Charge Observation Report

His formal work training started at Windsor Country Drive Care Center in Fremont, CA, where he held several positions from June 2009 until September 2013. He worked as a full-time Charge Nurse from June 2009 until September 2012. His duties as Charge Nurse include: administer

HIM Personnel play an important role in the Medicare system. Medicare has transitioned from “fee for service” to providing incentive payments for providers that issue high quality care at affordable prices. In order to achieve the “pay-for-quality” incentives hospitals and health care officials must improve their documentation processes. “If it isn’t documented, it wasn’t done” is more important than ever. It is the responsibility of the HIM professional to ensure the integrity of the patient chart. HIM professionals monitor the quality of documentation and ensure all clinical documentation is complete and accurate. HIM professionals are the key to identifying process problems while keeping in mind patient safety, quality of care, and revenue integrity. Medicare requires that hospitals report quality improvement measures in order to receive payments; HIM professionals can directly impact Medicare incentive payments. HIM professionals are directly involved with the Medicare Audit Improvement Act. The HIM professional collects health data that is subject to the audits; HIM professionals are the point of contact for responding to Medicare audit requests.

Advocate Illinois Masonic is a 408 bed Level I trauma center teaching hospital. Although the hospital isn’t attached to a university, it plays host to 200 residents and 500 students. The HIM department rests on the first floor and basement. The department has close to 40 employees. At this particular facility the morgue is under HIM department, which is a new trend. The HIM department has ROI, Outpatient Coding, Vital Stats, Medical transcription and unbilled accounts, Risk Management, Subpoena Clerk, Deficiency Analyst, Registry coder, Document Imaging and HIM Clerk. These are the different areas of the HIM department at Advocate Illinois Masonic Medical Center.

-The charge description master, or chargemaster, is an extensive list of items that's to be billed to a patient, payer or healthcare provider. Since the coders translate patient data to be input in the hospital or a facility's system, the billing staff would have to gather their information from the coders to be put into the care of the chargemaster so it can be translated into a list that will be provided for those who are providing the payment for the patient. So in all, the CDM staff, billing staff and coders are all interconnected for they need the data provided by one another to get their duties

Recently, I had the opportunity to train and work alongside the dedicated professionals at IQH. During my time there, I had the pleasure meeting IQH’s Chief Financial Officer (CIO), David Dale. Dale has an impressive resume that reflects his extensive experience. Trained as a computer engineer, he gravitated towards the healthcare industry. Healthcare offered Dale stability and security while he gained experience in information technology. Eventually, his talent and dedication to his profession caught the attention of the upper echelon of Merit Health’s Central Hospital. Promoted to the Director of Information Services, Dale began to

13). The clinical services department within the hospital is responsible for the accurate charting of any procedure or service that was provided to the patient. This process begins with patient registration and verification. The healthcare provider then will perform their job as necessary and will indicate what billable tasks were performed which can later be processed. The patient accounts department is responsible for going through the patient’s chart and recording the patient’s bill by use of the hospital’s chargemaster to send the bill to the payer by the health information department. In this department the initial coding of the patient’s medical record is done. Once overviewed for the sake of accuracy, the final coding is done and sent to the payer. Any inaccuracies by any of these departments could directly impact the hospitals reimbursement process through a slowing for the process or simply by failing to bill for a procedure performed, ultimately hurting the hospital’s financial stability. The patient financial services (PFS) department is responsible for ensuring compliance within the billing and coding policies through training and with quality assurance checks and regular audits. This ensures that the revenue and reimbursement cycle continues without any inaccuracies in patient charges. It is especially important to have quality management within this department, as it has the potential to affect the entire organization, reflective of the institutes financial situation. Poor PFS management can lead to a loss in revenue and can lead to a loss in budget if the hospital is losing too much as a result. Ensuring compliance with medical coding and billing guidelines and policies ensures a more accurate representation of the hospitals financial and budgetary situations, while

2. Bring the Styrofoam cup close to another person's hair. What do you observe? What conclusions can you make regarding charged Styrofoam?

Advocate Illinois Masonic is a 408 bed Level I trauma center teaching hospital. Although the hospital isn’t attached to a university, it plays host to 200 residents and 500 students. The HIM department rests on the first floor and basement. The department has close to 40 employees. At this particular facility the morgue is under HIM department, which is a new trend. The HIM department has ROI, Outpatient Coding, Vital Stats, Medical transcription and unbilled accounts, Risk Management, Subpoena Clerk, Deficiency Analyst, Registry coder, Document Imaging and HIM Clerk. These are the different areas of the HIM department at Advocate Illinois Masonic Medical Center.

The majority of the time the use of HIM coders are involved in billing and reimbursements. However, coding specialists are important players within the healthcare industry.(Davis, 2014,2007,2002) They certify that providers maintain accuracy with coding procedures and government rules. (Davis, 2014,2007,2002) HIM functions and complex of regulatory requirements where coding can be very challenging. (AHIMA, 2016) The coders follow guidelines of the American Health Information Management Association AHIMA) Code of Ethics. (AHIMA, 2016) On the patient level, it is vitally important for the coder to code accurately because this information will trail the patient success throughout their course of treatment and beyond.

Having an Associate in HIT and a bachelor’s degree in Business Administration helped me gain a management position in HIM. Management oversees health information systems to ensure that they meet medical, legal and ethical standards. As a management professional (HIM), we are the experts on patient data that doctors, nurses and other healthcare providers rely on to perform their jobs. I may my education and experience to manage databases and generate and analyze reports along the side of the HIT coders.

Data then flows into two functions: (1) the medical documentation, which becomes the basis for clinical decision making and goes into the medical record; and (2) the charge capture or entry, where the manual “charge slips” or automated direct order entry are priced in accordance with the price list referred to as Charge Master, also called Charge Description Master (CDM). Thereafter, data from both Medical Record and Charge master flow right into the billing system. Then, claims preparation follows by filling up of either of the two types of forms: (1) UB-04, which is used by hospitals for inpatient and outpatient service claims, or (2) CMS-1500, which is used by Physicians for professional claims. These forms are then carefully reviewed in the claims editing process to ensure there is enough information to warrant payment by the payer, and logical standards are complete and well documented. (Claims Editing is not conducted by all health care facilities, but is a critical effort to secure accurate and timely payment by payers). Finally, the claims are submitted to the payers.

In order to insure each staff member was obtaining their individual and team goals, each member was given their own business (Souza). The tools in which the PFS were given provided them with the tools to prioritize and automate account work lists, sort accounts in various ways and see at a glance their ranking with their work group and office-wide. Managers were given their own dashboard and tools which able them to use query all aspects of receivables for trending purposes and identify problem areas, drill down to the patient account level, monitor revenue, payments, adjustments, receivables, and days for periods from the previous day and week to the previous 18 months, calculate average daily revenue by day and 30-day period, assess their performance for the month to date, and estimate likely results at the month end, view all receivables or select any segment for quick analysis, and generate timely reports on demand, including aging analysis, A/R stratification, discharged not final billed (DNFB) analysis, credit balance analysis, and analysis of problem payers. Finally, a denials management component was implemented in late summer, which will allow registration staff to go online at the end of the year (Souza).

I have been employed as a Clinical Systems Analyst at Harbor UCLA since Late January 2009. Since my start I have been involved in addressing the needs of the Hospital Radiology Department. I was mainly tasked with identifying issues related to patient care and how IT systems support and address those issues. Many times it was the lack of properly implementing current systems and having qualified personnel available to address issues as they arrived.

There are 17 people responsible for health information services at Banner Home Care. The HIMS is Carrie Jacobs who is responsible for the entire HIM department within the facility. There are two Billing Review Associates, Lorrie Choate and LaVonda Shivers, who operate under the Home Health Billing Audit division of HIMS and handle all the billing and auditing for all the Banner Home Care facilities in the Phoenix, Arizona area as well as in Payson, Arizona, and Alaska. Under the Hospice division of HIMS are two Senior HIMS Clerks, Amanda Dietrich and Teresa Rua-Smith, who handle all the tasks related to the Banner Hospice Home Health medical records. Next is the Home Medical Equipment division which is currently only filled by one employee, Nicole Duncan, a Senior HIMS Clerk. If additional support is needed in this area it is filled with a Temp position. There is also only one person who handles the Home Health Face-to-Face medical records, Zeljka Branbley, who is also a Senior HIMS Clerk. There are 10 Senior HIMS

Kevin Hwang is a sophomore at the George Washington University, majoring in accounting, and working with ORA this semester. His interests are financial reporting and disclosure, market reseach, and government policy regulation. He is currently learning SAS programming and Bloomberg terminal to perform data analytics in assisting Trevor Tatum with upcoming projects. At the George Washington University, Kevin is a member of the Varsity soccer team, undergraduate consulting group, and a member of commercial real estate network group. He is extremely excited to intern at the DERA and looks forward to meeting everyone in the office.