A Day in the Life of a HIM Director & Expectations of HealthPort

Transcription

1 A Day in the Life of a HIM Director & Expectations of HealthPort Rita K. Bowen, MA, RHIA, CHPS, SSGB Sr. VP HIM Best Practice and Privacy Officer Alisha R. Smith, RHIA Manager, HIM Education

2 Overview Who are HIMs? Characteristics of HIM Professionals Health Records Where do HIM Professionals Work? Roles of HIMs Foundation of Health Information Management E-HIM Data Quality Privacy A Day in the Life of a HIM Director Expectations from HealthPort Why they would outsource How to make the partnership successful 2

3 What Healthcare requires in the future? Goal Regenerate trust that a shared care system can eliminate avoidable errors, variance, waste, delays and friction

4 HIM s Shades of Grey It s Not a Black and White Situation Grey area: An area or part of something existing between two extremes and having mixed characteristics of both An area, situation, etc., lacking clearly defined characteristics

5 Who are Health Information Managers (HIMs)? Provide essential information for: Clinical Research Quality Improvement Utilization Review Budgeting Hospital Decisions 5

6 Who are Health Information Managers (HIMs)? Protect patient information and promote confidentiality and awareness Implement the Electronic Health Record (EHR) Work with health information systems and databases Health information data collection and analysis Pathophysiology knowledge 6

7 Health Information Management Professionals Experts in Managing patient information and health records Administering computer information systems Coding diagnoses and procedures

8 Health Information Management Professionals Experts in Maintaining patient confidentiality Collecting and storing information Using and transmitting information

9 Employment Opportunities Hospitals Doctors Offices Nursing Homes Government Offices Colleges/ Universities

10 Employment Opportunities Pharmaceutical Companies Insurance Companies Consulting Firms Law Firms Correctional Facilities

11 Characteristics of HIM Professionals Detail-oriented Team-player, but Able to work independently with minimal supervision for long periods of time Comfortable with confidentiality Responsible 11

12 Characteristics of HIM Professionals Proficient with computers HIGH expectations for team members Customer Satisfaction remains a continued focus 12

13 Characteristics of HIM Professionals Often achieved their success through meticulous attention to detail and extensive control over every aspect of their business/department. 13

14 Characteristics of HIM Professionals Expect adherence to policies and processes, quality in all areas and respect. Control Transparency Security Quality to P&P Respect 14

15 Data Quality Ensure patient information is: Accurate Reliable Consistent Timely = Ultimate goal is Patient Safety 15

16 Privacy We assure the public s privacy is protected by ensuring that all access to health information is: Ethical Moral Legal 16

17 HIM GOALS for ROI and HIM Practice Consistent message regarding privacy and security Consistent corrective disciplinary action (thus the accountability matrix) Compliance and integrity of the program Enhance public trust Strengthen response to legal actions Strengthen response to penalties and/or fines

18 Roles of HIM Professionals Clinical Analyst Clinical Applications Coordinator Clinical Research Associate Clinical Vocabulary Manager Data Analyst Database Manager Document Management Coordinator Health Systems Specialist Educator Information Solutions Consultant Privacy Officer Process Improvement Manager Project Manager, Clinical Applications Records and Information Coordinator Risk Management Officer 18

19 A Day In The Life of a HIM Director Most likely started with a 7 a.m. meeting (core measures, quality, safety, DNFB, etc.. All links to coding and some to ROI) Staffing issues (either not enough, FMLA issues or forced staff reductions and other Human Resource issues) DNFB/Cash flow or Revenue Cycle.. rules above all. Why it can t be coded Tracking necessary documentation Assuring SOI, M&M, ROM and DRG for payment Assuring there is an order and medical necessity justification for outpatient treatments

20 A Day In The Life of a HIM Director Meeting with IT/supporting technologies Data life cycle: Governance and Stewardship (includes data capture and quality, as well as appropriate informatics standards paramount is MPI or EMPI issues) Health Information Exchange issues (usually data quality or privacy related) Dealing with request for Record Amendments Legal Issues (court/certifications ROI plays major link here) gov

21 A Day In The Life of a HIM Director Project Management of the various moving parts Transition from ICD 9 to ICD 10 Education and leading this change effort E-HIM Governance E-HIM transition Envisioning the future of HIM Embrace current CORE model and adapt the model as required.

22 HIM Core Model POLICY R E S E A R C H Data Capture, Validation and Maintenance Health Information Governance and Stewardship Information Analysis, Transformation and Decision Support Health Information Resource Management and Innovation Quality and Patient Safety Information Dissemination and Liaison S T A N D A R D S EDUCATION

23 Information Data Governance

24 Five Core Educational Requirements for anyone working with an Electronic Health Record (EHR) 1. Basic computer literacy skills 2. Health information literacy and skills 3. Health information skills using the EHR 4. Privacy and confidentiality of health information 5. Health information data technical security

25 Outsource Risk Management Record keeping and Management Oversight Transparency & Billing Accuracy KPIs and Service Levels

26 The HIM Director s Expectations of HealthPort Best practices: breach prevention program, accountability matrix and application of policies Lessen ROI vulnerability Dashboard/Executive summary reports Report any breach occurrence area and ongoing mitigation process Report any customer dissatisfaction incident (timely acknowledgement with immediate contact of any customer dissatisfaction incident and corrective action plan) Full understanding of access, requests and disclosure of PHI Understanding of payers... knowing what to release for payment Regular contact by the DM and VP, not just when there is an issue

27 The HIM Director s Expectations of HealthPort On time delivery/performance of task maintaining customer expectation levels High quality of the work that is output Project management skills Outsource risk management in general Contract Management Service Level Agreement (SLA) Billing Accuracy Other Expectations and/or assistance in meeting: JC MU Omnibus

28 Monitoring the Spokes of the Wheel Customer Service Goals and Objectives Revenue Cycle Management Strategies Legal and Regulatory Risk Controls

29 Application of AHIMA s Best Practices: Accountability Matrix Have a clear accountability matrix with expected follow-up and training related to specific incidences. Adhere to a strict breach protocol that mandates notification of general counsel. Other best practices include: No password sharing ID checking at every critical point HIPAA compliant scanning and process workflow No PHI in s Data encryption at rest and in transit All field laptops are encrypted Two factor patient identification and EMPI look-up Quality control measures for work processes and performance

30 Best Practice: Expectations Staff awareness of HIPAA privacy and security regulations Staff understands how and where PHI is created, received, stored and transmitted Staff trained regarding breach notification requirements Policy and Procedures (P&P) versus actual practice

31 Best Practice: Breach Report Format Common issues (description of disclosure) Focus for best practices Linked to breach matrix with required educational follow-up Detail of sites or locations Watch list and discussions with Operations Calls and/or site visits to follow

32 Best Practice Expectation: Understanding Payer Request Specifically Medical Necessity Requests RAC, etc Linking request to the RA so that bills can be processed and cash flows in

33 Expectation: HealthPort Associates Understand Regulations and Laws Regarding ROI Knowledge of and how to utilize state HIM Legal Handbook Understanding of noncustodial parental rights Minors Foster Children Abuse Understanding of sensitive information Behavioral / Mental Substance Abuse HIV/AIDS, STDs and other communicable diseases Restriction to a health plan Genetic information Adoption

34 Expectation: HealthPort Associates Understand Regulations and Laws Regarding ROI Understanding Disclosure issues related to Deceased patients Active records of currently hospitalized patients Autopsy information Employee Health or Occupational Safety Antiterrorism Initiatives Duty to warn Laboratory test results Medical emergencies Insurance companies and government agencies payment requests Public figures or celebrities

35 Expectation: HealthPort Associates Understand Regulations and Laws Regarding ROI Understanding disclosure issues related to Social Security Administration State Disability Determination Services General/overall management of ROI processes Authorizations for various type of release Verification of requestor Mail, telephone and walk-ins Determining if disclosure is appropriate Accounting of disclosure and tracking releases

36 Other Expectations Assistance in Meeting JC & State Reviews OCR Site Visit Readiness and Investigation Response Meaningful Use Omnibus Data Analysis and Use/Registries

37 Internal Compliance Audits - Evaluation for: Assessments of privacy and security program Review breach detection and notification processes Assure Policy and Procedures (P&P) are referenced Observe staff adherence to the written P&P Ensure the workforce has been appropriately trained, especially newer staff and that they understand and are effective in protecting privacy Look for failures in: Practical Realities Human Error Limited Staff Time Limited Resources

38 Internal Compliance Audits - Evaluation for: Application of OCR criteria guidelines Crosswalk to internal policies; validation of CE policies Staff asked to verbalize various policy specifics Staff observed applying policy and best practices Determination if key conversations have occurred with management of the CE Other factors as required/based on prior privacy incidents

39 Top Reasons Why HIM Directors Outsource The company s CORE competencies seeking core HIM skill sets. Need for specialized capability skilled work force to meet regulatory and legal requirements access to first class capabilities Quality of service that is provided company reputation Reduction of operations cost or need to reduce headcount Current function may be difficult to manage or out of control

40 Top Reasons Why HIM Directors Outsource Improve the department s focus especially right now. All focus is toward ICD-10 conversion A means to share risks

41 TOP 10 - How to Make the Partnership Successful 1. Assure that the objectives are clearly defined and documented. Must make sure that you re on the same page about expectations. 2. If you believe expectations are not set correctly or are unrealistic, call your experts for assistance. 3. Always alert CE management before they alert you/healthport of an issue. 4. Communicate, Communicate, Communicate in the style preference of management Have regular scheduled meetings (go beyond the metrics). Pay attention to what kinds of questions are being asked of you learn what is critical to management. Keep an open mind and do not become defensive.

42 TOP 10 - How to Make the Partnership Successful 5. Do know the metrics, and assure that the CE receives reports. Make the HIM Manager/Director s job easier. Always suggest a solution have your act together! 6. Assure the HealthPort team understands the CE culture. 7. Adequate resources ability to obtain staff, expertise in the industry, P&Ps and ability to train resources to meet workflow demand. 8. Be aware of community issues, facility in the news, etc.. Anything that could be causing strain on the organization or its leadership.

43 TOP 10 - How to Make the Partnership Successful 9. Assure that management s needs are met to ensure that micromanagement is not needed. Usually a sign of poor transition practices Inadequate communication and/or lack of trust Inadequate recognition of local expectations/culture 10. Flexibility today s environment changes rapidly, so bring solutions, not reasons why something can t be done.

44 Overarching Goals for ROI and HIM Practice A consistent message regarding privacy and security A consistent corrective disciplinary action (thus the accountability matrix) Compliance and integrity of the program Enhanced public trust Strengthened response to legal actions Strengthened response to penalties and/or fines

45 Questions?