on situations where the physician has not
indicated the need for a change in level
of care. Encourage physicians to provide
reasons that support medical necessity for
inpatient admissions and complete admission orders,” said Maccariella-Hafey.
11. Build reporting and printing capabilities into the EHR. Work with the
EHR design team to ensure that drop
down boxes and fields reflect clinical observations that support medical necessity.
12. Be a detective. When you receive audits or denials, look for patterns, advised
Wilson. Are you continually getting denied on cases where pneumonia is listed
as the secondary diagnosis? Is there a pattern of poor documentation or illegible
handwriting from certain physicians? Do
you need to engage the clinical documentation improvement (CDI) specialist?
13. Create policies to navigate the denials and the appeal processes. Consider
outsourcing to companies that manage
the denial process.
Jen Onsum is going to become an HIM professional. Nothing, not even muscular dystrophy, will keep the tenacious 30-year- old from that goal. Though confided to a wheelchair and requiring the aid of personal assistants for typical day-to-day needs, On- sum has never let her disease get in the way
of her dreams.
Currently a student at Minnesota State Community and Technical College, Onsum
plans to graduate in mid-2012 with an associate’s degree in health information technology. She hopes to get a job as a trauma registrar or inpatient coder, a profession well
within her physical capabilities thanks in part to the electronic health record.
“With some simple modifications and creative thinking there’s a lot I’m able to do
independently,” she said. “Nowadays pretty much everything is electronic and in some
shape or form involves working on a computer. That is one of the things that attracted
me, because HIM seemed like an extremely feasible line of work for me.”
of AHIMA Resources
14. Book, Responding to a Recovery Audit
Contractor (RAC) Evaluation by Donna D.
Wilson, RHIA, CCS, 2010
15. Article Series, RAC Forensics 101:
Part 1, Part 2, and Part 3, by Sharon Easterling, MHA, RHIA, 2011
16. Audio Seminar, RAC Current Events:
Medical Necessity, 72-Hour Rule, and
Other Program Initiatives by Bridgette
Kreuder, RN, CCS, and Deborah Mallon,
RN, MPA, CCS, CCS-P
17. Practice Brief, Understanding Governmental Audits, 2011. (Toolkit to come
later this year.)
18. Toolkit, Recovery Audit Contractor
19. Toolkit, Clinical Documentation
20. Toolkit, Health Data Analysis, 2011 v
Learning the HIM Basics
This summer Onsum is learning HIM firsthand during her professional practice experience at the Twin Cities-based Children’s Hospitals and Clinics of Minnesota. She’s
picked up a lot—be thorough and detailed when coding, maintain good communication with providers, and no day or patient is ever the same.
HIM will be her second career. For five years Onsum worked in public relations, but
decided to go back to school to pursue her true passion—healthcare. For Onsum,
random diseases, symptoms, treatments and procedures are quickly at mind’s reach.
Likely this talent is due to her many years spent in the hospital.
A Unique Understanding
“I grew up spending considerable time around doctors and nurses in the hospital
environment, and I think because of that I’ve always been fascinated by health and
medicine,” she said. She’s received treatment for muscular dystrophy since she was a
baby and feels her experience will provide a unique edge as an HIM professional. The
importance of healthcare is evident to Onsum, and she hopes her work as an HIM
professional will contribute to better patient care. “HIM might not have a direct impact on an individual patient, but the information gathered can be analyzed and used
to improve the quality of care being delivered to all patients,” she said.
A disability is not an excuse to forgo trying, Onsum believes. She faces obstacles. But
she’s found ways of “getting over them, or going around them” in the pursuit of life.
Leading by Example
Onsum leads by example, volunteering with the Muscular Dystrophy Association and
working with kids at a muscular dystrophy camp. “It’s important for me to show others
that it is possible to be active and encourage them to get out and maximize their potential,” she said. “If (kids) can see at a young age that they can go to college, get a job,
and be independent, they too will achieve their goals and dreams.”
Life won’t always be easy, but if you are willing to try, Onsum says, you can do anything you set your mind to. She just may need to do things differently than the average
person. “I feel everyone has the potential in them to be somebody and purse their
goals and dreams, no matter what your disability is,” she said, “Just because you’re
disabled that doesn’t mean you can’t do anything and be active in society.” v