HIM role expands into physician office
AHIMA creating special credential
Information management is expanding into physician practices, and beginning next year there will be a credential for these specialists.
The American Health Information Management Association (AHIMA) is creating a new physician-practice-based credential that, for the time being, is called "physician certified coding specialists" (PCCS), says Jack A. Segal, AHIMA spokesman. An analysis of the proposed credential is now under way, after which a curriculum for the credential will be developed. AHIMA hopes to offer the first certification exam in September 1997, Segal says.
The new credential could fill a big gap in the education of health information managers, says Amy Hagan, RRA. Hagan, who formerly made her living in the hospital environment, is now reimbursement coordinator in the ophthalmology department at The Emory Clinic in Atlanta.
Learn physician coding on the job
The first thing she found out when she made the switch was that she knew nothing about physician coding. What she knows now she learned on the job and from attending seminars not from her formal training in information management skills.
In addition to CPT-4 coding, Hagan says, she has had to come to grips with evaluation and management codes.
She also has had to become familiar with the details of the Baltimore-based Health Care Financing Administration’s (HCFA) Correct Coding Initiative (CCI). The CCI is part of HCFA’s campaign against fraud and abuse. Its goal is to develop correct coding methodologies and to control coding that leads to undeservedly high payment in Part B claims because of intentional or unintentional unbundling.
Unintentional unbundling is caused by error. But intentional unbundling is an attempt to manipulate coding to boost reimbursement. It involves billing multiple procedure codes for a group of procedures that are covered by a single comprehensive code. The CCI is intended to encourage physicians to use the correct comprehensive code. HCFA provides physicians with the appropriate edits to refer to during the coding process.
Hagan doesn’t recommend coming into physician office management straight from school. And even though her training was lacking in many areas related to physician practices, she says her background in HIM has stood her in good stead in her current position.
"It has given me a good background in understanding reimbursement policies and seeing the big picture with the different insurance carriers and HCFA guidelines," Hagan notes.
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