W hat I Think I Know (and really do)

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

EmCaresharon.randolph@emcare.com