W hat I Think I Know (and really do)

1. What I Think I Know (and really do) How to apply your HIM knowledge and experience to other job opportunities

2. Content • Analyzing Job Description • Applying background and experience • Willingness to learn something new • Enhancing what you already know • Realize your potential

3. Analyzing Job Description: Director of Practice Improvement • Position Description: • Provides extended resources and knowledgebase necessary to evaluate, measure, and deliver a designed plan of support services that will reduce error patterns and maximize practice performance as it relates to the final outcome of billable services. • Responsible for a distinct emergency medicine contract base; this position will often function as a liaison/facilitator between multiple internal and external business partners to resolve issues that surround the production and delivery of the patient health record.

4. Director of Practice Improvement • Qualifications: • Bachelor’s degree, preferably in a healthcare related field • Clinical background a plus • Minimum five years outpatient coding experience • Candidate for coding certification • Excellent written and verbal communication skills; strong analytical, organization, time management, and presentation skills • Excellent working knowledge of CPT, CMS and other payer documentation, compliance, reimbursement and coding requirements

5. Director of Practice Improvement • Experience in adult education/training including adept lecturing techniques • Exposure to healthcare finance • Knowledge of computers, operating systems and some familiarity with EMRs • Ability to work independently • Professional demeanor and appearance, strong work ethic, reliable, resourceful team player with positive attitude

6. Director of Practice Improvement • Duties and Responsibilities: • Evaluate all processes as they relate to the medical record and its submission for billing • Facilitates the execution of the appropriate clinical documentation to ensure the level of services and acuity of care are accurately documented in the medical record. • Coordinate with region to prioritize goals and metrics and deliver against those goals. • Strategic planning and financial benchmarks by practice and provider. • Statistical analysis of provider services employing expected outcomes.

7. Director of Practice Improvement • Serve as the regional resource to vendors and practitioners as regards to EMR issues and transition. • Keep up with any new EMR application and determine if in alignment with the EmCare’s technology strategic plan. • Keep all practices current on regulatory changes. • Establish a program for cyclical analysis and feedback to full time contract practitioners. • Track and trends contract performance. • Evaluate state payer guidelines as they pertain to billing practices and practitioner scope of practice (mid levels, teaching physicians). • A resource and participant on regional management calls.

8. Director of Practice Improvement • A resource to the site Medical Director, Nurse Manager, Utilization or Hospital Executives to help resolve issues related to identified ED clinical documentation changes or inadequacies. • Conduct annual site visit round table discussions with contract practitioners. • Evaluate all opportunities to maximize revenue opportunities. • Establish a working relationship with the local and regional staff/team and leadership and promote effective communication among those groups. • Communicates information effectively at all levels.

9. Director of Practice Improvement • Provides updates of performance trends and practice outcomes to regional leadership. • Consistently supports compliance and the EMSC code of conduct by maintaining confidentiality and supporting the organizational goals. • Conducts independent educational sessions for new provider employees. • Maintain a close working relationship with billing company practice management staff to communicate potential problems that will result in fluctuations in billing processes or financial losses.

10. Applying Background and Experience Presentation to Potential New Employer

11. What I Think I Know (But Correct Me If I Am Wrong!!!)

12. Content • Administrative Expectations • Participation in Establishing Corporate Goals • Implementation of Corporate Goals • Contributing to the Company’s Financial Bottom Line • Preparing Reports for Regional Leadership • Clinical Documentation, Coding, and Billing Compliance • Contract Practitioner Liaison

13. Administrative Expectations • Serves as a resource and participant on regional management calls • Serves as a resource to the site Medical Director, Nurse Manager, Utilization or Hospital Executives to help resolve issues related to identified ED clinical documentation changes or inadequacies

14. Administrative Expectations • Serves as the regional resource to vendors and practitioners as regards to EMR issues and transition • Effectively communicates information at all levels • Establishes working relationships with local and regional staff/team and leadership and promote effective communication among these groups

15. Administrative Expectations • Consistently supports Corporate Compliance program • Consistently supports the EMSC code of conduct by maintaining confidentiality • Consistently supports Organizational goals

16. Participation In Establishing Corporate Goals • Contributes to the strategic planning and financial benchmarks by practice and provider.

17. Implementation of Corporate Goals • Coordinates with region to prioritize goals and metrics and deliver against those goals

18. Contributing to the Company’s Financial Bottom Line • Evaluates state payer guidelines as they pertain to billing practices and practitioner scope of practice (mid levels, teaching physicians) • Evaluates all opportunities to maximize revenue opportunities • Communicates findings and make recommendations for implementation

19. Preparing of Reports For Regional Leadership • Tracks and trends contract performance • Conducts statistical analysis of provider services employing expected outcomes • Provides updates of performance trends and practice outcomes to regional leadership

20. Clinical Documentation, Coding, and Billing Compliance • Evaluates all processes as they relate to the medical record and its submission for billing • Facilitates the execution of the appropriate clinical documentation to ensure the level of services and acuity of care are accurately documented in the medical record

21. Clinical Documentation, Coding, and Billing Compliance • Keeps all practices current on regulatory changes • Maintains a close working relationship with billing company practice management staff to communicate potential problems that will result in fluctuations in billing processes or financial losses

22. Contract Practitioner Liaison • Establishes program for cyclical analysis and feedback to full time contract practitioners • Conducts annual site visit round table discussions with contract practitioners • Conducts independent educational sessions for new provider employees  

23. What I Do Know Is…… I Am The Woman For The Job!

24. Willingness to Learn Something New • Documentation Requirements: • Emergency Medicine • Urgent Care Center • CDU/Observation Medicine • Hospital Medicine (Hospitalist)

25. Emergency Medicine Documentation Requirements: HPI

26. History Component:History of Present Illness (HPI) • Location - e.g...Chest pain • Quality - e.g...sharp, dull, burning, pressure • Severity - e.g....mild, moderate, severe • Duration - e.g...1 minute, 1 hour, 3 years • Timing - e.g....started at 10am, constant, intermittent • Context - e.g....while walking, at rest • Modifying factors - e.g....improves with rest, increases with walking • Associated signs and symptoms - e.g....nausea, vomiting, HA

27. History Component:Review of Systems (ROS) • Constitutional • Psychiatric • Respiratory • Skin • ENT • Hematologic/lymphatic • Allergic/immunologic • Musculoskeletal • Cardiovascular • Gastrointestinal • Eyes • Endocrine • Genitourinary • Neurologic Required Elements Required Elements

28. History Component • Past Medical, Family, Social History (PFSH)

29. Physical Exam Summary Table

30. Physical Exam BODY AREAS INCLUDE: • Head, including face • Neck • Chest • Abdomen • Back • Genitalia • Extremities, each ORGAN SYSTEMS INCLUDE: • Constitutional • Eyes • ENT • Respiratory • Cardiovascular • Integumentary • Musculoskeletal • Psychiatric • Neurological • Hematologic/Lymphatic/Immunologic • GI • GU Required Elements Required Elements

31. Physical Exam Organ System Review Musculoskeletal Document performance of the following: • Examine hands, arms, shoulders, neck, or TMJ • Inspect and palpate the joints OR • Check range of motion T-System = may document either: • “Normal ROM” under “Extremities” or “ Neck” (or pertinent positive) • Joint Exam • Extremities Example “Exam of the back shows good ROM with no scoliosis or deformities”

32. Enhancing What You Already Know • Documentation Guidelines – Hospital to Physician • Part A to Part B CMS/Commercial Payer Regulations • Coding Compliance • HIPAA Guidelines • EMR Implementations/transmissions of data • Implementation of New Service Lines

33. Realize Your Potential • Your Understanding of the Operations of Hospitals and Healthcare • Your Experience in Dealing with Hospital and Medical Staff Leadership • Your Experience With Dealing With Medical Staff • Your Understanding of the Revenue Cycle Process • Your Understanding of Financial Management • Your Knowledge of Compliance and HIPAA guidelines • Your Knowledge of Clinical Documentation Guidelines • Your Experience in EMRs • Your Experience in Chart Completion Process • Your Experience in Problem Solving • Your Experience in Writing Policies and Procedures • Your Experience in Employee Training

34. REMEMBER: The Sky is The Limit, So Don’t Limit Yourself

35. QUESTIONS?

36. Thank You Sharon J. Randolph, JD, RHIA Director of Practice Improvement EmCare sharon.randolph@emcare.com