“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.”
There seems to be differences of opinions on the issue of a 40w0day gestation Can you clarify if P08.21 should be assigned for 40w0day infant or if it would not be assigned unless the infant’s gestation age was 40w1day or greater?
Coders may find situations where a patient is documented as meeting SIRS or sepsis criteria, or has some clinical indicators reflective of possible sepsis, but the physician never documents sepsis as a diagnosis. Should the coder always query for sepsis in these instances?
In this example, would it be appropriate to code the complication code T82.03XA, Leakage of heart valve prosthesis, initial encounter as the principal diagnosis over the HFpEF (heart failure exacerbation) code?
We interviewed our most productive coders and reviewers, asking them what steps they take to find a rhythm that works for them. This week, we talked with Kerry Atkins, CDIP, CCS‑P, COC, CPC, CPCO, CPMA, CEMC, COBGC, RMB, Physician Services Consultant at HIA, about the steps she takes to find her routine.
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.
With the implementation of ICD-10-PCS more codes were developed in order to accurately report procedures. Spinal fusion coding is still a problematic coding issue and at times, even a coder’s nightmare. Coders often report only the code for the fusion thinking that one code would include all of the other procedures that are performed.
Answer: I would code 0HPT0NZ for removal of tissue expander from right breast, open and change 0HPT0JZ, removal of synthetic substitute from right breast, open, for removal of the acellular dermal matrix to 0HPT0KZ, Removal of nonautologous tissue substitute from right breast, open approach.
There are certain conditions that have instructional notes in the ICD-10-CM tabular/coding conventions that guide the coder in sequencing. This is especially true when the condition has a common manifestation or underlying conditions of a chronic disease. If there is a “code first” note in the tabular, the coder should follow this instruction and sequence the underlying etiology or chronic condition first followed by the manifestation as an additional diagnosis.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and reviewers and asked them what steps they take to find a rhythm that works for them. This week, we talked with Meghan Schumacher, CPC, CPMA, Provider Coding Consultant at Health Information Associates, Inc., about the steps she takes to find her routine.
Last year, the Office of Inspector General (OIG) performed an investigation that found, “between 2014 and 2016, Medicare Advantage organizations overturned 75% of their preauthorization and payment denials upon appeal,” which is why, at HIA, we always advise our clients to engage in the appeals process.
There may be instances where a coder will suspect the patient has acute kidney injury (AKI), but the physician has failed to document the diagnosis. In another scenario, the physician may have made the diagnosis, but there is a question of clinical validity. In either case, a query would be justified.
Changes to CC/MCC designations included in the proposal could have a potentially dramatic effect on casemix. The presence of a major complication or comorbidity (MCC) or complication or comorbidity (CC) generally is representative of a patient that requires more resources.
How many times have you heard “it only takes one code to get the claim paid”? With the emphasis on the severity of illness and the move toward value-based reimbursement in today’s healthcare climate, it is more important than ever for coders to report all applicable diagnoses. There are three important pieces: what the provider documents, how to the coder interprets that documentation and codes it, and then how it is extrapolated.
The reimbursement landscape is already a complicated one – and the highly-complex claims denials process only adds fuel to the fire. A denied claim is one that has been determined by a payor to be in appropriate. Once a coding specialist amends the errors on a rejected claim, they can resubmit it for consideration. The time-intensive process has a significant impact on the cash flow for any setting in the healthcare environment. They are also very costly to appeal.
When a practitioner documents a diagnosis that does not appear to be supported by the clinical indicators in the health record, a coder has four choices: (1) Code the diagnosis; (2) Ignore the diagnosis; (3) Generate a query to confirm clinical validation of a diagnosis; (4) Follow the facility’s escalation policy for clinical validation.
A California-based healthcare services provider and several of its affiliates have agreed to pay $30 million to resolve allegations they submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans, according to the Department of Justice.
Happy National Volunteer Week! This week we celebrate the impact volunteer work has on building stronger communities. We know that our staff have a positive impact while they’re on the job, and we are proud to share a few ways our #PeopleBehindTheNumbers are taking time to volunteer in their own local communities.
Scrutiny of coding compliance in the growing ambulatory surgical center (ASC) market has increased in recent years from both Medicare and private payers. This will only increase as the Centers for Medicare and Medicaid Services (CMS) moves towards value-based care.
Patients being admitted for acute renal failure due to dehydration have been happening for many, many years now. Typically what happens is a patient gets dehydrated for one reason or another. Once dehydration sets in, it can quickly start to affect many body organs. This can lead to acute renal/kidney failure/injury.
In December 2018, a Pennsylvania for-profit hospital and health system, and its CEO agreed to pay a total of $12.5 million to settle allegations they submitted false claims to Medicare and other federal health care programs for orthopedic surgeries. The settlement resolves allegations that top executives exploited a loophole – AKA modifier 59 – that allowed them to double bill federal healthcare payers for surgeries and ignored coding consultants who advised them that they were improperly billing.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Zahra Ghahremani, CCS, Coding Specialist at Health Information Associates, about the steps she takes to find her routine.
All queries require at least two elements – clinical indicators and a query question. Coders can also include multiple choice options for response or leave the query open-ended for a free text response. The order in which these elements are listed in a query is open to coder or facility preference.
Giving back is an important part of the HIA mission. Each year, HIA employees take a consensus and choose three National charities to support. Individuals can volunteer a portion of their wages to one of the three organizations. HIA Corporate will match each individual donation up to five dollars. We are proud to share with you our 2018 contribution totals combined with HIA matching funds.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Donna Cowan, RHIT, CCS, Coding Specialist at Health Information Associates, about the steps she takes to find her routine.
The key to choosing reasonable options for a query response is to remember that the query must stand alone. Any clinical indicators supporting the options must be included in the query itself. In this week’s Query Tip, we provide examples of two queries in which the options for response are not reasonable based on clinical indicators used by coder.
Last week, we looked at tidbits for reporting the ICD-10-CM codes for pregnancy/obstetric records. Now we will look at some for the ICD-10-PCS reporting of these records. In reporting the appropriate ICD-10-PCS codes a coder must know what is included in the terminology of products of conception (POC).
Chances are, we all know someone affected by heart disease and stroke, because about 2,300 Americans die of cardiovascular disease each day, an average of 1 death every 38 seconds. But together we can change that.
There was a time when coding delivery records was considered simple. Many times, these types of records were given to the newer coders. However, as coding becomes more complex, this is no longer the case. With the implementation of ICD-10-CM came more codes for very detailed and specific issues that occur during pregnancy, childbirth and the puerperium.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Allison Curry, RHIT, CCS, Coding Specialist at Health Information Associates, about the steps she takes to find her routine.