Health Information Management Professional Fee Coder

Competency-Based Apprenticeship
Sponsoring Company:
American Health Information Management Association (AHIMA)
O*Net Code
29-2072.00
Rapids Code
2063CB
Req. Hours
0
State
DC
Created
Apr 04, 2021
Updated
Apr 04, 2021

Competency-Based Skills

11 skill sets | 11 total skills
Use and maintain electronic applications and work processes to support clinical classification and coding (for example, encoding and grouping software)
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)
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 facility-specific requirements for accurate reimbursement 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

Technical Instruction

Introduction to Coding Basics
Describe the health record and standard health record formats
# | 20 hrs
Identify organizations that direct health record format
# | 20 hrs
Recognize basic elements of health record documentation
# | 20 hrs
Understand the resources used to assign diagnostic and procedure codes
# | 20 hrs
Understand CPT structure and coding conventions
# | 20 hrs
Identify the sources of documentation that generate physician codes and charges
# | 20 hrs
Identify codable diagnostic and procedural statements (in physician office documentation)
# | 20 hrs
Understand the Ambulatory Coding Guidelines for ICD-10-CM
# | 20 hrs
Evaluation and Management Coding
Understand documentation guidelines
# | 20 hrs
Define evaluation and management services
# | 20 hrs
Understand terms commonly used in reporting E/M Services
# | 20 hrs
Define the levels of E/M Services
# | 20 hrs
Understand modifiers
# | 20 hrs
Define the various E/M categories
# | 20 hrs
Identify the HCPCS codes used in evaluation and management coding
# | 20 hrs
Anesthesia Coding
Describe the format and arrangement of codes in the anesthesia section
# | 20 hrs
Explain the anesthesia package
# | 20 hrs
Identify and apply the modifiers commonly used in reporting anesthesia services
# | 20 hrs
Identify codes used in reporting qualifying circumstances
# | 20 hrs
Perform the steps used in coding anesthesia services
# | 20 hrs
Calculate fees for anesthesia services
# | 20 hrs
Surgery Coding
Identify coding used in the surgery section
# | 20 hrs
Explain the use of modifiers used in surgery coding
# | 20 hrs
Assign codes used in all surgery sections
# | 20 hrs
Radiology
Describe the Radiology surgery section format and arrangement
# | 20 hrs
Identify and apply the modifiers used in Radiology coding
# | 20 hrs
Pathology and Laboratory
Describe the pathology and laboratory section structure and content
# | 20 hrs
Understand the Clinical laboratory Improvement Amendments of 1988 (CLIA)
# | 20 hrs
Interpret quantitative and qualitative studies
# | 20 hrs
Understand the Guidelines Pertaining to Pathology and Laboratory subsections
# | 20 hrs
Identify and apply the modifiers used in Pathology and Laboratory coding
# | 20 hrs
Medicine Coding
Understand the Medicine section content and code structure for all specialties
# | 20 hrs
Identify and assign the appropriate modifiers used in coding Medicine services
# | 20 hrs
Identify and assign the appropriate HCPCS codes used in coding Medicine services
# | 20 hrs
HCPCS Level II Coding
Understand the HCPCS code assignment hierarchy and the steps in HCPCS code assignment
# | 20 hrs
Understand the effect of HIPAA on HCPCS
# | 20 hrs
Identify the Level II codes that are inappropriate for professional billing
# | 20 hrs
Modifiers
Understand the types of Modifiers
# | 20 hrs
Identify and assign modifiers
# | 20 hrs
Reimbursement Process
Understand the reimbursement process and mechanisms
# | 20 hrs
Describe Fee Schedule management
# | 20 hrs
Identify sources of coding and reimbursement guidelines
# | 20 hrs
Identify payer-specific guidelines
# | 20 hrs
Understand how to submit claims and the claims process
# | 20 hrs
Identify the data elements of a computerized internal Fee Schedule
# | 20 hrs
Coding and Reimbursement Reports and Databases
Perform data evaluation
# | 16 hrs
Interpret computerized internal Fee Schedule Reports
# | 16 hrs
Analyze Payer Remittance Reports
# | 16 hrs