“[The House of Information is] a concept I’ve
been thinking about for a while, because this
House has an opportunity to be incredibly spe-
cial,” she said. “Each of you represents the wir-
ing of the house. The House needs to illuminate
so that we shine brightly and so that we can
carry out the mission and the vision.”
Building the House of Information is most
important, Harris said, because, “It’s about the
people who depend on us. The lives that we
change, the patients we impact, the students
we enrich, the employees we help. It’s about the
patients and the healthcare system that will not
improve unless we are at the table. I’m deter-
mined that we are going to have a strong house
of health information.”
Speaker of the House Shawn Wells, RHIT,
CHDA, thanked the members of the House of
Delegates for making their voices heard during
the past year. “Our passion is there. I appreci-
ate your contacting me about what you are pas-
sionate about,” Wells said. “It takes a village to
really govern this profession.”
Along the lines of governing the profession,
Watzlaf announced the formation of a Gover-
nance Task Force that will be reviewing AHI-
MA’s overall governance structure. The Task
Force will offer a number of opportunities for
members to offer feedback and serve as sound-
ing boards for its findings. Wells said a revised
charter would be made available for 30 days for
‘HIM Touches Everything’
Members of the House divided into groups to
discuss topics such as thought leadership, professional development, and environmental
scanning; serving as a health information professional champion; action items; and best
practices for engagement, communication,
Using the updated AHIMA strategy as a
baseline, delegates were asked to take a deeper
dive into priority areas of impact for the profession. They made recommendations for each
impact area of the strategy (defined by AHIMA as integrity, access, and connection) and
ranked them. These recommendations will
help inform AHIMA’s developing thought
Among the recommendations and observa-
• HIM touches everything.
• Privacy and security practices: need to
break down barriers between compliance
and IT to arrive at better practices. Be the
preferred credential for privacy and security.
• Members must take leadership roles in
their organizations, not just the HIM de-
partments. Make sure skill sets are up to
par so that they can be leaders. We need to
be training people to be in the C-suites.
• Members must learn technical languages,
programs, and standards so that they can
participate at the table.
• Having a vice president of health information role should be a requirement by Joint
Commission or other accreditation. Advocating for this in the states might be a foot
in the door.
• Emerging issues: Virtual healthcare/tele-health; business continuity/disaster planning; data governance is still a significant
part of the work; need to be planning for
cybersecurity crises as well.
• Apps are a significant issue. HIM should
be at the table with EHR vendors and app
• Diversity of settings: Ambulatory inclusion, behavioral and mental health are becoming more critical.
• Patients need to know how they can access
The delegates voted on three items, including
a motion to refer a proposed bylaws amendment that would change the composition of the
Nominating Committee to the Governance
Task Force was approved. In addition, a bylaws
amendment to require that no position on the
AHIMA ballot is uncontested was approved.
A proposal to create positions for seven regional delegate leaders was not approved. n
» continued from page 1
Clinical Coding Meeting Tackles
By Patricia Buttner, MBA/HCM, RHIA, CDIP, CHDA, CPHI, CCS, CICA
THER E are many reasons physician prac- tices might not routinely perform audits.
These rationalizations range from lack of appropriate coding staff, perceived lack of time,
“head in the sand” mentality, and choosing a
reactive approach rather than a proactive one.
But making the choice to not perform audits
can cause headaches for practices down the
line, explained Sandra Giangreco, RHIT, CCS,
CCS-P, CHC, PCS, CPC, COC, CPC-I, COB-GC, of CLA and Kim Garner Huey, MJ, CCS-P, CHC, CPC, PCS, CPCO, of KGG Coding
and Reimbursement Consulting in their presentation “Developing and Implementing an
Audit Program for Physician Services” at the
2019 Annual Clinical Coding Meeting on Saturday.
In today’s healthcare reimbursement land-
scape, there is a plethora of data collected and
submitted to various payers for reimbursement
of healthcare services. Providers in all settings
should take a proactive approach to ensure re-
imbursement is appropriate and the data sub-
mitted accurately reflects the patient condition
and the services utilized to care for and treat
the patient, by utilizing both internal and ex-
“The time invested in auditing on the front
end may save significant back end recoupments,” Huey said. A comprehensive compliance plan is a vital component and should
guide the practice in what to audit.
It’s important to perform both internal and
external audits, according to Giangreco and
Huey. Coding internal audits only is akin to
“the fox watching the henhouse,” they explained. External audits offer the benefit of experience as well as an outside perspective that
can bring new ideas to old issues.
It is imperative to select the correct external
auditor, skilled in the practice specialty and familiar with the practice’s payers.
Audit scope depends on the size of the prac-
tice, but at a minimum should include coding
and documentation. The accuracy of diagnosis
coding in the provider office setting has come
under the microscope. Compare what was
documented and what was billed. Additional
items to review include superbills, encounter
forms, claim forms, explanations of benefits
(EOBs), remittance advices, and payer policies
and contracts. The practice may also want to
consider identifying the top 10 reasons for de-
nials, the top 10 billed services, and any other
special issues that come to light.
Several methods can be useful when considering the sample size. It all depends on the type
of audit being conducted. Approaches include:
10 encounters per provider, a random sample,
one entire day, or the first ten listed on an EOB.
Recent claims can be audited to identify and
correct potential current issues and provide
education. Older claims audits will assist if
there is a problem suspected.
Provider education should be timely and targeted, the presenters noted. Education can be
provided to groups or to individuals to help
ensure the documentation supports the billing
and tells the entire patient story. n