CDI and HIM Collaboration

Good afternoon,

We are in the process of developing a new CDI program. We have made multiple attempts to obtain collaborative efforts with the HIM department and have been met with the upmost resistance. Concerns brought to our attention include taking up time from coders productivity, time spent holding the bill secondary to query and/or reconciliation process, financial loss from holding the bill and overall creating more work for the HIM department. The concepts of the integrity of the record, SOI/ROM/CMI and lastly reimbursement impact tend to fall on deaf ears in efforts to obtain collaboration. Requests to have access to coders for questions have also been denied as well as follow-up process for open queries post discharge. We recognize the collaboration between CDS and coders is critical for the organization's and the program's success. Sr leadership has been made aware of our struggles, however, HIM has assured Sr. leadership they 'support the program and will do whatever it takes' but their actions are clearly communicating the opposite.

Any other programs out there who have struggled with some of the same issues? If so, how were they handled or any advice on moving forward and creating a successful CDI program regardless of HIM cooperation?

Thank you!

Linda Belsanti, RN
Manager, Collaboration for Documentation Integrity Program
UMASS Memorial Medical Center
Worcester, MA

Comments

  • edited May 2016
    Hi Linda,

    Your email brings back some memories of when we started our program. Some of the true fear seems to be that they are afraid we will take their jobs. Also, our coders have such tight productivity measures that time is definitely an issue.

    We are now separate and apart from HIM. We are part of quality. This has made an incredible difference.
    You may need to make your own way and ACDIS is a good place to start. There is a wealth of information on this website.
    Also, can you visit other programs from other facilities to see how they practice independent of HIM.

    I believe if you have a good start-up training program, some organizations use Huron, JAThomas, 3M etc, you will be independent of the HIM process. We started with 3M and they provided us with a great start, training, follow up resources and continued support.

    I would enjoy talking to you someday if time permits and I can offer more ideas.

    Good Luck to you.
    Lisa


    Lisa Romanello,RN,BSN,FNS,CCDS
    Manager, Clinical Documentation Improvement Specialist
    CJW Medical Center
    Quality and Compliance
    804-228-6527
  • edited May 2016
    Our program was established in 2003. Initially we were under the center for performance improvement alongside care management and under their director for supervision. Separate space different floor etc. We eventually moved (2006) to HIM with the director of HIM as our supervisor who reports directly to the CFO. We have a room right within the coding department. We also have had a DRG coordinator off and on since the program started. Little by little we have earned the trust and respect of the coders. They know we are not there to do their job. And we likewise value and respect them for their expertise in coding. It has been a collaborative effort on all our parts. I think moving in with them was a huge step in the right direction. Good luck!



    Diane M Clement RN MS CCDS
    Team Leader Clinical Documentation Management Program
  • edited May 2016
    It saddens me when I read about issues with CDI and HIM..... since we all have the same goal. When our program started 6 years ago we were part of the HIM department and still reside there. I strongly believe that is why we were so successful. I recieved my initial training with the coders and then when the consultants left town the coding staff were my mentors.

    They soon realized that if I worked for changed up front...their work on the back side was a bit easier. We are in constant conversation with each other throughout the work day through our software and through instant messaging. Sometimes I will just ask them to read an op report and tell me if there is anything else needed.

    On the back side I assist them in writing retro queries or identifying the supportive data. I work as a translator between them and the physicians and am proud that my efforts work to ease their workload.

    suggestion- can they be invited to a session to explain what you will be doing, what your goals are etc? You need to show them that you will not be telling them how to code but will be helping to provide documentation that allows them to code in a timely manner- less need for retro queries etc. Invite them to maybe spend some time with you onthe floors.... so they can teach you. In the process you can teach them as well. They needed to see I had a deep respect for coding guidelines and referenced cloding clinics.

    I also provided lessons in anatomy, pharmacology and pathophys to them in thier monthly staff meetings and a year long anatomy course online. They began to see me as a resource as I did them. We have grown as a team by sharing our knowledge and expertise.

    I am so thankful that I learned this role in such an environment. I feel for you .

    Laurie L. Prescott RN, MSN, CCDS, CDIP
    lprescott@morehead.org
  • I would ask HIM what their plans are for ICD 10 Education? Clinical Documentation in my organziation is such a large part of that education to the providers. And I feel that our query process is going to be the way in which we reinforce the ICD 10 education we teach.
    That alone would benefit the coders so they can appropriately code, and won't be responsible for that education. If they don't have the documentation they need they won't be able to drop a bill at all. The entire case will not be reimbursed.

    Charonne Sutherland RN.BSN.CCDS.
    Supervisor Clinical Documentation Improvement
    St.Charles Health System, Bend Oregon
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