How to Capitalize on Opportunities

By Kim Murphy-Abdouch, RHIA, MPH, CHE

When I started my health care career in Health Information Management, I was convinced that one of the most important aspects of a hospital's administrative systems was the HIM department. Twenty-five years later, after making career transitions from health information management to quality improvement, utilization management, finance, strategic planning and hospital administration, I am even more convinced of the role of the Health Information Management.

Throughout my health care career, I have had the opportunity to observe the profound impact of the HIM department on patient care, legal and regulatory affairs, and the bottom line of the hospital. As a health information professional, I felt uniquely positioned to direct my career path to becoming a CEO. Similarly, your preparation in health information management can take you anywhere you want to go, or help you be most successful where you want to be. How well you understand and capitalize on this opportunity is up to you. This article will give you some ideas of the opportunities you have, and how to position yourself to seize those opportunities.

I started my career as the Director of Medical Records in a small rural hospital and ultimately became CEO of a 200+ bed urban medical center. Of course, managing people and working with medical staff is of vital importance as you progress through your career. But through all the different jobs I've had, the knowledge gained in HIM was some of the most relevant.

The technical knowledge of how to operate a health information department is important, but today the knowledge that will make you stand out in your profession is the understanding of how the health information department relates to and works with other departments to increase revenue for the hospital.

When you understand these relationships, you'll begin to see these other departments as major partners to your success, and the financial success of your hospital. Some of your partners in the revenue cycle may be the suppliers of the information necessary to create and add value to the medical records – patient access, medical staff, nursing, case management and chargemaster. Your other partners are those departments who use those records to increase hospital revenue - patient accounting, billing, and collections. The financial success of your hospital can be determined, in large part by how effectively you cultivate, train and work with your revenue cycle partners.

For example, I have had the opportunity to work in hospitals where HIM and the patient financial services/business office did not communicate effectively about claims denials. The business office collectors would receive notice of a claim denial and send an email to an HIM staff member for a copy of the record. Not understanding or being aware of the impact of timely medical records on the appeals process, the HIM department placed lowest priority on the business office requests for records. As a result, the filing deadline for claims appeals was frequently not met, and the hospital did not receive the payment it was due. When HIM and the business office began to work together as partners, they were able to increase the denial recovery rate. This has a direct impact on the hospital's bottom line. As another example relating to the current hot topic of changing inpatient admissions to outpatient observations, I have had occasion to work with hospitals where HIM was viewed by Case Management as the obstacle to reimbursement for observation services. Only by working together as a "revenue cycle team" is a hospital able to establish the groundwork for effective patient type management and appropriate billing and reimbursement.

In the next issue of the Journal we'll look further at the role that HIM plays in the revenue cycle of a hospital. We'll look at all of your revenue cycle partners with an eye to how you can most effectively contribute to the bottom line of your hospital.

 

Kim is Vice President and Principal of MPA Consulting. She has her BA in Health Information Administration from the College of St. Scholastica , and her Masters in Public Health from the University of Michigan . She is an RHIA and is board certified in healthcare administration, achieving Diplomate status in the American College of Healthcare Executives.