As the healthcare industry continues to respond to the extraordinary challenge of the COVID-19 pandemic, our nation’s HIM workforce has proven its resiliency and ability to pivot as needed. We asked several HIM leaders nationwide to share their experiences and lessons learned in the hopes that their insights can help others weather any storms that lie ahead, whatever they may be.
To view the complete roundtable discussion, see The Impact of COVID-19 on the Coding Function: A Roundtable Discussion.
Our first question deals with the impact of COVID-19 on staff in the coding function.
MODERATOR: COVID-19 has had such a huge impact on hospitals. How has it affected your coders specifically? Were staff furloughed or laid off? Did responsibilities change as patient volumes fluctuated? If so, how?
“We were dealing with new ways to bill patient responsibility—there were a lot of things we needed to check and verify on the coding side. We also needed to be nimble around the constantly shifting coding guidelines and lack of definitions.”
AUGUSTE: We moved our entire coding staff home. We definitely saw a dip in the number of outpatient visits, and our coders had to shift from one specialty to another as needed. Some coders also assisted with denials and prebill coding edit reviews when volumes were down.
TAKEI: Prior to COVID-19, all of our coders with the exception of one individual worked from home. During the pandemic, the onsite coder remained onsite to help with scanning and indexing. Our organization didn’t furlough staff or lay anyone off; however, we did ask for voluntary paid time off during the first few weeks of the pandemic.
HARMON: All of our coders were already working from home, and nobody was furloughed or laid off. Staff attrition worked in our favor as patient volumes decreased. The only thing that changed was that new hires who normally remained onsite for their training moved remote more quickly than usual because trainers were also working from home. We used Skype and Microsoft teams to train new staff remotely, and it has worked well. In terms of responsibilities, we sent fewer cases to our health system’s consolidated coding unit and handled them internally instead.
PELLETIER: We were very fortunate. Our organization protected the safety and well-being of everyone immediately by sending people home. We had significant financial losses due to our volume, but our organization made a decision to avoid layoffs and furloughs. Everyone has maintained their jobs.
We asked this question daily: Where is the volume, and are people running out of work? Some of our hospital coders with outpatient coding experience, for example, helped get old bills out the door in some of our provider-based clinics, and they also helped with telemedicine claims. My coding managers and I also looked at other hospitals within our system to see if they needed help. One of our hospitals had thousands of claims that weren’t being worked, so we reached out to their CFO and said would you like help? We were able to do that. It was the system working together to help each other out.
RUSHBROOKE: All of our coding production team already worked from home; however, managers and onsite-based auditing and administrative staff shifted to being fully remote in the middle of March. We did not furlough or lay off any staff.
With that said, our patient volumes definitely dropped because same-day surgeries, elective surgeries, and inpatient admissions weren’t happening. However two of our hospitals (Mass General and Brigham and Women’s) saw a large number of COVID admissions. They both converted vacant ambulatory surgery rooms to ICU beds. About a third or one half of our coders had to shift because we suddenly had all of this COVID volume—testing in particular. We were dealing with new ways to bill patient responsibility—there were a lot of things we needed to check and verify on the coding side. We also needed to be nimble around the constantly shifting coding guidelines and lack of definitions. We had to provide a lot of training and ongoing guidance. Nobody was idle. There was a lot of new learning about how things were flowing through the revenue cycle and how payers were going to treat COVID cases. It was an interesting couple of months.
There were also so many workflow considerations. We didn’t have an infrastructure in place for managing this volume of accounts. We had to create reasons to hold and reasons to release. It was pretty impressive how all of this was taken care of, and nothing got lost throughout this period.
OSBORNE: We had to be really nimble around coding COVID tests. There were times when we had 50,000 cases in our work queues. In May, we were able to automate parts of these processes so that as our regular inpatient and ambulatory surgery volumes started to come back up, we could handle it all.
In addition, our coders helped code cases in our field hospital—Boston Hope. The hospital, which was constructed in seven days, was located at the Seaport Convention Center and included 500 beds for patients with COVID and 500 beds for COVID-positive patients who were homeless.
Barbara Auguste, CPC, CPMA, Director of Professional Fee and Outpatient Coding Services at Maimonides Medical Center in Brooklyn, New York
Rebecca Harmon, MPM, RHIA, CCA, HIM Director and Educator in Pennsylvania
Maryellen Osborne, RHIA, Enterprise Director of RCO Coding and CDI at Mass General Brigham in Boston, Massachusetts
Wendy Pelletier, RHIA, CCS, CPC, Director of Coding at Maine Medical Center in Portland, Maine
Christopher Rushbrooke, MHA, RHIT, CCS, Associate Director of Coding and CDI at Mass General Brigham in Boston, Massachusetts
Cheryl Takei, MHA, RHIA, CDIP, CCS, HIM professional in southern California
Lisa A. Eramo, MA, moderator and freelance writer
Training Libraries Target Job-specific Learning Requirements
Inpatient? Outpatient? CDI? Targeted e-Learning Libraries encourage specificity, increased accuracy, and improved productivity. Learn more here.