Roundtable Discussion: COVID-19 Challenges, Solutions, and Guidance for 2021

By Bill Wagner, CHPS, CPCO

In September 2020, KIWI-TEK hosted a customer roundtable discussion with several revenue cycle and health information management (HIM) experts regarding their COVID-19 challenges, solutions, and lessons learned. The objective was to build a better understanding of how HIM and revenue cycle professionals met the unforeseen challenges of 2020, and how their experiences framed perspectives for the future. This article captures the essence of the conversation and offers guidance to help the HIM community navigate new challenges in 2021 and beyond. The discussion was moderated by Bill Wagner, CHPS, CPCO, chief operating officer of KIWI-TEK.

Wagner: What changes did your HIM department experience as a result of COVID-19, and how did you address them?

Lorie Mills, RHIT, CCS, director of coding and clinical documentation, Forrest Health: Adjusting workflows to accommodate employee needs was one of the biggest changes in our HIM department. Staff responsible for scanning traditionally floated around the hospital to retrieve pieces of the record that were not electronic. Due to potential health risks for older employees or anyone who was immunocompromised, we had to find workarounds to keep people healthy and ease the fears of our employees. We looked at who would be safest to go on the floors, make rounds, and get information. HIM also had to staff the controlled access entrances to the facilities, which created another challenge.

In addition, employee assignments were adjusted to accommodate health risk factors. We arranged for the majority of HIM operations staff to work from home. Our coding team has worked remotely for many years, so they were able to adapt more easily to the transition.

Matt Hoeger, senior director of revenue integrity, Penn State Health: During the transition to a remote workforce, the biggest challenge was communication. In-person team meetings were suddenly replaced with virtual meetings and conference calls. Though communication challenges are ongoing, our leadership has helped bridge the gaps through email communication and online meetings.

Tracy G. Hickey, MBA, RHIA, CPHI, FAHIMA, director, health information management, West Tennessee Healthcare: We experienced challenges related to the workload balance due to ever-changing volumes, employee furloughs, reduced hours, and closing of the HIM department to visitors who needed medical records. Social distancing also presented a problem. Due to close proximity in the hospital, many employees were sent home to work. However, productivity actually increased as our remote team embraced change and remained positive throughout the process.

Sarah Humbert, RHIA, vice president of coding operations, KIWI-TEK: The biggest hurdle for our coding partners has been the ever-changing volumes and the ability to schedule coders in a fluid environment. Ongoing communication is crucial to manage a mix of full-time, part-time, and PRN coders to fulfill evolving coding needs.

The second biggest challenge was keeping all staff up to date on coding guidance. To address constant changes from the Centers for Medicare and Medicaid Services (CMS) and payers, we conducted educational sessions and then housed all materials on a resource and training site. Providing updates on a regular basis keeps people informed and on task with their responsibilities.

Wagner: What specific adjustments did you make to accommodate a remote staff?

Mills: 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 responsibility to help people understand they still have a job to do from home, especially for people who’ve never worked remotely.

Hoeger: Even though we had folks working from home on a part-time basis, sending everyone home presented connectivity challenges. Our information systems team responded quickly with a creative solution: a hot spot in the garage at the end of campus. People could drive through with their laptops and the IS team got their VPN up and running. On the coding side, our staff did a great job of maintaining productivity. They liked working from home and wanted to continue doing so.

Hickey: One of the most critical adjustments was finding ways to keep the lines of communication open. We have remained connected virtually throughout the work-from-home experience, which is important to our staff and essential to sustaining productivity.

Humbert: Though our workforce has always been remote, family obligations shifted during the pandemic. We adjusted schedules and provided cross-training to accommodate schooling, caregiving, and other family priorities.

Wagner: What were the biggest HIM or revenue cycle challenges you faced this year, and how did you respond?

Mills: We faced two major challenges this year: 1) keeping abreast of daily changes to regulations and 2) adapting to the decrease in elective procedures. To combat ongoing regulatory changes, the patient accounts and HIM departments stayed in constant contact. The hospital patient accounts department provided a COVID-19 flow sheet with specific dates that regulations were put into place, which would serve as insurance in case of an audit. We also worked with KIWI-TEK to host a free webinar for the Mississippi Health Information Management Association (MSHIMA) on telehealth changes and regulations.

To address the decrease in elective procedures, our coding team reduced all vendor usage and reassigned coders that were most affected. Employees with a lot of banked time took PTO, and some employees agreed to take a day without pay every pay period. In addition, we assigned selected coders to participate in a special COVID-19 review project when their workload dropped off.

Hoeger: Our revenue cycle team managed the flood of payer updates in a similar way, as a tool to deal with frequent and inconsistent guidelines from payers. It was a struggle to build the system logic and edits that help ensure a clean bill gets out the door and paid. We held daily meetings with all the stakeholders involved in that process and updated payer grids as new information was received. Compliance was engaged to help make decisions and interpret payer communications. I highly recommend making sure you have all folks—billing, IT, HIM, and compliance—at the table. Overcoming departmental silos is essential.

Hickey: Our main challenge was furloughed staff and the ability to get work done with staffing reduction and a remote workforce. We set the expectation that the job is the same regardless of location. Consistent communication is absolutely necessary to help staff remain focused and productive while working from home.

Humbert: Scheduling coders to handle the changing volumes is an ongoing challenge that requires open communication and cross-training for a mix of full-time, part-time, and PRN coders. We have to be flexible and prepared to help sustain productivity within HIM and revenue cycle departments.

Wagner: What changes did you make in your HIM and revenue cycle workforce that you intend to carry forward after the pandemic?

Mills: Throughout this time of transition, communication and collaboration between HIM and revenue departments increased significantly. Based on our experience, other departments that did not support remote staff are making plans to do so. I expect this to be a continued practice in the future.

Hoeger: Working from home has proved to be a viable solution. A lot of folks thought staff would be less productive without consistent oversight. For our department, that scenario did not play out. As a result, other departments are following the same path, moving toward remote work as the standard beyond the pandemic. The organization is already looking to clear office space and downsize corporate locations to support more clinical activity.

Hickey: We closed our HIM department to visitors, removing the ability to pick up medical records or talk to staff. Our team is now looking at how to set up a location on-site or near the facility, allowing visitors easy access outside the hospital patient care areas. In addition, we intend to hold more virtual meetings as we relocate staff outside the main hospital facility.

Humbert: We have always tried to maintain staffing at approximately 20 percent over the coding need, which proved valuable during the crisis. Clients had coders go out unexpectedly and our coders were trained to jump right in. We will continue to share and promote this practice in the event of high volumes and illness.

Wagner: Having survived and conquered most of the challenges caused by the pandemic, what advice can you offer other revenue cycle leaders for managing a successful HIM department in 2021 and beyond?

Mills: When faced with unprecedented challenges, don’t fear change. A negative beginning is an opportunity to take charge and navigate the journey for positive change. Don’t wait for other people to initiate change. For example, I didn’t wait for the patient accounts department to determine how to catch accounts before they went out the door. I put stops in place to make sure we were doing everything appropriately. In my experience, change means we’re learning and growing.

Hoeger: I believe that we should continually test our assumptions about how we do business and try things outside of our comfort zone. Prior to COVID-19, part of my plan was to encourage both leadership and staff to get comfortable with a partial work-from-home status. As a result, the coding staff already had the laptops, connectivity, and other resources required.

In addition, we had gone through an emergency preparation planning session where we detailed plans for such emergencies. Best practice is to be prepared for the next “what if” situation. Also, redundancy is essential. Never rely on just one of anything, whether it’s a coder for a particular specialty or one laptop with special software needed to code a line of business. Talk with your staff about areas of risk and educate them to shift gears quickly.

Hickey: When dealing with a difficult situation, crisis, or change, always involve your team in planning and making decisions. Be prepared for anything, and don’t hesitate to ask others for ideas and suggestions. Communication is critical—especially during a crisis. For example, when faced with rearranging staff due to space issues, we asked who could go home and how we should reassign the work. Our staff responded with valuable input and helped simplify the process.

Humbert: Open communication is absolutely necessary. With changes in schedules, volumes, and coding guidance, email is not sufficient. Connection through phone calls and Zoom meetings has been invaluable for us to bring everyone together. Internally, we’ve been in constant communication with coders to accommodate schedule changes, provide cross-training, and make educational resources available to sustain high levels of expertise.

Author’s Note

We appreciate the wealth of information and valuable insights shared by our longtime HIM partners. Their perspectives amid unexpected challenges in our industry offer sound guidance for others to adopt in the future. An expanded version of this panel discussion is available online from KIWI-TEK, as is a consolidated version, titled “HIM’s How to Thrive Guide—COVID-19 Challenges, Solutions and Advice to Forge Ahead.”

Bill Wagner is the chief operating and security officer for KIWI-TEK.

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