AAPC News

Three Lessons Learned at HEALTHCON2017

By Steve Robinson, MS-HSM, PA-O, RN, SSBB, CDIP

AAPC’s 25th national conference delivers important insights for HIM leadership.

Clinical coding and clinical documentation improvement (CDI) are cottage industries. In the grand scheme of health care, these two functions remain obscure and misunderstood. However, in early May both professions gathered in Las Vegas, our nation’s most glaring and garish city.

Exposure was in the air for AAPC and the Association of Clinical Documentation Improvement Specialists (ACDIS). Both conferences were held during the same week and in the same city.

While Las Vegas offered plenty of gambling, shows, and shopping, the conferences included their share of education, networking, and products and services. This article summarizes three key takeaways from the nation’s largest gathering of outpatient and physician practice clinical coders—AAPC’s 25th National Conference, HEALTHCON2017.

Lesson 1: Outpatient CDI is a big concern for outpatient coders.
I conducted a session focused on the alliance between CDI and HIM. Approximately 150 AAPC members attended and the majority were outpatient coders. Several polling questions were completed by a very interactive and engaged audience. It is clear that outpatient coders have concerns about outpatient CDI initiatives. The following are several key concerns voiced at HEALTHCON2017.

Coders feel removed from physician queries. Address the issue by identifying a CDI representative with leadership authority to communicate to outpatient coders and include them in critical documentation discussions, education, and training.

There is lack of communication between CDI specialists and outpatient coders.In those settings where there is a CDI initiative underway, outpatient coders and CDI specialists lack consistent mechanisms to communicate regarding code specification questions or coding-CDI mismatches. It is uncommon for the person facilitating all coding applications in the outpatient setting to be a certified coder, medical assistant, or clinician. These personnel are often informally trained and lack a deeper understanding of the coding nuances that drive acuity and chronicity of the codes—two factors that contribute to quality outcomes and Medicare spend-per-beneficiary determinations.

To resolve these issues, better CDI (clinical expertise) and HIM (coding expertise) collaboration is needed in outpatient settings. By working together, teams can identify the best approach to address documentation gaps in the outpatient medical record. Prophetically, HIM and CDI leadership teams looking to expand into outpatient settings will need to consider a different operational approach than the ones used for inpatient CDI programs.

Another solution recommended by speakers was to advocate for coding and/or documentation auditors. Auditors can identify opportunities and trends of documentation concerns, and then create education venues to prevent repetition of the same errors. Speakers also recommended educating physicians on how their office documentation impacts the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Merit-based Incentive Payment System, and other quality payment programs. For outpatient settings, a little physician education goes a long way.

Physicians, specifically, are not aware of the documentation impact in outpatient and practice settings. Several session attendees mentioned disconnects between physicians in practice and physicians in acute care when it comes to CDI. Physicians in the outpatient setting are often unaware of how an assigned diagnosis through the practice EMR does or does not support the correct NCD or LCD (national or local coverage determination) categories.

Lesson 2: Physician practices aren’t ready for MACRA.
AAPC’s HEALTHCON2017 agenda also included several sessions on quality payment programs, with MACRA being a top focus. These sessions clearly indicate physicians will have a difficult time understanding how to comply with MACRA. Investments in internal coordinators and/or outside consultants are needed.

While compliance demands are minimal through 2019, penalties begin in that year and progress from 4% to 9% annually through 2022. Documentation efforts in 2017 will be used to formulate scores, which will have significant impact on physician practice revenue in 2019 and beyond. MACRA sessions at this year’s convention were introductory in nature. Future events will require more study, exposure, and implementation plan recommendations.

Lesson 3: Denials plague everyone.
Denials in the outpatient setting are more complex than those for inpatient claims due to multiple factors, including failed LCDs, failed NCDs, medical necessity, and diagnosis management. Multiple sessions highlighted outpatient denials, denial letter responses, false claims issues, and audit methodology. Areas of denials important for CDI specialists and coders to understand include retrospective rebuttals and proactive identification.

To prevent denials in the outpatient setting, teams should focus on portraying a clear picture of patient severity at the time of visit. Prebill audits and trending postbill denials for education purposes were highly recommended in outpatient settings.

Overall AAPC Takeaways
In keeping with tradition, the AAPC’s 25th national conference focused on specific coding topics such as pacemakers, infertility, cardiology, nephrology, and vascular surgery. Sessions covering the outpatient coding rule and outpatient CDI were also well attended. For each specialty, the need for better clinical documentation was emphasized and reiterated. In all care settings, including outpatient, it’s all about documentation, risk mitigation, and denial management.

— Steve Robinson, MS-HSM, PA-O, RN, SSBB, CDIP, is vice president of clinical revenue integrity at RecordsOne. Robinson holds advanced degrees and a unique understanding of the complete clinical documentation processes and its impact on health care facility revenue cycle. His experience includes clinical documentation and quality leadership for more than 250 health care facilities nationwide managing process improvement, throughput, and clinical documentation consulting engagements.

Tweets From HealthCon

@mymimi2016
#HCON17 HEALTHCON is always so timely with much needed information. AAPC is a true partner in our professional career.

@MasercolaWrites
“The ripple effect from this room alone has the power to change the face of health care.” @aapcstaff #HealthCon

@ChandraLynn426
#HCON17 Be sure to check out the Las Vegas history and Elvis quizzes in the conference app!

@JamiUtcaneuser
#HCON17 Margaret Fortin is giving an awesome OPPS presentation!

@vicky_dumi
#HCON17 Health care is complicated and this is the way to decipher it ... keep on learning @AAPC

@Lisa_Eramo
MACRA. You either love, hate it, or have been too busy to figure out how it applies to you. Stephanie Cecchini #HCON17

@MasercolaWrites
Coding is like writing a novella. You need to tell the story to the insurance company that’s not scrubbed in with you. Amy Pritchett @AAPC #Healthcon

@aapcstaff
“Who knew health care was so complicated? We did!” - Raemarie Jimenez, CPC, CDEO, CPB, CPMA ... instagram.com/p/BT4skIag_IZ/

@Sofia6
#HCON17 Day 3 “Codes — Not Always About Payment” w/@aapcstaff Raemarie Jimenez was interesting. Great Q&A afterwards.

@MasercolaWrites
If you are a coder on LinkedIn and aren’t being contacted by recruiters, you need to assess and revise key words in your profile #HealthCon

@aapcstaff
“The coding industry is at the heart of how we establish value.” — Governor Mike Leavitt ... instagram.com/p/BT2Az3KgB3-/

@darcifriedman
Gov. Leavitt: we will move from fee-based to value-based payment. @AAPC #HealthCon

@Lisa_Eramo
Physicians need to get involved in health care reform. If the MDs don’t do it, the MBAs will. Mike Leavitt #HCON17

@Sofia6
Encouragement to lead from the medical coding field. #HCON17 Former Utah Governor and former HHS Secretary Mike Leavitt — thought-provoking session.

@CoderCoryB
Great legal panel of talented individuals #HCON17

@mymimi2016
#HCON17 each year the Legal Panel is always my favorite! Thanks AAPC for always including three panel in our annual conference.

@aapcstaff
Packing up HEALTHCON until next year in Orlando. #hcon17 #packitup #solong @ Rio All-Suite Hotel ... instagram.com/p/BT7Qy1NAmJu/