By Ben Bohlen
Effective communication is the key to solving any information technology (IT) issue, especially in clinical coding and billing, where lack of technology resources is pervasive and multiple data formats are commonplace. Proper communication—or lack thereof—is a top challenge in solving technology issues as a health information management (HIM) professional in hospitals, health systems, clinics, and physician practices. This article helps HIM departments “talk the talk” of IT to get their clinical coding and billing interface issues solved.
Upfront Communication—What does the team need from you, and what do you need from the team?
IT service professionals want to fully understand your project objectives and end goal. What will the project achieve for the HIM workflow, process, or department? What is in and out of scope? What data are needed up front and what system will it come from? Effective communication of the answers to those questions—early and often—helps your IT team correctly determine the amount of work to be performed and number of IT resources needed.
For example, with multiple applications in place, HIM professionals should identify every source system and how the data will be received. This information should be communicated up front, during kickoff meetings with your IT department and vendors. Once IT and your vendors are clear on the incoming information flow, a plan and timeline to receive and test data from all the various source systems should be established and shared with HIM.
Stakeholders outside of HIM, IT, and your vendor partners should also be included in upfront communications to set realistic expectations and enlist their support. For coding and billing interfaces, this may include members of the billing department, patient access, or denial management. Once you’ve defined the scope and objectives with your IT team, get those additional stakeholders to review plans and agree to set timelines.
Do Your Due Diligence
Prior to beginning any interface project, obtain knowledge of the various systems you’ll be working with. Whether the new system is a widely-known electronic health record (EHR), a lesser-known niche application, or a combination thereof, HIM professionals should come to the project with basic working knowledge of the new software so they can communicate from the same level—or speak the same language—of the existing root system.
For example, if you’ve worked with the new system before, it could be beneficial to send a template of the format you have received in the past. This could help to level set the project, ensuring everyone is on the same page. Speaking their language will make for a smoother project throughout its duration.
Understand Your Organization’s Methodologies and Security
Each hospital has its own unique output and ways to capture data. Find out your organization’s methodologies—the ways in which they transfer clinical and administrative data—as well as the security framework. Whether VPN, FTP, SFTP or other protocols are employed, make sure you are privy to the methodology used so you can effectively discuss those buzz words with your IT counterparts and vendors.
Be aware that many HIM professionals and other department teams use common IT buzzwords as blanket terms to describe systems, networks, or functionalities. When referring to HL7, for example, does your IT team use general standards for information transfers, or the actual framework? By digging just a few more levels deeper on data transfer and security protocols, HIM professionals maintain a stronger presence during interface projects to help ensure deadlines are met and finger-pointing is curtailed.
Make It Work—Be Flexible and Accommodate for Technical Limitations
The key to success with the unique interfaces of hospitals or other medical facilities is flexibility. Even with technical limitations, a flexible mindset adapts to whatever data outputs are provided. The need to accommodate various data formats is a frequent occurrence in billing and coding, where paper and manual input and output are still commonplace. Conciliations and workarounds may need to occur at all levels—vendors, source systems, receiving systems, IT teams, coding professionals, and billers.
Finally, HIM professionals are also reminded to be flexible in their time and resource expectations when working with IT peers. Organizations always have multiple IT projects in place with various timelines and priorities. Your HIM project is one piece of a larger technology puzzle that IT leaders must solve. Use empathy. Be firm in communicating what you need, but flexible enough to work with what you do or don’t receive.
Keep the End in Mind—Improved Coding and Billing Workflow
With coding and billing process change, the goal is to improve workflow and hasten reimbursement while ensuring accuracy and compliance. Define what will be delivered by the project from those perspectives. Discuss what will be delivered and establish realistic deadlines based on the communicated need. Also ensure that you document project goals and parameters in enough detail to enable someone else to produce them accurately and effectively. Open and constant communication, thorough source system awareness, methodology and security alertness, and flexibility are the ultimate keys to success when solving IT issues in the billing and coding world.
Talk the Talk of Coding and Billing Interfaces: Lingo to Know
HL7 (Health Level 7, a standard interface methodology):
- ADT: The admission, discharge, transfer messages or patient demographic data
- DFT: Detail financial transaction message data; used for patient accounting and billing purposes
- ORU: Observation result, resulting from clinical observations this can be compiled and presented into chart data
- SIU: Scheduling data unsolicited
Secure Methods of Data Transfers:
- VPN: Virtual private network
- FTP: File transfer protocol used for data transfers through an established VPN tunnel (for security)
- SFTP: Secure file transfer protocol
Ben Bohlen is the business development and operations manager at LightSpeed Technology Group.