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Tips for Physicians to Improve Their EHR Documentation for Coding

Posted on February 1, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

During the last AHIMA, I sat down with Dr. Jon Elion, Founder and CEO of ChartWise Medical Systems and asked him about how a physician can improve their EHR documentation so that it matches the needs of medical coders better. In the following video, he offers a couple simple tips on how a physician can do this easily.

Considering ICD-10 is just around the corner, I thought many would find these tips interesting and useful.

ICD-10 Benefits for Population Health

Posted on November 13, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve asked many people why we haven’t had more stories on the benefits of ICD-10 since so many other countries have been using ICD-10 for many years.

In the following video I asked Doris Gemmell, BSc, MBA, CHIM, Director of Coding Services at Accentus Inc. about the benefits of ICD-10 to population health and she provided an answer from her ICD-10 experience in Canada.

You should also check out this video where Doris Gemmell talks about the patient benefits of ICD-10. Plus, Doris also has a blog.

What Are the Problems with EMR Documentation Today?

Posted on October 29, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While at AHIMA 2012, I asked Susan Sumner, Executive Vice President of Ambulatory Services at Accentus Inc. about some of the problems with EMR documentation today. Here’s her video answer with her views on narrative EMR documentation vs point and click EMR documentation:

EHR Upcoding, Meaningful Use Stage 2, Interoperability, EHR Consolidation, and ACOs Video – Burning Topics with Dr. Nick

Posted on October 24, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently sat down with Dr. Nick van Terheyden, CMIO of Nuance to talk about some of the Burning Health IT topics. In the following video Dr. Nick and I talk about EHR Upcoding, Meaningful Use Stage 2, Interoperability, EHR Consolidation, and ACOs. Enjoy and I hope you’ll extend our conversation in the comments.

Challenges and Risks Associated with Disclosure of Health Information in an EHR World

Posted on October 22, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While at AHIMA 2012, I had a chance to sit down and talk with Rita Bowen, MA, RHIA, CHPS, SSGB, Sr. VP of HIM and Privacy Officer at HealthPort to talk about some of the challenges and risks associated with the disclosure of health information in this new world of EHR software. In this video, Rita talks about some challenges with EHR software disclosures that I bet a lot of people haven’t thought about before.

Changes in Clinical Documentation

Posted on October 8, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While at AHIMA 2012, I had a chance to sit down with Dr. Jon Elion, Founder and CEO of ChartWise Medical Systems. I asked him about the changes in clinical documentation he’s seeing and I grabbed a video of his answer below. His answer was an interesting and insightful look into clinical documentation and ways that coding is effecting the clinical documentation.

I find Dr. Elion’s answer quite interesting in the terms of using clinical documentation intelligence in EHR. Add in things like coding engines, NLP, and EMR templates and you can see why getting the documentation right is a challenge even in an IT optimized world.

Dr. Nick, CMIO of Nuance Talks About Their Acquisition of Quantim and J.A. Thomas & Associates

Posted on October 4, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While at AHIMA 2012, I had a chance to sit down with Dr. Nick van Terheyden, CMIO of Nuance Communications, to learn a little bit more about the recent Nuance acquisitions of Quantim (HIM division of QuadraMed) and J.A. Thomas & Associates. I asked Dr. Nick to describe how these acquisitions will fit into Nuances portfolio in the following video.

And the #AHIMACon12 Winner Is …

Posted on October 3, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

… ICD-10 by a landslide. For those of you wondering whether “upcoding” might just steal 10’s thunder, it wasn’t meant to be. Providers and vendors alike brushed aside the phrase – some with a shrug of the shoulders, others with a roll of the eyes, and some with a “What did you expect?” The general consensus I gathered on the show floor was that technology such as electronic medical records enables doctors to code more accurately – not fraudulently. Everyone agreed that paper-based processes have for years resulted in doctors under-coding, and now that technology and workplace culture have caught up, those same doctors are finding it more efficient to code accurately, thus leading to more accurate, i.e. higher, reimbursement.

Speaking of reimbursement, John mentioned in a recent blog that ICD-10 is on the list when it comes to Top 5 Revenue Cycle Management Issues, and I couldn’t agree more. Talking with vendors and their physician customers at the show brought home to me just how fine a line providers walk when it comes to coding and revenue. As we move closer to Oct. 1, 2014, and the final push towards ICD-10, I am eager to see how these more granular, accurate codes play out in the revenue space. If a doctor codes more accurately in 10 (and hopefully provides quality care at the same time), and as a result sees higher reimbursements, will this somehow turn into a price increase that will trickle down to patients through payers? Where will the touted cost-effectiveness really come in? At any rate, I am definitely seeing the cause and effect relationship between coding and revenue more clearly as the ICD-10 deadline draws near.

ICD-10 was the focus of the only educational session I was able to attend, and it was well worth the time. “The Good, the Bad and the Reality: Lessons from the Frontlines of ICD-10 Implementation” featured the stories of Sutter Health, Vanderbilt University Medical Center and Deloitte Consulting. Both Danielle Reno from Sutter Health and Gary Perrizo from VUMC stressed strategy, education and testing in the run up to 2014. I got the impression from them and the physicians in the audience with me that though everyone is grateful for the extra time to make the switch, no one should be taking the time for granted. “Lollygagging” as I tell my children, is not advisable.

As you probably know by now, I’m a big fan of social media in the healthcare space, and I was very impressed with the efforts the AHIMA team took to incorporate social networking into just about everything – especially compared to last year. The attendees at AHIMA seem more like a Facebook crowd, and that was indeed the sentiment I heard from several vendors. That being said, I do think the tweet stream was more active than last year, probably due in large part to the @AHIMAResources team taking a proactive approach to socially marketing the event. I hear that next year (the event will be in my hometown of Atlanta) we’ll see the hashtag on all the slide presentations, which may encourage attendees to get in on the tweeting action.

Overall it was a fun, educational first trip to Chicago and second trip to AHIMA. (You can check out some of the more memorable images from the show below.) Seeing the sun rise and set over Lake Michigan in early Fall was a real treat. I hope that Atlanta will have equally spectacular vistas to offer next year.

AHIMA 2013 will take place in Atlanta Oct. 26-30.

This book caught my eye on the show floor. Anyone read it yet?

This picture does no justice to the spectacular views I had from the 95th floor of Chicago’s John Hancock building, thanks to the fun folks at Healthport.

The Precyse team flew a special member in just for the show.

The Friedman Marketing group was nice enough to hold another tweetup after show hours.

My coworkers presented me with a lovely birthday balloon bouquet from one of the two balloon artists on the show floor.

Top 5 Revenue Cycle Management Issues

Posted on September 27, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Like Jennifer, I’m going to be heading to AHIMA 2012 as well. She correctly identifies that ICD-10 is a major AHIMA topic and Upcoding is the topic de jour, but another topic which I think continues to sit under the radar at AHIMA is revenue cycle management.

In many ways this makes sense when you consider that the ICD-10 has such an influence on revenue. Upcoding is all about revenue. Even healthcare documentation is dominated by a discussion of its impact on revenue (Yes, we could discuss why this should be about patient care in a future post). While many don’t want to admit it, humans need to get paid to survive and they want to get paid as much as they can get. Last that I checked doctors were human.

What then are the challenges that doctors face with revenue cycle management (or revenue integrity which many like to call it)? Here’s a great list of RCM challenges as listed by Ruth Zwieg on LinkedIn:

1. Managing the revenue cycle of a practice starts with good Practice Management (PM) software; one that has an easy to use scheduling tool for the front desk and that can determine insurance eligibility before the patient arrives so that the practice can collect the correct co-pay and/or out-of-pocket expenses up front before seen by the physician. This increases A/R and saves time instead of spending resources collecting after the fact which is time consuming and expensive.

2. The PM software must be easy to integrate with their existing or new EMR so that the physician group can show meaningful use and get that incentive money. Many practices still think they have to get new Practice Management software when they start looking at EMRs and many EMR companies try to sway them this way so they can get the sale for their PM software and their EMR.

3. ICD-10 – Need I say more – you have written about this in detail. Some Practice Management systems have a coding assistant built in but most do not. Coding correctly determines payment.

4. Staff training is very important from the beginning of the revenue cycle (scheduling, verifying insurance) to managing the patient once he/she checks in to when the physician sees them to check out and billing/collecting. Just like every other business, time has to be managed and time is money, especially a physician’s time. The more efficient the staff and their use and understanding of the software, the more patients the physician can see.

5. Many hospitals have and still are purchasing physician practices because the physician either does not know the business side of running a practice or just wants to be on salary and get rid of the headaches. Billing for physician practices is different than hospital billing. Hospitals are realizing that their hospital staff may not be doing the best job of that. In addition, the hospitals are realizing that their hospital system’s EHR does not have the desired functionality that a physician group needs or worse, they have multiple physician practices all using different EMRs that the hospital now has to manage or integrate into one.

I find this list really interesting and does speak to many of the revenue challenges healthcare faces. If we could solve these five challenges we’d have done a lot of good for doctors.

Battle of the AHIMA Buzzwords: Upcoding vs. ICD-10

Posted on September 26, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

I’m heading to Chicago this weekend for the annual AHIMA show. It will be my second time attending, and last year’s experience will be hard to beat. I stayed at the Grand America hotel, which has now spoiled me for days when it comes to tradeshow accommodations (or vacation accommodations, for that matter). The show was in beautiful Salt Lake City, which literally was a breath of fresh air every time I walked from the hotel to the convention center. The show floor was bustling, attendees were friendly and chatty, and exhibitors were eager to talk about their latest offerings in the world of coding, transcription and health information management, with a dash of healthcare IT thrown in for good measure. And how can I forget the great networking off the show floor? Those HealthPort folks sure know how to karaoke!

Needless to say, AHIMA set the bar high in Utah, and I’m eager to see if my experience in Chicago will live up to it. The time definitely seems right for talking to providers and vendors about ICD-10, of course; but I believe ICD-10 has met its match in the EMR-related buzzword “upcoding.” You may have seen it mentioned in the major news outlets in recent days, read John’s post about EHR Incentive Increasing Medicare Costs, or come across this statement from the government:

“There are … reports that some hospitals may be using electronic health records to facilitate “upcoding” of the intensity of care or severity of patients’ condition as a means to profit with no commensurate improvement in the quality of care.

“False documentation of care is not just bad patient care; it’s illegal.”

The government obviously means to let providers know that inappropriate documentation will result in legal action, but there is another side to this story in that some providers claim they aren’t “upcoding,” but rather more accurately documenting care now that they have the technology to do so. For hospitals that are struggling financially, implementing new EMR/billing technology may simply allow them to clean up their documentation and billing methods. Seems to me that it’s pretty easy to immediately go from red to black if you’re used to using paper, but now have all kinds of efficient technology at your fingertips.

At any rate, the upcoding conundrum has, for me, elucidated the link between coding and documentation, the EMR and a healthcare facility’s fiscal health. Harold Gibson makes a number of good points around this relationship is his recent blog, “Medical Documentation Specialists can do Better Medical Billing:”

“The medical record is the basis for every financial transaction that follows its creation. EHRs have the advantage of being instantly accessible to a credentialed medical coder or biller at any location. The value of EHRs cannot be underestimated, nor can computer assisted coding software, but they are not a panacea for the elimination of billing errors.”

I hope to find out as I walk the show floor next week how vendors and providers alike are trying to get past this problem. If you have any insight, please share them in the comments below, or, if you’ll be at the show, grab me on the show floor for a quick chat.

Also, if you’re in Chicago and/or at AHIMA 2012, then be sure to come by the AHIMA Tweetup on Monday, 10/1 5:30-6:30. Swissotel, Friedman Marketing suite.