A conversation with Tammy Combs and Melissa Potts of the American Health Information Management Association (AHIMA)

Tammy Combs, RN, MSN, CCS, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, Director of HIM Practice Excellence, CDI/Nurse Planner at AHIMA

Tammy Combs Picture

Melissa Potts, RN, BSN, CCDS, CDIP, CDI Practitioner, HIM Practice Excellence, CDI/Nurse Planner at AHIMA

Melissa Potts Picture

The American Health Information Management Association (AHIMA) represents more than 103,000 health information professionals in the United States and around the world. AHIMA is committed to promoting and advocating for high quality research and best practices in health information and to actively contributing to the development and advancement of health information professionals worldwide.

AHIMA and Artifact Health have partnered to provide hospitals with a mobile physician query platform that can utilize a library of electronic query templates developed and maintained by AHIMA experts. We spoke with AHIMA clinical documentation integrity (CDI) experts, Tammy Combs and Melissa Potts, about the importance of clinical documentation improvement during the COVID-19 pandemic.

What is the greatest CDI and coding challenge hospitals have faced during the pandemic?

CDI programs are vital to the hospital's financial sustainability and the accurate reporting of patient data. During this pandemic, we've seen hospital CDI and coding teams confronted with trying to maintain provider engagement around clarifying documentation for accurate coding purposes.

Historically, providers struggle with balancing administrative duties, such as documenting for coding purposes, and their desire to stay focused on patient care. During the last few months, hospitals dealing with COVID-19 outbreaks could not possibly expect providers to focus on anything more than patient care.

However, as hospitals are getting back to preforming elective surgeries, engaging providers around clarifying documentation for proper coding and reimbursement will be critical to their financial sustainability.

What other CDI and coding challenges have arisen from the pandemic?

Another significant challenge was hospitals had to rapidly and unexpectedly move CDI teams to a fully remote model. This overnight transition required that hospitals procure and provide the correct technology to support productive remote work. And, all of this happening while having to furlough employees to reduce costs and stay solvent.

As the pandemic continues and spikes again in other regions, engaging providers around accurate documentation and coding is critical to our public health. CDI and coding teams ensure that the hospital reports patient disease burden accurately. Without correct documentation and coding, we as a community cannot study the true repercussions of this virus.

During these next phases of opening up and hospitals getting back to normal operations, how critical are CDI programs?

The quality of physician documentation directly impacts hospital reimbursement. CDI programs are an extremely valuable resource to help document patient information completely and accurately so that the hospital may justify full and proper reimbursement for services.

To rebound from the pandemic losses, CDI teams must help hospitals find ways to continue and enhance engagement with providers when their documentation is unclear. Physician responses to CDI and coding queries help the hospital properly and compliantly code and bill for patient encounters. So, greater provider engagement around queries will translate into more accurate reimbursement for hospitals, at a time when they need it most.

Along with engagement around queries, CDI specialists are responsible for educating providers on new regulations and specific documentation requirements for accurate coding and quality reporting. CDI teams will be vital to delivering updated education on medical conditions not related to COVID-19, as hospitals begin performing elective procedures again.

How is AHIMA helping hospitals deal with the pandemic?

AHIMA developed a webpage with links to numerous COVID resources. Included are two CDI query templates for COVID-19, which we added to our compliant query template library embedded within Artifact Health's mobile query platform. The COVID-19 templates support two query opportunities brought to AHIMA's attention by the CDI industry – diagnosis validation and diagnosis specificity of COVID-19.

Also, AHIMA's COVID resources webpage includes other resources and information to support the healthcare industry during this pandemic, such as free educational webinars.

What benefits does the alliance between AHIMA and Artifact Health offer hospitals and health systems?

The integration of AHIIMA's expert, compliant query template library with Artifact Health's innovative mobile physician query platform can help hospitals ensure accurate reimbursement and quality scores. Physicians are able to answer queries compliantly in as little as 30 seconds from their mobile device or desktop.

The ease and convenience of the Artifact mobile app is more satisfying for providers than receiving queries through email, in-person interruptions or the EMR system, and ultimately helps hospitals get queries answered as quickly as possible.

For more information

Contact Tammy Combs and Melissa Potts at cdiexperts@ahima.org.