importantly, the same mistakes do not continue to happen,” Heidi said.
“It’s nice to have someone to assimilate with,” says Diana, who credits the partnership with repairing the communication barriers present before.
“We have a very diverse group of coders – some even speak different languages. So, in the past, I always thought they understood the instruction. But I’ve learned that was not the case,” said Diana. “Heidi will sit with them and field as many questions as they ask. She waits until it clicks.”
Heidi and the HIA team want to debunk the myth that auditing is a ‘bad word.’
“I know when they first come in to these type of positions, coders can be apprehensive because of bad past experiences,” said Heidi. “But we approach it as we are joining a team.”
And that team mentality couldn’t ring more true to HIA’s education philosophy.
“If I don’t have the answer to something, or if I want another opinion, I have an entire education department with some of the best in our industry to talk to,” Heidi said. “When I came into this position, on paper it may have looked like it would just be me. But really, it’s the entire company – and I know that is not the industry norm.”
Diana says their accuracy rate is improving and, this time, she knows it’s accurate. “Our coders are progressing quickly with the added education and training, there has been a decrease in the number of charts being denied.”
“Based on the increase in quality results we have been seeing, we’ve even been able to release one coder to be working on her own. That’s a great benefit,” Diana said. “The others are coming along.”
Diana says that while she knew the partnership with HIA would be beneficial on all fronts, she still had to convince her CFO to approve the added cost.
“I knew that the longer we left our coders untrained, the longer we would have to be spending money to outsource a portion of our coding and our quality wouldn’t improve,” she said.
Since HIA had been doing audits for the hospital for more than four years, Diana could show the quality of work to the CFO.
“Our cases are so unique. I’ve worked with other companies before and the quality just isn’t there,” she said.
“I just don’t trust other companies the way I do HIA.”
Our Comprehensive Approach
Internal Quality Assurance
Whether it’s providing real time feedback for new coders, or helping to refine the skill sets of more seasoned professionals, HIA can provide the type of supportive mentorship that leads to long term success. A constructive, one on one, approach that focuses on utilizing the proper references is key to developing an independent and effective coding professional.
The demands related to focused auditing can be daunting. Quality Measures, Pepper reports, OIG Work plan, Focus DRG’s, the list goes on. Our experienced consultants can assist with overflow volumes when internal resources are stretched too thin.
The seemingly ever increasing volume of denials from reluctant payers represents one of the greatest challenges facing facilities today. HIA’s denial/appeal support will provide a seamless option. From determining the validity of a denial, to preparing a well constructed appeal letter, we can help. As an added benefit, we can assist in trending the denials and providing education to the coding team in order to eliminate future denials.
Pending Account Resolution
Nearly every coding department relies on a pending accounts queue to assist staff with the more challenging cases. The volumes can often be detrimental to the unbilled report. During these times HIA can assist with determining the validity of pending status, answering questions, providing guidance to finalize accounts, even writing queries when appropriate. We can also trend the information to determine areas of educational opportunity and eliminate repetitious inquiries.
Annual evaluations can be challenging. Relying on well documented audit results from an unbiased third party can help alleviate some of the anxiety. Our audit database will allow for tracking and trending of coder specific results throughout the year and is available upon request.
“Because that’s the way we’ve always coded it.”
Whether a formal internal guideline, or one that could never quite be located, this phrase is dangerous. Having the fresh perspective of a qualified external party can often be the catalyst for positive change. HIA’s extensive resources go well beyond the consultant(s) assigned to your facility and the full team is always at your disposal.
The ever changing payer guidelines make billing edits a fact of life. HIA’s experienced team of consultants will go beyond simply managing the volume, we’ll identify the source and work through appropriate channels to eliminate invalid edits.