Latest / Becker’s Healthcare Digital Health + Health IT / Dawson Ballard, Coding Auditor & Educator at RUSH University Medical Center

Transcript

Dawson Ballard, Coding Auditor & Educator at RUSH University Medical Center · Becker’s Healthcare Digital Health + Health IT

• 0:00
  This is Laura Dierda with the Becker's Healthcare
• 0:02
  podcast.
• 0:03
  I'm thrilled today to be joined by Dawson
• 0:05
  Ballard, coding auditor and educator at Rush University
• 0:08
  Medical Center. Dawson, it's a pleasure to have
• 0:10
  you on the podcast today.
• 0:11
  Thanks for having me. Pleasure to be here.
• 0:14
  Now I'm looking forward to our discussion and
• 0:16
  really highlighting some of the cool things that
• 0:18
  you're doing at Rush as well as how
• 0:19
  you're thinking about the future. But before we
• 0:21
  dive in, I'm wondering, can you tell us
• 0:23
  a little bit more about yourself and your
• 0:24
  background?
• 0:25
  Absolutely.
• 0:26
  I have been in the coding
• 0:29
  HIM realm since 02/2003.
• 0:33
  My coding experience has always been on the
• 0:35
  prophy side, not the inpatient side. I I
• 0:38
  certainly
• 0:39
  understand the concepts of inpatient coding, but all
• 0:42
  of my experience has been on the prophy
• 0:45
  side.
• 0:46
  And I've run the gamut, everything from
• 0:49
  chiropractic
• 0:50
  to
• 0:51
  therapy, PT, OT, speech,
• 0:54
  behavioral health, risk adjustment,
• 0:57
  E and M, urology,
• 0:59
  surgery,
• 1:00
  you name it.
• 1:01
  And I've been with Rush for about a
• 1:03
  year now. Actually, it was a year just
• 1:05
  a couple of weeks ago, but I've got
• 1:07
  a lot of extensive background in compliance,
• 1:10
  coding, auditing, education,
• 1:13
  those types of things.
• 1:16
  That's amazing to hear. You know, definitely, it's
• 1:18
  such an important skill set to have, especially
• 1:20
  now given a lot of the, macro challenges
• 1:23
  in the health care space as well as,
• 1:25
  you know, hospitals and health systems really looking
• 1:27
  to maximize their operations and and figure out
• 1:30
  how they can,
• 1:31
  move into more financial stability in the future.
• 1:34
  So I'm wondering, first and foremost, what are
• 1:37
  some of the opportunities and headwinds that you
• 1:39
  have your eye on right now?
• 1:41
  Well, definitely
• 1:42
  the telemedicine
• 1:44
  debacle.
• 1:46
  That's been trending all over the news. So
• 1:48
  trying
• 1:50
  to get Congress on the back end to
• 1:52
  officially
• 1:53
  extend that before it runs out in March
• 1:56
  and trying to get some specific answers
• 2:00
  from payers about what they're going to do.
• 2:03
  We know Medicare won't accept the new codes
• 2:05
  that CPT created,
• 2:07
  but we can't in some instances, we've been
• 2:09
  unable to get some specific answers
• 2:12
  from the commercial payers as to what direction
• 2:14
  they're going to go, if they're going to
• 2:16
  take the new codes or they're going to
• 2:18
  follow CMS.
• 2:19
  So that's one thing that is definitely
• 2:21
  trending out there that I'm keeping my eye
• 2:23
  on.
• 2:24
  And another is the price transparency.
• 2:27
  As we know, we have something called the
• 2:28
  no surprises act
• 2:30
  to where patient or hospitals and entities have
• 2:33
  to be upfront with patients
• 2:36
  specifically
• 2:36
  about what their potential out of pocket cost
• 2:39
  could be so they don't get slammed with
• 2:42
  a $10,000
• 2:43
  bill later on. And I know there's been
• 2:46
  some issues to where some hospitals and health
• 2:49
  care entities have not been in compliance
• 2:51
  with that.
• 2:53
  So definitely following to see what the federal
• 2:55
  government is is going to be doing to
• 2:57
  handle that piece of it.
• 3:02
  Well, that's fascinating to hear. And I think
• 3:04
  on both fronts, as you mentioned, just looking
• 3:06
  at telemedicine
• 3:07
  in virtual care has been such a boon
• 3:09
  in access, I know, for so many across
• 3:11
  the country. And, health systems have built and
• 3:14
  invested a lot in that type of infrastructure.
• 3:16
  And so, you know, trying to get a
• 3:18
  clear answer from congress. I know it was
• 3:20
  never easy, but we're watching that very closely
• 3:22
  at Becker's too. And then, you know, looking
• 3:24
  at, price transparency,
• 3:26
  all the other,
• 3:27
  legislation that's coming down the pipe,
• 3:30
  Considering just the amount of uncertainty that there
• 3:32
  is today,
• 3:34
  you know, how do you kind of move
• 3:35
  forward and and continue to,
• 3:38
  keep your eye on, you know, what you
• 3:40
  need to do on a daily basis and
• 3:41
  knowing that any number of these things could
• 3:44
  be reversed, you know, by congress or or
• 3:47
  at a federal level, and you might need
• 3:49
  to change on drop of a dime.
• 3:51
  Well, I'm I'm I'm involved with my national
• 3:54
  MAC carrier, which is national government services for
• 3:57
  the region of Illinois.
• 3:59
  So I'm on their per, provider
• 4:02
  outreach and education advisory board where we meet
• 4:05
  quarterly
• 4:06
  to discuss potential changes that are coming down
• 4:09
  the pipe to CMS.
• 4:11
  And we are usually the first ones to
• 4:13
  know if there's changes from Medicare that is
• 4:16
  coming as well as
• 4:18
  CMS has their eye on the, of course,
• 4:20
  what's going on in Washington, and that trickles
• 4:23
  its way back down to NGS.
• 4:25
  So I'm pretty fortunate from that standpoint that
• 4:27
  I'm usually right in the know of what's
• 4:30
  going to be happening
• 4:32
  before it happens so I can get that
• 4:34
  information back out
• 4:36
  back out to my providers. But there's a
• 4:38
  lot of uncertainty out there. I get that
• 4:40
  all the time from my providers, and I
• 4:42
  know the
• 4:43
  anxiety that we went through at Rush when
• 4:47
  we thought that telemedicine was going to go
• 4:49
  away per se,
• 4:50
  except for those that were in rural health
• 4:52
  areas. But
• 4:54
  being where we're located at in Chicago, that's
• 4:56
  not a rural health area. So we were
• 4:59
  looking at, you know, definitely a big cut
• 5:02
  in our revenue
• 5:04
  and a huge disservice to our patients.
• 5:07
  So I'm able to keep up with it
• 5:09
  through
• 5:10
  my involvement in the field and to be
• 5:13
  kind of the eyes and ears on the
• 5:16
  ground for what could potentially be coming down
• 5:18
  the pike.
• 5:20
  That makes a lot of sense. And, certainly,
• 5:22
  it is helpful to have someone like you
• 5:24
  on the forefront just to, you know, prepare
• 5:26
  in a meaningful way,
• 5:27
  and understand early on how things are trended.
• 5:30
  Now when you look into the future, how
• 5:32
  are you thinking about growth and adding value
• 5:34
  to the RushHealth system overall?
• 5:39
  Well, I we are definitely
• 5:41
  on track for that.
• 5:44
  For me in particular,
• 5:46
  we're working on creating standardization
• 5:49
  across for our coding. We know there are
• 5:51
  ins and outs of coding all the time.
• 5:53
  We know that different payers have can have
• 5:55
  different rules,
• 5:57
  but we're trying to create
• 5:59
  processes
• 6:00
  to where our
• 6:02
  it's pretty straightforward for our providers, creation of
• 6:05
  templates in the EMR so they know specifically
• 6:08
  what the documentation
• 6:09
  requirements are for those procedures,
• 6:12
  ongoing education,
• 6:14
  ongoing reviews.
• 6:15
  So we're trying to do the best that
• 6:17
  we can, and I'm helping with that as
• 6:19
  well to try to streamline that process so
• 6:22
  providers can focus specifically on seeing patients
• 6:26
  and take that decoding burden off of them
• 6:29
  per se.
• 6:32
  That's helpful to know. And, you know, really,
• 6:35
  makes a big difference for the providers and
• 6:37
  and clinicians being able to have the right
• 6:40
  things in place and so they don't have
• 6:41
  to worry as much about that and and
• 6:43
  more on caring for patients. And I think
• 6:46
  it seems like there's been a a boon
• 6:48
  in just the types of processes, services, and
• 6:50
  technology available to do that. And so it
• 6:52
  seems like an exciting time for that perspective
• 6:54
  to really rethink how things are going and
• 6:56
  and, you know, up the ante in terms
• 6:59
  of what you're able to do in the
• 7:00
  revenue cycle process.
• 7:02
  Absolutely.
• 7:03
  And then with the dawning of AI coding,
• 7:06
  which is coming, I mean, it's inevitable. You
• 7:08
  can't stop it. It's gonna be
• 7:11
  here. And trying to,
• 7:14
  you know, work with the process to choose
• 7:16
  the right AI vendor when we get to
• 7:18
  that to that
• 7:20
  to that step, to that area, to that
• 7:23
  place in our system,
• 7:25
  and
• 7:26
  and making sure that you're asking the right
• 7:28
  questions, that you don't just go with the
• 7:30
  first thing you see, but making sure that
• 7:34
  the platform that you choose
• 7:36
  specifically meets the needs for the organization.
• 7:39
  So, you know, a lot of people have
• 7:40
  already started to implement AI. It's coming. I
• 7:43
  see it as a good thing, but I
• 7:45
  think you need to make sure you're taking
• 7:47
  the right steps when it comes to implementing
• 7:49
  that. But that's certainly one thing we have
• 7:51
  our eye on at Rush.
• 7:54
  That's amazing to hear. You know, thank you
• 7:57
  for spelling that out for us. And I'm
• 7:59
  wondering too,
• 8:01
  I know lots of big opportunities and things
• 8:03
  that are helpful, but I know there's also
• 8:06
  a lot of challenges ahead. And so, you
• 8:08
  know, when you you look at this next
• 8:09
  year, what do you see as a a
• 8:11
  risk or investment that's worth making to bring
• 8:14
  you, closer to overall,
• 8:17
  organizational
• 8:17
  goals?
• 8:21
  Well, definitely, the technological
• 8:23
  advances
• 8:24
  with the integration as AI, as I talked
• 8:26
  about, and the automation of of medical coding,
• 8:29
  that's creating new job roles. So it's creating
• 8:32
  new
• 8:33
  new opportunities
• 8:35
  for maybe some new newbie coders out there
• 8:38
  and, also for the for the seasoned coders
• 8:42
  like myself to be able to adapt to
• 8:44
  those technologies and to be able to find
• 8:46
  ourselves perhaps at the forefront of the industry,
• 8:49
  maybe help to supervising the AI driven process
• 8:53
  and those types of things. Also,
• 8:56
  remote work opportunities,
• 8:59
  where coders can now work anywhere providing that
• 9:02
  type of flexibility.
• 9:03
  But I would also say that
• 9:06
  there needs to be continuous learning and development,
• 9:09
  that you have to stay abreast of the
• 9:11
  constant changes of the coding standards,
• 9:13
  such as the ICD 10 updates,
• 9:16
  and possibly looking forward to the future prepare
• 9:19
  for ICD 11. We don't know when it's
• 9:21
  coming, but it's coming.
• 9:22
  So start looking at that, for example. And
• 9:25
  I don't think we're there yet at rush,
• 9:28
  but I know there has been some discussion
• 9:29
  around ICD 11 and trying to get ahead
• 9:32
  of the game, so to speak.
• 9:35
  Absolutely. That's such a good call. I know
• 9:37
  it's a big, changeover when it does happen.
• 9:40
  So,
• 9:40
  I appreciate, you know, the time and energy
• 9:43
  and resources it takes to get that process
• 9:46
  started.
• 9:47
  Now before we wrap up here, I'm wondering,
• 9:49
  you know, given some of these changes, additional
• 9:52
  technology, automation, and and focus on, you know,
• 9:54
  what really is a fast moving, health care
• 9:58
  industry, what do you see as being some
• 10:00
  of the big opportunities,
• 10:02
  invest opportunities
• 10:03
  for you personally to grow in the future?
• 10:07
  Well, I'm pursuing additional certifications,
• 10:10
  to become more specialized in for the providers
• 10:13
  that I that I educate and audit for.
• 10:16
  I'm pursuing dermatology,
• 10:18
  urology, general surgery.
• 10:20
  Even though I have experience in that, I'm
• 10:22
  not particularly
• 10:23
  specialized
• 10:24
  or certified in that. So I'm pursuing those.
• 10:27
  I'm pursuing additional educational
• 10:29
  opportunities.
• 10:31
  I'm working to
• 10:33
  share
• 10:34
  my coding
• 10:36
  knowledge, I guess, to call it, by presenting
• 10:39
  at conferences across the country and APC local
• 10:43
  chapter meetings.
• 10:44
  I guess what I'm trying to say is
• 10:46
  I'm trying to give back what I've been
• 10:48
  given in the past in terms of I
• 10:50
  was mentored, I was given the opportunity to
• 10:53
  grow. So I'm trying to foster that kind
• 10:55
  of relationship
• 10:56
  with with future coders and current coders in
• 10:59
  the field.
• 11:02
  That's amazing to hear. I I know having
• 11:04
  that strong pipeline of people that, you know,
• 11:06
  you're building up around you and the team
• 11:08
  around you is really helpful.
• 11:10
  I'm wondering, you know, what advice do you
• 11:12
  typically give them these days, or or, what's
• 11:15
  a meaningful
• 11:16
  thought, I guess, that you should typically share
• 11:18
  with new folks coming to the field hoping
• 11:20
  to, continue to grow, within the profession?
• 11:24
  Well, I give the same advice whether it's
• 11:26
  to newbies or to those in the seasoned
• 11:29
  field, and that is never stop learning.
• 11:33
  Coding is an ongoing changing thing. It changes
• 11:36
  at the drop of a hat. We know
• 11:39
  Medicare has rules for one thing and commercial
• 11:41
  say something else, and we know that all
• 11:44
  changes at the drop of a hat. So
• 11:46
  my advice is always pretty the same across
• 11:48
  the board, and it's to never ever
• 11:51
  stop learning. Continue to educate yourself
• 11:54
  on the trends in the industry. Continue to
• 11:57
  educate yourself
• 11:59
  on CMS
• 12:00
  policies and the coding rules around your specific
• 12:03
  specialty.
• 12:04
  There's always a lot there to learn, and
• 12:06
  you'll always find that you'll learn something that
• 12:08
  you didn't know.
• 12:11
  I love that, Dawson. Thank you so much
• 12:13
  for joining us on the podcast today. This
• 12:15
  has been a really fun and inspiring conversation,
• 12:17
  and I look forward to connecting with you
• 12:18
  again soon.
• 12:20
  Absolutely. Thank you for having me. I appreciate
• 12:22
  it.