Presentation Transcript

1. Domain I-Health Data Management (20%)

   RHIA Prep Workshop 2014
2. Domain Content 1.Manage health data elements and/or data sets 2.Develop and maintain organizational policies, procedures, and guidelines for management of health information 3.Ensure accuracy and integrity of health data and health record documentation 4.Manage and/or validate coding accuracy and compliance
3. Domain Content 5.Manage the use of clinical data required in reimbursement systems and prospective payment systems (PPS) in healthcare delivery 6.Code diagnosis and procedures according to established guidelines 7.Present data for organizational use (for example, summarize, synthesize, and condense information)
4. Hot Topics Ancillary functions of health records Data Vital statistics reporting Accreditation Qualitative vs. quantitative Database types Object oriented Relational Hierarchical Structured Query Language (SQL)
5. Hot Topics Levels of data models Conceptual Logical Physical Entity relationship diagram (ERD) Unified modeling language (UML) Relationships One-to-one One-to-many Many-to-many
6. Databases Data Dictionary Important tool to control data quality Database management systems (DBMS) Relational (RDBMS) Object-oriented (OODBMS) Organization-wide data dictionary Promotes consistency across the organization MPI Primary Key…Unique identifier Foreign key…Used to link one table to another
7. Database Life Cycle
8. Standardized Data Sets Minimum Data Set (MDS) for Long-term care and resident assessment protocols Outcomes Assessment Information Set (OASIS) Data Elements for Emergency Department Systems (DEEDS) Essential Medical Data Set (EMDS)
9. UHDDS Uniform Hospital Discharge Data Set Set of uniform data elements collected in all inpatient health records Diagnosis related groups (DRGs) Medicare Prospective Payment System Uniform Ambulatory Care Data Set (UACDS)
10. Standards for EHR/Electronic Data Continued… Structure and content standards Health Level Seven (HL7) Standards, guidelines, and methodologies for interoperability American Society for Testing Materials (ASTM) E31- develops standards for EHR Identifier standards Unique numbers for patients, providers, etc.
11. Standards for EHR/Electronic Data Laboratory Logical Observation Identifier Name Codes (LOINC) Clinical representation standards Classification systems, vocabularies, terminologies, lab and clinical observation codes, drug code, info modeling, and metadata Technical standards Electronic data interchange (EDI) X12N- transfer info between providers, plans, and payers Digital imaging and communications in medicine (DICOM)
12. Practice Question #1 In order to effectively transmit healthcare data between a provider and payer, both parties must adhere to which electronic data interchange standards? X12N LOINC IEEE 1073 DICOM
13. Coding Standards Evaluating quality: Reliability Validity Completeness Timeliness Coding process Review relevant documentation Select conditions, treatments, and procedures to be coded Select most appropriate codes Enter or abstract data into the computer Utilize the appropriate reimbursement classification system.
14. Practice Question #2 A 65 y/o woman was admitted to the hospital. She was diagnosed with septicemia secondary to staphylococcus aureus and abdominal pain secondary to diverticulitis of the colon. What is the correct code assignment? A41.01 Sepsis due to Methicillin Susceptible Staphylococcus Aureus A41.89 Other specified sepsis A49.01 Methicillin Susceptible Staphylococcus Aureus infection, unspecified site B95.61 Methicillin Susceptible Staphylococcus Aureus infection, as the cause of diseases classified elsewhere K57.32 Diverticulitis of large intestine without perforation or abscess without bleeding R10.9 Unspecified abdominal pain K57.32, B95.61 A41.01, K57.32 A49.01, K57.32, R10.9 A41.89, K57.32
15. Coding Compliance Cornerstone of accurate coding is physician documentation. Physician query process Clarification of data that may influence proper code assignment. Develop a standard form to be used in communication with physicians. Concise, present facts, not leading, not mentioning financial impact. Coding compliance plan Code of conduct Policies and procedures Education and training Communication Auditing Corrective action reporting
16. Technology Used in Coding Encoders Assists coders in assigning appropriate codes Computer-assisted coding Analyzes documentation to assist in assigning appropriate codes.
17. Practice Question #3 One technology used for computer-assisted coding is: Logic-based encoding Natural language processing Artificial intelligence Coder intervention
18. Chargemaster Charge Description Master (CDM) Allows providers to accurately charge routine services and supplies to the patient. Must be updated to reflect coding changes.
19. Revenue Cycle Admitting, patient access management Case management Charge capture Health information management Patient financial services, business office Finance Compliance Information technology
20. Prospective Payment Systems Predetermined rate based on the DRG. Omnibus Budget Reconciliation Act (OBRA) Hospitals: Used in Psychiatric, rehabilitation hospitals, long-term care hospitals, children’s hospitals, cancer hospitals, critical access hospitals. Skilled nursing facility PPS (SNF PPS) Outpatient PPS (OPPS) Home Health PPS (HH PPS)
21. Practice Question #4 In the LTCH PPS, what is the standard federal rate? Constant that converts the MS-LTC-DRG weight into a payment Relative weight based on the market basket of goods Geographic wage index Adjustment mandated by the Benefits Improvement and Protection Act (BIPA)
22. Practice Question #5 What part of the Medicare program was created under the Medicare Modernization Act of 2003 (MMA)? Part A Part B Part C Part D
23. Policies and Procedures Used to ensure consistent quality performance. Policy: statement about what an organization does Procedure: describes how the work is to be done, instructions.
24. Incomplete Records Delinquent records Records that are not completed in a certain timeframe Medicare and The Joint Commission state 30 days post discharge. Electronic signatures Must be controlled by password security and unique assignment. Verbal and Telephone Orders Authentication timing requirements governed by state law, facility policy, accreditation standards, and government regulations. Medicare and The Joint Commission state 48 hours in absence of state law.
25. Practice questions
26. In the past, Joint Commission standards have focused on promoting the use of a facility-approved abbreviation list to be used by hospital care providers. With the advent of the Commission’s national patient safety goals, the focus has shifted to the: Prohibited use of any abbreviations Flagrant use of specialty-specific abbreviations Use of prohibited or ‘dangerous’ abbreviations Use of abbreviations in the final diagnosis
27. You have been asked to identify every reportable case of cancer from the previous year. A key resource will be the facility’s Disease index Number control index Physicians’ index Patient index
28. As the Director of a Health Information Technology Program, your community college has been selected to participate in the workforce development of electronic health record specialists as outlined by ARRA and HITECH. In order to keep abreast of changes in this program, you will need to regularly access the website of this government agency___. ONC CMS OSHA CDC
29. The health record states that the patient is a female, but the registration record has the patient listed as a male. Which of the following characteristics of data quality has been compromised in this case? Data comprehensiveness Data granularity Data precision Data accuracy