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