CC-HIM-0102 - Charge Capture, Coding, and Other HIM Operations

Course Description

This course will cover the set of functions that are needed for accurate claims submission and optimization of revenue received.  Topics covered are charge capture, verification of clinical documentation and charge capture accuracy, ensuring patient and health insurance information is correct, and checking that appropriate diagnosis/procedure codes and modifiers are present.  Students will explore how these skills and tasks ultimately result in correct claim submission. A focus will be on quality and accuracy of these tasks to prevent claims denials.  Students will also connect these functions to the complete revenue cycle and health information management operations. This training requires completion of part 1 Front End training or be ideal for those that already have front end experience.

Learner Outcomes

• Demonstrate an understanding of the law and ethics related to working in the healthcare field with an emphasis placed on HIPAA and ethical billing practices
• Describe the roles of key billing staff such as billing manager, medical coder, charge entry, charge entry, claim submission clerk, payment poster, and accounts receivable clerk
• Distinguish between outpatient and inpatient reimbursement methodologies
• Identify how clinical documentation translates to coded data used for reimbursement purposes
• Explain the importance of accurate assignment of ICD-10-CM/PCS, CPT, and HCPCS codes in the processing of healthcare claims and the connection to medical necessity
• Describe the steps that can be taken to prevent claims denials prior to remittance
• Explain how this level of revenue cycle management impacts the final steps of the revenue cycle.
• Describe how this level of the revenue cycle has a direct connection to health information management operations to include the following:  release of information, scanning, record processing, quantitative analysis, data integrity, and patient identity.
• Demonstrate professional communication and behavior.