PROFESSIONAL SUCCESS IN HEALTH INFORMATION MANAGEMENT- CODING FOCUSMARCH 26, 2015

Julieanne Arcuri, MS BS RHIT CCS

HIM Coding Manager

AHIMA approved ICD -10-CM/PCS Trainer

Rochester Regional Health System

Introduction• Graduated from MCC with RHIT in 1993• The Genesee Hospital- Inpatient Coding 1993-2000

• Part time RIT for BS in HSA

• URMC Medical Center- Inpatient Coding 2000-2008• Part time URMC SON for MS Leadership in Healthcare Systems

• RGHS Corporate Compliance 5 years 2008-2013• Current Coding Manager in HIM 2013- current

Vast Arena for Coding Professionals• Acute care hospitals • Outpatient provider offices• Ambulatory surgery sites• SNFs• Research institutions• Government agencies• Third party payers• Vendors

Industry Certifications Include: • RHIT: Registered Health Information Technician• RHIA: Registered Health Information Administrator• CCS: Certified Coding Specialist• CCS-P: Certified Coding Specialist- Physician based• CPC: Certified Professional Coder • CIC: Certified Inpatient Coder• CPC-P: Certified Professional Coder- Payer• COC: Certified Outpatient Coder (formerly Certified

Professional Coder- Hospital (CPC-H))• CIRCC: Certified Interventional Radiology Cardiovascular

Coding• CCDS: Certified Clinical Documentation Specialist• ICD-10 Approved Trainer certification

HIM Coding Team• Coding Integrity Coordinator/Educator

• Inpatient• Ambulatory Surgery• ED/Observation/Ancillary

Coding Teams:• Inpatient• ASC• OBS• ED• Ancillary

Coding Integrity Coordinator/Educator- PB or HB

Key Responsibilities include:•Conducts on-going audits of IP and/or OP coded data•Provides on-going coder training and education•Assists with organizational training for ICD-10•Serves as subject matter expert on documentation, coding and regulatory compliance•Compiles information and/or prepares reports and analysis of data integrity findings with appropriate recommendations.•Works collaboratively with HIM leaders (Coding Manager, CDI Manager and HIM Director) to develop education strategies to promote complete and accurate clinical documentation.•Reports negative trends with clinical documentation to HIM leaders.•Acts as HIM liaison with external coding auditors

Clinical Documentation Improvement Specialist

Required Licensure/Certification Skills:

Certified Clinical Documentation Specialist (CCDS) certification

RHIA/RHIT

CCS

RN license for nursing-prepared candidates

Clinical Documentation Improvement Specialist- continued• Minimum Qualifications:• RHIA/RHIT with a minimum of five years inpatient coding

experience• -OR-• AAS in Nursing required, BS in Nursing preferred: with a

minimum of five years acute care nursing experience.• Advanced clinical expertise and knowledge of complex disease

processes with a broad clinical experience in an inpatient setting.

• Coding familiarity/experience in a hospital setting performing inpatient coding utilizing the AP DRG and the Medicare DRG systems preferred.

• Demonstrates adaptability and self-motivation by staying current on CMS rules and regulations

• Knowledge of federal, state and private payer regulations

DRG/Coding Denials Management Specialist

• Performs the RAC and DRG Validation reviews and queries• Compiles submits the appeals• Educates on findings/trends• Collaborates with Physician Advisor Team, CDI Team, Coding

Integrity Coordinator/Educator and Coding Leadership to provide feedback to coders and physicians on both coding and documentation opportunity.

• Works closely with denial team, including Utilization Management, Central Business Office, and Physician Advisor to help streamline and perfect the denial/appeal process

• Prevent loss of revenue by processing all denials in a thorough and complete manner

Quality Assurance for Coding

• This responsibility may be part of a CIC/E role or may be performed by a dedicated QA lead coder.

• Perform monthly data quality reviews on a random sample of cases

• The audit findings are distributed to each coder for review and education purposes.

• Trends are shared with the coding team

Contract Coding Opportunity

• Working as a coder for a contract company

• Excellent chance to broaden your horizons and experience coding in different facilities

• Working as a hospital coder, and acting as liaison with contract company/coders

Necessary Traits & Skills:

• Ability to work as part of a team• Interpersonal skills• Communication

• Time Management skills• Prioritization and delegation

• Policy & Procedure Writing (Technical Writing)• Strong Research Skills• Draw on expertise of team

• Know your supports and resources

• Self Motivator• Balance between professional and personal life

Educational Resources:

• Utilize department CDs, text books & on-line resources• Education sessions at work

• Inservices• Webinars

• Tuition Reimbursement• Take advantage of employer paid education• Do it part time rather than not doing it at all

Shadowing• Exposure to Coding• Typical charts• Walk through process• Review documentation

Conclusion• “Baby steps”- Part time classes • Shadow opportunities• Communicate with your supervisor/manager about your

goals• Cross-training

References:

•Rollings, Genna. "Professional Development: How to Get Started, How to Keep Growing." Journal of AHIMA 82, no.8 (Aug 2011): 18-22.

•AHIMA. "Tips for Breaking into the Health Information Management Industry." Journal of AHIMA 85, no.11 (November–December 2014): expanded web version.•https://www.aapc.com/training/prepare-for-exam.aspx

•http://www.hcpro.com/acdis/certification.cfm