How COVID-19 Changed HIM and What We’ve Learned

Biggest COVID-19 and Revenue Cycle Challenges

Workload imbalance due to employee reduction. KIWI-TEK customers had to furlough patient coding staff or cut hours for staff that remained in-house. Other options included cross training staff members to take on new tasks. No matter what the situation, everyone felt poised to deal with the unknowns of how to address the new workload.

“We made good progress, employees stepped up to the challenge and we found out who some of our stars were.” – Tracy G. Hickey, MBA, RHIA, CPHI, FAHIMA, Director of Health Information Management, West Tennessee Healthcare

Social distancing created a problem. Many folks were sent home to work due to close proximity in the hospital. The risk was too high to continue working on-site, but patient coding staff adjusted very well. Our coding partners reported that there was no decrease in productivity or quality.

“Our staff has remained positive all the way around.” – Tracy G. Hickey, MBA, RHIA, CPHI, FAHIMA, Director of Health Information Management, West Tennessee Healthcare

Ever-changing volume created a fluid environment. The KIWI-TEK team was constantly changing coders from one area to another depending on case mix.

“We were in constant communication with clients to see where their gaps were. KIWI-TEK has a strong mix of employees – full-time, part-time and PRN coders – so we could constantly shift based on clients’ needs.” – Sarah Humbert, RHIA, VP of Coding Operations, KIWI-TEK

Education guidance. April alone had 15 educational sessions with the latest health information management guidance for KIWI-TEK clients. Then the material was housed on an internal resource and training site. Constant changes from CMS and payers were big challenges at the onset of the pandemic, but have become more manageable.

Adjusting workflow and process for the scanning department. At Forrest Health, scanners traditionally floated around the hospital to pick up pieces of the record that weren’t electronic. Lorie and her team considered the risk to older employees or anyone who was immune compromised.

“We looked at who is going to be safest to go on the floors, make rounds, and get information. It took some compromise. We realized we had medical needs for employees to keep them healthy and happy. It was a scary time for everyone and we had to ease the fears of our employees.” – Lorie Mills, RHIT, CCS, Director of Coding and Clinical Documentation, Forrest Health

Sending employees home that had never worked remotely or who had to care for sick family members. Forrest Health has had a remote medical coding staff for 18 years, but this was not the case for health information management and support teams. It was an easy transition but also a shock to employees who worked on-site for so long.

“We first focused on our immune-compromised or at-risk folks. Then we started to consider loved ones of our employees. Many had to care for elderly family or children which changed schedules.” – Matthew Hoeger, Senior Director of Revenue Integrity, Penn State Health

Regulation changes and payer updates. All customers agreed it was impossible to keep up with what was changing day to day. Lorie stated the group concurred, “I’ve never seen the federal government move that fast in my entire life.” Things moved every two days for most organizations.

Forrest Health’s patient accounts and HIM departments stayed in constant communication.

The hospital patient financial services department put together a COVID-19 flow sheet to list specific dates certain regulations were put into place to have as insurance in case of a medical coding audit. “We had daily calls to relay what we were seeing and how we were going to handle it.”If an auditor later says the organization didn’t follow a regulation, Forrest Health has a workflow in place. Matt Hoeger and the Penn Health revenue cycle team managed the flood of payer updates in a similar way.

“Collaboration was key to dealing with constant changes. We also had a point person gathering all information and entering into a spreadsheet by payer.”

It was a tool to deal with the constant changes. Hershey would get direction from a payer, get claims in, only to start seeing rejections.

“It was a struggle. Daily meetings lasted a month, early on, and then we weaned ourselves off as changes decreased. Communication was essential – coders got to see it, billers got to see it.” – Mathew Hoeger, Senior Director of Revenue Integrity, Penn State Health

“KIWI-TEK presented a webinar for our clinic coders on telehealth changes and regulations to help us stay on top of it. This was very beneficial to us. I don’t know where we would’ve been without this.” – Lorie Mills, RHIT, CCS, Director of Coding and Clinical Documentation, Forrest Health

Days off without pay. Forrest General didn’t do any furloughs, but instead asked employees who had a lot of banked paid time off to use it. Employees agreed to take a day without pay every pay period. There were also special COVID-19 projects –encounters, lab charges – that coders were assigned to when their workload dropped off.

Overcoming departmental silos. “The magnitude of information flowing was a challenge. We had cooperation across all parties. We made sure we tried to think of every stakeholder who could possibly be touched by this and get them involved. Compliance folks were also at the table, in the war room taking and making calls daily. I highly recommend making sure you have all those folks – billing, IT, HIM professionals and compliance–at the table.” – Matthew Hoeger, Senior Director of Revenue Integrity, Penn State Health

“We’re all experts in our field but with so much going on, we had to all rely on each other. I questioned some days ‘Do I really know what I’m doing?’ It was very overwhelming at times. Even on the clinical side, they were stretched so thin. We were running lunches up the floor, delivering things to patient rooms, and more. The humanistic side came out a lot in this pandemic.” – Lorie Mills, RHIT, CCS, Director of Coding and Clinical Documentation, Forrest Health

Adjustments for a Remote Medical Coding Staff

Sending New Coders Home “I had just hired five new coders straight out of school. We sent them home and set up Zoom calls every day. We had productivity issues with one of the new coders so we brought her in-house a few days a week. It’s our duty to help people understand they still have a job to do from home, especially for people who’ve never worked from home.” – Lorie Mills, RHIT, CCS, Director of Coding and Clinical Documentation, Forrest Health

Remote Access “Even though we had folks working from home on a part-time basis, when we sent everyone home, plus other portions of revenue cycle, it really challenged everyone’s connectivity. Our information systems team responded pretty quickly and got creative. They put a hot spot in the garage at the end of campus. People could drive through with their laptop and the IS team got their VPN up and running. We were really impressed.” – Matthew Hoeger, Senior Director of Revenue Integrity, Penn State Health

Penn State Health’s coders did a great job of maintaining productivity. Matt believes the main reason for that is they simply liked working from home and wanted to continue doing so. 

Family Obligations “While our workforce has always been remote, kids, parents, or other family members were also at home and using the same Wi-Fi connection,” shared Sarah Humbert, Vice President of Operations, KIWI-TEK. The company shifted schedules to accommodate schooling or caregiving. Cross-training was quickly provided so everyone had coverage in the event of an illness for staff or family member. “We took precautions with being over staffed and cross trained.” – Sarah Humbert, RHIA, VP of Coding Operations, KIWI-TEK

Health information Management Resolutions to Carry Into 2021 

WFH is truly a viable solution A lot of folks think people are less productive at home if you don’t have oversight of them in the o­ffice. From what Penn State Health has seen so far, remote medical coding solves a lot of space concerns and staff has remained productive. So much so, that other departments will be following the same path. The organization is now looking at clearing up offi­ce space and downsizing their corporate locations for more clinical activity.

“O­ffice space will be available for training sessions or meetings but we’re looking at terminating leases and downsizing as a whole. These are significant changes for us.” – Matthew Hoeger, Senior Director of Revenue Integrity, Penn State Health

New medical records procedures West Tennessee Healthcare closed their HIM department to visitors, removing the ability to pick up medical records or talk to staff. Tracy’s team is looking at how they can set up a location off‑site or close to the facility so visitors don’t have to come in to get their records.

“We closed our department and set up in our admitting area so people could walk up if they were in the building and request release forms. This was a big change for us, patients, and visitors.” – Tracy G. Hickey, MBA, RHIA, CPHI, FAHIMA, Director of Health Information Management, West Tennessee Healthcare

How to ensure excess staff has enough work until they’re needed “We manage a lot of PRN and project work for clients. For example, reviewing edits or medical coding audit projects. We also had some clients who used outsourced medical coding sta­ff in other countries that went into full quarantine and needed our help. This provided opportunities for our coders to have work in other areas. Because we work with so many clients across the US, some areas were more open or had more patients than others. It helps when coders have more than one responsibility and can participate in project work.” – Sarah Humbert, RHIA, VP of Coding Operations, KIWI-TEK

Overstaffing “One of the sta­ffing models we’ve always promoted with clients is to be overstaffed. We like to be overstaffed by 20 to 25% historically for vacations and volumes but we really saw the value during the crisis. Clients had coders go out unexpectedly and our coders were trained so it was easier to jump right in. We are still receiving calls where high volume is happening with COVID-19 testing or coders being out.” – Sarah Humbert, RHIA, VP of Coding Operations, KIWI-TEK

Health information Management Advice for a Successful 2021 and Beyond

Don’t fear change. Be the driver of the change. Don’t wait for others to make the change. For example, I didn’t wait for the patient accounts department to decide on what to do to catch accounts before they went out the door. I put stops in place to make sure we were doing everything appropriately. Some people fear change but it personally makes me happy to know we’re learning and growing. – Lorie Mills, RHIT, CCS, Director of Coding and Clinical Documentation, Forrest Health

Involve your team. Ask them for ideas, help, and suggestions. Keep them involved and a part of the change. If we’re communicating, and asking, and keeping people involved, it makes them more open to accepting change. For example, we knew we had to rearrange some of the health information management staff because of space issues. We asked them who could go home and how we should reassign all the work. The employees had input, they helped us deal with the whole process and made it so simple. – Tracy G. Hickey, MBA, RHIA, CPHI, FAHIMA, Director of Health Information Management, West Tennessee Healthcare

Redundancy. I started to stress this with my team because of COVID-19. Where do we have only one go-to person that knows how to code X, Y, or Z? What if we get information from one specific computer and it goes down? Talk with your staff about where those risk areas are and educate folks so you can hand it off in a timely fashion. Don’t wait for an emergency to come along. We can move on and shift gears quickly. Always be thinking about that next big event that could throw you off track. When we put plans in place, we’re not panicked, we just move to plan B. – Matthew Hoeger, Senior Director of Revenue Integrity, Penn State Health

Communication is most critical. Don’t undervalue the act of picking up a telephone and calling someone. Throughout this crisis it’s been invaluable for us to speak with clients, understand what they’re seeing, and be ready to help with their challenges. Internally, we’ve been constantly speaking with coders to accommodate schedule changes they need and be aware of their areas of expertise. We have a lot of great resources and cross-training material available. –Sarah Humbert, RHIA, VP of Coding Operations, KIWI-TEK