March-April 2021

Evolving Education: HIM Training Adapts to the New Normal
By Stacy Swartz, RHIA, CCS, CPC
For The Record
Vol. 33 No. 2 P. 6

The last year has been extraordinarily challenging for health care organizations. Nevertheless, despite a pandemic bearing down on them, they’re determined to survive and are exploring innovative ways to ensure staff are prepared to support the organization’s needs and tackle any challenges.

During these times, strategies on how best to conduct and deliver workforce training have had to be readjusted. What follows are tips and ideas on the best methods to achieve success in these areas.

Targeted Training
“The ability of individual coding and documentation integrity professionals to do what their organization needs them to do and of organizations to benefit from a fully and flexibly trained workforce depends on ongoing and targeted training,” says Cari A. Greenwood, RHIA, CCS, CPC, CICA, an education specialist with Libman Education.

With no time to prepare, some HIM leaders experienced a dramatic rise in inpatient cases due to an overwhelming number of COVID-19 admissions. As leaders experienced staffing shortages and volume fluctuations, these organizations needed to increase their inpatient coding capacity while simultaneously ensuring coding quality did not suffer from the challenges of managing a newly remote workforce.

In addition, most coders were not experienced in telehealth coding and, of course, were now faced with coding and documentation issues specific to COVID-19.

Targeted training was necessary to maintain compliance with quality assurance initiatives. A mixed bag of scheduled weekly, biweekly, and impromptu meetings were used to provide education and guidance on correct code assignment. In addition to internal education, some organizations partnered with outside training providers to provide in-depth knowledge on specific topics.

The effort to target specific training requirements should pay off in the long term as well. “As an educator I am probably biased, but I firmly believe that targeted and specific training made a big difference in the ability of organizations with whom we work to roll with the challenges presented by COVID. And, very importantly, HIM departments that rose to the challenge in real time will be better positioned to respond to the prospect of increased payer audits,” says Gail I. Smith, MA, RHIA, CCS-P, a subject matter expert with Libman Education.

Cross-Training to Meet Changing Needs
The importance of cross-training has been widely recognized for several years now. COVID-19 introduced an increased need for such initiatives to fill knowledge gaps and to support operations as volumes and service lines fluctuated.

Leaders worked to build teams of coders that can effectively code documentation from all health care settings and service lines. The increased flexibility gained by cross-training team members, even as many organizations placed a hiring freeze on open positions, resulted in greater efficiency.

“Cross-training became an even more important tool in ensuring that staff members were able to do their work,” Greenwood says. “Many organizations’ best outpatient coders were cross-trained to support newly expanded inpatient services.”

To meet the growing need for inpatient coders, each coder’s skillset was evaluated to identify areas for focused education. When facing a decline in outpatient services, claim editors, emergency department coders, same-day surgery coders, and observations coders were transitioned to inpatient coding or other work in order to support the increased volume and variability.

These changes not only presented opportunities for skilled coders to be of service to their organization but also helped expand their résumés. Coders who provided education and performed quality reviews for newly cross-trained coders and who shared their in-depth knowledge with their colleagues helped them acquire auditing and training skills that position them to move into coding education, clinical validation, and auditor roles.

Time for Leadership to Step Forward
“Having been in HIM forever, I was confident our colleagues would rise to the challenge of keeping their staff engaged and productive as they were dealing with new work processes. The health care industry is fortunate to have so many dedicated professionals working hard to keep the revenue cycle humming,” Smith says.

Although COVID-19 overwhelmed many departments and brought with it a host of obstacles, the HIM workforce rallied. New skills, leadership qualities, and strengths that were previously unrecognized were now on full display as coders stepped up to partner with their teammates to meet the needs of their organizations.

One of the major challenges of COVID-19 was understanding the rules for ensuring correct code assignment. Coders were quick to jump in and pull interim coding guidelines to educate themselves and others within their departments as well as providers on how this new diagnosis should be coded. Staying on top of the changes to the guidelines as they were released was a major factor in ensuring code accuracy.

The ICD-10-CM Official Guidelines for Coding and Reporting for COVID-19 cases were implemented April 1, 2020. Organizations held daily team meetings with coders and clinical documentation improvement (CDI) professionals to promote understanding and ongoing monitoring and assessment. These two groups worked closely with each other to ensure complete documentation and accurate code assignment.

The Challenge of the Remote Workforce
Prior to the arrival of COVID-19, many of the coding work force was still working on-site alongside their teammates and supervisors. Coders had easy access to shared information and the opportunity to keep each other on track. Being accustomed to working directly with their peers, both team members and leaders may have found the transition from office to home difficult to manage. In fact, they may still be discovering best practices for delivering updates, ensuring quality and productivity, and staying on top of communication.

The situation was particularly challenging for leaders who were managing a remote workforce for the first time. How would they keep staff engaged and motivated?

To that end, communication is crucial. To give the arrangement the best chance of succeeding, experts recommend the following:

• Outline work schedules and expectations and ensure employees understand the process for questions, support, resources, and education.

• Ensure that file locations for policies and procedures, reference materials, and daily assignments are clearly designated and communicated.

• Discuss communication strategies (eg, e-mail, phone calls, texts, intranet, video chats) to determine which method best aligns with organizational and team initiatives.

• Although frequency of communication may vary, minimum expectations should be set.

• Schedule daily morning huddles to talk about workloads, challenges, and changes that may affect workflow. Doing so will help keep everyone on the same page.

Measuring Competence and Ensuring Quality
Coding assessments help determine areas where skills or knowledge are lacking and additional education is needed. With many coders cross-training in preparation for coding accounts from different health care settings, coder assessment was a crucial step in terms of both professional development and the organization’s accuracy goals.

Ongoing internal quality reviews, preferably monthly, but no less than quarterly, are critical. Although 10% of case volume may be an organization’s standard sample size, auditing for specific topics known to be an issue, such as COVID-19, may provide greater value in identifying areas where coding can be improved. Many organizations validate the reliability of their internal audits by conducting external reviews on an annual basis.

Once areas of inadequacy have been identified, relevant education solutions—whether formal or informal, internal or external—need to be implemented for improved coding quality to be realized.

One Year Later
Although it’s been approximately one year since the onset of the pandemic and much has been learned about the virus—including coding and documentation guidelines—there is still much to learn. No one can predict the how long the virus’ tight grip will remain or how it will affect health care operations moving forward.

The past year led the HIM profession down a difficult path but it achieved some remarkable outcomes, all of which should be celebrated. Nevertheless, changes to organizational business models must be anticipated and embraced in an effort to meet the demands of unanticipated outside forces.

Smith views the future optimistically. “There were many lessons learned from this last year. Hopefully it will be another century before a pandemic again challenges us, but medicine and technology is always moving forward,” she says. “Organizations are expanding service areas; rules and guidelines are always changing. If anything, we have learned that we can pivot to meet the needs of the health care industry.”

— Stacy Swartz, RHIA, CCS, CPC, is senior director of coding and CDI solutions for eCatalyst Healthcare Solutions. She has 25 years of experience in HIM, having worked in all facets of the profession, from coding and billing to vice president of operations.