1. PROFESSIONAL SUCCESS IN HEALTH INFORMATION MANAGEMENT- CODING FOCUS MARCH 26, 2015 Julieanne Arcuri, MS BS RHIT CCS HIM Coding Manager AHIMA approved ICD -10-CM/PCS Trainer Rochester Regional Health System

2. Introduction Graduated from MCC with RHIT in 1993 The Genesee Hospital- Inpatient Coding 1993-2000 Part time RIT for BS in HSA URMC Medical Center- Inpatient Coding 2000-2008 Part time URMC SON for MS Leadership in Healthcare Systems RGHS Corporate Compliance 5 years 2008-2013 Current Coding Manager in HIM 2013- current

3. Vast Arena for Coding Professionals Acute care hospitals Outpatient provider offices Ambulatory surgery sites SNFs Research institutions Government agencies Third party payers Vendors

4. Industry Certifications Include: RHIT: Registered Health Information Technician RHIA: Registered Health Information Administrator CCS: Certified Coding Specialist CCS-P: Certified Coding Specialist- Physician based CPC: Certified Professional Coder CIC: Certified Inpatient Coder CPC-P: Certified Professional Coder- Payer COC: Certified Outpatient Coder (formerly Certified Professional Coder- Hospital (CPC-H)) CIRCC: Certified Interventional Radiology Cardiovascular Coding CCDS: Certified Clinical Documentation Specialist ICD-10 Approved Trainer certification

5. HIM Coding Team Coding Integrity Coordinator/Educator Inpatient Ambulatory Surgery ED/Observation/Ancillary Coding Teams: Inpatient ASC OBS ED Ancillary

6. Coding Integrity Coordinator/Educator- PB or HB Key Responsibilities include: Conducts on-going audits of IP and/or OP coded data Provides on-going coder training and education Assists with organizational training for ICD-10 Serves as subject matter expert on documentation, coding and regulatory compliance Compiles information and/or prepares reports and analysis of data integrity findings with appropriate recommendations. Works collaboratively with HIM leaders (Coding Manager, CDI Manager and HIM Director) to develop education strategies to promote complete and accurate clinical documentation. Reports negative trends with clinical documentation to HIM leaders. Acts as HIM liaison with external coding auditors

7. Clinical Documentation Improvement Specialist Required Licensure/Certification Skills: Certified Clinical Documentation Specialist (CCDS) certification RHIA/RHIT CCS RN license for nursing-prepared candidates

8. Clinical Documentation Improvement Specialist- continued Minimum Qualifications: RHIA/RHIT with a minimum of five years inpatient coding experience -OR- AAS in Nursing required, BS in Nursing preferred: with a minimum of five years acute care nursing experience. Advanced clinical expertise and knowledge of complex disease processes with a broad clinical experience in an inpatient setting. Coding familiarity/experience in a hospital setting performing inpatient coding utilizing the AP DRG and the Medicare DRG systems preferred. Demonstrates adaptability and self-motivation by staying current on CMS rules and regulations Knowledge of federal, state and private payer regulations

9. DRG/Coding Denials Management Specialist Performs the RAC and DRG Validation reviews and queries Compiles submits the appeals Educates on findings/trends Collaborates with Physician Advisor Team, CDI Team, Coding Integrity Coordinator/Educator and Coding Leadership to provide feedback to coders and physicians on both coding and documentation opportunity. Works closely with denial team, including Utilization Management, Central Business Office, and Physician Advisor to help streamline and perfect the denial/appeal process Prevent loss of revenue by processing all denials in a thorough and complete manner

10. Quality Assurance for Coding This responsibility may be part of a CIC/E role or may be performed by a dedicated QA lead coder. Perform monthly data quality reviews on a random sample of cases The audit findings are distributed to each coder for review and education purposes. Trends are shared with the coding team

11. Contract Coding Opportunity Working as a coder for a contract company Excellent chance to broaden your horizons and experience coding in different facilities Working as a hospital coder, and acting as liaison with contract company/coders

12. Necessary Traits & Skills: Ability to work as part of a team Interpersonal skills Communication Time Management skills Prioritization and delegation Policy & Procedure Writing (Technical Writing) Strong Research Skills Draw on expertise of team Know your supports and resources Self Motivator Balance between professional and personal life

13. Educational Resources: Utilize department CDs, text books & on-line resources Education sessions at work Inservices Webinars Tuition Reimbursement Take advantage of employer paid education Do it part time rather than not doing it at all

14. Shadowing Exposure to Coding Typical charts Walk through process Review documentation

15. Conclusion “Baby steps”- Part time classes Shadow opportunities Communicate with your supervisor/manager about your goals Cross-training

16. References: Rollings, Genna. "Professional Development: How to Get Started, How to Keep Growing." Journal of AHIMA 82, no.8 (Aug 2011): 18-22. AHIMA. "Tips for Breaking into the Health Information Management Industry." Journal of AHIMA 85, no.11 (November–December 2014): expanded web version. https://www.aapc.com/training/prepare-for-exam.aspx http://www.hcpro.com/acdis/certification.cfm