Hot Topics from AHIMA17
The 89th AHIMA Convention and Exhibit held in Los Angeles, California, was abuzz with people gathering to talk about the many ways health information professionals can inspire, innovate and lead their organizations into the future of health data analytics, informatics, and information governance. For everyone meandering back and forth across the convention’s vast exhibition hall, attending engaging education sessions or rushing to networking receptions or events, having an abundance of energy at AHIMA17 was a must.
To get to the heart of what made AHIMA17 special, we connected with Lisa Knowles, Harmony Healthcare’s Compliance, Education and Privacy Officer, who attended the convention and is deeply engaged with the health information management community. With so much activity, it was impossible to cover everything, but here are some key topics from AHIMA17 that you won’t want to miss.
Meet our interviewee:
Lisa Knowles has more than 25 years of healthcare experience specializing in health information and revenue cycle management with a focus on coding and compliance. She has held several positions at various healthcare organizations including Revenue Cycle Director and Enterprise Director of Coding and Reimbursement. Lisa is a frequently requested presenter on the national and state level having presented for AHIMA, 3M, and state HIMA conferences. Connect with Lisa on LinkedIn.
What was your favorite session at AHIMA17?
Knowles: One of my favorite sessions had to be the opening day general session where Donald Rucker, MD, head of the Office of the National Coordinator for Health IT, delivered a phenomenal presentation and engaged the audience addressing topics of urgent concern to HIM – including cybersecurity and interoperability. Cybersecurity is a “massive issue” according to Rucker, who noted that the ONC is working to incorporate best practices for security into its health IT certification program – but some measure of responsibility belongs to patients as well, he said.
What topic was hottest, either in session themes or in on-the-ground conversation?
Knowles: Denials got a lot of buzz. Everyone and I mean everyone was talking about denials. There were conversations about the amount of denials received from commercial payers including coding denials, clinical indicator denials, medical necessity denials, and prior authorization denials. It seems commercial payers have clinical indicator denials as their new favorite form of denial. This is where the coding team has correctly coded the account based on physician documentation, however upon review the commercial payer is stating that the physicians’ diagnosis is not supported by clinical indicators in the medical record documentation. People were also talking about the demands on staffing and the need to have qualified staff to write succinct, source documentation driven appeal letters.
What should be the top priorities for health information management professionals within their respective organizations?
Knowles: Revenue integrity and coding audits. The presentations around audits had great content and were very thought provoking. As we journey into our third year in ICD-10, health facilities and physician practices are now receiving the audits and denials from payers that had been anticipated to begin earlier post ICD-10 implementation; with most payers wishing to remain budget neutral. For each claim sent out, hospitals need to consider what they are leaving on the table in terms of dollars. If a facility doesn’t have a current pre-bill quality review process of a random or focused sample, it is highly likely that there are dollars being left off each claim being submitted due to errors or omissions.
Special thanks to Lisa for her time and insights. Though five days of education and networking can be exhausting, there can be no doubt that all left AHIMA17 with renewed energy and determination to transform healthcare through innovative health information management. At Harmony Healthcare, we’re committed to helping health systems achieve and maintain a higher level of billing integrity to ensure reimbursement accuracy and compliance adherence.
