Med_Coder_PD_6_Mar17.pdf

MEDICAL CODER I

SUMMARY: Medical Coder I coders are responsible for verifying and coding of the diagnosis, evaluation and management, surgeries, procedures or any other codes required for the completeness and accuracy of the medical record. Medical Coder I coders verify the component parts of medical record to ensure completeness and accuracy of diagnosis, operations, and special therapeutic procedures that must conform to industry standards and MHS Coding Guidelines. Medical Coder I coders code the primary diagnosis, co-morbidities, complications, therapeutic and diagnostic procedures, supplies, materials, injections, and drugs with the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) – all levels, and any other coding classification systems required by the DoD. Medical Coder I coders input codes into applicable MHS coding systems.

Medical Coder I coders primarily review medical documentation and assign codes for Outpatient encounters. Medical I coders may be directed by the AFMS MCPO to provide remote coding support to other AFMS MTFs via MHS computer systems.

QUALIFICATIONS:

1.1. Mandatory Knowledge and Skills.

1.1.1. Knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM);

Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology

(CPT).

1.1.2. Knowledge of reimbursement systems, including Prospective Payment System (PPS);

Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale

(RBRVS).

1.1.3. Practical knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes.

1.1.4. Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures;

ancillary services (includes, but is not limited to, Laboratory, Occupational Therapy, Physical Therapy, and Radiology).

1.1.5. Solve practical problems by choosing appropriately from a variety of mathematical and statistical techniques.

1.1.6. Make well-informed, effective, and timely decisions, even when data are limited or solutions produce unpleasant consequences; perceives the impact and implications of decisions.

1.1.7. Receive, attend to, interpret, and respond to verbal messages and other cues such as body language in ways that are appropriate to listeners and situations.

1.1.8. Utilize medical computer software programs to abstract, analyze, and/or evaluate clinical documentation and enter/edit diagnosis and procedure codes.

1.1.9. Clearly express information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information.

1.1.10. Display courtesy, empathy, and tact, developing and maintaining effective relationships with others; effectively work with individuals who are difficult, hostile, or distressed to resolve differences; and be able to relate well to people from varied backgrounds and in different situations.

1.1.11. Work with internal and external customers to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations.

1.1.12. Contribute to maintaining the integrity of the organization; display high standards of ethical conduct and understand the impact of violating these standards on an organization, self, and others.

1.1.13. Be open to change and new information; adapt behavior or work methods in response to new information, changing conditions, or unexpected obstacles; effectively deals with uncertainty.

1.1.14. A high level of effort and commitment towards performing the work, using efficient learning techniques to acquire and apply new knowledge and skills; uses training, feedback, or other opportunities for self-learning and development.

1.1.15. Understand and interpret written material, including technical material, rules, regulations, instructions, reports, charts, graphs, or tables; applies what is learned from written material to specific situations.

1.1.16. Attention to detail and completeness with a thorough understanding of government rules and regulations, medical coding and reimbursement guidelines, and potential areas of risk for fraud.

1.2. Education/Certification:

1.2.1. Education: A minimum of one of the following:

1.2.1.1. An associate’s degree in Health Information Management;

1.2.1.2. A university certificate in medical coding;

1.2.1.3. At least 30 semester hours’ university/college credit that includes relevant coursework such as anatomy/physiology, medical terminology, health information management, and/or pharmacology.

Education in section must be from an accredited educational institution recognized by the American Health Information Management Association (AHIMA) and/or American Academy of Professional Coders (AAPC).

1.2.2. Coding Certifications: The following are recognized professional certifications: Registered

Health Information Technician (RHIT); Registered Health Information Administrator (RHIA);

Certified Professional Coder (CPC); Certified Outpatient Coder (COC); Certified Coding Specialist (CCS); or Certified Coding Specialist – Physician (CCS-P). Medical Coder I coders are required to possess one of the above professional services coding certifications.

1.2.3. Continuing Education Requirements: Medical coders shall maintain the required continuing education hours in order to maintain current and proper national certification(s) requirements for this position at no expense to the Government, unless approved for training paid by the Government, in which case the coder will be required to sign a Memorandum of Agreement (MOA) approved by contractor management and the AFMS MCPO. The MOA must stipulate that the coder agrees to continue employment with the contractor for a specified term after successful completion of the training. If the coder fails to successfully complete the training, or leaves the contractor’s employment before the end of the specified term, the contractor will reimburse the Government for the cost of the training.

1.3. Experience: A minimum of 4 years of medical coding and experience in 2 or more medical or surgical specialties within the past 8 years, OR 3 years’ outpatient coding experience within the last 6 years in a military coding environment. A minimum of one (1) year of performance in the specialty is required to be qualifying. Multiple specialties encompass different medical specialties (i.e. Family Practice, Pediatrics, Gastroenterology, OB/GYN, etc.) that utilize ICD, E&M, CPT, and HCPCS codes. Ancillary specialties (PT/OT, Radiology, Lab, Nutrition, etc.) that usually do NOT use E&M codes do not count as qualifying experience. Additionally, coding, auditing and training exclusively for specialties such as home health, skilled nursing facilities, and rehabilitation care will not be considered as qualifying experience. Coding experience limited to making codes conform to specific payer requirements for the business office (insurance billing, accounts receivable) is not a qualifying factor.

1.4. Coding Test. Pass a pre-employment coding test that is provided by the AFMS MCPO, or developed by contractor management and approved by the AFMS MCPO, administered by contractor management IAW AFMS MCPO instructions, with a score of 80% or higher.

1.5. Developmental and Full Performance Classifications. A candidate for a Coder I position is considered to meet full performance classification if they meet all requirements in sections 1.1 through 1.4 of this PD.

1.5.1. A candidate that does not meet all requirements in section 1.1 through 1.4 of this PD may be accepted in a developmental classification by the AFMS MCPO under the following conditions:

Scored at least 70% on the pre-employment coding test; AND one of the following:

1.5.1.1. Possess the required experience listed in 1.3 of this PD AND proof of a professional services coding certification in good standing as an apprentice from AAPC or AHIMA (example: CPC- A); an IDP will be required to ensure that all additional training and experience required to advance from apprentice to full certification is completed within the timeframe prescribed;

1.5.1.2. Possess the required experience listed in 1.3 of this PD AND show proof of enrollment in good standing in a university program with progress towards completing one of the educational requirements in 1.1 of this PD; OR successful completion of a course for medical technicians, hospital corpsmen, medical service specialists, or hospital training, obtained in a training program given by the Armed Forces or the U.S. Maritime Service under close medical and professional supervision, may be substituted on a month-for-month basis.

1.5.1.3. An Individual Development Plan (IDP) will be required to document requirements and progress towards full performance.

1.5.2. The Medical Coder I will be classified at the full performance level once the IDP has been completed and approved by the Contracting Officer and AFMS MCPO.

1.6. Work Environment/Physical Requirements. The work is primarily sedentary. Requirements may include prolonged walking, standing, sitting, or bending. Carrying or lifting of medical records or documentation may be required daily. Use of one or more computer programs and monitors simultaneously is typical and frequent. May be directed by the AFMS MCPO to provide remote coding support via MHS computer systems to other AFMS MTFs in contingency situations.

2. Unique Military Health Care Systems/Procedures:

2.1. Composite Health Care Systems (CHCS)

2.2. Armed Forces Health Longitudinal Technology Application (AHLTA). An electronic medical record documentation system designed for the MHS

2.3. Defense Enrollment Eligibility Reporting System (DEERS);

2.4. Military Filing System - by sponsor social security number, terminal digit order, color-coded and blocked filing system;

2.5. Contents of a military medical record, layout, sections, family member prefix designation, forms used in a MTF, and the medical record tracking procedures;

2.6. EssentrisTM, the client-server version of the Clinical Information System (CIS);

2.7. MHS GENESIS

2.8. Coding Compliance Editor (CCE) Systems;

2.9. Biometric Data Quality Assurance Service (BDQAS) - https://bdqas.afms.mil/;

2.10. AFMS Internal Coding Audit Methodology - AFMOA Audit Tool/ Coding Audit Review System (CARS) or current audit tool;

2.11. MHS Coding Guidelines http://www.tricare.mil/ocfo/bea/ubu/coding_guidelines.cfm

3. PERFORMANCE OUTCOMES:

3.1. Accurately assigns diagnosis, procedure, and supply codes for the professional components of Outpatient encounters. Codes assigned include International Classification of Diseases, Clinical Modification (ICD-CM), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and modifiers. Applies knowledge of medical terminology, anatomy and physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection. Adheres to accepted coding practices, guidelines and conventions when choosing the most appropriate diagnosis, operation, procedure, ancillary, or Evaluation and Management code to ensure ethical, accurate, and complete coding. Monitors ever-changing regulatory and policy requirements affecting coded information for the full spectrum of services provided.

3.2. Reviews encounter and/or record documentation to identify inconsistencies or discrepancies that may cause inaccurate coding, medico-legal re-percussions or impacts quality patient care. Identifies any problems with legibility, abbreviations, etc., and brings to the provider’s attention. Examines records for proper sequence of documents, presence of authorized signatures, and sufficient data is documented that supports diagnosis, treatment administered, and results obtained. Develops and submits a written (electronic or hard copy) query IAW AFMS guidelines to the provider to request clarification of provider documentation that is conflicting, ambiguous, or incomplete in regards to any significant reportable condition or procedure. Works with providers to resolve documentation issues to support coding compliance. Assigns accurate codes to encounters based upon provider responses to queries and reports queries and responses IAW AFMS guidance.

3.3. Acts as a source of reference to medical staff having questions, issues, or concerns related to coding.

Responds to provider questions and provides examples of appropriate coding and documentation reference(s) to provide clarity and understanding. Based on contacts from the medical staff identifies training opportunities and works with coding training personnel to focus on consistency and clarity of coding advice provided. May assist medical training specialist with providing initial coding training to providers by providing guidance to professional and technical staff in documentation requirements for coding.

3.4. Supports AFMS coding compliance by performing due diligence in ethically and appropriately researching and/or interpreting existing guidance, including seeking clarification from the supervisor, coding trainers, or Service coding representatives. May perform focused audits of specific MTFs, medical specialties, clinics, coders, or providers as directed and IAW AFMS audit procedures.

Performs administrative related tasks associated with medical records final reviews/audits and contacting various departments, services, or medical staff to obtain data needed to complete the records. Maintains a delinquency report of missing records in order to facilitate completion of work within the required Air Force thresholds. Maintains confidentiality and privacy of medical, personal, and sensitive information in compliance with the Health Insurance Portability and Accountability Act.

Complies with AFMS coding compliance requirements regarding training and reporting of potential violations.

4. Work Schedule: 0800 – 1700 Monday – Friday Federal Holidays are not considered work days.

Additionally: The following dates are designated as PACAF Family Days for CY17:

Family Day - Associated Holiday 30 Dec 16 - New Year’s Day 13 Jan 17 - Martin Luther King, Jr. Day 17 Feb 17 - Washington’s Birthday 26 May 17 - Memorial Day 3 Jul 17 - Independence Day 1 Sep 17 - Labor Day 10 Oct 17 - Columbus Day 24 Nov 17 - Thanksgiving Day 22 Dec 17 - Christmas Day