Since writing an article for the October 2016 Journal of AHIMA entitled “Auditing ICD-10 Through the Lens of Education”, the inestimable value that HIM professionals bring to the healthcare conversation has remained in the forefront of my mind.  Despite the fact that the HIM profession has never been one of endless self-promotion, the vast body of knowledge and significant intellectual capital that its members possess are noteworthy.

For example, we not only possess expert-level knowledge of the micro view of coding and data quality but the macro view of the global significance of our work. As the “guardians of the patient’s story”, we are obliged to nurture and mentor the next generation of HIM professionals.  From the auditing perspective, the focus has shifted to education and mentorship with the goal of empowering coders to become their own subject matter experts.  Some ideas to consider:

  • Accurate and complete coding is a foundational element of the metrics associated with quality measures.
  • Coding portrays the severity level of the patient and is used in part to assess quality of care and patient outcomes.
  • The dangers of poor documentation and coding include an inaccurate representation of the severity of the patient and care rendered to a patient as well as skewed quality data.
  • Accurate and complete coding is also necessary for survival in today’s climate of value-based models with financial incentives tied to quality of care and ramifications of accurate Hospital Acquired Condition (HAC) and Patient Safety Indicator (PSI) reporting. The patient’s story is linked to a wide variety of initiatives related to healthcare quality, effective patient care, healthcare economics, policy and reform.
  • It is important to take full advantage of the specificity that ICD-10 provides in order to capture robust data that is used in assessing patient severity, the quality of care received, and patient outcomes.
  • Since management of the appeals process requires a significant investment in human capital, any efforts directed toward reduction of denial rates will directly affect an organization’s bottom line.
  • Effective coding compliance audits are designed to review the record as a whole and take into account the stakeholders involved in the creation of the medical record. They identify deficiencies that may impact revenue and data quality by focusing not only on incorrect coding but also data abstraction errors and gaps in provider documentation.
  • The old saying “the way in which a message is delivered is often as important as the message itself” is particularly applicable to audit results. Auditors must deliver audit results in a manner that promotes dialogue and learning, and thereby encourages the coding professional’s full engagement in the audit process.
  • Focus on documentation and coding quality and correct reimbursement will follow.

Daniel Land, RHIA, CCS