With the move toward EHRs, the dynamic nature of HIM and an ever-present focus on revenue, reporting structures, which dictate whom departments ultimately report to in a facility, are changing. New models are emerging where HIM departments report to the chief information officer (CIO) or where coders are being spun off into their own department. Many remain traditional, reporting to the chief financial officer (CFO) and keeping coding close to the vest, but change is rolling through HIM reporting structures.

In an online survey conducted by ADVANCE and HealthPort last year, more than 65 CIOs and HIM directors answered, and 47 percent of those responded that the HIM department ultimately answers to the CFO. Reflecting the current movement toward EHRs, however, four in 10 respondents noted that HIM reports to the CIO, instead. Some facilities have also blended their organizational structures, with HIM reporting to another higher-up, and coding spinning off to report to the CFO or another department head in the financial realm. We'll take look at the advantages of the blended model and some advice if you think your reporting structure needs a shake up.

An Emerging Trend
Nancy Hirschl, BS, CCS, president, Hirschl and Associates, Laguna Niguel, CA, visits many HIM departments as a leader of an HIM consulting firm. She sees many hospitals make coding its own department, separate from HIM. "We do see in many organizations coding being its own department and reporting to either revenue management or finance or revenue integrity or compliance. This approach works very well," Hirschl explained.

She surmised these changes may be due to an expanded and enhanced view of coding within facilities. Coding goes beyond just summing up documentation into a concise medical code--it plays a huge role in the revenue cycle, and coders have valued expertise as well as a complete view of the entire patient visit.

When coding becomes its own independent department, that department may ultimately report to the same administrator as the HIM department, but the coders roles may change when the department spins off. Coders in those departments are getting involved in other aspects of the revenue cycle. Hirschl noted that in some independent coding departments, coders tackle charge entry and charge capture. While some coders may be hesitant about the new responsibilities, others embrace it wholly. "This approach broadens their scope, it's new and, quite frankly, I believe it is the way coding is going to move, for many different reasons," Hirschl said, and she counted computer-assisted coding and automated encoding as a few of those reasons. "We, as HIM coding professionals, need to position ourselves to have greater depth and breadth in all aspects of coding-from traditional coding to 'hard,' charge-assigned coding functions."

Making the Change
When the coding department spins off in facilities, Hirschl said while at times, that change comes from those at upper levels in the organization, many times HIM initiates the change. She noted seeing a lot of success when the coding department becomes independent, such as a shorter chain of command and quicker organization-wide response to issues.

If an HIM department would like to make the change to an independent coding department, know that it's typically about the bottom line, and speak to those in charge in those terms. Show examples of other facilities that have made a similar move, and document successes. "Put something into motion that you can show to whomever is going to be making those final decisions," Hirschl said.

She also suggested having either an internal or external audit to look at not only the traditional key performance indicators, like DNFB, but also revenue indicators such as emergency department and GI lab charge capture.

Coding may continue to effectively reside in HIM, with expanded coder roles and enhanced coding expertise.

Whether its own department or a valued component of HIM, "coding" as we have known it is taking on new frontiers. "The best point of seeing an entire complete picture of a patient's stay is at the end, with a complete view of patient services, documentation and final outcomes. Who better than the coder to sum it all up," Hirschl said.

Lynn Jusinski is an associate editor with ADVANCE.