HIM (Health Information Management) Hospital Coder

AHIMA Foundation

National (OA)

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)

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

Apply diagnosis and procedure codes according to current nomenclature

Apply diagnosis and procedure codes according to current nomenclature

Ensure accuracy of Diagnostic/procedural groupings such as DRG (Diagnosis Related Group), MSDRG (Medicare Severity), APC (Ambulatory Payment Classification), etc.

Ensure accuracy of Diagnostic/procedural groupings such as DRG (Diagnosis Related Group), MSDRG (Medicare Severity), APC (Ambulatory Payment Classification), etc.

Validate coding accuracy using clinical information found in the health record

Validate coding accuracy using clinical information found in the health record

Adhere to current regulations and established guidelines in code assignment (focus on assignment of principle diagnosis, principle procedure, and sequencing as well as other clinical coding guidelines)

Adhere to current regulations and established guidelines in code assignment (focus on assignment of principle diagnosis, principle procedure, and sequencing as well as other clinical coding guidelines)

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

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

Resolve discrepancies between coded data and supporting documentation

Resolve discrepancies between coded data and supporting documentation

Communicate with physicians and other care providers to ensure appropriate documentation

Communicate with physicians and other care providers to ensure appropriate documentation

Apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in healthcare delivery

Apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in healthcare delivery

Apply policies and procedures to comply with changing regulations among various payment systems for healthcare services such as Medicare, Medicaid, managed care, etc.

Apply policies and procedures to comply with changing regulations among various payment systems for healthcare services such as Medicare, Medicaid, managed care, etc.

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

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

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

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

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

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

Ensure accuracy of diagnostic/procedural groupings such as DRG and APC

Ensure accuracy of diagnostic/procedural groupings such as DRG and APC

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

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

Related Instruction Outline

HIM (Health Information Management) Hospital Coder

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