S02 D.12 HANDBOOK_5005_APP_G35_CHANGE_128_5_MAR_2020.pdf

VA HANDBOOK 5005/128

Transmittal Sheet March 5, 2020

STAFFING

1. REASON FOR ISSUE: To revise the Department of Veterans Affairs (VA) qualification standard for Medical Records Technician (Cancer Registrar), GS-0675, under the authority of 38 U.S.C. § 7401(3) and 38 U.S.C. § 7405(a)(1)(B).

2. SUMMARY OF CONTENTS/MAJOR CHANGES: This handbook contains mandatory procedures on staffing. This policy establishes qualification standards for the Medical Records Technician (Cancer Registrar) occupation. This standard is effective on the date of publication. Significant changes include removing the qualification requirements for the Medical Records Technician (Coder), Medical Records Technician (Release of Information), and Medical Records Technician (Health Information Technician) sub-specialty assignments in Appendix G35. The qualification requirements for these sub-specialties can be found in the newly established qualification standard in Appendix G57, G58, and G59, respectively. These changes will be incorporated into the electronic version of VA Handbook 5005 that is maintained on the Office of the Chief Human Capital Officer Website.

3. RESPONSIBLE OFFICE: Recruitment and Placement Policy Service (059), Office of the Chief Human Capital Officer.

4. RELATED DIRECTIVE: VA Directive 5005, Staffing.

5. RESCISSION: VA Handbook 5005/79, Part II, Appendix 35 dated September 5, 2014.

CERTIFIED BY:

/s/ Melissa S. Glynn, Ph.D.

Assistant Secretary for Enterprise Integration

DISTRIBUTION: Electronic only

BY DIRECTION OF THE SECREARY OF

VETERANS AFFAIRS:

/s/ Daniel R. Sitterly Assistant Secretary for Human Resources and Administration/ Operations, Security, and Preparedness

Attachment D.12 36C25522Q0114

Department of Veterans Affairs Washington, DC 20420 https://vaww.va.gov/OHRM/HRLibrary/Dir-Policy.htm https://vaww.va.gov/OHRM/HRLibrary/Dir-Policy.htm

VA Handbook 5005/128 March 5, 2020

II-viii

CONTENTS-CONTINUED

PARAGRAPH PAGE

APPENDICES-Continued

II-G35 MEDICAL RECORD[S] TECHNICIAN [(CANCER REGISTRAR)]………………..II-G35-1

II-G36 DENTAL ASSISTANT………………………………………………………………….II-G36-1

II-G37 DENTAL HYGIENIST…………………………………………………………………..II-G37-1

II-G38 BIOMEDICAL ENGINEER.................................................................................... II-G38-1 II-G39 SOCIAL WORKER ............................................................................................... II-G39-1

II-G40 DEVELOPMENT OF QUALIFICATION STANDARDS FOR

VETERANS HEALTH ADMINISTRATION (VHA) POSITIONS

FILLED UNDER 38 U.S.C. § 7401(1) ................................................................. II-G40-1 II-G41 BLIND REHABILITATION SPECIALIST ............................................................... II-G41-1 II-G42 BLIND REHABILITATION OUTPATIENT SPECIALIST ....................................... II-G42-1 II-G43 LICENSED PROFESSIONAL MENTAL HEALTH COUNSELOR ........................ II-G43-1 II-G44 MARRIAGE AND FAMILY THERAPIST ............................................................... II-G44-1 II-G45 MEDICAL SUPPORT ASSISTANT ...................................................................... II-G45-1 II-G46 NURSING ASSISTANT ....................................................................................... II-G46-1 II-G47 MEDICAL SUPPLY TECHNICIAN (STERILE PROCESSING) ............................ II-G47-1 II-G48 THERAPEUTIC MEDICAL PHYSICIST ............................................................... II-G48-1 II-G49 BIOMEDICAL EQUIPMENT SUPPORT SPECIALIST ......................................... II-G49-1 II-G50 HEALTH TECHNICIAN (TELEHEALTH CLINICAL) ............................................. II-G50-1 II-G51 GENETIC COUNSELOR ...................................................................................... II-G51-1 II-G52 HEALTH TECHNICIAN (OPHTHALMOLOGY) .................................................... II-G52-1 II-G53 ACUPUNCTURIST ............................................................................................... II-G53-1 II-G54 RADIOLOGIST ASSISTANT [ ] ............................................................................ II-G54-1 II-G55 HISTOPATHOLOGY TECHNICIAN ..................................................................... II-G55-1 II-G56 [HEALTH TECHNICIAN (MASSAGE THERAPY) ................................................ II-G56-1 II-G57 MEDICAL RECORDS TECHNICIAN (CODER) .................................................. II-G57-1 II-G58 MEDICAL RECORDS TECHNICIAN (RELEASE OF INFORMATION) ............... II-G58-1

II-G59 MEDICAL RECORDS TECHNICIAN (HEALTH INFORMATION TECHNICIAN) . II-G59-1

II-G60 RECREATION AND CREATIVE ARTS THERAPIST ........................................... II-G60-1 II-G61 CYTOTECHNOLOGIST ....................................................................................... II-G61-1

II-H. APPOINTMENT PROCEDURES BY OCCUPATION/ASSIGNMENT

II-H1. PROCEDURES FOR APPOINTING PHYSICIANS TO SERVICE CHIEF

AND COMPARABLE POSITIONS ...................................................................... II-H1-1

March 5, 2020 VA Handbook 5005/128

PART II

APPENDIX G35

II-G35-1

APPENDIX G35. MEDICAL RECORD[S] TECHNICIAN [(CANCER REGISTRAR)]

QUALIFICATION STANDARD

GS-0675

Veterans Health Administration

1. COVERAGE. The following are the requirements for appointment as a Medical Record

Technician (MRT) [(Cancer Registrar)] in the Veterans Health Administration (VHA). [ ] [Cancer registrars maintain clinical registries and work to meet the standards of regulatory and accrediting agencies that approve cancer programs and/or other programs requiring registries.] Coverage under this standard and the assignment of individuals to this occupation is restricted to the specific position [ ] identified above. [All qualification requirements for other Medical Records Technician parenthetical titles are in the respective newly established qualification standard] in this handbook 5005 part II.

[2. DEFINITIONS.]

a. Creditable Experience. Knowledge of current [m]edical [r]ecord [t]echnology. To be creditable, the candidate’s experience must have demonstrated the use of knowledge, skills, and abilities associated with current [ ] cancer registry practice and may be paid or non-paid employment.

b. Quality of Experience. Experience is only creditable if it is either directly related to the position to be filled or in a related field. Qualifying experience must also be equivalent to the next lower grade level. Experience satisfying this requirement must be active practice, which is paid/non-paid employment as a MRT [(Cancer Registrar)].

c. Part-Time Experience. Part-time experience as a professional MRT is creditable according to its relationship to the full-time workweek. For example, a MRT would receive one week of full-time credit for each two weeks of half-time work.

[3.] BASIC REQUIREMENTS.

a. Citizenship. Be a citizen of the United States. Non-citizens may be appointed when it is not possible to recruit qualified citizens in accordance with [38 U.S.C. § 7407(a).]

b. Experience and Education

(1) Experience. One year of experience that indicates knowledge of medical terminology and general understanding of the health record. Six months of the required one year of experience must have provided the knowledge, skills, and abilities (KSAs) needed to perform MRT work.

OR

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(2) Education. Two years above high school with a minimum of 12 semester hours directly related to MRT work (e.g., courses in medical terminology, anatomy and physiology, and introduction to health records).

OR

(3) Experience/Education Combination. Equivalent combinations of experience and education are qualifying. The following educational/training substitutions are appropriate for combining education and experience:

(a) Six months of experience that indicates knowledge of medical terminology and general understanding of the health record and one year above high school with a minimum of six semester hours of health information technology courses.

(b) 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. Training may be substituted on a month-for-month basis for up to six months of experience, provided the training program included courses in anatomy, physiology, and medical record techniques and procedures.

The position requires six additional months of experience that indicates knowledge of medical terminology and general understanding of the health record.

c. Grandfathering Provision. All persons employed in VHA as a [MRT (Cancer

Registrar)] on the effective date of this qualification standard are considered to have met all qualification requirements for the title, series and grade held, including positive education that is part of the basic requirements of the occupation. For employees who do not meet all the basic requirements in this standard, but who met the qualifications applicable to the position at the time they were appointed to it, the following provisions apply:

(1) Such employees may be reassigned, promoted up to and including the full performance (journeyman) level, or changed to lower grade within the occupation, but may not be promoted beyond the journeyman level or placed in supervisory or managerial positions.

(2) MRTs [(Cancer Registrar)] who are appointed on a temporary basis prior to the effective date of the qualification standard may not have their temporary appointment extended or be reappointed on a temporary or permanent basis, until they fully meet the basic requirements of the standard.

(3) MRTs [(Cancer Registrar)] initially grandfathered into this occupation, who subsequently obtain additional education that meets all the basic requirements of this qualification standard must maintain the required credentials as a condition of employment in the occupation.

II-G35-3

(4) Employees who are retained as a MRT [(Cancer Registrar)] under this provision and subsequently leave the occupation, lose protected status and must meet the full VA qualification standard requirements in effect at the time of reentry as a MRT [(Cancer Registrar)].

d. Physical Requirements. See VA Directive and Handbook 5019, Employee

Occupational Health Service.

e. English Language Proficiency. MRT (Cancer Registrar) candidates must be proficient in spoken and written English to be appointed as authorized by 38 U.S.C. § 7403(f)..

[4.] GRADE REQUIREMENTS. [All individuals assigned to this occupation must have an approved title as described below:]

[a.] MRT (Cancer Registrar) [ ]

[b.] MRT (Cancer Registrar) Coordinator; or

[c.] MRT (Cancer Registrar) VISN Coordinator

[d. Lead MRT (Cancer Registrar)]

[5.] GRADE DETERMINATIONS.

a. [ ] MRT (Cancer Registrar), [GS-4]

(1) Experience or Education. None beyond basic requirements.

(2) Assignment. [MRT (Cancer Registrar)] at this level serve in entry level [ ] positions and receive close supervision from more experienced [MRT (Cancer Registrar)] staff members.

b. [ ] MRT (Cancer Registrar), [GS-5]

(1) Experience. One year of experience equivalent to the next lower grade level or successful completion of four years of education above high school from an accredited college or university with a minimum of 24 semester hours in health information technology.

(2) Demonstrated [Knowledge, Skills, and Abilities]. In addition to the experience above, the candidate must demonstrate [all of] the following KSAs:

II-G35-4

(a) Ability to utilize health information technology and various office software products utilized in MRT (Cancer Registrar) positions (e.g., the electronic health record, coding and abstracting software, release of information systems, etc.)[.]

(b) Knowledge of the Joint Commission requirements, [Centers for Medicare &

Medicaid Services], Commission on Cancer [ ], and American College of Surgeons (ACoS) guidance and/or health record documentation guidelines[.]

(c) Ability to manage priorities and coordinate work [ ] to complete duties within required timeframes and ability to follow-up on pending issues.

(3) Assignment. [MRTs (Cancer Registrar)] at this grade level serve in developmental positions [ ] and receive guidance from more experienced MRT (Cancer Registrar) staff members for more complex issues and/or procedures.

c. [ ] MRT (Cancer Registrar), [GS-6]

(1) Experience. One year of experience equivalent to the next lower level.

(a) Knowledge of medical terminology to understand the content of the medical record [.]

(b) Knowledge of anatomy and physiology to understand the location of the cancer[.]

(c) Ability to operate computerized programs [ ] to review documentation within the electronic medical record[.]

(d) Ability to notify appropriate parties and organize all required documentation to ensure complete case presentation at tumor boards.

(3) Assignment. [MRT (Cancer Registrar)] at this grade level searches the medical record to identify and abstract/code information. The abstract is conducted by collecting, summarizing, [ ] coding detailed demographic and clinical information, and assisting with organizing and maintaining the cancer registry data system.

Assists with lifetime follow-up on patients, including cancer status and vital status.

Coordinates and participates on tumor boards to ensure that appropriate documentation is maintained.

d. [ ] MRT (Cancer Registrar), [GS-7]

(1) Experience. One year of experience equivalent to the next lower grade level.

II-G35-5

(a) Knowledge of pathophysiology [ ] to understand the spread of the cancer disease process[.]

(b) Ability to analyze the electronic health record and enter appropriate data into the

OncoTrax cancer registry software abstract[.]

(c) Knowledge of ACoS standards regarding tumor boards, including clinical staging, prognostic indicators, clinical guidelines, and clinical trials availability.

(3) Assignment. [MRTs (Cancer Registrar)] at this grade level serve in developmental cancer registrar positions by thoroughly searching the medical record to identify and abstract/code all information. Organizes and maintains the cancer registry data system. Reviews lifetime follow-up on patients including cancer status and vital status. Coordinates and attends multidisciplinary tumor boards to ensure that appropriate documentation is maintained. Abstracts by collecting, summarizing and coding detailed demographic, and clinical information.

e. [ ] MRT (Cancer Registrar), [GS-8]

(a) Knowledge of professional registry operations[.]

(b) Knowledge of medical terminology, staging of cancer, and requirements of internal and external approving organizations[.]

(c) Knowledge of the cancer committee processes and procedures [ ] to improve patient care and verify compliance with ACoS and/or facility standards[.]

(d) Ability to serve as a subject matter expert on cancer programs for the medical center[.]

(e) Skill in utilizing electronic health records and cancer registry software.

(3) Assignment. This is [ ] the full performance level for this assignment. [MRTs

(Cancer Registrar)] at this level perform all tasks and duties autonomously.

Searches the medical record to identify and abstract/code all information. Organizes and maintains the cancer registry data system. Reviews lifetime follow-up on patients including cancer status and vital status. Oversees tumor board documentation, ensuring documentation meets the requirements and standards set

II-G35-6

forth by ACoS and/or facility standards. Ascertains a random sampling of annual analytic case load for physician review to ensure quality registry data.

f. [ ] Lead MRT (Cancer Registrar), [GS-9]

(a) Ability to organize work, set priorities, and delegate tasks/responsibilities [ ] to meet deadlines[.]

(b) Knowledge of neoplastic disease processes, cancer staging systems, biologic and molecular prognostic indicators to determine derived stage[.]

(c) Knowledge of reportable diseases, surveillance, epidemiology and end results [ ] program, cancer staging systems, multiple primary and histology rules, international classification of diseases for oncology, [ ] morphology and topography, cancer treatment modalities, and data requirements[.]

(d) Ability to analyze data using comparative statistical methods and present the data in graph [ ] format[.]

(e) Ability to interpret and apply facility bylaws regarding the cancer program[.]

(f) Knowledge of legal and regulatory requirements governing cancer registry operations to plan, organize, and maintain special cancer registries[.]

(g) Ability to communicate orally and in writing to ensure staff compliance with written directives, rules, and regulations.

(3) Assignment. For all assignments above the full performance level, the higher-level duties must consist of significant scope, complexity (difficulty), and range of variety, and be performed by the incumbent at least 25% of the time. Lead [MRTs (Cancer Registrar)] are responsible for developing, organizing, implementing and maintaining an accurate system to identify all reportable diagnoses, assuring that all eligible cases are identified and coded into the registry system. Utilizes the electronic health record to identify and abstract/code the required data elements. Conducts lifetime follow-up on patients, documenting the progression/recurrence of their disease and other required elements. Distributes workload and maintains productivity while assuring accuracy and completeness of registry data. Analyzes and submits data to the internal and external entities as required. Prepares routine statistical reports.

g. [ ] MRT (Cancer Registrar) Coordinator, GS-9]

II-G35-7

(a) Knowledge and understanding of ACoS and/or facility requirements for administering, monitoring, and reporting compliance of the cancer program to the governing bodies[.]

(b) Ability to interpret data [ ] to set, evaluate, and adjust the cancer program and/or facility goals and objectives[.]

(c) Ability to inform cancer registry staff on the technical components of the cancer database, coordinate workflow and monitor data for accuracy and quality measures[.]

(d) Ability to multitask[.]

(f) Ability to communicate with diverse disciplines regarding the facility requirements of the cancer program[.]

(g) Ability to analyze and interpret data for use in facility strategic planning[.]

(h) Ability to develop cancer program/cancer registry policies and procedures to ensure patient-centered care for cancer patients in accordance with government-wide, agency, and facility requirements.

duties must consist of significant scope, complexity (difficulty), [ ] range of variety, and be performed by the incumbent at least 25% of the time. [MRTs (Cancer Registrar)] function as the coordinator of all activities associated with the cancer registry and cancer program. Provides technical direction to program clerks and technicians who assist with the cancer registry. Performs analysis of work processes to identify reasonable and efficient measurement of the quality of the work and identify areas of possible improvement. Prepares routine and special statistical reports, narratives and graphic representations requiring use of registry data. Conducts special studies and surveys for identifying opportunities to improve patient care. [MRT (Cancer Registrar)] are subject matter experts on ACoS and/or facility standards pertaining to setting and monitoring goals, presenting statistical and written reports to identify resource needs and process improvement opportunities, and participating in strategic planning. Serves as a liaison between the cancer committee and internal and external entities. Serves as a core member on cancer committees to ensure that the discussions are consultative, address patient management issues, and contain applicable staging schema. [MRT (Cancer Registrar)] are subject matter experts on registry and cancer program issues.

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h. [ ] MRT (Cancer Registrar) VISN Coordinator, [GS-9]

(a) Knowledge and application of program data sources, professional association standards, and other data resources[.]

(b) Ability to organize, coordinate and prioritize simultaneous work assignments, both individual and team related[.]

(c) Knowledge of data extraction, data and statistical analysis techniques, operations and research techniques, and methods of problem analysis [ ] to make appropriate recommendations[.]

(d) Ability to identify and recommend changes in procedures or programs that lead to accreditation and/or a minimum set of standards for cancer care[.]

(e) Knowledge of pertinent laws, regulations, policies and precedents relating to the use of cancer registry information[.]

(f) Ability to communicate both verbally and in writing with administrative and management personnel, line supervisors, and top-management [ ] to optimally disseminate information, resolve queries, and handle administrative functions[.]

(g) Ability to develop and implement training mechanisms for registry staff within the

VISN.

duties must consist of significant scope, complexity (difficulty), and range of variety, and be performed by the incumbent at least 25% of the time. [MRTs (Cancer Registrar)] function as VISN registry coordinator mentoring and training new and experienced tumor registrars within the VISN utilizing electronic cancer registry data collection systems. Performs quality assurance on registry data and may initiate studies to assess completeness, appropriateness and consistency in data collection.

Encourages team building by means of teleconferencing and face-to-face meetings within the VISN to assure continuity of care, training, education, and support.

Develops training mechanisms utilizing resources available via the web and other sources. Serves as VISN registry experts to VISN management and staff for all programs requiring access to registry data. [MRT (Cancer Registrar)] are responsible for supporting programs with backlog abstraction and/or follow-up.

Provides support in the development of cancer registrar programs including establishing a set of minimum standards for cancer care throughout the VISN.

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[6.] DEVIATIONS.

a. The appointing official may, under unusual circumstances, approve reasonable deviations to the grade determination requirements for MRTs [(Cancer Registrar)] in VHA whose composite record of accomplishments, performance, and qualifications, as well as current assignments, warrants such action based on demonstrated competence to meet the requirements of the proposed grade.

b. The placement of individuals in grade levels or assignments not described in this standard must be approved by the Under Secretary for Health, or designee, in VHA Central Office.

Authority: 38 U.S.C. §§ 7401(3), 7402, 7403, 7405, 7407(a)]