9 ADVANCE FOR HEALTH INFORMATION PROFESSIONALS / CODING Clinicians can use documentation data to show impact on patient outcomes and make a case for participation in quality based payment models and accountable care contracts. ever, requirements have also led to the implementation of rigid, time-intensive workflows that direct providers to capture required information during patient encounters.3 Pharmacists are not considered healthcare providers under the Social Security Act and, therefore, not impacted by Meaningful Use. Although there is extensive evidence showing pharmacist care improves patient outcomes, these clinicians are unable to directly participate in provider-focused quality incentive programs.4 Pharmacists provide a variety of services, including medication reconciliation, disease state management, medication monitoring and patient education. Clinical documentation by pharmacists is inconsistent and varies by practice, but is widely adopted within Medication Therapy Management (MTM) programs. MTM is a Medicare Part D sponsored program that allows pharmacists to obtain reimbursement for clinical services. The CMS Innovation Center recently announced an Enhanced MTM Model beginning January 2017 and granting selected participants regulatory flexibilities and financial incentives for meeting certain requirements, including the submission of detailed clinical documentation using SNOMED CT.5 The data will undoubtedly be used to study patient care activities and understand factors that improve outcomes and reduce spending. In some areas of healthcare, such as in the skilled nursing facility (SNF), consultant pharmacists are required by federal regulation to provide Medication Management Review (MMR) on a monthly basis and upon a change in condition. “New CMS requirements of participation for SNFs emphasize the need for medication review by a consultant pharmacist at transitions of care and the IMPACT Act of 2014 will require standardized data reporting for medication reconciliation across all sites of care,” noted Arnold E. Clayman, PD, FASCP, vice president of Pharmacy Practice and Government Affairs at the American Society of Consultant Pharmacists. With more frequent transitions into and out of facilities, consultant pharmacists need to communicate clinical documentation in a standardized manner. JANUARY 2017 Coding Educator/DRG Validator Health Information Management Dept. Full Time, Days • Trenton, NJ Capital Health is the region’s leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Comprising two hospitals (our Regional Medical Center in Trenton and Capital Health Medical Center – Hopewell), our Hamilton outpatient facility, and various primary and specialty care practices across the region, Capital Health is a dynamic healthcare resource accredited by The Joint Commission. Responsibilities: • Educates coders in ICD-10, CPT and HCPCs Level II coding guidelines, modifier guidelines, proper diagnosis and procedure code selection, documentation guidelines and abstracting for reimbursement, insurance and statistical reports. • Acts as liaison in a supporting role to physicians to assist in their documentation efforts. • Creates training materials to guide physicians in their education process for more accurate documentation, and participates in informal and formal medical staff education. • Acts as the primary department expert on APCs and DRGs. • Conducts regular audits, reviews medical records, and assists with external and internal reviews for coding accuracy. • Reviews claim denials and rejections pertaining to coding and medical necessity issues. • Provides management with various statistical reports, data and audits information on health information management compliance issues, internal and external quality assurance results and activities, performance improvement activities and other statistical information. Requirements: • High school diploma or GED. • Associate’s degree in Health Information Technology preferred. • Five years of coding experience in a healthcare setting. • CCS coding certification required. • Experience with encoder computer system. • Acquired expertise in DRG and APC assignment and the application of the requirements needed to comply with federal and local regulations. • Strong knowledge of medical terminology and anatomy/physiology, and understanding of disease management. We offer: • Competitive salaries • Tuition reimbursement • Low employee expense for medical and dental insurance • 403(b) Savings and Retirement Program Easy commute from PA and major NJ routes. Find out why our 3000+ employees have chosen Capital Health. For more information and to apply online, please visit www.capital.attnhr.com/jobs/124136/ Equal Opportunity Employer. RELATED CONTENT Moving Forward with ICD-10 Looking back, the coding conversion has played out significantly better than even the optimists imagined.
Advance for Health Information Professionals • January 2017
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