By Beth Friedman, Sr. Partner, FINN Partners
LinkedIn:Â Beth Friedman
LinkedIn:Â FINN Partners
AHIMA was founded in 1928 to improve the collection and organization of health information for medical professionals to improve public health. Fast forward nearly 100 years and the association’s new president, Dr. Kevin Klauer, modernized this vision to reiterate health information (HI) professionals’ essential roles: collect, analyze, share, and protect patient information.
Medical records are no longer paper, and patient information is now digitized. However, HI professionals’ valuable contribution is the same with a keen focus to:
- Automate coding and clinical documentation
- Facilitate safe and secure clinical data sharing and exchange
- Support revenue cycle integrity
- Integrate and optimize EHRs
- Protect patient privacy, including new rules for reproductive health information
HI professionals sit at the forefront of pairing new AI technologies with deep patient information knowledge and expertise. They are active members and leaders of information governance teams, EHR projects, AI implementations, and financial sustainability in healthcare. For example, when a legacy HI company such as MRO Corporation announces a premier partnership with CHIME, you know an important evolution is taking place. Here are seven insider insights heard at AHIMA24.
Clinical Data Exchange
Angela Rose, MHA, RHIA, CHPS, FAHIMA, Vice President, Client Success, MRO
“There is growing demand for clinical information amid constant change in the industry. If you are not automated or already considering automation of your data exchange process, you’re behind the times.”
Public health, providers, insurers, legal, patients, and families are all requesting greater volumes of information, and at a faster pace. For example, a single payer will request information for the same patient three to five times annually for risk adjustment, HEDIS, payment integrity audits, prior authorization, and care management. And large health systems can receive up to 400K requests per year.
In her presentation with Banner Health, Angela shared how new advancements in exchange technology are paired with HI expertise to address these challenges. Here are Banner Health’s results:
- Patients’ requests for information are received via the Banner website and processed by MRO’s platform, resulting in higher levels of patient portal adoption and satisfaction.
- 96% to 98% of all requests for information are automatically retrieved, making the entire process more efficient, effective, and compliant.
- Fast healthcare interoperability resources (FHIR) convert analog work to automated tasks to eliminate rework and redundancy when the same patient record is requested multiple times.
- Profit sharing between MRO and Banner Health for chargeable requests increases as more records are processed digitally.
Clinical Coding Know How
Cassi Birnbaum, MS, RHIA, CPHQ, FAHIMA, Jevan Consulting
“Today’s HI professionals engage with technology to expand on all the great things we’ve done in the industry including automating coding, clinical documentation, and data quality. Codes must go beyond reimbursement to fully support value-based care, medical research, and so much more.”
Clinical coding expertise is the foundational expertise for HI professionals. And ICD-10 codes are core to value-based progress. Today’s professionals make the most of that knowledge while also expanding their involvement across all information functions and technologies.
According to Cassi, savvy health systems engage HI professionals to lead AI governance teams, make health information exchange decisions, and vet AI coding and ambient clinical voice vendors. Cassi described the current relationship between nascent technologies and HI professionals. “We’re in it together!”
Data Capture and Innovation
Stacey Sexton, RHIA, Vice President, TruBridge
“What excites me about AI and the HI professional is our ability to combine coding and billing expertise with revenue cycle technology innovation. Every advancement we make today is a steppingstone to the ultimate result: a fully automated revenue cycle and more cohesive healthcare.”
HI professionals at AHIMA24 are making demonstrable progress toward standardized data capture that will support better care delivery and data quality. We are taking baby steps now, and the ultimate evolution is years away. But eventually we’ll be able to track and predict the cost of care across all variations in patients, diseases, providers, and more.
However, real human logic is still needed to be sure individual and aggregated clinical data makes sense. Data alone doesn’t always paint the clear picture. We’ve seen this dynamic with computer-assisted coding (CAC).
CAC systems are trained, and they can learn new coding rules. But CAC systems only know what is received from human input and coding. Codes change. Rules change. Interpretations change. Coding remains complex and we will always need experts to work alongside technology as it also evolves and advances.
Prior Authorization Automation
Robert Tennant, Vice President, Federal Affairs at the Workgroup for Electronic Data Interchange
“There is clear interest by Washington to push forward on streamlining prior authorizations. We may be a divided nation, but we’re not divided on prior authorization.”
A prior authorization is a conversation between provider and payer, which requires accurate, timely, clinical data to support the conversation. If you can’t exchange clinical data, each stakeholder is back to sharing attachments by fax, mail, email, etc. FHIR is one part of the electronic prior authorization solution along with the HIPAA 278 transaction. Both will be used.
Anthony Murray, CISO and ISSO at MRO, reminded attendees that HI professionals are the guardians of digital information in healthcare. “While we all want to accelerate clinical data exchange (including for prior authorization), there is a juxtaposition between protecting information while also sharing information more freely. Balance must be achieved for secure clinical data exchange, and HI professionals have the knowledge to serve both masters.
AI-Powered Autonomous Coding
Brad Justus, Vice President, CodaMetrix
“While medical coding has traditionally focused primarily on fee-for-service reimbursement due to staffing constraints, AI-powered autonomous coding is transforming this paradigm.”
By accurately and compliantly coding the complete patient encounter—including clinical data that may not impact billing—we’re creating a new clinical asset that drives value beyond the revenue cycle. This comprehensive approach means health systems no longer need multiple coding passes and costs to support population health, medical research and clinical registries.
Even if AI technology codes only a portion of the data, its high accuracy and compliance standards make it invaluable. The shift from coding purely for billing to coding for total clinical value represents a fundamental evolution in how we capture and use healthcare data, which will benefit the entire healthcare ecosystem.
Winning Payer Battles
Dawn Crump, MA, CHC, LSSBB, Senior Director, Revenue Cycle Solutions, MRO
“If you’re not moving forward in this industry, you’re moving backward. To fight against rising payer denials and revenue recoupment, health systems must centralize, standardize, and automate. Collaboration between HI professionals and denial teams is essential.”
HI professionals are critical to ensuring timely, correct payments to health systems, but they must be fully engaged with other revenue cycle teams. This is particularly important to prevent and manage payer denials.
Joined by experts from Wellstar, Maine Health, and Christus, Dawn’s standing-room-only panel session provided these eight valuable insights.
- Use technology to centralize the intake payer requests for information, automate the denial management process, and optimize staff.
- Increase digitization and payer connectivity to accelerate time-to-payment from payers.
- Reconcile payers’ receipt of records, identify gaps in information provided, and fight back against multiple and redundant requests.
- Automate workflows based on payer denial codes and EHR work queues. There are multiple variations on how records should be released to payers electronically.
- Keep avenues of communication open to identify issues and new payer denial trends.
- Implement prebill coding audits to become more proactive versus reactive with payer denials.
- Use data to build and implement payer scorecards to compare actual versus contractual payer performance.
- Don’t be afraid to push back against your payers. Analytics are your best defense.
Next Year in Minneapolis
Next year’s annual conference will be held in Minneapolis, Minnesota. Until then, I expect the profession to report faster adoption of technology, greater presence on data governance and exchange teams, and tighter collaboration with revenue cycle peers.
As incoming AHIMA president, Maria Caban Alizondo, PhD, RHIT, FAHIMA, mentioned in her closing remarks, “Our vision is for the healthcare industry to see all the various HI professionals, wherever they work, as a unified profession and recognize the importance of our credentials to improve health.”