Category Archives: HIM Services

Nearterm, a Health Information Management (HIM) services provider, shares news on key HIM issues affecting today’s hospitals & healthcare organizations.

What is Health Information Management & Why Is It Important?

what is medical health information management

Individuals involved in healthcare around the world acquire and generate a significant amount of personal health information about patients. The scope of health information includes not only personal information and private health data, but also associated payment forms and transactions. Clinical notes, pharmacy, and outpatient care records are also covered health information.

As technology has developed, it has greatly increased the potential for reliability, speed, efficiency, and usability of medical records. However, this also increased the ability for information to be misused, sold, and accessed without an individual’s consent.

As technological advancements outpaced ethical and legal policy, it became necessary to define medical/healthcare information management.

What is Health Information Management?

According to AHIMA; “Health Information Management (HIM) is the practice of acquiring, analyzing, and protecting digital and traditional medical information vital to providing quality patient care.”

The American Health Information Management Association (AHIMA) was formed to define and oversee the training and educating of Registered Health Information Technicians (RHIT) and Registered Health Information Administration (RHIA) certifications.

In tandem with this association, several laws were passed to support patient rights and the practices involving HIM. The Health Insurance Portability and Accountability Act (HIPAA) along with subsequent Privacy and Security Rules were designed to address many issues in this field. These were augmented by the Health Information Technology for Economic and Clinical Health Act (HITECH) which requires contingency plans for emergencies and for when PHI health information management technology systems are impacted.

Besides regulations and requirements for covered entities, these laws also moved to standardize many aspects relating to HIM. Recently healthcare has started transitioning to value-based therapy reflecting each organization’s role in overall healthcare management.

What is HIM in Healthcare?

 

Health Information Management is essential for healthcare providers and other HIPAA-covered entities to ensure patient information privacy and security. HIM involves medical coding and billing, ensuring compliance with government regulations, and handling customer requests for Personal Health Information (PHI).

This field also involves medical records retention and transition to electronic formats, as well as analysis of health care trends and the implementation of improvements. Because healthcare information overlaps many different areas in any healthcare cycle, it became necessary for many organizations to create HIM departments to oversee these important requirements are adhered to as well as managing training and education of staff.

Healthcare Information Managers would oversee all facets of an organization’s collection and retention of records as well as security, privacy, analysis, and implementations, coding, billing, and compliance.

Healthcare information managers work in healthcare organizations and associated businesses around the world. These include hospitals, dentists, pharmacies, chiropractors, and third-party healthcare services.

Security and HIM

Healthcare breaches have become a significant problem for healthcare providers today. In 2015 almost 100 million healthcare records were breached by cyber attacks. The impact from breaches has declined since then due to the implementation of privacy and security regulations for healthcare providers; however, the number of attempted breaches has increased over that same time.

As attackers become more organized or sophisticated the potential for successful breaches will increase unless organizations keep pace or excel with relevant health information management practices. Those interested in stealing health information may also gain access through the front door. In organizations that utilize unsecured wireless networks, or have lax regulations concerning secured network devices, someone could gain access from within and walk out with the data.

Role of a Health Information Manager

importance of health information management technology

What a healthcare information manager does will vary by organization. Many roles in this field require one to first pass an accredited academic program as well as a certification test. These roles include collecting and securely storing medical records and Protected Health Information (PHI).

Healthcare facilities often utilize coders and claims specialists, even third-party medical coding services, to handle medical records and healthcare revenue cycle management. HIPAA rules also impact what information you share with business associates. Your organization might be liable for damages even if a breach occurred due to a third-party business, which is why it is important to choose certified HIM companies.

In addition to the roles above, HIM staff would also implement and enforce security and privacy rule adherence on top of designing and improving network security.  At a minimum, this includes considering administrative, technical, and physical safeguards for traditional and electronic PHI.

Health information management duties can also include analysis and implementation of improvements. For example, an analyst might use the aggregate available information to determine patterns in various areas which can be used to devise improvements to an organization.

Importance of Health Information Management

HIM is vital for every healthcare organization and associated business. Not only are there legal requirements that must be adhered by to receive certain incentives and avoid penalties, but organizations have an ethical responsibility to protect PHI in their possession.

Breaches impact patient trust in a healthcare provider and may prohibit a patient from sharing vital information for fear of exposure. Hackers can also steal patient payment information causing residual harm such as identity theft and stolen money. Both of those factors can impact a patient’s willingness to seek care at certain providers.

A focus on HIM also allows an organization many positive benefits such as the potential for increased efficiency and optimization of healthcare information system access and other key aspects involved with revenue cycle management. A coordinated effort to standardize and efficiently operate tasks involving PHI will take a manager dedicated to the task, especially in larger organizations.

For healthcare management consulting, or for more information on HIM and how it may impact your organization, please contact Nearterm today.

 

Posted By: nearterm-admin

A Deluge of ICD-10 CM/PCS Codes is Coming to All Healthcare Facilities: What to Do?

Jim Matthews  ICD-10 CM/PCS
Jim Matthews, Principal, Nearterm Corporation

On October 1st of this year, a deluge of over 5,000 new ICD-10 CM/PCS medical codes and other changes are coming to hospitals and clinics nationwide. The stakes are high so it is important to get it right the first time. Errors may lead to delayed or denied claims, negatively impacting the revenue cycle management process and, therefore, cash flow.

On top of that, complying with ICD-10 CM/PCS requires a substantial investment in education and technology, pushing the stakes even higher.

Below, Nearterm offers suggestions on what hospitals can do to mitigate the impact of ICD-l0 CM/PCS. The big one is to create a Plan of Action (POA) to uncover and address shortfalls and unpreparedness in all RCM functional areas.

HIM Management

  • Develop a POA. Determine the level of quality and sufficiency in current coding and documentation processes by doing a formal discovery and assessment. Research might reveal that a Clinical Documentation Improvement (CDI) program is needed or should be All relevant Changes to PracticeWork Flow and Business Processes should be covered in the POA.

Medical Coding & CDI

  • Ensure all Medical Coders and CDI specialists are trained on the new/revised codes and how they may impact current business
  • Update CDI and Medical Coding policies to include directives on the new codes if applicable
  • Follow up weekly with Coders and CDI specialists to discuss specific code sets/procedures that may require updating current Queries.
  • Ensure that you have a point person assigned to regularly check coding for quality

Physicians & Practitioners

  • Physicians must be vigilant and ensure that all documentation remains at a high level of specificity
  • For high impact surgeries and diagnoses, complete a 5-to 10-chart/ provider documentation review to ensure the documentation supports the highest level of specificity
  • Include the physicians and practitioners in the audit results and provide education on documentation opportunities that support the severity of illness of their patients.

Billers

  • Billers should also become familiar with expanded ICD-10 code sets for the specialty for which they bill
  • There will likely be snafus related to reimbursements. How to create referrals and order services IS going to change. Effective October 1, 2016, Medicare will no longer accept unspecified codes for Part B. Have the POA include ways to prevent these accounts from being billed before a second level coding review can be done.

Outpatient

  • In the outpatient hospital side, queries may have to be sent back to the ordering provider requesting specificity either before the patient is seen (at registration) or at the time of coding for final billing

Vendors

  • Do not forget to make sure that vendors are up to date and ready for the expanded codes on October 1, 2016.

About Nearterm

Established in 1997, Nearterm is an employee-owned, professional managed services company providing expert revenue cycle management (RCM) and financial management services to hospitals and healthcare organizations nationwide.

Nearterm specializes in the delivery of additional “horsepower” for implementing and supporting RCM activities and projects. These resources can work from remote locations and/or onsite, whatever hospital and the POA requires of them. Nearterm delivers only top notch talent;

  • Consulting (Discovery, Research, Analysis, Planning, POA, Implementation Support
  • Leadership (VP, Director, Manager, Supervisor, Team Leader)
  • Technicians (AR Specialists, Coders)

Nearterm is a recognized authority in Revenue Cycle Management

 

Posted By: nearterm-admin

Are you Ready for the ICD-10 CM & PCS Deluge?

ICD-10 CM & PCS Deluge Medical Coding

NEARTERM WILL KEEP YOU DRY

On October 1st, of this year a deluge of over 5,000 new CM and PCS medical codes and other changes are coming your way!

  • CMS opens the dam to release the five-year hold on these codes and a one year reprieve for unspecified codes.
  • ICD-10 CM will have 1,943 new codes, 422 revisions & 305 deletions
  • ICD-10 PCS will have 3,651 new codes and 487 revisions

This represents a formidable challenge for healthcare organizations as we approach implementation of these changes. Your organization should be prepared with coder training, clinical documentation policies and new query updates already underway.

In addition, it is important to ascertain that providers are included in educational opportunities to review the new documentation requirements supporting Severity of Illness, Risk of Mortality and Medical Necessity.

There are many risks associated with the coming changes that hospital and physician organizations must consider. Here is a summary:

  • Susceptibility to denials and loss of payment if coding reported does not meet the expanded coding standards
  • Presence of staffing adequate to sustain DNFB targets – it will take additional time to navigate through coding pathways to refine coding practices.

If you would like extra horsepower as you prepare for what’s coming and/or perhaps additional support post-implementation, we are available to talk about how we can help. Our professional staff and medical coders are led by AHIMA Approved ICD-10 CM/PCS Trainers. Our coders and consultants undergo continuous education via coding clinics and “hands on” training aimed at new coding guidelines and compliant query opportunities.

We can get you ready for the deluge and we’ll keep you dry.

Learn More about our Medical Coding Services

Learn about our RCM Project Staffing Capabilities including for Coding

Ask the RCM Experts

Posted By: nearterm-admin

Got HIM Pain? Get Relief with Interim HIM Services

Interim HIM Services to Relieve HIM Pain

Nearterm Interim Health Information Management (HIM) services can make your HIM pain go away.

Our highly experienced Interim HIM management professionals are interim careerists, meaning they prefer to work on an interim basis and have developed the skill sets “in the trenches of management” to do so. When placed in a new work environment, can rapidly assimilate new business values, operating objectives and culture. They can quickly formulate and implement proven action plans.

Here are some the pains for which our Interim HIM Managers and Leaders can offer relief.

Leadership Loss

The pain: “Our current leadership gap can affect overall RCM performance. We need an interim solution now until we find a permanent replacement.”

Nearterm Interim HIM Managers available:

  • Director of Health Information Management (HIM)
  • Medical Records / HIM Manager and Supervisor
  • Director, Manager, Supervisor of Coding
  • HIM Operations Manager and Supervisor

Coding Backlog

The pain: “We are behind in coding and it is impacting Cash Flow. We just need to catch up ASAP.”

Nearterm HIM/Medical coding professionals for backlog relief, able to work on-site or remote:

  • Managed Medical Coders
  • HIM Project Staffing managed by a Nearterm Partner
  • EMR/EHR Project Manager / Analyst
  • ICD-10 Project Manager / Analyst

Denials Too High

The pain: “Increasing denials are affecting accounts receivable forecasts. Can you help us with the difficult denials?”

Nearterm offers talented professionals prepared to resolve the tough denials while your staff continues to do the easy ones in order to minimize impact on cash flow:

  • Interim Medical Coding Auditor
  • HIM Project staffing to clean-up the difficult denials. Managed by a Nearterm partner
  • ICD-10 Project Manager
  • CDI Liaison / Specialist

EMR/EHR Implementation behind Schedule

The pain; “We need a manager to identify the causes for delays and implement solutions. Delays are costing us too much.”

Nearterm professionals deliver objective analysis, useful action plans and implementation assistance:

  • EMR/EHR Project Manager
  • Operation Analyst
  • Imlementation Coordinator

Overall HIM Department Performance Needs to Be Improved

The pain: “How can we optimize performance of the HIM department in general?”

Nearterm Leader/Manager specialists can do a performance check-up and recommend (and even implement) solutions to get the HIM department humming:

  • Interim HIM Consultant

For HIM pain relief, give us a call or send us an email. We do house calls.

Ask the RCM Experts

See also: Health Information Management (HIM) Services & Careers

Posted By: nearterm-admin
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