competency in skills and knowledge through assessment tests,
but are not required to complete a specific number of hours.
Professional Fee Coder
American Health Information Management Association (AHIMA)
Work Process Content
On the Job Training
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Use and maintain electronic applications and work processes to support clinical classification and coding (for example, encoding and grouping software)
1
- Demonstrates understanding 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)
1
- Audits indicate appropriate code and sequencing use following regulations and guidelines
Ensure accuracy of diagnostic/procedural APC (Ambulatory Payment Classification) system
1
- Audits indicate accuracy of APC assignment
Validate outpatient coding accuracy using clinical information found in the health record
1
- 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)
1
- Identifies correct coding nomenclature for patient type and location
Resolve discrepancies between coded data and supporting documentation. Communicates with providers to ensure appropriate documentation.
1
- 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.
1
- Adheres to national, regional and facility-specific requirements for accurate reimbursement by payer type
Support accurate billing through coding, chargemaster, claims management, and bill reconciliation processes
1
- 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
1
- 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
1
- Participates in coding audits
Participate in compliance (fraud and abuse), HIPAA (Health Insurance Portability and Accountability Act of 1996), and other organization specific training.
1
- Attends required compliance training
Related Instruction Content
Training Provider(s):
Program orientation
1
Orientation Teleconference: Introduction to the AHIMA Apprenticeship Program Orientation to Immersion Program Training Structure: • Program expectations • Program length, goals, deliverables Directions on how to navigate the technical components Contact Information for concerns etc.
VLab tutorial
1
Resources Training Teleconference: PowerPoint/Video/LMS Tutorial • VLab • AHIMA Academy
Pre-immersion assessment
4
Pre- immersion Coding Assessment for Professional Skills Training: CCS-P Exam Data Bank randomized questions (Not Timed) • Multiple Choice
Chapters 1, 2 and 3 in Procedure Coding & Reimbursement for Physician Services textbook. Complete online assessments.
20
Introduction to Coding Basics, E&M coding, anesthesia coding Chapter 1 - Online and self-directed – Introduction to Coding Basics • Describe the health record and standard health record formats • Identify organizations that direct health record format • Recognize basic elements of health record documentation • Understand the resources used to assign diagnostic and procedure codes • Understand CPT structure and coding conventions • Identify the sources of documentation that generate physician codes and charges • Identify codable diagnostic and procedural statements (in physician office documentation) • Understand the Ambulatory Coding Guidelines for ICD-10-CM Chapter 2 – Online and self-directed - Evaluation and Management Coding • Understand documentation guidelines • Define evaluation and management services • Understand terms commonly used in reporting E/M Services • Define the levels of E/M Services • Understand modifiers • Define the various E/M categories • Identify the HCPCS codes used in evaluation and management coding Chapter 3 - Online and self-directed – Anesthesia Coding • Describe the format and arrangement of codes in the anesthesia section • Explain the anesthesia package • Identify and apply the modifiers commonly used in reporting anesthesia services • Identify codes used in reporting qualifying circumstances • Perform the steps used in coding anesthesia services • Calculate fees for anesthesia services
Chapter 4 in Procedure Coding & Reimbursement for Physician Services textbook. Complete online assessment.
20
In-depth review of surgery coding with CPT by body system Chapter 4 – Online and self-directed – Surgery Coding • Identify coding used in the surgery section • Explain the use of modifiers used in surgery coding • Assign codes used in all surgery sections
Chapters 5, 6, and 7 in Procedure Coding & Reimbursement for Physician Services textbook. Complete online assessments.
20
Review of radiology, pathology, laboratory and medicine coding Chapter 5 – Online and self-directed – Radiology • Describe the Radiology surgery section format and arrangement • Identify and apply the modifiers used in Radiology coding Chapter 6 – Online and self-directed – Pathology and Laboratory • Describe the pathology and laboratory section structure and content • Understand the Clinical laboratory Improvement Amendments of 1988 (CLIA) • Interpret quantitative and qualitative studies • Understand the Guidelines Pertaining to Pathology and Laboratory subsections • Identify and apply the modifiers used in Pathology and Laboratory coding Chapter 7 – Online and self-directed – Medicine • Understand the Medicine section content and code structure for all specialties • Identify and assign the appropriate modifiers used in coding Medicine services • Identify and assign the appropriate HCPCS codes used in coding Medicine services
Chapters 8, 9 and 10 in Procedure Coding & Reimbursement for Physician Services textbook. Complete online assessments.
20
Review of HCPCS Level II coding, modifiers, and reimbursement process for outpatient coding Chapter 8 – Online and self-directed – HCPCS Level II Coding • Understand the HCPCS code assignment hierarchy and the steps in HCPCS code assignment • Understand the effect of HIPAA on HCPCS • Identify the Level II codes that are inappropriate for professional billing Chapter 9 – Online and self-directed – Modifiers • Understand the types of Modifiers • Identify and assign modifiers Chapter 10 – Online and self-directed – Reimbursement Process • Understand the reimbursement process and mechanisms • Describe Fee Schedule management • Identify sources of coding and reimbursement guidelines • Identify payer-specific guidelines • Understand how to submit claims and the claims process • Identify the data elements of a computerized internal Fee Schedule
Chapters 11 and 12 in Procedure Coding & Reimbursement for Physician Services textbook. Complete online assessments.
16
Review of coding and reimbursement reports and databases and evaluation of coding quality Chapter 11 – Online and self-directed – Coding and Reimbursement Reports and Databases • Perform data evaluation • Interpret computerized internal Fee Schedule Reports • Analyze Payer Remittance Reports Chapter 12 – Online and self-directed – Evaluation of Coding Quality • Understand the tools for evaluating coding quality • Perform internal audits
Review Exercises in Procedure Coding & Reimbursement for Physician Services textbook.
4
Office visit, operative reports, surgical case auditing and E&M auditing Clinical coding practice coding original redacted medical records (55 records): • 25 Outpatient clinic cases • 16 Emergency department cases • 14 Outpatient surgery cases
Hands on coding practice on redacted original medical records.
20
Outpatient clinic, outpatient surgery, emergency department, and observation cases. Clinical coding practice coding original redacted medical records (35) records in VLab/Solcom EDCO: • 4 ambulatory surgery cases • 26 emergency department cases • 5 outpatient cases
Common employability modules
10
Common employability skills to include: • Communication skills • Analysis and problem-solving • Behavioral characteristics • Business knowledge • Teamwork Common Employability Resources & Toolkit • Module 1: Analysis and Problem Solving – Provide instruction to help apprentices identify and assess business problems and develop effective solutions that meet the needs of their employers. • Module 2: Behavioral Characteristics – The curriculum will include modules on developing effective working relationships, whether onsite or online. The program will also focus on integrity in the work place and cover essential qualities such as ethics, trustworthiness, and personal organization. • Module 3: Business Knowledge – Module will include instruction in general business practices and environmental awareness. • Module 4: Leadership Communication – Provide instruction in perception, communication objectives, and communication formats. • Module 5: Teamwork – Focus on working with key stakeholders and their employer to meet shared objectives and facilitating desired outcomes.
Post-immersion assessment
4
Questions from CCS-P exam domains CCS-P Exam Database randomized questions (Timed) • Multiple choice
Meetings with Coding Trainers
4
Review activities, provide feedback and instruction