Meet a Member: CDI work means more than accurate coding

Kimberly Huff, BA, COC, CCDS, is a clinical validation denials coordinator for Providence Ministry (formerly known as Providence St. Joseph Health). She is a founding member and leader of the Arkansas ACDIS chapter

ACDIS: How long have you been in the CDI field?
Huff: Oh, my goodness, this is going to “date” me. I’ve been in CDI for 15 years. I was thrown into the field of CDI in 2005. I was essentially told to “sink or swim,” as I was tasked with piloting the CDI program for the facility I worked at back then.

ACDIS: What did you do before entering CDI? 
Huff: Two weeks after I graduated from college I began working as a case manager for our local hospital. My duties also included utilization management. I covered all of the units, including our skilled nursing unit (SNU). But I predominantly covered our ER and the ICU. The ICU was by far my favorite group of patients to follow and assist.

ACDIS: Why did you get into this line of work?
Huff: After a couple of years of working in case management (CM)/utilization management (UM), “compassion fatigue” set in. There was no “leaving it at the office” for me. My patients were on my mind day in and day out. I felt myself becoming really burnt out and pessimistic. I didn’t like that at all. My CM/UM director was aware of how I felt. It just so happened that at that time (unbeknownst to me) our facility had been tasked with piloting a CDI program by our health system’s corporate leaders. The program would be housed within our HIM department. My director spoke with the HIM director and the rest is history.

ACDIS: What has been your biggest challenge?
Huff: I don’t think I can pick just one, because two things immediately come to mind:

1. Converting our biggest adversary into the unofficial physician champion of our CDI program.
2. Educating C-suite leadership about the various types of denials, the complexity of clinical validation denials, as well as the lengthy appeals process.

ACDIS: What has been your biggest reward?
Huff: Hearing feedback from ACDIS session attendees (I’m still getting emails from some who attended my session two years ago), webinar attendees and those who I have trained on clinical validation denials. When I receive feedback such as “I’ve become a better CDI specialist,” “I learned so much,” “I look at charts differently since working with you. I understand even more of what my job entails, not just MCCs or CCs but the clinical validation too.” That type of feedback gives me the encouragement to keep fighting. It gives me hope that what I can share with and teach others will create a ripple effect throughout our industry.

ACDIS:How has the field changed since you began working in CDI?
Huff: When I started in CDI, our administrative team’s focus was on case mix index (CMI) impact. They cared somewhat about physician response rates, but the CMI impact is how they established our staffing needs. CMI impact is how I was able to justify adding a second CDI specialist to our program and so forth. (When I moved into a corporate role, we had five full-time CDI specialists.) Now our industry is also concerned with severity of illness (SOI)/risk of mortality (ROM), etc. Queries have moved to an electronic format. Records are no longer on paper, allowing some CDI specialists to work from home. So much has changed since 2005.

ACDIS: Can you mention a few of the “gold nuggets” of information you’ve received from colleagues on The Forum or through ACDIS?
Huff: I always enjoy reading and/or hearing how other healthcare systems are approaching their denials and appeals programs. It’s great to hear what worked or didn’t work for them, any payer or review agency specific knowledge they’re willing to share, as well as how they’ve grown their program.

ACDIS: If you've attended, how many ACDIS conferences have you been to? What are your favorite memories? 
Huff: I’ve been to Vegas (2017), San Antonio (2018), and Orlando (2019). I presented for the first time in Orlando. That was both a terrifying and exhilarating experience. I was chosen to speak again for the 2020 Conference which was subsequently cancelled due to COVID-19. I thoroughly enjoyed ZDogg’s keynote session in Vegas in 2017. He was hilarious but also nailed so many of the things that can and should be changed in today’s healthcare system.

ACDIS: What piece of advice would you offer to a new CDI specialist?
Huff: Something I’ve always tried to drive home with trainees is that the goal of CDI is to ensure that an accurate clinical picture can be reported for the patient’s admission. The codes tell the patient’s story. What conditions did they have prior to admission? Did they develop any additional conditions during the admission? Are there any healthcare statuses that are pertinent to the stay? How did we address their diagnoses during their stay with us? At the end of the day, if we aren’t enabling our coding team to accurately report that information, we simply aren’t doing this role or our field justice.

Also, never ever do work that you aren’t proud enough of to put your name upon. Shoddy work yields shoddy results.

ACDIS: If you could have any other job, what would it be?
Huff: Photography. I would love to be able to earn a living traveling to new places and selling pictures I take along the way. I’ll settle for traveling and taking pictures in retirement.

ACDIS: What was your first job?
Huff: I worked at Brady Mountain Riding Stables on Lake Ouachita. I did everything from feeding horses, saddling and unsaddling 15+ horses, taking customers on trail rides, mucking stalls. If it needed to be done, I did it. Man, do I miss the arms and shoulders I had back then…

ACDIS: Can you tell us about a few of your favorite things?

• Vacation spots: The beach or in all honesty, anything on the water. Ocean, lake, river. If it’s on the water, I’m happy.
• Hobbies: I like to read, and I enjoy coloring (stress relief). I’m a mom of three, so I don’t have a lot of downtime for much else.
• Non-alcoholic beverage: I’m a southern gal, so answering with anything other than “sweet tea” would be sacrilegious.
• Foods: Seafood! Spicy crawfish, grilled fish, pretty much any meat that comes from the water. But for the love of all that is holy, do not expect me to eat oysters. Tried them. Not a fan.
• Activities: Watching my boys compete in rodeos and roping jackpots, horseback riding, deer hunting, fishing—I even went shark fishing a few years ago. It’s a lot of work to reel them in but it’s also a lot of fun.

ACDIS: Tell us about your family and how you like to spend your time away from CDI:
Huff: I started dating my husband when I was 16 and we’ve been together ever since. We just celebrated our 20th wedding anniversary this past July. We have three kids: Brody (17 years old), Braden (14 years old), and Erynn (2 years old). We live on property that’s been in my husband’s family for five generations now. We have horses, cattle, and three dogs. Occasionally we have goats and a couple of years ago the boys raised pigs for their 4-H project. Animals, lots of animals. Time away from CDI is typically spent hauling the kids to & from rodeos, as their rodeo season lasts about 8 months/year.

ACDIS: Is there anything else you'd like to add?
Huff: Some fun facts: I’m a bit of an adrenaline junkie. I bungee jumped when I was 13. I would do it again. I want to go ziplining so bad I can hardly stand it. I would also like to go parasailing. I love roller coasters. In fact, I laugh the entire time I’m on them. The laughter is totally involuntary too. They’re just that much fun. I’m a really good shot with a rifle and one of my favorite scents is gunpowder.