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Diagnosis And Treatment Of “Epic Finger”

Posted on January 20, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The following is a summary of an “academic” paper written by Andrew P. Ross, M.D., an emergency physician practicing in Savannah, GA. In the paper, Dr. Ross vents about the state of physician EMR issues and repetitive EMR clicking (in quite witty fashion!). Rather than try and elaborate on what he’s said so well, I leave you with his thoughts.

At long last, medical science has identified a subtle but dangerous condition which could harm generations of clinicians. A paper appearing in the Annals of Emergency Medicine this month has described and listed treatment options for “Epic finger,” an occupational injury similar to black lung, phossy jaw and miner’s nystagmus.

Article author Andrew Ross, MD, describes Epic finger, otherwise known as “Ross’s finger” or “the furious finger of clerical rage,” as a progressive repetitive use injury. Symptoms of Epic finger can include chronic-appearing tender and raised deformities, which may be followed by crepitus and locking of the finger. The joint may become enlarged and erythematous, resembling “a boa constrictor after it has eaten a small woodland mammal.”

Patients with Epic finger may experience severe psychiatric and comorbid conditions. Physical complications may include the inability to hail a cab with one’s finger extended, play a musical instrument or hold a pen due to intractable pain.  Meanwhile, job performance may suffer due to the inability to conduct standard tests such as the digital rectal exam and percussion of the abdomen, leading in turn to depression, unhappiness and increased physician burnout.

Dr. Ross notes that plain film imaging may show findings consistent with osteoarthritic changes of the joint space, and that blood work may show a mild leukocytosis and increased nonspecific markers of inflammation. Ultimately, however, this elusive yet disabling condition must be identified by the treating professional.

To treat Epic finger, Dr. Ross recommends anti-inflammatory medication, aluminum finger splinting and massage, as well as “an unwavering faith in the decency of humanity.”  But ultimately, to reverse this condition more is called for, including a sabbatical “in some magnificent locale with terrible wi-fi and a manageable patient load.”

Having identified the syndrome, Dr. Ross calls for recognition of this condition in the ICD-10 manual. Such recognition would help clinicians win acceptance of such a sabbatical by employers and obtain health and disability insurance coverage for treatment, he notes. In his view, the code for Epic finger would fit well in between “sucked into jet engine, subsequent encounter,” “burn due to water skis on fire” and “dependence on enabling machines and devices, not elsewhere classified.”

Meanwhile, hospitals can do their part by training patients to recognize when their healthcare providers are suffering from Epic finger. Patients can “provide appropriate and timely warnings to hospital administrators through critical Press Ganey patient satisfaction scorecards.”

Unfortunately, the prognosis for patients with Epic finger can be poor if it remains untreated. However, if the condition is recognized promptly, treated early, and bundled with time spent in actual patient care, the author believes that this condition can be reversed and perhaps even cured.

To accomplish this result, clinicians need to stand up for themselves, he suggests: “We as a profession need to recognize this condition as an occult manifestation of our own professional malaise,” he writes. “We must heal ourselves to heal others.”

Will Medical Billing Systems Fail Under ICD-10 Phase 2?

Posted on April 6, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The people at CureMD sent out this tweet and image with a pretty powerful assertion about the future of medical billing systems.
Medical Billing Systems Fail Under ICD-10

I’d like to know where CureMD got the stat in their tweet. That’s a pretty strong assertion about medical billing systems. Based on my knowledge and experience, I’m not sure I agree with them. If they’d have said that ICD-10 in general would cause 50% of medical billing systems to fail, I would have thought it was high but possible. It’s not clear to me how phase 2 of ICD-10 will be so much worse for medical billing systems. Maybe they’ll share in the webinar.

I have seen a bunch of medical billing systems that were running on fumes heading into ICD-10. There was no one really actively developing these systems and they weren’t worrying about ICD-10. They were just sucking whatever revenue they could out of their existing clients and they were going to end of life the product once they ran out of clients. They’re like medical billing system zombies.

Turns out that there are a lot more of these types of systems in healthcare than you probably realized. In fact, I’m surprised we haven’t heard more about their demise after ICD-10’s implementation last year. Whenever I’d talk to doctors, they’d often tell me which EHR they had or which EHR they were considering. Then, I’d ask them which PM system they used and they’d tell me about some software I’d never heard of before. They knew it. They liked it. Many of them would happily say that “you could pull it from their cold dead hands.”

It’s interesting to see CureMD predict that it may be time for us to start doing just that. What are you seeing? Are medical billing systems going to have trouble with the 2nd phase of ICD-10? Will we see a bunch of them finally close up shop? What do you see?

How Does Your EHR Vendor Solve Challenging Situations?

Posted on July 22, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I was asked if I thought a specific EHR feature (in this case it was cloud hosted) was one area practices should consider looking at to avoid having a short sighted view of their EHR vendor. The specific feature and question are interesting, but I think it’s a short sighted way to look at an EHR vendor.

My immediate response was that when I look at an EHR vendor, I look at how they solve challenging situations and if they’re still solving those problems. I’m more interested in the EHR vendors direction and approach than I am any specific feature or function they offer today.

Let’s take them in the inverse order. Is your EHR vendor still solving your problems? This is a hard one to evaluate since meaningful use and EHR certification has hijacked the EHR development process. However, when you dig into an EHR vendor you can tell which ones are really investing in improving their platform and which ones are just doing the minimum necessary to retain their customers. It’s a totally different mindset. A forward thinking EHR vendor is trying to push the envelope, is interested in user feedback and is working towards a brighter future. An EHR vendor that’s doing the minimum necessary is just barely meeting the EHR certification and meaningful use requirements and never really responds to customer requests. Sure, they’ll do a bug fix here or there or fix anything major, but there’s no real investment in the future.

One easy way for you to start evaluating which vendors are investing in their future and which aren’t is to talk to their sales people. Does the salesperson have something new to sell you (like RCM or some other service)? If they do, it’s quite possible your EHR vendor has started focusing (and investing) on some new product and not the EHR anymore. Just remember that it’s really hard for a company to focus and invest in more than one area.

Sadly, I think many EHR users know that their EHR vendor has stopped innovating their product. They know this based on the release cycles of the EHR vendor. When was the last time your EHR vendor put out something that made your life as a clinician or a practice easier and it didn’t have to do with MU?

Related to the above is something that’s even more telling when it comes to the future of your EHR. Ask yourself the question, how does my EHR vendor approach solving challenging situations? If you talk to a lot of EHR vendors like I do, you can pretty quickly tell how an EHR vendor approaches problems. Unfortunately, many of them do the minimum work possible to solve the problem. The best EHR vendors dive deeply into the problem and not only solve the problem, but try to think of a better way to optimize everything surrounding the problem.

I still remember sitting down with an EHR vendor for breakfast one day. As they described their ePrescribing solution, they described how they could have implemented ePrescribing really quickly. However, they didn’t just want to have ePrescribing. They wanted to take the time to really understand ePrescribing and ensure that the doctor could ePrescribe with as few clicks as possible. They wanted to make sure that the process was efficient and accurate. It wasn’t enough to just be able to ePrescribe, but they wanted their doctors to be efficient while doing it too.

Reminds me of many of the ICD-10 implementations I’ve seen. I’d describe EHR vendor implementations as ok, better, and best. The “ok” implementation is that they have a search box which can search by word or code. Theoretically, this works. It just means you’re going to have a big book next to you or an app on your phone which lets you really find the code and then all you’re doing is entering the code. Not good!

The “better” implementation is the vendors that group codes so that when you search you can choose the group of codes and then essentially drill down into the group and find the code you need. In most cases, I’ve seen this type of implementation done by integrating a third party vendor. The EHR vendor often passes that third party cost on to the end user (imagine that). I’ll admit that a third party vendor integration for this feels kine of lazy. I’m all for third party integrations, but your EHR vendor won’t ever be able to take coding to the next level if they’re working with a third party. This kind of “grouping” approach is better, but it’s not the best.

The best type of ICD-10 implementation I’ve seen is one that integrates deeply into the EHR documentation. The documentation essentially narrows down the ICD-10 code list for you as you document the visit. Then, when it’s time to do your assessment, the hard work of identifying the right codes is already done for you. Sure, you’ll need to verify that the machine approach to ICD-10 identification is right, but it’s the best approach I’ve seen to ICD-10.

Hopefully this ICD-10 example gives you a view into what I mean when I say that you have to evaluate how an EHR vendor works to solve a problem. Are they just trying to get by or do they take their solution to the next level of automation? I feel sorry for the doctors who are stuck on EHR software that’s no longer investing in their EHR and just take the minimal necessary approach to EHR development.

Going back to the person’s initial question about cloud hosted EHR, it’s easy today to say that every EHR vendor should be on the cloud. The cloud has won in every industry and it will eventually win in healthcare as well. However, cloud or not is not what concerns me. I’d be more interested in hearing an EHR vendors reason for going cloud or not. Not to mention their reasons for moving to cloud or not. That will tell you how an EHR solves a problem and how an EHR works with new technology. Their direction and approach to those challenges is much more important than the specific choice they make.

Crazy ICD-10 Codes? Let’s Put Them In Perspective

Posted on July 16, 2015 I Written By

The following is a guest blog post by Jennifer Della’Zanna, medical writer and online instructor for Education2Go.
Jen HIM Trainer
Exhibit A: W55.21XA Bitten by a cow, initial encounter

Exhibit B: Y92.241 Hurt at the library

Exhibit C: Y93.D1 Accident while knitting or crocheting

Exhibit D: W56.22 Struck by Orca, initial encounter

These are the kinds of codes trotted out to “prove” how ridiculous moving the ICD-10 coding system is. What do we need these codes for? Everybody seems to be asking this question, from congressmen to physician bloggers to—now—regular people who have never before even known what a medical code was.

Here are a few things you should know about these codes. Some of you actually should know this already, but I’ll review for those who have been sucked into the maelstrom of ridicule swirling about the new code set.

  1. You’ll notice that all those crazy code examples start with the letters V, W, X and Y. These are all “external cause codes,” found in just one of ICD-10’s 21 chapters (Chapter 20). In my version of the manual, that encompasses 76 pages. Out of 848.

    External cause codes are the only ones ever trotted out as ridiculous. Do the math. They make up 9% of the codes. They are used mainly to encode inciting factors and other details about trauma/accident situations. There are some other uses, but not many. Do most people use them in everyday coding? No. That’s not going to change with the new system. If you’re a coder who is not already using external cause coding on a day to day basis, you will likely not have to start now. Most people never look in this chapter—ever.

  2. The reason there are such funny codes is the system allows you to “build” a code using pieces, which is what makes the book so easily expandable in all the right places (which is the point of the entire code change—the external cause codes just came along for the ride). Let’s look at Exhibit A: Bitten by a cow, initial encounter:
    The first three characters of the code indicate the category. Each additional character adds some detail.W55 is the category “Contact with other mammals”The 4th character 2 indicates contact specifically a cow (although included in this code is also a bull). You can change the animal to a cat by using 0 or a horse by using 1. You get the idea, right?

    The 5th character 1 indicates that the injury is a bite. A 2 would mean the patient was struck, not bitten.

    The 6th character X is a placeholder because this code requires a 7th character extension to indicate what encounter this visit was.

    The 7th character A indicates that this was an initial encounter. You could change this to a D if the patient has returned for subsequent visits or an S if the patient ends up with another problem later that could be attributed to this original cow—or bull—bite.

  3. We can code most of those same ridiculous codes with ICD-9, although most times not quite to the same specificity. I’ll match the ones below to the exhibits we have at the top:
    Exhibit A: E906.3 Bite of other animal except arthropod

    This is what we would currently have to use for “bitten by a cow.” There is no way in the current code set to indicate whether this is an initial encounter or a follow-up encounter for this accident, however. Since the code is so vague, this code could actually also be used to mean “bitten by a platypus” or “bitten by a pink fairy armadillo,” so yes, you can still code that in ICD-9, but not as well.

    Exhibit B: E849.6 Accidents occurring in public building

    Do you consider a library a public building? I do. Yep, you can code that with ICD-9, but not as well.

    Exhibit C: E012.0 Activities involving knitting and crocheting

    This is what we call a one-to-one mapping. A specific code for this already exists in ICD-9 with exactly the same description. Next.

    Exhibit D: E906.8 Other specified injury caused by animal

    This is the code we would have to use to indicate an attack by an Orca. Again, no indication of what encounter it is, but this time there is actually no reason to even use this code because, really, what information is it giving you? The patient was injured by an animal. We have no idea what kind of injury or what animal caused it. I’m all for going to a useful code for those rare occurrences of attacks by Orcas (which, as we all know, do occur from time to time!).

The real point is not what kinds of crazy things are now able to be coded, it’s what critical things can be coded with ICD-10 that could not be coded with ICD-9. The most newsworthy one is Ebola. In ICD-9, we have to use 065.8 Other specified arthropod-borne hemorrhagic fever. In ICD-10, we have A98.4 Ebola virus disease. But there are other reasons to go to the new system. There are new concepts in ICD-10 that didn’t exist in ICD-9, like laterality. We now have the ability to indicate which side of the body an injury or other condition occurs. This inclusion is one of the biggest reasons for the book’s code expansion. Each limb and digit has its own code (but, again, it’s the changing of one number in the overall code that indicates left or right, and which digit is affected). With all the complaints about the increased documentation required for the new code set, one would hope that most physicians already document which hand or arm or leg or ear or eye or finger is affected. As I mentioned above with the seventh-character extension, there is the ability to indicate the encounter and, more importantly, to link a prior condition with a current one with the use of the S character that indicates “sequela.”

There’s much evidence that the ICD-10-CM will help make patient records more accurate and reporting of conditions more precise. This will lead to improved research abilities and a healthier worldwide population. And the ridiculing of ICD-10 codes, which I’m sure will continue long after this blog post has disappeared from your newsfeed? Well, they always say that laughter is the best medicine!

About Jennifer Della’Zanna
Jennifer Della’Zanna, MFA, CHDS, CPC, CGSC, CEHRS has worked in the allied health care industry for 20 years. Currently, she writes and edits courses and study guides on medical coding and the use of technology in health care, as well as feature articles for online and print publications.  You can find her at and on Twitter @HIMTrainer.

Great ICD-10 Image and Poll

Posted on March 25, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and 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 saw this great graphic on Twitter today which made me laugh:

I have friends in DC with AHIMA trying to make the case to their representatives in Congress that they shouldn’t delay ICD-10. Word on the street is that as of now (subject to change as we saw last year), the SGR fix bill doesn’t contain an ICD-10 delay. Of course, the real challenge with ICD-10 now is the uncertainty of it all.

I thought it might be interesting to see what the readers of EMR and EHR predict for ICD-10. So, here’s a simple ICD-10 poll about whether ICD-10 will be delayed or not.

5 Features to Look for in a Medical Billing Company

Posted on March 4, 2015 I Written By

The following is a guest blog post by Harold R Gibson, Chief Financial Officer at M-Scribe Technologies, LLC.
Harold Gibson
A full-service medical billing company does more than code and file medical insurance claims. While that may still make up the bulk of a company’s output, a good medical billing company should offer additional services to help a practice achieve both profitability and compliance goals. Look for the following main features in a medical billing company:

  1. With the transition from ICD-9 to the new ICD-10 coding system in place, a billing company’s coding, billing and other EHR staff should be trained and experienced to ensure optimum accuracy – the foundation of compliance, and therefore improved timely payment. Since many practices have less time or budget for training billing staff in all aspects of the newer, more complex coding system, it falls to the medical claims processing service to fill in any gaps in the EHR process. A company which carefully monitors the EHR content entered will improve the accuracy of the codes and therefore ensure better compliance and payment as well as lessen the chances of an audit. Duplicate claims, payments included in a previously-billed service or procedure already adjudicated and non-covered charges are some of the most common reasons for claim denials. Make sure your practice doesn’t make these billing mistakes by letting a professional medical billing services company handle the workload.
  1. Accurate medical documentation is critical to having claims paid on time, with no rejection due to errors or incomplete filings. This is especially true of Medicare claims, whereby a Certificate of Medical Necessity and other required documentation must be correct and current to merit payment without multiple resubmissions. The right medical billing services company should use  technology and experience when entering only claim-relevant content data, correct procedure (CPT) and diagnosis codes (ICD-9 and ICD-10). These should then be entered into the EHR charts, providing convenience, increased efficiency and cost reduction.
  1. Specialty-specific billing services are available to group practices and clinics as well as individual physicians. Whether your practice uses billings systems such as eClinicalWorks, Greenway, Kareo, NextGen or other popular systems, the right service should be able to help. Whether your practice specializes in Surgical, Dermatology, Nephrology, Orthopedic, Radiology or anything else this should not be a problem for your billing provider. As a bonus, full-service billing companies can provide other services to you, including patient scheduling, verification of eligibility, performing patient demographics, coding and claims submission.
  1. Pre-RAC audit-related support: Complying with the complexities of Medicare and Medicaid regulations can be challenging even for an experienced billing staff in many practices – even more so for smaller or solo practitioners, who often have just one or two staffers handing billing as well as other duties. On the other hand, offering pre-audit support can be tricky for smaller, less experienced billing companies.  An experienced medical billing company can help with preparing a pre-audit checklist to supply requested audit information.
  1. Training webinars for billing and coding staff are another service designed to reduce the chance of errors caused by unfamiliarity with the new coding system as well as keeping abreast of regulatory and other changes. Offered free of charge, these webinars explore the history of ICDs, a comparison of ICD-9 and ICD-10, coding guidelines and formats as well as a step-by-step plan for implementation. These webinars can help solve the dilemma of not enough time or money to send busy staff to expensive, days-long ICD-10 training classes.

If you are looking for a medical billing company, it is important to choose a company that houses the above five features and remember to look for a company that will help with profitability and compliance goals.

About Harold R Gibson
Harold R Gibson is the Chief Financial Officer at M-Scribe Technologies, LLC, an accomplished healthcare professional with extensive experience in the medical billing and coding industry. You can find him on Twitter @mscribetech. He is interested to get your feedback/suggestions. Please email him at

A Do-Not-Forget Checklist for EHR Switchers on the Hook for Meaningful Use

Posted on November 21, 2013 I Written By

The following is a guest post by Tom S. Lee, PhD, CEO and Founder at SA Ignite.

According to a recent survey by Black Book rankings, as many as 16 percent of ambulatory EHR users may become  EHR switchers within the next 12 months.  Large health systems such as Intermountain (a client of ours) and the Department of Defense have recently announced that they are switching EHRs or are currently evaluating a change. Many such organizations are planning to switch EHRs while continuing to meet increasingly difficult Stage 2 Meaningful Use (MU) requirements.  According to past National Coordinator  Dr. Farzad Mostashari, there will be no delay of MU Stage 2. That means your health IT road map may now include switching EHRs, managing Stage 2 attestations, and achieving ICD-10 compliance.

How do you switch jugglers while the number of balls in the air increases at the same time?

We have encountered a common set of issues and questions in our work with clients, discussions with prospects, and exchanges with thought leaders in the industry related to the EHR switching scenario, especially as it relates to Meaningful Use.  Here are some things to consider:

1. Assess and properly store data from your old EHR for future MU audits. A recent wave of MU audit notices has been sent by CMS to some of the country’s leading health systems. Each MU attestation is subject to audit 6 years after the attestation date.  With this in mind, be sure to pull out and securely and centrally store all supporting data from your old EHR before its license expires.  Get expert assistance if needed to understand how to build a comprehensive and solid audit trail.  One great place start is the guidance on audit documentation provided by CMS.

2. Optimize the timing of the EHR switch relative to government reporting timelines.  For example, in 2014 there is a one-time opportunity to report on only a calendar quarter’s worth of data for many eligible providers, rather than the entire year.  This modification to MU was originally made to accommodate delayed Stage 2 certifications by the EHR vendors.  However, it can also be leveraged by EHR switchers who can time the switch to happen within 2014 to benefit from a lower compliance bar while the massive impacts of switching EHRs are absorbed by the organization.

3. Plan to merge data across EHRs to meet MU reporting requirements.  Even with the 2014 calendar-quarter reporting reprieve, for many hospitals and eligible providers to achieve Meaningful Use in an EHR-switching year it’ll be necessary to stitch together Meaningful Use data across the old and new EHRs in order to meet many MU reporting requirements.  For example, this may be required simply to meet the minimum certified EHR usage threshold to be eligible for the MU program in that year.  Assume merging data will be necessary, prepare how to do so before your old EHR license expires, seek help, or do both. An interesting contingency we have seen is to drive eligible providers to “over perform” on their MU measures on the old EHR in anticipation that MU performance will drop at the outset of adapting to the new EHR.  This will increase the chances that providers’ total MU performance within a reporting period spanning both EHRs will end up above threshold.

4. Plan to be supporting two EHRs at the same time.  Although it is sometimes possible to do a “big bang” switchover to a new EHR across an entire organization, we often see that rollout plans for the new EHR are phased across specialty, location, or other sub-groups.  During those periods when the organization could be supporting two different EHRs, such as two ambulatory EHRs in different geographic regions, it is important to organize and align teams to not only handle the immediate demands of MU but also transition completely to supporting the new EHR.  For example, MU data reporting and attestation can be hard enough for just one ambulatory EHR, much less two.  It takes preparation well in advance of the EHR switch and government attestation deadlines to avoid 11th hour fire drills.

Is your organization juggling MU requirements while switching EHRs? If so, I’m sure that you’ve found there are additional considerations surrounding an EHR switch that are important to keep in mind. I’d love to hear your suggestions in the comments.

HIPAA and ICD-10 Courses

Posted on October 11, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the real telling things I learned this week as I traveled to the MGMA Annual Conference and then the CHIME Fall Forum was how unprepared organizations are for ICD-10 and HIPAA Omnibus. It was amazing the stories I heard and I’m sure these will be topics I write about much more in the future.

One of the stories I heard was a medical practice who was asked if they were ready for ICD-10. The practice said that they were ready. Then, they were asked what they’d done to prepare for ICD-10. Their response was that their vendor said that they were ready for ICD-10.

We could really dig in to reasons why that practice might want to verify that their EHR vendor is really ready, but we’ll save that for future posts. What was amazing to me was that this practice thought they didn’t need to do anything to train their doctors and coders on ICD-10 to be ready for the change. They’re in for a rude awakening.

At a minimum, these organizations should look at a course like the Certificate of ICD-10-CM Coding Proficiency (20% discount if you use that link and discount code). The course looks at the key changes in coding with the implementation of ICD-10. Plus, it’s a course that looks to bridge your ICD-9 knowledge to ICD-10. Once you start digging into this content, you realize why your organization better have some ICD-10 training or you’re organization will suffer.

The same applies to HIPAA. So many people don’t realize (or remember) that as part of HIPAA compliance you need to have regular HIPAA training for your staff. This is particularly true with all of the changes that came with HIPAA omnibus. How many in your organization know the details of the changes under HIPAA omnibus?

An online courses like the Certified HIPAA Security Professional are such a great option since you can work on them when you have time and come back to them later while helping to protect you against a HIPAA audit. Plus, the course linked above includes a HIPAA “Business Associate Agreement” downloadable template which I’m quite sure many organizations still need. I recently asked a doctor’s office I was working with for their EHR business associate agreement. They told me they didn’t have one (more on that in future posts). Really? Wow!

Certainly each of these courses and training take some commitment to complete. Although, when your colleagues ICD-10 reimbursement becomes an issue or the HIPAA auditor knocks on your door, you’ll sleep much better knowing you’ve made the investment. Those who don’t will likely pay for it later.

Must-See Sessions, Exhibitors at HFMA #ANI2013

Posted on June 13, 2013 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.

It’s that time of year again. The Healthcare Finance Management Association’s annual ANI conference is just days away. I’ve come to associate the month of June with all things revenue cycle and the anticipation of learning more than I ever wanted to know about financial risk, reimbursement strategies, RACs, coding … the list could go on and on. I do enjoy the show, almost more than HIMSS, because it is smaller, shorter and so much more manageable from a logistics standpoint. HFMA puts out a great mobile app each year, and this year marks the first time I’ll be able to take advantage of it thanks to a (finally) upgraded phone.

Last year in Las Vegas, the show floor and educational sessions were largely focused on ICD-10 and ACOs. Flipping through this year’s brochure, I see that health insurance exchanges, Stage 2 of Meaningful Use and payer relationship strategies will also see a bit of the limelight. Personally, I’m looking forward to learning what healthcare finance folks think of this surge in healthcare consumer cries for price transparency. Are they paying attention? Will charge masters ever change (for the better)?

I thought I’d share some of the sessions I’m most looking forward to attending. I admit that I’m a big fan of panel discussions. Solo presenters can turn into sleep-inducing monologues far too quickly.

To Merge or Not to Merge: Hospital Executive Panel Discussion (Monday, 6/17)
What are the advantages and challenges of maintaining stand-alone status? What factors could influence a decision to see affiliation partners? What various affiliation strategies have worked for others?

Living in Atlanta, which has seen its fair share of hospital mergers and partnerships, I’ve often wondered why some facilities choose to go it alone and some choose to affiliate. I’m looking forward to hearing some inside scoop from the four scheduled hospital executives.

Transitioning to Value: Barriers, Solutions and Opportunities (Tuesday, 6/18)
Former CMS administrator Don Berwick will give this keynote address, which promises to “identify the barriers that must be overcome to reform the delivery system, the outcomes of successful delivery models, and the signals of progress within provider organizations.”

I can’t help but wonder how his stage presence will compare to Farzad Mostashari’s, and what sort of neck attire he’ll don.

Physician/Hospital Revenue Cycle Integration: a Panel Discussion (Tuesday, 6/18)
This session will cover the “opportunities and challenges of unifying the revenue cycle to reduce overall costs while increasing collections and patient satisfaction.”

I think it will be interesting to hear from providers just how important patient satisfaction (and presumably referrals) are to a provider’s bottom line. I expect at least one of the panelists will bring up Stage 2, as I’m learning that patient engagement and satisfaction are closely intertwined.

Women as Leaders: Charting the Course (Tuesday, 6/18)
As I mentioned in a recent post, I’m looking forward to learning how the HFMA board members (dare I call them #RevCycleChicks?) on this panel manage careers, families and communities.

Quiet: Harnessing the Strengths of Introverts to Change How We Work, Lead and Innovate (Wednesday, 6/19)
This keynote from author Susan Cain seems tailor-made just for me. Until social media came into my life, I’d always considered myself an introvert. But social networks have turned that idea on its head in unexpected ways, and so I wonder if Cain will touch on digital media in her presentation.

Best Practices for Managing Consumer Payments in the Current Environment (Wednesday, 6/19)
This “late-breaking session” promises to share best practices on improving collections and patient satisfaction.

I hope they’ll touch on the “future” environment, as it seems reasonable to assume that 2014 will likely make a number of current best practices out of date.

Then, of course, there is the exhibit hall, which I always enjoy roaming around without plan or purpose. A few recent postcards have piqued my interest in several companies:


I’m not even sure what the name of this company is, but the idea of a singing sock intrigues me.


I fared poorly at Emdeon’s Cash Stacker games last year, and am determined to do better this time around. Plus, the company always seems to be doing interesting things in the revenue cycle space, so I look forward to catching up with several of their team members to get the inside scoop.


I’m very intrigued by the idea of provider benchmarking at the moment, so I’m planning to learn more about what RelayHealth is doing in this area.


While this postcard doesn’t allude to athenahealth’s recent claims of guaranteed ICD-10 compliance, it will definitely be my main talking point when I stop by their booth.

Good works are always a good idea, and several companies are making charitable contributions in lieu of giveaways:



What sessions and exhibitors are you looking forward to? Let me know what I shouldn’t miss via the comments below.

Great & Powerful Oz Grants Kansas PHR Access

Posted on March 21, 2013 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.

It is unlikely that author Frank L. Baum imagined citizens of the Emerald City would ask the Great & Powerful Oz for better healthcare. In reality, that is just what the state of Kansas – home to Dorothy, Toto, Auntie Em and fantasy-inspiring twisters – is offering its citizens in the form of a free personal health record.

The news is timely, only because I just saw the movie Oz the Great & Powerful, which portrays Oz as a con man who stumbles into greatness, and saves the people of Oz along the way. (Anyone know the ICD-10 code for injury due to hot air balloon crash? Leave it in the comments section below and I’ll have my daughter Dorothy sing Somewhere Over the Rainbow to you.)

While Kansas isn’t suffering from attacks of the Wicked Witch variety, it seems to be facing healthcare challenges similar to the rest of the country – a need to improve communication and quality, and a desire to increase patient engagement as part of Meaningful Use requirements.

According to a recent write up in The Wichita Eagle, the Kansas Health Information Network (KHIN) may be “the first statewide exchange in the country to provide a personal health record portal for patients.” It plans to provide portal access this summer to patients at no charge, with full operation anticipated by next year. Provider access will be included in KHIN membership. KHIN selected PHR vendor NoMoreClipboard to supply the technology.

Details around set up and access have yet to be determined, according to the story. The bigger question, I think, is how are providers going to get their patients to fill in information on their own time, and on their own dime, so to speak. I’ve attempted to be proactive and fill out one for my daughter, and, I’m ashamed to admit, it was just too time consuming to keep up with. Perhaps making the PHR portal available to patients on mobile devices would up the data input rate. The NoMoreClipboard website does mention its PHR is available for mobile phones.

I’m thinking that patients would need some serious incentive to go to the trouble of all that data entry, which is perhaps where payers come in. I might be persuaded to keep up with my PHR is I received some sort of discount on healthcare services.

Perhaps the Great & Powerful Oz could grant the good patients of Kansas the ability to enter their own healthcare data in the blink of an eye, or, as they say in the Emerald City, at least no longer than it takes to follow the yellow brick road.