w hat i think i know (and really do)

36
How to apply your HIM knowledge and experience to other job opportunities

Upload: natan

Post on 14-Jan-2016

27 views

Category:

Documents


0 download

DESCRIPTION

W hat I Think I Know (and really do). How to apply your HIM knowledge and experience to other job opportunities. Content. Analyzing Job Description Applying background and experience Willingness to learn something new Enhancing what you already know Realize your potential. - PowerPoint PPT Presentation

TRANSCRIPT

Page 1: W hat I Think I Know            (and really do)

How to apply your HIM knowledge and experience to

other job opportunities

Page 2: W hat I Think I Know            (and really do)

Analyzing Job Description

Applying background and experience

Willingness to learn something new

Enhancing what you already know

Realize your potential

Page 3: W hat I Think I Know            (and really do)

Position Description: ◦ Provides extended resources and knowledgebase

necessary to evaluate, measure, and deliver a designed plan of support services that will reduce error patterns and maximize practice performance as it relates to the final outcome of billable services.

◦ Responsible for a distinct emergency medicine contract base; this position will often function as a liaison/facilitator between multiple internal and external business partners to resolve issues that surround the production and delivery of the patient health record.

Page 4: W hat I Think I Know            (and really do)

Qualifications:◦ Bachelor’s degree, preferably in a healthcare

related field◦ Clinical background a plus◦ Minimum five years outpatient coding experience◦ Candidate for coding certification◦ Excellent written and verbal communication skills;

strong analytical, organization, time management, and presentation skills

◦ Excellent working knowledge of CPT, CMS and other payer documentation, compliance, reimbursement and coding requirements

Page 5: W hat I Think I Know            (and really do)

◦ Experience in adult education/training including adept lecturing techniques

◦ Exposure to healthcare finance◦ Knowledge of computers, operating systems and

some familiarity with EMRs◦ Ability to work independently◦ Professional demeanor and appearance, strong

work ethic, reliable, resourceful team player with positive attitude

Page 6: W hat I Think I Know            (and really do)

Duties and Responsibilities:◦ Evaluate all processes as they relate to the medical

record and its submission for billing◦ Facilitates the execution of the appropriate clinical

documentation to ensure the level of services and acuity of care are accurately documented in the medical record.

◦ Coordinate with region to prioritize goals and metrics and deliver against those goals.

◦ Strategic planning and financial benchmarks by practice and provider.

◦ Statistical analysis of provider services employing expected outcomes.

Page 7: W hat I Think I Know            (and really do)

◦ Serve as the regional resource to vendors and practitioners as regards to EMR issues and transition.

◦ Keep up with any new EMR application and determine if in alignment with the EmCare’s technology strategic plan.

◦ Keep all practices current on regulatory changes.◦ Establish a program for cyclical analysis and feedback to

full time contract practitioners.◦ Track and trends contract performance.◦ Evaluate state payer guidelines as they pertain to billing

practices and practitioner scope of practice (mid levels, teaching physicians).

◦ A resource and participant on regional management calls.

Page 8: W hat I Think I Know            (and really do)

◦ A resource to the site Medical Director, Nurse Manager, Utilization or Hospital Executives to help resolve issues related to identified ED clinical documentation changes or inadequacies.

◦ Conduct annual site visit round table discussions with contract practitioners.

◦ Evaluate all opportunities to maximize revenue opportunities.

◦ Establish a working relationship with the local and regional staff/team and leadership and promote effective communication among those groups.

◦ Communicates information effectively at all levels.

Page 9: W hat I Think I Know            (and really do)

◦ Provides updates of performance trends and practice outcomes to regional leadership.

◦ Consistently supports compliance and the EMSC code of conduct by maintaining confidentiality and supporting the organizational goals.

◦ Conducts independent educational sessions for new provider employees.

◦ Maintain a close working relationship with billing company practice management staff to communicate potential problems that will result in fluctuations in billing processes or financial losses.

Page 10: W hat I Think I Know            (and really do)

Presentation to Potential New Employer

Page 11: W hat I Think I Know            (and really do)

(But Correct Me If I Am Wrong!!!)

Page 12: W hat I Think I Know            (and really do)

Administrative Expectations Participation in Establishing Corporate Goals Implementation of Corporate Goals Contributing to the Company’s Financial

Bottom Line Preparing Reports for Regional Leadership Clinical Documentation, Coding, and Billing

Compliance Contract Practitioner Liaison

Page 13: W hat I Think I Know            (and really do)

Serves as a resource and participant on regional management calls

Serves as a resource to the site Medical Director, Nurse Manager, Utilization or Hospital Executives to help resolve issues related to identified ED clinical documentation changes or inadequacies

Page 14: W hat I Think I Know            (and really do)

Serves as the regional resource to vendors and practitioners as regards to EMR issues and transition

Effectively communicates information at all levels

Establishes working relationships with local and regional staff/team and leadership and promote effective communication among these groups

Page 15: W hat I Think I Know            (and really do)

Consistently supports Corporate Compliance program

Consistently supports the EMSC code of conduct by maintaining confidentiality

Consistently supports Organizational goals 

Page 16: W hat I Think I Know            (and really do)

Contributes to the strategic planning and financial benchmarks by practice and

provider.

Page 17: W hat I Think I Know            (and really do)

Coordinates with region to prioritize goals and metrics and deliver against those goals

Page 18: W hat I Think I Know            (and really do)

Evaluates state payer guidelines as they pertain to billing practices and practitioner scope of practice (mid levels, teaching physicians)

Evaluates all opportunities to maximize revenue opportunities

Communicates findings and make recommendations for implementation

Page 19: W hat I Think I Know            (and really do)

Tracks and trends contract performance

Conducts statistical analysis of provider services employing expected outcomes

Provides updates of performance trends and practice outcomes to regional leadership

Page 20: W hat I Think I Know            (and really do)

Evaluates all processes as they relate to the medical record and its submission for billing

Facilitates the execution of the appropriate clinical documentation to ensure the level of services and acuity of care are accurately documented in the medical record

Page 21: W hat I Think I Know            (and really do)

Keeps all practices current on regulatory changes

Maintains a close working relationship with billing company practice management staff to communicate potential problems that will result in fluctuations in billing processes or financial losses

Page 22: W hat I Think I Know            (and really do)

Establishes program for cyclical analysis and feedback to full time contract practitioners

Conducts annual site visit round table discussions with contract practitioners

Conducts independent educational sessions for new provider employees  

Page 23: W hat I Think I Know            (and really do)

I Am The Woman For The Job!

Page 24: W hat I Think I Know            (and really do)

Documentation Requirements:

Emergency Medicine

Urgent Care Center

CDU/Observation Medicine

Hospital Medicine (Hospitalist)

Page 25: W hat I Think I Know            (and really do)

HISTORY E&M level

History of present illness (HPI)

Review of systems (ROS)

Past, family, social histories (PFSH)

99281 Problem-focused history

Brief 1-3 elements

None None

99282 Expanded problem-focused history

Brief 1-3 elements

Problem pertinent 1 system

None

99283 Expanded problem-focused history

Brief 1-3 elements

Problem pertinent 1 system

None

99284 Detailed history

Extended 4+ elements

Extended 2-9 systems

Pertinent 1 of 3

99285 Comprehensive history Extended 4+ elements

Complete 10+ systems

Complete 2 of 3

Page 26: W hat I Think I Know            (and really do)

• Location - e.g...Chest pain• Quality - e.g...sharp, dull, burning,

pressure• Severity - e.g....mild, moderate, severe• Duration - e.g...1 minute, 1 hour, 3 years• Timing - e.g....started at 10am, constant,

intermittent• Context - e.g....while walking, at rest• Modifying factors - e.g....improves with

rest, increases with walking• Associated signs and symptoms -

e.g....nausea, vomiting, HA

Page 27: W hat I Think I Know            (and really do)

Required Elements Required Elements

• Constitutional• Psychiatric• Respiratory• Skin• ENT• Hematologic/

lymphatic• Allergic/immunologic

• Musculoskeletal• Cardiovascular• Gastrointestinal• Eyes• Endocrine• Genitourinary• Neurologic

Page 28: W hat I Think I Know            (and really do)

◦Past Medical, Family, Social History (PFSH)

Page 29: W hat I Think I Know            (and really do)

PHYSICAL EXAMINATION E&M level

Body area/organ system requirements Type of exam

Problem-focused examination 99281

1 BA or OS Limited exam of affected BA/OS

Expanded problem-focused exam 99282

2-7 BA or OS Limited exam of affected BA/OS + symptomatic/related OS

Expanded problem-focused exam 99283

2-7 BA or OS Limited exam of affected BA/OS + symptomatic/related OS

Detailed exam 99284

2-7 BA or OS (3 or > items for affected BA/OS)

Extended exam of affected BA/OS + symptomatic/related OS

Comprehensive exam 99285 8 OS only General multisystem exam or complete exam of a single

organ system

Page 30: W hat I Think I Know            (and really do)

Required Elements Required Elements

BODY AREAS INCLUDE: •Head, including face•Neck•Chest•Abdomen•Back•Genitalia•Extremities, each

ORGAN SYSTEMS INCLUDE:

• Constitutional• Eyes• ENT• Respiratory• Cardiovascular• Integumentary• Musculoskeletal• Psychiatric• Neurological• Hematologic/Lymphatic/

Immunologic• GI• GU

Page 31: W hat I Think I Know            (and really do)

MusculoskeletalDocument performance of the following:

Examine hands, arms, shoulders, neck, or TMJ Inspect and palpate the joints OR Check range of motion

T-System = may document either: “Normal ROM” under “Extremities” or “ Neck” (or

pertinent positive) Joint Exam Extremities

Example“Exam of the back shows good ROM with no scoliosis or

deformities”

Page 32: W hat I Think I Know            (and really do)

Documentation Guidelines – Hospital to Physician

Part A to Part B CMS/Commercial Payer Regulations

Coding Compliance HIPAA Guidelines EMR Implementations/transmissions of data Implementation of New Service Lines

Page 33: W hat I Think I Know            (and really do)

Your Understanding of the Operations of Hospitals and Healthcare

Your Experience in Dealing with Hospital and Medical Staff Leadership

Your Experience With Dealing With Medical Staff Your Understanding of the Revenue Cycle Process Your Understanding of Financial Management Your Knowledge of Compliance and HIPAA guidelines Your Knowledge of Clinical Documentation Guidelines Your Experience in EMRs Your Experience in Chart Completion Process Your Experience in Problem Solving Your Experience in Writing Policies and Procedures Your Experience in Employee Training

Page 34: W hat I Think I Know            (and really do)

REMEMBER:The Sky is The Limit, So Don’t Limit Yourself

Page 35: W hat I Think I Know            (and really do)

QUESTIONS?

Page 36: W hat I Think I Know            (and really do)

Sharon J. Randolph, JD, RHIADirector of Practice Improvement

[email protected]