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Hospital Coder

Published
Competency-Based Apprenticeship
Sponsoring Company:
National Center for Healthcare Apprenticeships (NCHA)
O*Net Code
29-2072.00
Rapids Code
2029CB
Req. Hours
0
State
NY
Created
Aug 30, 2021
Updated
Aug 30, 2021

Competency-Based Skills

14 skill sets | 24 total skills
Uses and maintains electronic application and work process to support clinical classification and coding
Ability to utilize health information management systems as related to coding
Gain encoding proficiency
Proficiency in using grouping software in order to accurately determine reimbursement rates
Applies diagnosis and procedure codes appropriately
Ability to utilize both coding books and 3M coders
Demonstrates skills needed to ensure accuracy of diagnostic/procedural groupings
Develop skills/systems to determine diagnostic/procedural accuracy of DRG’s, MSDRG’s and other groupings
Develop skills/systems to determine diagnostic/procedural accuracy to apply ICD 10 codes
Applies coding and is able to validate accuracy using clinical information found in health record
Applies current regulations and established guidelines while coding
Understand and apply regulations and guidelines as they apply to principal diagnosis
Understand and apply regulations and guidelines as they apply to principal procedures
Understand and apply sequencing and other coding guidelines
Uses and maintains applications and processes to support other clinical classifications
Resolves discrepancies between coded data and support documentation
Communicates appropriately with physicians and other care providers to ensure appropriate documentation
Develop specific communication techniques and skills to enhance communications with physicians and other care providers
Develop strong ability to work collaboratively with other coders, supervisors and other hospital personnel
Applies policies and procedures for the use of clinical data required in reimbursements and prospective payment systems (PPS)
Applies policies and procedures to comply with changing regulations among various payment systems
Apply policies and procedures to comply with Medicare
Apply policies and procedures to comply with Medicaid
Apply policies and procedures related to Medicaid managed care plans
Apply policies and procedures to comply with private insurers and State regulations
Able to support accurate billing through coding, charge master, claims management, and bill reconciliation processes
Demonstrates understanding and the ability to apply established guidelines such as the National Correct Coding Initiative to comply with reimbursement and reporting requirements
Demonstrates proficiency in performing quality reviews
Validate code assignment and compliance with reporting requirements
Ability to create patient data reports
Ability to ensure accuracy of diagnostic/procedural groupings such as DRG and APC

Technical Instruction

Medical Terminology - 50 req. hrs
Focus on medical terminology: students learn to articulate concepts of body systems, components within individual systems, and relationships between systems including the terminology of body systems relevant to disease, diagnostic and therapeutic tests, and procedures.
Computer Fundamentals and Applications - 50 req. hrs
An introduction to computers and their use in information processing. Use computer programs such as word processing, spreadsheets, and data base management, as well as Internet applications
Anatomy and Physiology/Human Biology - 50 req. hrs
The organization of the human body, the definition of the terminology used to describe the location and function of anatomical structures, the outline of the basic chemical concepts essential for understanding physiological processes.
Pathophysiology/Pharmacology - 50 req. hrs
Combination of the study of human disease processes and treatments. Discussion of etiology and pathogenesis of diseases along with the application of diagnostic procedures and patient care. Includes pathology and underlying principles of the human systems along with characteristics of typical drugs, side effects, cautions, and interactions.
Reimbursement/Revenue Cycle - 50 req. hrs
Payment systems, including those for inpatient and ambulatory care settings, as well as those for psychiatric, hospice, and home health services.
Legal and Ethical Issues and Compliance - 50 req. hrs
Legal principles and terminology, as well as health records as legal documents, administration of the law, legal aspects of healthcare facilities, medical staff organization, privacy, and security.
Introduction to Health Information Management - 50 req. hrs
Introduction to the health information management field and opportunities available for students after graduation. Presents an evolutionary view of health information systems. Professional ethics and exposure to current issues impacting the field are included.
Coding Classification/Clinical - 50 req. hrs
The historical development of classification systems for documenting diagnoses and procedures. Application of current and future coding systems as well as coding clinical guidelines for diseases and procedures. Both inpatient and outpatient systems will be reviewed. Compliance and ethics are stressed in each lesson.
Diagnosis Coding - 50 req. hrs
In-depth study of diagnosis coding using the International Classification of Diseases (ICD) classification system.
Procedure Coding - 50 req. hrs
An in-depth study of procedural coding using the International Classification of Diseases (ICD) classification system and the Current Procedural Terminology (CPT) system
Advanced Coding - 50 req. hrs
Intermediate and advanced study of International Classification of Diseases (ICD) classification systems, the Current Procedure Terminology (CPT) system, and HCPCS Level II classification systems. Students will demonstrate mastery of coding conventions, coding principles, and official inpatient and outpatient guidelines using case studies.

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