HIM Professionals Help Physician Practices Now More Than Ever

Deborah Robb and Whitney Gregg, for HealthLeaders Media, May 28, 2009

As physician practices move away from paper-based record keeping and into the era of electronic medical records, the caliber of staff needed to coordinate, manage, and protect patient information grows exponentially. Clerical staff, once well-qualified to manage paper charts, may not make the grade where new technology is concerned.

For example, practices that receive stimulus dollars under the Health Information Technology for Economic and Clinical Health (HITECH) Act will be under closer scrutiny for HIPAA security and privacy compliance. Providers that implement an EHR that then results in HIPAA violations can face fines as hefty as $50,000 per occurrence?quickly negating the $44,000 per physician incentive. Security and privacy of health information within the EHR is of paramount importance.

With all of these challenges, how can physician practices successfully make the transition to electronic records? The answer for many practices is to hire a credentialed Health Information Management (HIM) professional.

Who are HIM Professionals?
Formerly known as medical record technicians or administrators, these allied health professionals provide tremendous value to physician practices in such areas as HIPAA compliance, record management, coding, reimbursement, clinical documentation, and more. HIM professionals bring a wealth of knowledge, training, and expertise to the areas that are critical to the overall financial health of a physician's practice. And because they possess a unique combination of clinical knowledge and business acumen, they are highly effective in translating the clinician's process of diagnosis and treatment into dollars and cents.

Accredited by the American Health Information Management Association (AHIMA), HIM professionals are a vital layer of protection for all chart-management concerns. They are the keeper of the keys, so to speak, and provide a tremendous return on the investment in their services.

Managing and Protecting Charts
For over 70% of physician practices, loose documents, untimely filing, and misplaced records can be the downfall of their businesses. Some practices have records dating back to the 1950s, which can be a nightmare when cleaning out in preparation for EMR. The HIM professional knows state and federal guidelines for all aspects of record management?storing, archiving, retrieving and purging. If pulled into court, the practice must have well-organized, accurate, and accessible records (paper or electronic) that comply with state and federal regulations to back a case. HIM professionals can help.

Migrating to an HER
HIM professionals also provide valuable support for EHR initiatives in physician practices in three critical areas: demonstrating a return on investment, training and support, and migration of clinical documentation and legal records to an electronic environment.

HIM can help the entire practice become informed about the various aspects of EHR. "We can show providers how to save time, reduce operating costs, increase revenue, and sustain quality of care," says Catherine Stemple, RHIT, Office Manager of Barbour County Family Medicine, Philippi, WV. The benefits are contingent upon the internal efficiencies of the practice and the ability to make informed decisions that will ensure successful implementation. That's a key area where the HIM professional can add value to the practice.

Finally, HIM professionals are astute at creating policies and procedures to protect patient information. Though electronic records are more secure in many ways, there are new risks for privacy and security breaches. The American Recovery and Reinvestment Act (ARRA) includes guidance related to "breach notification," how providers must notify stakeholders in the event of a privacy breach, and security of personal health information (PHI). The Act includes specific definitions for a "breach" and lays out the various notifications that must be made to the individual and the media.

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."

Deborah Robb is a physician management consultant at HealthPort, and Whitney Gregg is manager of Health Information Management at St. John's Clinic in Springfield, MO.
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