Appendix A NATIONAL CENTER FOR HEALTHCARE APPRENTICESHIPS STANDARDS OF APPRENTICESHIP. Developed by

Transcription

1 Appendix A NATIONAL CENTER FOR HEALTHCARE APPRENTICESHIPS STANDARDS OF APPRENTICESHIP Developed by SEIU/AFSCME National Center for Healthcare Apprenticeships National Joint Apprenticeship Training Committee (NJATC) WORK PROCESS SCHEDULE AND RELATED INSTRUCTION OUTLINE A - 1

2 Appendix A WORK PROCESS SCHEDULE OCCUPATION TITLE Hospital Coder O*NET-SOC CODE: RAPIDS CODE: 2029CB This schedule is attached to and a part of these Standards for the above identified occupation. 1. TYPE OF OCCUPATION Time-based Competency-based Hybrid 2. TERM OF APPRENTICESHIP The term of apprenticeship is based on the apprentice s demonstration of mastery of all competencies as specified in these Standards, supplemented by the required hours of related instruction. 3. RATIO OF APPRENTICES TO JOURNEYWORKERS The apprentice to journeyworker ratio is: 4 apprentices to 1 journeyworker/mentor. 4. APPRENTICE WAGE SCHEDULE Apprentices shall be paid a progressively increasing schedule of wages based on either a percentage or a dollar amount of the current hourly journeyworker wage rate. These rates will be determined by the local CBAs or by the NJATC subcommittee for the region. 5. WORK PROCESS SCHEDULE (see below) The sponsor, through its local NJATC subcommittee may modify the work processes to meet local needs including for the purpose of addressing local labor market concerns and/or the desire to co-register with a local registration agency. 6. RELATED INSTRUCTION OUTLINE Related Instruction These courses can be completed before apprentices are hired as apprentices or can be completed during the apprenticeship period. It is recognized that the content outlined below may be delivered through different courses provided by different educational institutions. A - 2

3 Course Medical Terminology Computer Fundamentals and Applications Anatomy and Physiology/Human Biology Pathophysiology/Pharmacology Reimbursement/Revenue Cycle Legal and Ethical Issues and Compliance Content 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. 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 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. 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. Payment systems, including those for inpatient and ambulatory care settings, as well as those for psychiatric, hospice, and home health services. 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 A - 3

4 Introduction to Health Information Management Coding Classification/Clinical Diagnosis Coding security. 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. 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. In depth study of diagnosis coding using the International Classification of Diseases (ICD) classification system. Procedure Coding Advanced Coding Coding Capstone An in depth study of procedural coding using the International Classification of Diseases (ICD) classification system and the Current Procedural Terminology (CPT) system 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. Students use the skills they have learned in diagnostic and procedural coding and apply it to experiential A - 4

5 Total Hours learning through virtual and/or fieldbased coding practice (to be demonstrated through project work) hours A - 5

6 WORK PROCESS SCHEDULE OCCUPATION TITLE Hospital Coder O*NET-SOC CODE: RAPIDS CODE: 2029CB Competency will be verified by Mentors/Journeypersons according to a scale from 1 to 5 with 5 being the highest level of competency. Advancement within the Apprenticeship program will require a score of 4 or 5. However, the local NJATC committee may in some cases mandate a score of 5 in some or all of the competencies listed. In addition, other forms of assessment may be used as agreed to by the local NJATC subcommittee that could include demonstrations, observations, portfolios, etc. A. Use and Maintain Electronic application and work process to support clinical classification and coding 1. Ability to utilize health information management systems as related to coding; 2. Gain encoding proficiency; 3. Proficiency in using grouping software in order to accurately determine reimbursement rates. B. Apply diagnosis and procedure codes according to current nomenclature 1. Ability to utilize both coding books and 3M coders C. Develop skills needed to ensure accuracy of diagnostic/procedural groupings 1. Develop skills/systems to determine diagnostic/procedural accuracy of DRG s, MSDRG s and other groupings 2. Develop skills/systems to determine diagnostic/procedural accuracy to apply ICD 10 codes D. Apply and validate coding accuracy using clinical information found in the health record E. Apply current regulations and established guidelines while coding 1. Understand and apply regulations and guidelines as they apply to principal diagnosis 2. Understand and apply regulations and guidelines as they apply to principal procedures 3. Understand and apply sequencing and other coding guidelines F. Use and maintain applications and processes to support other clinical classifications A - 6

7 G. Resolve discrepancies between coded data and support documentation H. Communicate with physicians and other care providers to ensure appropriate documentation 1. Develop specific communication techniques and skills to enhance communications with physicians and other care providers 2. Develop strong ability to work collaboratively with other coders, supervisors and other hospital personnel I. Apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) J. Apply policies and procedures to comply with changing regulations among various payment systems 1. Apply policies and procedures to comply with Medicare 2. Apply policies and procedures to comply with Medicaid 3. Apply policies and procedures related to Medicaid managed care plans 4. Apply policies and procedures to comply with private insurers and State regulations K. Support accurate billing through coding, charge master, claims management, and bill reconciliation processes L. Understand and apply established guidelines such as the National Correct Coding Initiative to comply with reimbursement and reporting requirements M. Gain proficiency in performing quality reviews 1. Validate code assignment and compliance with reporting requirements 2. Ability to create patient data reports N. Ensure accuracy of diagnostic/procedural groupings such as DRG and APC O. Participate in department compliance (fraud and abuse) training 1. Participate in HIPAA training 2. Participate in other employer specific training A - 7

8 Competency will be verified by Mentors/Journeypersons according to a rubric of competencies scaled from 1 to 5 with 5 being the highest level of competency. Advancement within the Apprenticeship program will require a score of 4 or 5. However, the local NJATC committee may in some cases mandate a score of 5 in some or all of the competencies listed. Other forms of assessment including portfolios and scenario based assessments, demonstrations, and observations may also be used as approved by the local NJATC subcommittees. See below for the core rubric. Basic Competency Uses and maintains electronic application and work process to support clinical classification and coding Applies diagnosis and procedure codes appropriately Demonstrates skills needed to ensure accuracy of diagnostic/procedural groupings Applies coding and is able to validate accuracy using clinical information found in health record Applies current regulations and established guidelines while coding Uses and maintains applications and Does not demonstrate competency Can perform competency with direct assistance from mentor Demonstrates competency at an entry level Demonstrates competency Demonstrates competencies at an exceptional level Comments/Recommendation s for improvement, next steps, or completion A - 8

9 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 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 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 A - 9

10 with reimbursement and reporting requirements Demonstrates proficiency in performing quality reviews Ability to ensure accuracy of diagnostic/procedural groupings such as DRG and APC Participates in and benefits from department compliance (including fraud and abuse) training A - 10