HCPro.com: Medical Records Briefing

Guiding Health Information Management professionals through the continuously changing field of medical records and toward a stronger process for fifteen years!

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July 2008 (Volume 23, Issue 7)	view entire issue

HIM directors discuss appealing RAC denials and tracking data
Editor's note: This is the second article in a two-part series in which HIM directors in three Recovery Audit Contractor (RAC) states recount their experiences with audits thus far. Last month's article focused on staffing, building a RAC team, and productivity. This article focuses on tracking and appealing denials. Just because a RAC denies your claim and wants to recoup money doesn't necessarily mean you have no recourse. And preparing for national RAC implementation in 2010 includes designing a plan for your hospital to track data, appeal denials, and manage work flow. During a March 11 HCPro audioconference, "Recovery Audit Contractors: Lessons Learned to Help Your Hospital Prepare Now," HIM directors in California, New York, and Florida shared their perspectives on these topics during a roundtable discussion.

Choose wisely when hiring a CDI specialist
Editor's note: The following is an excerpt from HCPro's book The Clinical Documentation Improvement Specialist's Handbook. For more information, visit www.hcmarketplace.com/prod-5975.html. Hiring the right clinical documentation improvement (CDI) specialist can make or break a CDI program. And if the job description and requirements are inaccurate, you may be excluding your best candidate, or the best candidate may exclude him- or herself.

Ask these questions to define your legal health record
Unlike clothing, "one size fits all" is not an option when defining a legal health record (LHR). Federal, state, and some local laws provide the initial framework for an LHR, but fine-tuning the definition is ultimately the organization's responsibility. AHIMA defines the legal health record as "generated at or for a healthcare organization as its business record and is the record that would be released upon request." "What we're really talking about is what are you going to hand out upon subpoena or other legal request," says Kelly McLendon, RHIA, president of Health Information Xperts, LLC, in Titusville, FL.

Backlog, backlog, go away: Don't come back another day
HIM consultants often encounter backlogs long after they have spiraled out of control, causing an increase in the discharge-not-final-billed rate and a decrease in staff morale. Chronic, out-of-control backlogs seem to be a discouraging and growing trend: One minute everything seems fine, and the next, there's sheer chaos. Backlogs can be even more detrimental to the success of HIM departments at facilities that are experiencing significant change, such as EHR implementation. Do endless industry changes set the stage for crisis situations?

Understand requirements for patient restraint and seclusion
Editor's note: This column is a continuation of our series on standards outside of the "Information Management" chapter in the Comprehensive Accreditation Manual for Hospitals that have documentation implications. Clark is the service line director for HIM at Roper Saint Francis Hospital in Charleston, SC, and author of Information Management: The Compliance Guide to The Joint Commission Standards, Fifth Edition, published by HCPro. PC.11.10-PC.11.100 apply to medical and surgical care restraints for patients of any age. This includes pediatric as well as obstetric patients.

Prepare for the worst, hope for the best
Most HIM directors think a disaster will never occur at their hospitals. And although channeling positive thoughts is generally laudable, it isn't a realistic approach when disaster can strike at any moment. A disaster doesn't necessarily need to take the form of a hurricane, tornado, or pandemic to severely incapacitate an HIM department. What happens when the power goes out? Or how about when the computer system crashes?

The severity train is leaving the station
We have experienced a fury of changes recently, including an increased focus on patient care and more thorough documentation so we can receive the payments that we deserve. The only problem is that it seems we are being paid less than we deserve. This trend is troubling to some of us, but others are taking it in stride and doing quite well. Why the difference in reaction?

Other recently-published articles from Medical Records Briefing:

Electronic health IT advances create opportunities, challenges for HIM directors and staff members

Requirements for patient discharge and transfer

Put a stop to stamped signatures once and for all

AHIMA’s final query practice brief reflects growing CDI efforts

How to code common winter ailments

Knock, knock! Who’s there? It’s ICD-10, and you’d better be ready

HIPAA: Transcription, breaches, and PHI for research

Ask what leadership means, and use self-assessment to pinpoint strengths and weaknesses

Understand the details of personal health records to serve as a valuable patient resource

Flag identity theft as federal rule takes effect

Polish your profile by clarifying heart failure, pneumonia, and pressure ulcers

Diabetes classification integral to hospital quality measurement, correct code capture

Address coder shortage with an apprentice program

Know requirements for sedation and anesthesia

Ensure that coders review the new ICD-9-CM coding guidelines effective October 1

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