“We have one final surprise tonight – and it’s something we’ve all been able to keep a secret,” laughed Angie Christen. She was holding a large, white album with a ribbon tied around it.
“Betsy, can you please come up here?”
It was the final night of Health Information Associates 25th Anniversary celebration and, to mark the momentous occasion, founder and CEO Betsy Bailey invited all HIA employees and their guest to the Salamander Resort in Middleburg, Virginia. The three-day event was exactly what she had hoped for, a nonstop celebration with everyone that helped the company reach this milestone.
“We wanted to give you something to show how much we appreciate you, this company, and all it has brought to our lives,” continued Christen as Bailey made her way to the stage.
The past three days had been a truly humbling experience for Bailey – she never imagined her one-woman coding consulting company , which she started in a home office in North Carolina, would turn into one of the most respected in the industry, creating more than 250 jobs in its 25 years.
But the celebration was also bittersweet as there was one very important member of the HIA family missing – her dad, Deane Beamer, with whom she founded the company with in 1992. Beamer passed away in 2012 at the age of 78.
Once Christen gave the album to Bailey and she realized its contents, she was speechless. In the album were handwritten letters from every HIA employee. Many of them had been with the company for more than a decade. Each letter told a different story of how they came on board with the company and what the HIA family meant to them.
It was a pinch-me-moment for Bailey.
“I still don’t know how this all happened,” she laughed.
Growing up, Bailey and her dad had a special bond – especially when it came to business.
“I loved it. Especially those dinner table conversations, talking about the healthcare industry and bouncing ideas off of each other,” she said. “It’s just how I grew up.”
Beamer, a veteran of the United States Air Force, studied at the Medical College of Virginia where he received his Master’s Degree in Hospital Administration. He completed his residency at Memorial Mission Hospital in Asheville, North Carolina and then moved to Marion, Virginia to serve as CEO where he was instrumental in establishing Smyth County Community Hospital. After retiring from SCCH, Beamer consulted and served in various interim hospital CEO positions throughout the Southeast.
Bailey attended Emory & Henry College for three years, before transferring with her now husband Bruce to the Medical College of Virginia where she received her BS in Health Information Management. Following graduation she took a job as the Director of Medical Records at Tidewater Memorial Hospital from 1987-1988 (now Riverside Tappahannock) and then moved on in 1988 to the Director of HIM at Humana St. Lukes Hospital in Richmond, Va. (now Parham Doctors Hospital )
Bailey’s husband, having completed his Masters in Health Administration, was offered a job as Assistant CEO at Humana Clinch Valley in Richlands, Virginia in 1990 (now Clinch Valley Medical Center) It was following their relocation to Richlands that Bailey entered the healthcare auditing world as a self-employed consultant. Her first client in 1990 was her Dad’s hospital. Once Beamer saw his daughter’s findings and the educational opportunities for his coding staff, he spread the word to other area hospitals that this is something they really should be doing. Bailey added several more hospitals to her small business.
“I honestly wanted to help these not-for-profit hospitals get the reimbursement they deserved because the smaller facilities were struggling in those days. In addition, I loved teaching what I knew about coding to their staff.”
It was also during this period that Bailey had her first child, Beth Ann, in 1991.
As Bruce’s career progressed, the couple moved to North Carolina to pursue an opportunity at Lake Norman Regional Medical Center in Mooresville.
“Supporting Bruce’s career and being a mom were important to me,” she said. “But I also wanted to continue to grow my own business and keep my coding skills sharp. I guess you could say I wanted to have it all.”
It was in 1992 that Bailey landed her largest client to date – a group of HCA hospitals based out of Richmond, VA. At the same time she found out she was pregnant with her second child, Tyler.
“I remember thinking ‘there’s no way I can handle this all on my own and do these contracts justice,’” said Bailey. “That’s when my dad advised me that it may be time to hire someone to help me.”
That same year, Bailey with the support of her dad founded Health Information Associates, Inc. They hired their first employee, Pam Riddle, that same year. In the year to follow she hired her next two employees Amanda Williams (now Roeschke) and Patti Kulp, both who were former classmates at Medical College of Virginia with her…and are still with the company to this day.
“And I guess that’s when it all started,” laughed Bailey.
In the first five years, Bailey also hired Christen, now VP of Operations at HIA and Joel Shealy, now VP of Business Development.
“I swear, even in the early years, I just thought ‘this is so much fun, I get to work with my best friends every day and do something I love.’”
“It still hadn’t hit me.”
As the coding review relationships continued to grow, more and more clients began looking for other ways to take advantage of HIA’s expertise. Soon the requests for as needed coding support to cover vacations, maternity leaves and vacancies began rolling in and another mainstay service line was born. Interim Coding Management was not far behind and eventually services were expanded to encompass the physician coding and compliance side.
Bailey says the gradual growth of HIA over the next several years – during which she also welcomed her third child, Rachel – was by design.
“We grew slowly but steadily. We didn’t want to take big risks and I never wanted to hire someone if I couldn’t guarantee consistent work for them,” she said. “Clients were patient with us because they knew the quality of work we produced – so they would wait until we could fulfill the contract.”
Bailey says Christen and Shealy were instrumental to HIA’s growth.
“Every corner we turned another opportunity presented itself and we would say ‘okay what do we need to do to get to this level?’ – but we never made huge leaps or ventured outside of our area of expertise, coding,” said Bailey. “We made every decision as a team.”
By 1999, HIA had clients in 26 states. It was that same year that Bailey took over the company as sole owner, with Beamer continuing to serve as an advisor.
By 2011, the company had more than doubled in size.
Today, HIA has clients spanning 45 states and continues to employ only the best in the industry.
“For me, these aren’t just employees – they are family,” said Bailey.
The sentiment rings true to all that HIA does – from its slogan The People Behind the Numbers to its annual meeting, instead called the Family Reunion.
“Even as we continue to hire on more people, we still maintain the core values we established so many years ago,” said Bailey. “HIA is only as good as its people – and I truly believe we have the best of the best in this industry.”
Bailey often refers to HIA as another child of hers, and she believes the culture she has established for the company is not something to take for granted.
Case and point: she wants her kids to work elsewhere for at least two years until they even consider joining the company.
“I don’t believe in just giving your children a handout because you have a successful business,” she said. “Of course, you always want them to be interested in what you are doing, but it’s up to them to figure that part out. I would love to have them all working for HIA someday but this may not be the path for all of them – they have their own interests and I support that.
That sentiment made this year’s celebration that much more special for Bailey, whose daughter Beth Ann Moran, 26, joined the company as part of the recruitment team nearly two years ago.
“To see her have the same love and respect for this company and its people that I do – it makes me unbelievably proud,” said Bailey.
Moran says joining the HIA family “officially” is a dream come true.
“I grew up with most of you and I feel so lucky to be a part of this amazing company,” said Moran during the event Salamander. “I saw how hard my mom worked and how much she and my ‘Big Daddy’ cared for all of you, so it really is special for me.”
For Bailey, it’s a full circle moment.
“Now it’s Beth Ann and me, in addition to my husband, sitting at the dinner table, talking business and bouncing ideas off of each other,” she said.
Bailey paused for a moment as she looked at the album of letters before continuing.
“I can’t thank you all enough for taking a leap of faith and joining me on this journey,” said Bailey. “Working with you all day in and day out has been the greatest joy of my life.”
She could only think of one other person who would be more overjoyed than her in that moment.
“I have no doubt that my dad is up there, celebrating harder, screaming louder, than any of us right now,” she said. “He is so proud of all we have done.”
In the weeks following the celebration, Bailey says she reads the letters often daily.
“They are constant reminders of how lucky I am to be in this position and they serve as motivation on those days when you are feeling down or stressed,” she said.
As for what is next for HIA, Bailey says she will do what she’s always done, work with her team to ensure they are on the right track.
“The industry is changing so much and, we have to change with it. Or change before it,” she said. “We need to be prepared for what’s coming – and we will be.”
Bailey says the company will navigate the changes the same way they always have – as a team.
“I think we are successful because the people working here have a say – their voices matter,” she said. “And that’s something – no matter how much we grow – that’s something we’ll never change.”
This is Part 5 of a five part series on the new 2021 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
This is Part 4 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes in the urinary, nervous, ocular and auditory systems. There are 2 new urinary/male reproductive system codes with no revisions or deletions; 3 new female reproductive codes with 2 deletions, 0 new with 4 deleted nervous system codes with 5 revisions; 5 new eye category III codes; and finally a 2 new auditory codes with one deletion.
This is Part 3 of a five part series on the new 2021 CPT codes. In this series we will explore the cardiovascular system CPT changes. There are 5 new cardiovascular CPT codes added with 0 deletions and 4 revisions.
This is Part 2 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include some examples to help the coder understand the new codes. There are 0 new musculoskeletal CPT codes added with 0 deletions and 2 major revisions along with an extensive update to arthroscopic loose body removal requirements. For the respiratory system, there were 2 new codes, one code deletion and no revisions.
This is Part 1 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include examples to help the coder understand the new codes. For 2021 in general, there were 199 new CPT codes added, 54 deleted and 69 revised.
In January, new CPT codes were released. There were 248 new CPT codes added, 71 deleted and 75 revised. Most of the surgery section changes were in the musculoskeletal and cardiovascular subsections. These included procedures such as skin grafting, breast biopsies, deep drug delivery systems, tricuspid valve repairs, aortic grafts and repair of iliac artery.
We have seen many updates and changes to COVID-19 (SARS-CoV-2) since the pandemic started. On January 1, 2021 we will see even more changes as outlined in this post. Also the CMS MS-DRG grouper will be updated to version 38.1 to accommodate the changes.
In the previous three parts of this four-part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2021 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2021.
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2021.
This is Part 2 of a 4 part series on the FY2021 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented. For FY2021 ICD-10-PCS there are 78,115 total codes (FY2020 total was 77,571); 556 new codes (734 new last year in FY2020)…
This is Part 1 of a 4 part series on the FY2021 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. Here is the breakdown: 72,616 total ICD-10-CM codes for FY2021; 490 new codes (2020 had 273 new codes); 58 deleted codes (2020 had 21 deleted codes); 47 revised codes (2020 had 30 revised codes)
Acute pulmonary edema is the rapid accumulation of fluid within the tissue and space around the air sacs of the lung (lung interstitium). When this fluid collects in the air sacs in the lungs it is difficult to breathe. Acute pulmonary edema occurs suddenly and is life threatening.
“Client S” is a small, not-for-profit, 40 bed micro-hospital in the Southeast. HIA performed a 65-record review this year for Client S and found an opportunity with 15 of them. 9 had an increased reimbursement with a total of $43,228 found.
The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition.
In the past, there had been an Excludes1 note at I46.- Cardiac arrest that excluded R57.0, Cardiac shock. HIA had also received a letter from AHA on a case in the past that had stated that only I46.- Cardiac arrest would be coded if both were documented. In addition, the Third Quarter Coding Clinic page 26 had a similar case that asked if both could be coded, and AHA had instructed that only I46.9, cardiac arrest, cause unspecified would be coded if both were documented and that the CDC would be looking at possible revision to the Excludes1 note.
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Lately we have seen several cases where the endarterectomy was assigned along with the coronary artery bypass (CABG) procedure when being performed on the same vessel to facilitate the CABG. A coronary artery endarterectomy is not always performed during a CABG procedure, so when it is performed it becomes confusing as to whether to code it separately or not.
Assign code Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases” for all patients who are tested for COVID-19 and the results are negative, regardless of symptoms, no symptoms, exposure or not as we are in a pandemic.
The Centers for Medicare & Medicaid Services (CMS) announced new procedure codes for treatments of COVID-19 – effective as of August 1, 2020. Among the new codes are Section X New Technology codes for the introduction or infusion of therapeutics including Remdesivir, Sarilumab, Tocilizumab, transfusion of convalescent plasma, as well as introduction of any other or new therapeutic substances for the treatment of COVID-19.
One common element in many value-based programs is risk adjustment using Hierarchical Condition Categories (HCCs) to create a Risk Adjustment Factor (RAF) score. This method ranks diagnoses into categories that represent conditions with similar cost patterns.
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
This is part 1 in a series focused on coding of acute kidney injury (AKI) and/or acute renal failure (ARF). AKI/ARF is reported often, but is also one of the most common diagnosis found in denials.
With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Effective March 1, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. This great for providers whose patients are reluctant to visit the office.
The biggest reasons why some hospital systems are moving to single path coding is to eliminate duplicative processes and to optimize productivity. In addition, costs are reduced when only one coder “touches” the record and completes both types of coding.