Sample Narrative Report For Clinical Informatics

Subjective
I am having a great experience at Baptist Lexington. I cannot say enough good things about my supervisor, Linda. She genuinely cares about making sure I get the most out of my time at Baptist, by scheduling time for me to visit with other departments, letting me know when she has ideas of things I can incorporate into my projects and allowing me to go with her to every meeting that she can.
This past week I was able to visit with Revenue Integrity on Alexandria Drive. When I returned to the HIM department the next day, Christina was so excited to see me and told me that she had some awesome news for me. She told me that Dr. Bailey and Leslie Combs at revenue had called the HIM department and said that I was the most impressive student
that had been sent to them and that they also had called the executive director and told him that if there ever were a position available that I would be a good candidate even though they typically only hire people with quite a bit of experience. I wanted to scream, I was so excited to hear that, especially because claim denials and appeals, and the reimbursement side of healthcare as a whole interests me the most.
Objective
I usually have a meeting or another department to go to every single day.
Last Friday I spent the day with Todd Williams. It was interesting seeing what goes into implementing epic behind the scenes versus in the hospital setting. I also spent time with clinical informatics last week. I was able to see how much time and detail goes into making EHR templates clinician-friendly. Clinical Informatics had to sit with physicians individually and determine how they wanted their specific electronic charts to function, for example whether they wanted free text, or drop down boxes to identify a patients
symptoms.
Last week I spent one full day with Coding, CDI, and Revenue Integrity. In the morning I sat with Paula, the coding director. First she informed me of a problem that she was having with a claim denied by Humana. A claim that had been pre-approved by Baptist’s in-house Humana representative was later being denied by Humana after the final bill had been sent. Apparently this is a problem that has been on-going, and many managers in areas related to the revenue cycle believe that Humana should be sued due to the lack of justification for the denied claims and the fact that appeals are never won therefore doctors are no longer willing to help in the appeals process. The legal department shoots that idea down because Humana is Baptist’s biggest player. We also coded an inpatients chart. I had never thought about how different outpatient coding and inpatient coding were. Outpatient coders code around 150-200 charts a day while inpatient coders were lucky to complete 20 charts a day due to the length of the chart. We spent almost an hour on 1 inpatient chart. I also learned that Baptist sends all of the coded claims to contracted company called HUFF, that reviews that claims and makes sure that the coder did not overlook anything in a chart that could be coded resulting in a higher paying DRG.
After spending the first half of the day with Coding and CDI, I went to the Revenue Integrity office and sat with Leslie Combs and Dr. Bailey. They deal solely with the level 3 appeals processes, they write appeal letters, develop cases for the independent third party reviewer for private payers, and sit in on ALJ hearings. I really enjoyed this part of the day. I learned about Interqual, which is criteria used to assess the level of care necessary, and also used in the appeals process by the hospital and the payer to build a case for denials. When I sat with Dr. Bailey he told me that any denial that they think they may have a decent case for they will appeal and he also informed me that since he has started in the the Revenue Integrity department, they have won 11 of 12 of their ALJ hearings. He also informed me that one of the biggest problems they are having right now is that DRG 470 for Major Joint Replacements are being performed and then almost all of them are being denied because there is a long list of criteria that must be documented in order to receive reimbursement, such as weight loss attempted, use of brace attempted, physical therapy etc. and they are currently working on building those ALJ cases.
As far as minor projects I have created an epic training log spreadsheet for Linda, that allows her to track each employees training hours and what different courses each of them have taken.
I have also completed delinquent medical record reports for the last 12 months, that are sent the Joint Commission. One of the coolest things I have done so far, is go to Wilmore, KY with Linda to Kentucky Underground. Kentucky Underground is literally a cave, where the Highbridge Springs bottled water is manufactured and it also serves as a huge record storage warehouse. Baptist recently realized that there were records that were stored there that needed to be either kept or destroyed based on retention laws but the records were not sorted between adult and pediatrics. Adult records only have to be kept for 10 years but pediatric records must be kept until the child is 23 years old. Our job was to go to KY underground where the records were stored to assess the scope of job and report it back to corporate so they can determine they most cost effective way to go about getting the records sorted and destroyed if
appropriate.
Assessment
I believe I have started to become much more comfortable working in the HIM department and in turn that has allowed me to start building strong relationships with my supervisors and my co-workers. I am not hesitant about asking to help them with a project, or express concerns that I have. This really has been a growing experience for me already and I feel like I am doing everything I can do to make the most of it.
Plan
Over the next 2 weeks I will be spending a full day doing mock Joint Commission Tracers with Ann White, the Director of Regulatory Affairs. I will also be going to Louisville and working with Kelsie Redding on November 30th. Other than that I will be spending the rest of my time working on my final project in the HIM department. My plan is to make a list of every single step in my project and map out each day with those tasks so I complete my project in the most efficient manner that still allows time for me to make sure my presentation is the best it can be and that I have enough time to practice quite a bit.