Category Archives: HIM Services

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

Revenue Integrity & Capture – Who’s Herding the Cats?

Cross functional processes can be difficult to manage in hospitals. One reason pertinent to Revenue Integrity is that typically, the organization structure is a series of vertical disciplines with differently defined focus (HIM, PFS, PATIENT ACCESS, ANCILLARY DEPARTMENTS, MD’s, This structure can be and is very effective in many hospitals. However, revenue integrity management doesn’t always “fit”. It requires that all of these disciplines (a) agree on work definition, (b) have consistent education addressing CDM changes, compliance matters and related topics, (c) have the tools in place to manage their performance (d) are clear on current state and change opportunities that require attention (e) communicate routinely specifically about Revenue Integrity matters.

We all know the obvious – if revenue is not captured, coded and billed correctly we risk HIPAA violation consequences, cash flow, cost associated with denials and duplicate handling of work, patient satisfaction and P&L impact. So in an environment where cross functional processing challenges exist and the expressed risks are critical, “WHO’S HERDING THE CATS” in your organization to ascertain that you are banking every dollar that is coming to you? Who in your organization is charged to remain contemporary on what you can bill for and what you cannot bill for and related implementations as change occurs? Is that responsibility spread among various stakeholders and if so, do all disciplines in the revenue capture continuum agree or is there a need for conflict resolution – who identifies and handles that? Who is the leader?

Some hospitals have a staff position designated to lead the revenue integrity charge. In order to be effective, this role must be defined such that it carries authority that crosses organization lines. Other hospitals have established a committee or team consisting of representation from key stakeholders. The committee or team is usually lead by the CFO, VP Revenue Cycle or COO. Either structure or even some hybrid can be effective.

However, many hospitals have not embraced this field with a well-defined multidisciplinary plan that has a specific function as part of the organization. When we are asked to consult with those hospitals about revenue issues, it is usually because they are experiencing symptoms like inordinate denials, decline in same-store revenue, cash flow issues and sometimes conflict regarding coding policy. Our initial discovery work is designed to identify current state, confirm those “symptoms” and address what has caused them. As a result, we can introduce early wins and sometimes interim leadership but the more strategic solution often requires organization change that establishes Revenue Integrity discipline and accountability. It is rewarding to facilitate and see transformation in Revenue Integrity practices at hospitals that previously focused more on symptoms than development of a strategic approach.

If you are working on charge capture, CDM or another component of Revenue Integrity and have questions or if you have in place relevant best practices you are willing to share, please post to this BLOG so that others can benefit. Our healthcare management consulting experts are always available to answer questions or assist you regardless of where you are on the path leading to Revenue Integrity.

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 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.


  • 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


  • 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


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
Managed RCM