Unit 4 Common Question Activity2024

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____________________________________________________________________ HIM 4520 - Directed Practice Professional Practice Experience Unit 4 ~ Clinical Coding Common Question Exercise Purpose of this assignment : Identify possible job opportunities related to this unit’s content and explore the management, technologies, operations and processes of clinical coding. Assignment Instructions: Answer each of the questions below using this worksheet and submit the assignment as an attachment via the proper Brightspace link. ** Please utilize the resources provided to you (readings, articles, virtual presentations, videos, etc.) and conduct additional research on your own to answer each question thoroughly. ** Cite all sources in APA format on an APA-formatted reference page. Hospital Revenue Cycle Note: Memorize this revenue cycle. It can differ at each organization, but generally it will follow this type of pattern. We will learn about each step in this course 1. Research jobs related to Coding processes and functions. What are common job titles for those that work with Coding and the processes and functions associated with Admissions Clinical Documenta tion Case Manageme nt HIM Doc. Manageme nt HIM Coding/ Abstracting Business Office Finance Department

Coding? Enter those job titles at the top of each column in the table below. Then address the questions in column #1 for each of the job titles you identified. Job Title #1: Strategy and Operations Analyst, Medical Coding Job Title #2: Florida Blue - PrePay Medical Coder, COC, CPC - Remote Job Title #3: Medical Coding Specialist I What are the education/knowledge requirements for each of these jobs? MBA degree Current AAPC or AHIMA certification(s) and medical coding/auditing outpatient experience in a professional setting 4+ years experience Familiarity with ICD–9 & 10, DRG, CPT/HCPCS coding, and reimbursement and pricing methodologies. HS diploma or equivalent one year of experience coding professional services What are the required skills for each of these jobs? • Prior healthcare experience working with medical coding guidelines • Coding compliance • computer skills • Knowledge and computer skills • Oral and written communication skills • Strong analytics experience Consulting experience Ability to read and interpret medical records Clinical experience • Speech skills, and manual dexterity to operate keyboards, mouse, and phones. • prolonged sitting For each job title addressed above, identify and list the job functions performed by each? • this role is cross-functional and works across product, sales, finance, operations, and engineering. • review and audit medical records and physician documentation for diagnosis and procedure code accuracy • Track and summarize coding billing rules for the product team • code for a broad array of outpatient specialties • ensure claims are paid according to the provider and member contracts as well as ensure that standard claims processing guidelines and billing procedures for each type of service and type of provider are followed • independently perform analysis of high-risk and/or high-dollar claims on a pre- payment basis utilizing coding and claims processing background to ensure claims are neither over nor underpaid. • Works with appropriate medical staff and other coders when performing coding functions. • Performs standard coding, charge entry, and registration. • Works with billing partners in developing efficient coding processes by reviewing incoming denials. • Maintains a working knowledge of common coding and documentation requirements within the medical offices. • Responds to customer concerns through coding reviews requested by other

departments. For each, also address how the functions of the job would impact Coding and the Functions & Processes associated with Coding for each job title. A Strategy and Operations Analyst, Medical Coding job works directly in the coding, and functions processes that are associated with coding. The Medical Coder, COC, CPC, works directly with processing and coding billing claims using coding skills and functions As a Medical Coding Specialist work strictly in coding and with billing to ensure standard coding, charge entry, and registration. How does each of these functions impact the work and/or the needs of others in the organization (i.e. billing, nursing, lab, etc.)? Explain the impact and what it is. The hospital revenue cycle relies on this job position to ensure proper billing and other aspects are properly coded so that everyone gets paid and all documents are accurate. The hospital revenue cycle relies on this job position to ensure proper billing and other aspects are properly coded so that everyone gets paid and all documents are accurate. They also ensure claims are neither over nor underpaid. The hospital revenue cycle relies on this job position to ensure proper billing and other aspects are properly coded so that everyone gets paid and all documents are accurate. They also work with appropriate medical staff How are each of these functions impacted by the work and/or the needs of others in the organization (i.e. Billing, nursing, lab, etc.)? Explain the impact and what it is. Because they review and audit medical records and physician documentation, the other departments must be documented correctly. This job position works closely with other departments and this keeps the cycle going. Works with billing partners in developing efficient coding processes by reviewing incoming denials. They work closely with other departments. https://g.co/kgs/q2r5Z3Q https://g.co/kgs/wNFwNRs https://g.co/kgs/WyuuSni 2. What is an encoder system? What is a computer-assisted coding (CAC) system? How do the two systems differ? • An encoder system is a tool or software that assists medical coders in assigning the appropriate codes to diagnoses, procedures, and services. and it helps coders navigate through coding guidelines, documentation, and rules to ensure the code is accurate. • Computer-assisted coding (CAC ) is a tool intended to improve the efficiency of the coding and claims submission process and is also an emerging technology used in the coding process. • The difference is an encoder system helps human coders by giving references and suggestions while a CAC system is a more advanced tool that automates the coding processes using technologies to improve efficiency and accuracy in medical coding 3. How will CAC impact the work of the coder? How will CAC impact the work of the coding manager?

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Work of a Coder: • Increase in efficiency because the CAC system can automate the process. • Better accuracy because the CAC system can help improve coding accuracy by reducing the likelihood of human errors. • The employees may first need time to adjust and get used to the new system. Work of a Manager: • Coding managers can use CAC to enhance quality assurance processes because the system contributes to consistent coding practices and adherence to guidelines. • The managers may be able to monitor the effectiveness and efficiency of the quality assurance through the system. • The managers may have to spend time training their employees to ensure they understand and can use the CAC system correctly. 4. A coding manager for a 120-bed hospital wants to develop productivity standards for the coders working in her department. What are three things she should consider as she sets out to determine an appropriate productivity standard for the coders? Consider the information from this article . • It is the coding manager's responsibility to ensure that productivity requirements balance the speed and accuracy of coding. Although speed is needed for efficiency, coding accuracy shouldn't be sacrificed for speed. • The coding manager should consider the nature of the cases in the hospital's service mix. If the hospital handles many complex medical or surgical cases, coding accurately and completely may take longer than national productivity averages suggest. • Look at the facility's payer mix because different payers might have different criteria and payment schedules. They could set distinct productivity standards but make sure that precision isn't compromised for speed. 5. How can a coding manager ensure the accuracy and quality of coded records? Please explain the processes that could be implemented to ensure accuracy and quality. • Regular Audits • Continuous training and education • Understanding of coding procedures and policies • Using Computer Assisted Coding (CAC) systems • Being informed on coding and coding guideline updates • Manager checking in with employees often 6. What is a chargemaster? How does a hospital utilize a chargemaster to bill for its services? • The charge description master (CDM) is an electronic file that represents a master list of all services, supplies, devices, and medications charged for inpatient or outpatient services. The CDM contains the basic elements for identifying, coding, and billing items and services provided to patients, and it is the mechanism for representing captured charges on the billing claim.

• Each billable service or supply is set up in the CDM and assigned an internal charge code number, which links it to the various data elements necessary for billing and tracking charge activity within the organization. The CDM contains the following general data elements: • Charge code— a unique identifier to identify and represent each billable service or supply. The number is meaningful only to the organization and does not appear on the billing claim. References Oachs, P. and Watters, A. (2020). 6th Edition. Health Information Management: Concepts, Principles and Practices. Chicago. AHIMA Sturgeon, J. (2010, August 2). Tips for Setting Productivity Standards. For The Record, 22(14), 6.