For breaches involving more than 500 entities or individuals, the Secretary of Health and Human Services (HHS) must also be notified. Again, HIM professionals can help ensure compliance with these new guidelines by establishing policies about what is and what is not acceptable with appropriate sanctions in place for non-compliance.
Case In Point: St. John's Clinic
At St. John's Clinic in Springfield, Missouri, the EHR is fast becoming a reality, making its way to 170 clinics on a rolling schedule that started in April 2008 and is slated for full implementation in Summer 2009. St. John's is a physician-led and professionally managed multi-specialty group practice encompassing more than 500 physicians and 140 mid-level and allied health practitioners in southwest Missouri and northern Arkansas. The HIM department manages HIM for all clinics, oversees a staff of 25 transcriptionists, manages supervision and training, participates in creating policy and procedures and coordinating privacy and HIPAA security.
One of the first steps in migration to the EHR was to centralize patient charts and address the problem of missing charts. HIM implemented a Procedure Checklist system for each clinic to keep track of charts and conducted training for managers and staff. From there, they created a system for purging old records and deciding which information to upload or integrate into the new EHR. This required cleaning out and organizing a centralized warehouse containing 600,000 records along with annual purging of thousands more charts from each clinic. HIM knows exactly where records are for medical and legal purposes.
Documentation Requirements and Reimbursement
The bottom line for physicians is reimbursement. Providers often don't realize the critical link between proper documentation and appropriate reimbursement, as well as the liability involved. Many, if not most, practices tend to under-code. And coding mistakes can result in fines and administrative consequences imposed by regulatory agencies for failure to comply.
HIM professionals are the experts on clinical coding and documentation—they know the elements required to determine what goes on the bill to capture all charges. That's why physicians need trained HIM professionals in charge of coding, clinical documentation improvement, and developing best practices for capturing the data required to ensure proper reimbursement.
Finally, HIM professionals are trained in the appeals process, which involves researching the patient record to determine the validity of a denial and following through with an appeal if necessary. Increased revenue is largely contingent upon reduced denials. Sound HIM clinical documentation practices can ensure a complete and accurate record before it is submitted, resulting in optimal reimbursement.
The Bottom Line
HIM professionals are in a unique position to help physicians better manage their patient information in a paper world and successfully migrate to electronic medical records. They are natural leaders with the ability to anticipate problems in practice before they occur and take proactive measures to seek solutions. With a broad range of skills required to see the big picture—scheduling, office visit, precertification, documentation, coding, payment—they can identify areas that need improvement and determine the best approach for achieving desired outcomes.
"In physician practice, everyone has to wear a lot of hats," says Phyllis Schuck, CIO at Pinehurst Surgical, a multi-specialty surgical practice comprised of nine specialty centers and 54 providers located in Pinehurst, North Carolina. "In addition to managing vast volumes of medical records, our HIM manager plays a key role in defining the designated record set for litigation (legal record), conducting HIPAA training, and serving on a clinical leadership committee whose goal is to involve clinicians in identifying problems and working together to find the best solutions."