Find Your Routine: Increase Reading Speed to Maximize Productivity
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our new 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 Brooke Sechrest, RHIT, CCS, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
Q: Describe in detail your daily routine.
A: I check HIA email, if it’s something that can wait until the end of the day, I do that. Since we do so much reading throughout the day, I try to limit the amount of information in the morning before I begin coding – I feel that’s best. Next, I check my client email and pending chart list. If I have any high dollar accounts or accounts that have been pending for a long length of time that I know the client would want dropped immediately I will take care of those, otherwise I will complete charts at the end of my shift or throughout the day. Here is why – when I know I have 8 full hours to work, I spend more time re-reviewing those pending charts. When I leave those charts for the end of the day, there’s only so much time that I can spend on them. Also, if I feel I need a break from a “new” chart throughout the day, I may switch over and do a pending chart just to give my mind somewhat of a break. I almost always take a break a couple hour into work, but if I’m feeling extremely productive that day and have a good rhythm going, I will wait until lunch time. After lunch I code for the rest of the afternoon. I will check email again and complete any pending charts usually about the last hour of the day.
When I start coding a chart, I enter all account information in log and do any abstracting—disposition, admitting, and attending—take care of all of that first. ED, H&P, consult, progress reports, and discharge summary. I check CDI for any queries and just read their notes to make sure there is nothing missing on my end. If query is needed, I will complete that at that point.
Q: How do you maintain your routine day after day, week after week?
A: I think once you understand all of your client’s policies/procedures, their EMR and coding system, and their physicians and how they document you can start to develop a good routine. I started to notice doing the same thing over and over each day that I was only getting better. It did take time to get there, but once I started to consistently reach my goal, I knew that is WAS possible and could be done and the negative thoughts of “I can’t do it” were finally out of my head. At the end of the day I feel like I’ve done my job and that makes me feel happy and want to continue that each day.
Q: What techniques have you found to minimize distractions?
A: My two biggest distractions were the cell phone and email. I’ve learned in order for me to be productive, my phone has to be out of sight. It’s too easy to grab it when it’s near. Even just spending a couple minutes on it during a chart can throw me completely off. I also have to exit completely out of emails. Otherwise, I think I can multitask by answering an email while I’m in the middle of a chart and the email ends up taking way more time than I thought. The sound of an email notification or seeing one come through while I’m in a chart will have me wondering what it says, so I find it best to exit out. If something is urgent, the client has your phone number.
Q: What are the productivity goals that you set for yourself? And how do you track them?
A: My goal is to code two charts an hour. This is what most of the clients that I have worked for expect. I find that thinking of and setting my goal of two charts an hour, rather than thinking of it as 16 charts in a full day makes it easier for me to work through. I like to keep an eye on the timer each time I’m in a chart, and make sure that I stay around the 30-minute mark per chart. If I feel that I’m behind, I’ll take a look at lunch time and see where I was at 4 hours and how many more charts, I need to hit goal and see how much time that leaves me per chart and just try and set goals that way throughout the day. Thankfully, HIA tracks our number of charts coded per day and the time it took to code each and this is visible to us during coding so that we don’t have to track time ourselves.
Q: What motivates you the most? Positive feedback from managers, self-motivation by reaching personal goals, financing incentives? Or other?
A: For me, all of the above could be motivating. Thinking back to when I really started to consistently hit productivity, I was self-motivated as well at motivated by my co-workers and how they were performing. I would hear that other coders that I worked with were hitting their productivity goals and that made me question myself. There’s no reason why I shouldn’t be at 100% too. If I am not doing my job at 100% then I feel like I have failed. I also remind myself that the company I work for only wants the best of the best, and I’m extremely lucky to be here, so I need to represent them the best I can!
TIP: What else can I do to meet productivity? Speed reading. Don’t spend too much time reading each and every sentence in the notes. I would take a good look at the most important notes such as H&P, Consults, DS, and then scan/speed read the rest. Most of the time there’s a lot of repeat in the notes, and if there’s not, it will stand out to you. I think if your quality is under control, give speed reading a try to increase productivity.
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.
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.
One area that coders struggle with is when to report a separate condition code when an already assigned combination code includes the condition. For example, if an obstetric patient is admitted and delivers, and the physician documents “obstetric patient delivered with anemia,” should both code O99.02 Anemia complicating childbirth and D64.9, Anemia, unspecified be coded or should only O99.02 be assigned?
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.
One way to shorten a lengthy query is by avoiding repetition in the supporting documentation. Does the same diagnosis really need to be mentioned multiple times in the clinical indicators? Is it necessary to list the results of a chest x-ray twice? Does listing the same documentation multiple times give further specification or explanation to the query?
Tobacco use can lead to tobacco/nicotine dependence and serious health problems. Quitting smoking greatly reduces the risk of developing smoking-related diseases. Tobacco/nicotine dependence is a condition that often requires repeated treatments, but there are helpful treatments and resources for quitting.
This is Part 5 of a five part series on the new 2019 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 3 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There are 9 new cardiovascular CPT codes added with 2 deletions and 3 revisions.
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 Tilina Sablan, RHIT, CCS, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
This is Part 2 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There are 4 new musculoskeletal CPT codes added with 2 deletions and 0 revisions.
This is Part 1 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There were 15 new integumentary CPT codes added with 3 deletions and 1 revision.
In part 5 of our series, we look at DRG 64—Intracranial hemorrhage or cerebral infarction with MCC. For this DRG recommendation the majority (almost all) were recommended to DRG 65 (Intracranial hemorrhage or cerebral infarction with CC) with deletion of the reported MCC.
The majority of the recommendations from DRG 190 (Chronic obstructive pulmonary disease w/MCC) was to DRG 189 (Pulmonary edema and respiratory failure) with re-sequencing of respiratory failure as the PDX or adding as a new code and sequenced as PDX.