Posted by Samantha Serfass on January 21, 2020 in Blog, News


Improving analytics and implementing data-driven strategies are proving to be on the forefront of healthcare organizations agendas. Approximately 88% of hospitals have some sort of data-driven strategy with a dedicated analytic team (1). Value based payment models have forced provider organizations to invest more in data tools and strategies. Some organizations are even trying to monetize their data. New AI capabilities are taking advantage of the large data sets like never before. While a data-driven strategy is important knowing the quality of your data is key.

According to AHIMA, “most hospitals have between 5-10% duplicate medical records and health systems that are multi-facility have an average duplicate rate of 20%” (2). The more complex a health system is, the higher percentage of duplicate records can be found. A prime example occurred in Houston, TX. In 2016, Harris Health System reported 2,488 records with the name of “Maria Garcia”— of those records, 231 shared the same birthdate (3). Recording and analyzing the data is crucial to help identify and eliminate duplicate, incomplete or overlapping data from the system.

Reducing the amount of duplicate data can help reduce the total spend. The expense of a duplicate medical record costs on average $800 per Emergency Department visit and upward of $1950 per Inpatient stay. It can cost a hospital on average $1.5 million, and throughout the industry the cost is estimated at over $6 billion (4).

Identifying why the duplicate medical record occurred is vital to decrease issues. Duplicate medical records are created as a result of patient identification errors, which typically occur during the inpatient registration. However, errors in both the Emergency Department and Outpatient Clinics can contribute to the error rate. Although biometric devices prove useful to initially identify patients, the issue lies within the registration system.

Registration systems often do not leverage advanced logic to help identify an existing patient. A simple error such as a misspelled name can result in an incorrect, duplicated medical record. This error could potentially end up costing the hospital around $1950.

At Excite Health Partners, we understand the importance of quality data. We work to implement solutions leveraging advanced logic (similar to Google searches) to ensure the right patient is found within your EHR.

Regardless of the presence of biometrics, our team of experienced professionals work efficiently to integrate the solutions within your environment. Our approach reduces patient check-in time, producing a positive RIO for the organization. Improving the quality of data and decreasing the cost of errors, Excite Health Partners has the best fit solutions for your organizational needs.

Todd Klein

CIO VP of EHR Services & Digital Services


  1. Health IT Analytics
  2. AHIMA
  3. Lab Soft News
  4. Black Book Market Research


Posted by Samantha Serfass on December 19, 2019 in Blog, General, News


When an E/M service is performed in the hospital inpatient (POS 21), hospital outpatient (POS 19, 22), or emergency department (POS 23) and is shared between a physician and non-physician practitioner (NPP) from the same group practice, the service may be billed as a split/shared E/M service.

The CMS definition of split/shared visits can be found in the CMS Internet Only Manual (IOM): Medicare Claims Processing Manual Publication 100-04, Chapter 12, Section 30.6.1 Split/Shared E/M Visit: 

“A split/shared E/M visit is defined by Medicare Part B payment policy as a medically necessary encounter with a patient where the physician and a qualified NPP each personally perform a substantive portion of an E/M visit face-to-face with the same patient on the same date of service.  A substantive portion of an E/M visit involves all or some portion of the history, exam, or medical decision-making key components of an E/M service.  The physician and the qualified NPP must be in the same group practice or be employed by the same employer.”

The following documentation requirements must be met in order to report the service as split/shared:

  • Both the physician and the NPP must provide a face to face encounter with the patient.
  • Each clinician must document a note in the medical record. Typically, the NPP note is more extensive, but that is not a requirement.
  • Physician must document at least one element of the history, exam, and/or medical decision- making component of the E/M service.  It is not sufficient for the physician to simply document “seen and agree” or simply countersign the non-physician practitioner (NPP) documentation. 
  • Physician must legibly sign the documentation.
  • Physician and the NPP must be actively involved in the Medicare Program and both have a valid provider number for reporting purposes.

The level of E/M service selected to report is based on both the physician and NPP documentation. 

If any of the above elements are lacking, then the service will be reported using the NPP’s NPI.  This will result in a reduction in payment for the E/M service as NPPs receive 85% of the fee schedule rate, whereas reporting using a physician’s NPI number will receive 100% of the fee schedule rate.

The following services may not be reported as split/shared services:

  • Critical care services-this is a Medicare rule.  Do not combine time for critical care services done by a physician and NPP, even when working in the same group, same specialty.
  • Procedures are performed by one person.  Report under the NPI number of the clinician who performed the service.

Remember that physician supervision alone is insufficient for split/shared services, proper documentation is the key!

Janice Spaulding, CCS CPC

Auditor, Coding Educator Excite Health Partners

Telehealth: The Importance of Utilizing the System

Posted by Samantha Serfass on December 16, 2019 in Blog, News

Telehealth: The Importance of Utilizing The System

Telehealth is the use of communication technologies, to access healthcare services remotely and manage your healthcare. These may be technologies you use from your home to access information or a provider. Providers use telehealth technology to improve the care services you receive (physician to physician consultation). 

There are 3 types of Telehealth/Telemedicine.

1) Synchronous or real-time Video doctor to home visits

2) Asynchronous, (AKA Store-and-forward) where a patient collects medical information and then sends it to a care provider

3) Patient Monitoring, where patients use wearables to collect information which is sent to a care provider

The ability to bill for Telehealth services and out of state licensure has been an obstacle for the growth of Telehealth.  Laws mandating coverage /reimbursement for Telemedicine have passed in 42 states.  On October 3rd, 2019, President Trump signed an Executive Order for Medicare Advantage (MA) plans to reimburse for Telehealth in 2020.  The American Telemedicine Association helps monitor telemedicine state policies and is working with others to help resolve licensure obstacles.

Telehealth is particularly beneficial for Americans with chronic clinical needs that require frequent visits to their physicians, primary care MD’s and behavioral health visits.  These are all areas were Telehealth has shown great strengths. Reducing remittance of patients with costly diagnosis such as CHF (Congestive Heart Failure) is also key to support a positive ROI.  Telemedicine has grown 250% from 2015 to 2017 and experts are predicting Telemedicine sector will grow into $130.5 Billion US Market by 2025, from the $21.2 Billion in 2018. 

Due to the complexities associated with implementation, Telehealth programs within large hospital systems often have difficulties utilizing the full services offered.  Frequently, Telehealth systems are developed by individual departments, resulting in virtual patient transfers to be difficult for providers. This virtual hand-off is required to help support each provider’s ability to work at their highest level of licensure.   It’s important to develop an implementation approach to ensure the Telehealth program meets the needs of the overall health system.  Workflows also need to be developed to address the acuity of the patient and the needs of the providers, while ensure charge capture is taking place. 

As with all Implementations stakeholder and champions are essential. Local coordinators/stakeholders also need to be engaged, trained and accountable so the system(s) can be effectively used and adoption can be sustained.   At the center of the implementation strategy should be the patient, followed by caregivers. Reports have shown Telehealth can increase patient and provider satisfaction, a goal that should be front and center.  Thus, the Telehealth implementation should be integrated with the overall patient engagement strategies of the health system.  

Excite Health Partners has the knowledge and experience to assist your organization ensuring your Telehealth program meets, and exceeds, your goals and expectations. We work with you to confirm your system can be sustained and thrive moving forward

Todd Klein

CIO VP of EHR Services & Digital Services

Sources: National Market & Global Market

In The Know: Introduction to the IOCE V20.3

Posted by Samantha Serfass on November 19, 2019 in Blog, News

All institutional outpatient claims, regardless of facility type, process through the Integrated Outpatient Code Editor (IOCE). The IOCE is a program utilized by Medicare Administrative Contractors (MAC) for outpatient hospitals both subject to and not subject to the Outpatient Prospective Payment System (OPPS).

The IOCE performs two major functions:

  1. Edit the claims data to identify errors and return a series of edit flags.
  2. Assign an Ambulatory Payment Classification (APC) number for each service covered under OPPS to be used as input to an OPPS PRICER program. For Non-OPPS claims, a series of Non-OPPS applicable edits are returned.

All applicable services should be submitted as a single claim record to the IOCE. The IOCE only functions on a single claim and does not have any cross-claim capabilities. The IOCE accepts up to 450-line items per claim. The IOCE software is responsible for ordering line items by date of service. The span of time that a claim represents is controlled by the From and Through dates identified on the claim. If the claim spans more than one calendar day, the IOCE subdivides the claim into separate days for the purpose of determining discounting and multiple visits on the same calendar day.

The IOCE identifies individual errors. Each edit is unique, as it directly links the reason the edit is returned, any related information at the line or claim level, and the action required indicated by the edit disposition. The IOCE performs all functions referencing HCPCS codes, modifiers and ICD-10-CM diagnosis codes. Since these coding systems are complex, the centralization of the direct reference to these codes and modifiers in a single program reduces effort and reduces the chance of inconsistent processing of claims.

The current version includes 111 edits. We highlighted 27 edits below of specific interest to outpatient coders.

Edit Edit Description Reason for Edit Generation Disposition
1 Invalid diagnosis code The principal diagnosis field is blank, there are no diagnoses entered on the claim, or the entered diagnosis code is not valid. RTP
2 Diagnosis and age conflict The diagnosis code includes an age range, and the age reported is outside that range. RTP
3 Diagnosis and sex conflict The diagnosis code includes sex designation, and the sex does not match. This edit is bypassed if condition code 45 is present on the claim. RTP
5 External cause of morbidity code cannot be used as principal diagnosis The diagnoses reported is considered a morbidity code and cannot be used as the principal diagnoses RTP
6 Invalid procedure code The entered HCPCS code is not valid for the selected version of the program. RTP
8 Procedure and sex conflict The sex of the patient does not match the sex designated for the procedure code reported. This edit is bypassed if condition code 45 is present on the claim. RTP
12 Questionable covered service The procedure reported is flagged as a Questionable covered service. Suspend
17 Inappropriate specification of bilateral procedure The same inherent bilateral procedure code occurs two or more times on the same service date. This edit is applied to all relevant bilateral procedure lines, except when modifier 76 or 77 is submitted on the second or subsequent line or units of an inherently bilateral code. Note: For codes with an SI of V that are also on the Inherent Bilateral list, condition code G0 will take precedence over the bilateral edit; these claims will not receive edit 17. This edit is also bypassed if the bill type is 85x. RTP
20 Code2 of a code pair that is not allowed by NCCI even if appropriate modifier is present The second procedure reported is part of an NCCI pair, which will cause the generation of edit 20 to LIR even in the presence of a modifier. LIR
21 Medical visit on the same day as a type T or S procedure without modifier 25 One or more type T or S procedures occur on the same day as a line item containing an E&M code, without modifier 25. RTP
22 Invalid modifier The modifier is not in the list of valid modifier entries and the revenue code is not 540. RTP
23 Invalid data The service date and/or the from and through dates are invalid. Or the Service date falls outside the range of the From and Through dates. This edit terminates processing for the claim. RTP
27 Only incidental services reported All line items are incidental (status indicator N). If edit 27 is present no other edits are performed. Claim Rejection
37 Terminated bilateral procedure or terminated procedure with units greater than one A modifier 52 or 73 is present, as well as: an independent or conditional bilateral procedure with modifier 50 or a procedure with units greater than 1. RTP
40 Code2 of a code pair that would be allowed by NCCI if appropriate modifier were present The procedure is identified as part of another procedure on the claim coded on the same day, where the modifier was either not coded or is not an NCCI modifier. Only the code in column 2 of a code pair is rejected; the column 1 code of the pair is not marked as an edit. LIR
42 Multiple medical visits on same day with same revenue code without condition code G0 Multiple medical visits (based on units and/or lines) are present on the same day with the same revenue code, without condition code G0 to indicate that the visits were distinct and independent of each other. RTP
43 Transfusion or blood product exchange without specification of blood product A blood transfusion or exchange is coded but no blood product is reported. RTP
44 Observation revenue code on line item with non-observation HCPCS code A 762 (observation) revenue code is used with a HCPCS other than observation 99217-99220, 99234-99236, G0378, reported. RTP
48 Revenue center requires HCPCS The bill type is 13x, 74x, 75x, 76x, or 12x/14x without condition code 41, HCPCS is blank, and the revenue center status indicator is not N or F. This edit is bypassed when the revenue code is 100x, 210x, 310x, 099x, 0905-0907, 0500, 0509, 0583, 0660-0663, 0669, 0931, 0932, 0521, 0522, 0524, 0525, 0527, 0528, 0637, or 0948; see also edit 65. RTP
60 Use of modifier CA with more than one procedure not allowed Modifier CA is present on more than one line or Modifier CA is submitted on a line with multiple units. RTP
70 CA modifier requires patient discharge status indicating expired or transferred CA modifier requires patient discharge status indicating expired or transferred. RTP
73 Incorrect billing of blood and blood products Blood product claims lack two identical lines (of HCPCS code, units, and modifier BL), one line with revenue code 38x and the other line with revenue code 39x. RTP
74 Units greater than one for bilateral procedure billed with modifier 50 Any code on the Conditional or Independent bilateral list is submitted with modifier 50 and units of service are greater than one on the same line. RTP
79 Incorrect billing of revenue code with HCPCS code The revenue code is 381 with a HCPCS code other than packed red cells (P9016, P9021, P9022, P9038, P9039, P9040, P9051, P9054, P9057, P9058) or The revenue code is 382 with a HCPCS code other than whole blood P9010, P9051, P9054, and P9056). RTP
84 Claim lacks required primary code Certain claims are returned to the provider if a specified add-on code is submitted without a code for a required primary procedure on the same date of service (edit 84). Add-on codes 33225, 90785, 90833, 90836 or 90838 are submitted without one of the required primary codes on the same day. RTP
86 Manifestation code not allowed as principal diagnosis A diagnosis code considered to be a manifestation code from the Medicare Code Editor (MCE) manifestation diagnosis list is reported as the principal diagnosis code on a hospice bill type claim 81X, 82X. RTP
92 Device-dependent procedure reported without device code A device-dependent procedure is reported without a device code. RTP

For more information on the index, check out CMS.

Lisa Marks, VP of HIM Services


Posted by Samantha Serfass on November 12, 2019 in Blog, News


Wearable technology is making big impacts in the Telehealth field.  Wearable technology collects patient data outside of the hospital and clinic walls and report back to care providers information based on measure data, instead of human memory & recall.  

Departments throughout hospital systems see advantages to wearable technology, specifically chronic disease and geriatric health management. Heart attack and heart failure patients are also a targeted demographic for wearable technology.

With the adoption of Current Procedural Terminology, CPT, codes for Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) by CMS, healthcare providers are more able to be reimbursed by Medicare for implementing patient wearables. The reimburse model can not only pay for a wearable, but it can also show an ROI addressing high risk and costly patients within the healthcare system.

Engaged patients are healthier patients and they reduce the cost needed to support a population within an ACO. By combining wearable technology and patient engagement, health systems are able to reduce the risk in a risk adjustment payment model all while collecting important clinical data.

Collecting a patients clinical data outside hospital walls can help increase patient engagement through text messages and secure messaging alerting the patient to their specific health information.  Patient engagement strategies can incorporate displaying personalized care plans on smart phones, remind patient to take medications, perform prescribed activities, measure vitals, etc. The wearable solution should be integrated with the healthcare organizations patient engagement solution.

It’s important to collect the data over a period of time to ensure patients are staying on track with their care plan. The type, time and frequency of messaging with a patient can be automated and crafted for the specific wearable and targeted outcome – allowing patients to receive critical information in real time.

There are many types of wearables on the market, what type and how the wearable is worn can dramatically impact the quality of the data collected by the wearable. Below is an example of the different types of wearables, their functionality and where they are worn. 

Source: Piwek L, Ellis DA, Andrews S, Joinson A. The rise of consumer health wearables: promises and barriers. PLoS Med. 2016;13(2):e1001953.

There are several factors to consider when looking at a wearable solution; quality, usability, comfort, durability and arguably most important – accuracy. Not all wearables require FDA approval, some devices can even report measurements with a significant deviation from the true reading so it’s important to research the options extensively.

There are many things to consider when entering into a patient care model that extends into the patients home. The patient experience can be greatly improved via nursing and informatics’. Nursing can make sure upon discharge that the patient knows how important the data is, how to wear the devices, and who to call with questions, this should be considered the basics. 

Home Health services can provide follow up support ensuring the patient knows how to use the devices and is collecting accurate data, this can be a key part to reducing readmission rates.

At Excite Health Partners we can help you identify areas of opportunity to utilize wearable solutions.  We start with a phased approach to ease your health system into properly using wearable technology and collecting the data.

 We help identify solutions specific to each facility needs. Below is a common phased approach we use:  

  1. Using existing hardware (such as iPhones) and automated reminders  
  2. Addition of one wearable device and integration into one EHR
  3. Secure messaging to improve patient engagement
  4. Adding additional EHR integration and additional Wearables

Through the phased approach, organizations are able to ease into wearable technology and its benefits and a low cost with immediate results. We have the experience and expertise to identify the best fit solution for your organization while increasing patient engagement, quality outcomes, and reducing costs with a healthier patient population.

Todd Klein, CIO VP of EHR Services & Digital Solutions


Posted by Samantha Serfass on October 8, 2019 in Blog, News


With security as an increasing focus in the healthcare space, CIO’s and CTO’s spend significant time ensuring the safety and privacy of patient information. However, the varying degrees of security attacks and privacy concerns leave IT specialists and stakeholders with a never-ending list of concerns.

Types of Security attacks (although not an all-inclusive list):

  • ADVANCE PERSISTENT THREATS (APT) – a security threat to the network remaining undetected for an extended period of time, most common when the data is of high-value.
  • AI ATTACKS – an attack which can automate identity, crack passwords and DOS making these attacks much more formidable.
  • DISTRIBUTE DENIAL OF SERVICE (DDoS) – the goal is to deny access to the server by overwhelming the target system by flooding it with network traffic.
  • MALWARE – a stealthy approach, without end-users knowledge, to put code on a device (i.e.: Trojan Horse).
  • PASSWORD ATTACK – an unsecured source attempting to break in or obtain a user’s password.
  • PHISHING – Social engineering to obtain information or approval to run code on a device.  C-suite you’re a Favorite target for an attach like this.
  • PHYSICAL SECURITY & DRIVE BY ATTACK – an unsecured wireless environment allowing threats to easily attack the system.
  • RANSOMWARE –blocks access to date with the threats to permanently compromise the data unless a ransom is paid.

Social engineering is the foundation of several attacks. These attacks occur when a source acts as a trusted advisor gaining access to codes and passwords for various devices. These attacks provide the source with the ability to obtain damaging information and/or create a foothold in the network to further exploit security issues.

IT and cyber-attacks in the healthcare industry rate as one of the most damaging and costly occurrences compared to other industries. As a whole, the healthcare industry spends an estimated $6 billion dollars a year dealing with security attacks and breaches.

According to one of the latest Becker’s reports, more than 5 million US patients can be accessed online by just a basic web browser. The below diagram published by the HIPAA Journal, shows rise in the number of reported data breaches.

Image from: HIPAA Journal

Steps to prevent a security break and ensure the privacy and safety of information is secure is a fraction of what an organization could lose in a cyberattack. Addressing these five items can help to eliminate the possibility of future threats and attacks.

  1. NETWORK ACCESS: Access to the network can be as easy as identify the SID (Security Identify) and a password breaker available on the internet for free. Make sure the wireless connection doesn’t advertise the SID and that communications are encrypted.  Using an advanced authentication protocol as the environment will handle like a Kerberos and Network Encryption protocols like IPsec will help safeguard the network.
  2. PROFESSIONAL INSTALLATION: Hiring highly qualified staff to administer the network and DMZ (the entry way into your network from public networks). This will ensure firewalls, protocol and port analyzers are proactivity looking for breaches. Conducting a penetration by a 3rd party will also confirm safety measures are correctly in place.
  3. SECURE DEVICES: Ensure the network and PC devices are locked down. Leveraging bio identification technology or a 3rd party code generator for two-factor authentication will help improve overall security of the system. Utilize a three-factor authentication and additional security to access addition data or performing sensitive activation (i.e. ordering narcotics) is also another way to safeguard high-valued information.  Lastly, having end-users security policies in place and enforced will also increase protection.
  4. 3rd PARTY ASSISTANCE: Use 3rd parties who specialize in healthcare security when necessary. It’s important to include security that covers the protection of medical devices and patient devices/wearables such as heart monitors.

At Excite Health Partners we use consultants and partners who specialize in Healthcare IT.  We can perform assessments to ensure the environment and the patient’s data is well protected. 

Todd Klein, CIO VP of EHR Services & Digital Solutions


Posted by Samantha Serfass on September 23, 2019 in Blog, News

Assigning & Sequencing: Addressing Pain Codes

Codes to define pain were present in ICD-9-CM, first being published in 2006.  Prior to this, most alphabetical index entries directed the coder to index pain, by site or the underlying cause of the pain.  The codes were created specifically to reflect treatment of pain only, such in cases of pain management.  Although the guidelines have not changed through the years, there is still some confusion about coding and sequencing pain codes.

The first rule of successfully utilizing the pain codes is to follow the alphabetical and tabular index, and to understand the guidelines. 

In the alphabetical index under PAIN, there is a subheading for “acute” which leads the coder to code R52 Pain, Unspecified.  However, listed under R52 is a list of EXCLUDES 1 notes for acute and chronic pain, not elsewhere classified (G89.-) and also localized pain, unspecified type which directs the coder to code to pain, by site (i.e., abdominal pain R10.-; back pain M54.9, etc.)

Under the G89.- section, there are very specific entries for types of pain:

  • G89.0    Central Pain Syndrome
  • G89.1    Acute pain, not elsewhere classified
  • G89.11  Acute pain due to trauma
  • G89.12  Acute post-thoracotomy pain
  • G89.18  Other acute postprocedural pain
  • G89.2    Chronic pain, not elsewhere classified
  • G89.21  Chronic pain due to trauma
  • G89.22  Chronic post-thoracotomy pain
  • G89.28  Other chronic postprocedural pain
  • G89.29  Other chronic pain
  • G89.3    Neoplasm related pain (acute)(chronic)
  • G89.4    Chronic pain syndrome

Other than Central Pain Syndrome and Neoplasm Related Pain, correct code assignment relies on clear physician documentation of “acute” or “chronic” to assign a code from this section.    

When a patient presents and is admitted specifically for pain control, the coder may sequence the pain code as principal diagnosis (or first listed).  An example of this would be:  a patient with lung cancer (previously resected) with metastasis to brain and bone is admitted for treatment of his bone pain caused by the metastasis.  There is no treatment directed at the cancer itself (i.e., chemotherapy or radiation therapy) so the coder may sequence Neoplasm-related pain, G89.3, as the principle diagnosis followed by the neoplasm codes.  As evidenced by the tabular index, the physician does not need to specify whether the pain is acute or chronic, as both of these are designated nonessential modifiers after the code description.

If the patient presents for attention to the site of the pain for further clinical work-up or any reason other than primary pain control, then the site of the pain is coded, and depending on the documentation an additional code from the G89.- section may be used. 

For example: a patient has a fracture of the ulna and had recently undergone a reduction of the fracture with casting.  The patient returns with complaints of acute pain at the site of the fracture.  After x-ray it is found that the fracture has slightly displaced, so another reduction and casting is performed.  The code for the ulnar fracture would be sequenced first, and the code G89.11 Acute pain due to trauma may be coded as a secondary diagnosis. 

Likewise, if a patient presents to the emergency department for acute abdominal pain, it is not appropriate to assign a code from G89- as the physician did not specify the acute pain as being due to trauma, post-thoracotomy, or other postprocedural pain.  This is an instance where the coder would assign the code for site of the pain (abdomen) only.

There are two chronic pain codes, G89.2 Chronic pain, not elsewhere classified, and G89.4 Chronic pain syndrome, which is described as chronic pain associated with significant psychosocial dysfunction.  Pain with psychosocial dysfunction typically means pain that is so debilitating that it interferes with activities of daily living and has resulting psychological disorders such as depression.  Again, the physician documentation must be very clear in noting that the patient has chronic pain syndrome in order to assign this code.

In summary, pain codes can be very helpful in further defining the type or extent of pain a patient is experiencing and give a clear picture of the focus of treatment and utilization of resources.  The coder must carefully review the documentation in order to determine if it is appropriate to assign a code from category G89, and then which code within that category should be used.

Robyn McCoart, RHIT

Managing Auditor, Excite Health Partners


Posted by Samantha Serfass on September 12, 2019 in Blog, News


Healthcare systems face several types of chart demands when focusing on abstraction projects. From abstracting patient data in an outpatient setting prior to Go-Live, to abstracting medication for in-hospital patients before activation – the list of abstracting needs is ever changing.

With the increase of Mergers & Acquisitions, converting charts and patient information from one system to another has been a key focus for many healthcare systems. While abstraction projects can face several challenges, remote abstraction projects bring their own set of unique problems.

Technology is a major obstacle to tackle during remote projects. Excite established a “Remote Hardware Requirement Guide” that helps to ensure all professionals have the proper elements needed for the remote project.

Although issues with internet providers can generate issues, ensuring all hardware requirements are up to standards will help eliminate numerous problems. Increasing technical resources on a remote abstraction project can also help free up the health system’s help desk when issues arise.

Clinical resources are an important factor in eliminating issues during a remote abstraction project.

By creating a collaborative environment, these resources can double check the work output is performed correctly.

Refining internal processes and tools to improve efficiency between management and teams also helps decrease issues. Progress trackers are setup to monitor each patient’s chart so abstractors can input the data into the new EMR system. Daily progress reports are another key element to track the project’s development. Project management tools like “burn down charts” allow leadership teams to track and monitor the teams progress and issues.

It’s important to continue to document, communicate, and adapt during abstraction projects. Excite Health Partners recently worked with a healthcare system to remotely support their abstraction needs, through our experience and expertise we have the resources to help with various abstraction project demands.

Todd Klein, CIO VP of EHR Services & Digital Solutions


Posted by Samantha Serfass on August 28, 2019 in Blog, News


Anxiety is a normal and often healthy emotion. However, when a person regularly feels disproportionate levels of anxiety, it may become a medical disorder. Anxiety is often described as a feeling of worry, nervousness, or unease. Typically, these feelings occur when faced with an imminent event which is often an event with an uncertain outcome.

 Factors that put people at risk of an anxiety disorder are:

  • Chemical imbalances
  • Long-lasting stress
  • Family history of anxiety
  • Trauma
  • Abuse of biological agents such as alcohol, drugs, or prescription medication.

Common medical conditions that may cause anxiety include asthma, diabetes, heart disease, hyperthyroidism, and hypothyroidism. Proper documentation of anxiety disorders is the key to capturing the patient’s condition in ICD-10-CM. Most often, the physician simply documents anxiety in the patient’s record. The U.S. Department of Health and Human Services recognizes five major types of anxiety disorders, and each have ICD-10-CM diagnosis codes.  

Generalized Anxiety Disorder (GAD)

GAD is an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension.  This can be present even when there is little or nothing to provoke it. 

Obsessive-Compulsive Disorder (OCD)

OCD is an anxiety disorder that is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors may include frequent hand washing, counting, checking, and cleaning.

Panic Disorder

Panic disorder is an anxiety disorder that is characterized by unexpected and repeated episodes of intense fear which can be accompanied by physical symptoms such as chest pain, heart palpitations, shortness of breath, or dizziness.

Post -Traumatic Stress Disorder (PTSD)

PTSD is an anxiety disorder that can develop after exposure to a terrifying event or ordeal.  These events often may involve grave physical harm which occurred or was threatened.  Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat. 

Social Phobia (or Social Anxiety Disorder)

Social Phobia, or Social Anxiety Disorder is an anxiety disorder that is characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations.  It can be limited to only one type of situation such as fear of public speaking or fear of eating in front of others.  In its most severe form, this disorder may cause a person to experience symptoms anytime they are around other people.

A physical examination and a psychological evaluation are necessary to make a diagnosis of anxiety. Sequencing anxiety codes will depend on the circumstance of the admission and the physician’s documentation in the medical record. While anxiety appears normally in everyday life and is useful when alerting a person to danger, it can become concerning when it disrupts normal activities.

Cynthia Alder-Smith, RHIT CCS

Auditor/ Educator Excite Health Partners

Mergers and Acquisition: Improving The Bottom Line

Posted by Samantha Serfass on August 19, 2019 in Blog, News

Mergers & Acquisition: Improving The Bottom Line

The transition from volume-based care to value-based care has been a driving force in the rise of merger and acquisitions in the recent years. Mergers and acquisitions allow organizations to tighten operations, streamline services and increase revenue. Many of the mergers and joint ventures are changing reimbursement models to cover the health of a populations all while reducing costs.

When merging two organization in ACO model, efficiency is key. An organization focusing on leveraging technology and increasing patient engagement is better suited to accommodate the public while targeting costs for the ACO.

Integration conversations are an important component surround mergers & acquisition. Integrating operations, IT assets, and supporting services as well as sharing of data between the two originations are vital pieces to consider. 

S.W.O.T Diagrams of each of the organizations can assist in developing the pieces of the puzzle when combining organizations. Identifying areas of weakness allow for additional partnerships to form strengthening the needed services. As healthcare organizations become larger and broader, niche services have the opportunity to accommodate certain patient populations. By increasing the patient satisfaction and leveraging technology, these services have the opportunity to be more efficient

Excite Health Partners is working with such a company right now.  By increasing patient engagement and satification, this organization excels in skill nursing services. As a result, they are purchasing service lines from healthcare organizations throughout the U.S.

Excite has also assisted a company by abstracting patient data. By scheduling the integration discussions in timely manner, Excite has helped to abstract data from three different EHR systems and able to populate all the data into our clients single EHR.

Whether it comes to strategic analysis, patient engagement, leveraging technology or just brute physical abstracting, Excite Health can be your Partner for your M&A.

Todd Klein

CIO, VP of EHR Services & Digital Solutions