w hat i think i know (and really do)
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 PresentationTRANSCRIPT
How to apply your HIM knowledge and experience to
other job opportunities
Analyzing Job Description
Applying background and experience
Willingness to learn something new
Enhancing what you already know
Realize your potential
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.
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
◦ 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
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.
◦ 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.
◦ 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.
◦ 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.
Presentation to Potential New Employer
(But Correct Me If I Am Wrong!!!)
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
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
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
Consistently supports Corporate Compliance program
Consistently supports the EMSC code of conduct by maintaining confidentiality
Consistently supports Organizational goals
Contributes to the strategic planning and financial benchmarks by practice and
provider.
Coordinates with region to prioritize goals and metrics and deliver against those goals
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
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
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
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
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
I Am The Woman For The Job!
Documentation Requirements:
Emergency Medicine
Urgent Care Center
CDU/Observation Medicine
Hospital Medicine (Hospitalist)
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
• 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
Required Elements Required Elements
• Constitutional• Psychiatric• Respiratory• Skin• ENT• Hematologic/
lymphatic• Allergic/immunologic
• Musculoskeletal• Cardiovascular• Gastrointestinal• Eyes• Endocrine• Genitourinary• Neurologic
◦Past Medical, Family, Social History (PFSH)
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
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
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”
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
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
REMEMBER:The Sky is The Limit, So Don’t Limit Yourself
QUESTIONS?
Sharon J. Randolph, JD, RHIADirector of Practice Improvement