Health Information Management Privacy and Security Officer

AHIMA Foundation

Documents

Individual state requirements may vary. Please contact your local apprenticeship office to ensure this version is suitable to your state’s requirements.

Work Process Schedule

Work Process Content

On the Job Training

Anonymous

Skills

Use and maintain electronic applications and work processes to support clinical classification and coding (for example, encoding and grouping software)

Demonstrates understandin g in use and application of encoder and grouper software

Apply outpatient diagnosis and procedure codes according to current nomenclature and demonstrate adherence to current regulations and established guidelines in code assignment (focus on assignment of first listed diagnosis, and sequencing as well as other clinical coding guidelines)

Audits indicate appropriate code and sequencing use following regulations and guidelines

Ensure accuracy of diagnostic/procedural APC (Ambulatory Payment Classification) system

Audits indicate accuracy of APC assignment

Validate outpatient coding accuracy using clinical information found in the health record

Audits indicate accuracy of diagnostic and procedural coding

Use and maintain applications and processes to support other clinical classification and nomenclature as appropriate to the work setting (e.g., DSM V (Diagnostic and Statistical Manual of Mental Disorders), SNOMED-CT (Systematized Nomenclature of Medicine – Clinical Terms)

Identifies correct coding nomenclature for patient type and location

Resolve discrepancies between coded data and supporting documentation. Communicates with providers to ensure appropriate documentation.

Creates compliant physician queries

Apply policies and procedures for the use of clinical data required in reimbursement and outpatient prospective payment systems (OPPS) in healthcare delivery as well as changing regulations among various payment systems for healthcare services such as Medicare, Medicaid, managed care, etc.

Adheres to national, regional and facilityspecific requirements for accurate reimburseme nt by payer type

Support accurate billing through coding, chargemaster, claims management, and bill reconciliation processes

Reviews codes identified manually and by the chargemaster to ensure compliant billing

Use established guidelines to comply with reimbursement and outpatient reporting requirements such as the National Correct Coding Initiative and others

Follows coding edits for compliance with NCCI

Compile patient data and perform data quality reviews to validate code assignment and compliance with reporting requirements such as outpatient prospective payment systems

Participates in coding audits

Participate in compliance (fraud and abuse), HIPAA (Health Insurance Portability and Accountability Act of 1996), and other organization specific training.

Attends required compliance training

Related Instruction Outline

Related Instruction Content

Training Provider(s):

Online

Online and self-directed

Online assessment

Online self-directed

Teleconference

VLab Online

140

RI hours

Program orientation

Program overview

VLab tutorial

VLab training

Pre-immersion assessment

Questions from CCS-P exam domains

Chapters 1, 2 and 3 in Procedure Coding & Reimbursement for Physician Services textbook. Complete online assessments.

Introduction to Coding Basics, E&M coding, anesthesia coding

Chapter 4 in Procedure Coding & Reimbursement for Physician Services textbook. Complete online assessment

In-depth review of surgery coding with CPT by body system

Chapters 5, 6, and 7 in Procedure Coding & Reimbursement for Physician Services textbook. Complete online assessments.

Review of radiology, pathology, laboratory and medicine coding

Chapters 8, 9 and 10 in Procedure Coding & Reimbursement for Physician Services textbook. Complete online assessments.

Review of HCPCS Level II coding, modifiers, and reimbursement process for outpatient coding

Chapters 11 and 12 in Procedure Coding & Reimbursement for Physician Services textbook. Complete online assessments.

Review of coding and reimbursement reports and databases and evaluation of coding quality

Review Exercises in Procedure Coding & Reimbursement for Physician Services textbook.

Office visit, operative reports, surgical case auditing and E&M auditing

Hands on coding practice on redacted original medical records.

Outpatient clinic, outpatient surgery, emergency department, and observation cases.

Common employability modules

Common employability skills to include: Communication skills, Analysis and problemsolving, Behavioral characteristics, Business knowledge, Teamwork

Post-immersion assessment

Questions from CCS-P exam domains

Meetings with Coding Trainers

Review activities, provide feedback and instruction

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