The contractor shall code billable care including Medical Services Accounts (MSA), all Other Health Insurance (OHI) and encounters in clinic specialties requiring expertise in a specific area of medicine.
The contractor shall research/resolve problematic coding practices identified by the MTFs to include data quality discrepancy items.
The contractor shall code encounters in clinic specialties where a high level of coding expertise in a particular specialty is required.
The contractor shall resolve medical record documentation deficiencies through healthcare provider query and provide routine feedback to health care providers to correct future deficiencies.
The contractor shall work as part of a team interacting with the health care providers, government personnel and contract employees to perform medical record coding and research errors or missing documentation.The contractor shall comply with the following turnaround times which begin upon receipt of the record.
The contractor shall perform a quality assessment of records, including verification of medical record documentation (both electronic and hand written) and provide the department head and individual health care providers with feedback.
The contractor shall recode records on the Data Quality (DQ) discrepancy list as stated in the task order. The level of effort associated with these records is approximately 3 times that of a standard Outpatient record. Records on the DQ discrepancy list are records that have a logic error between the provider documentation and the codes in the system such as a pediatric code in an adult record. If the contractor initially coded the record incorrectly, the government will not be charged for recoding the record.
If the government does not agree with a code assigned to a medical record by the contractor, the MTF will notify the contractor of the discrepancy. The contractor shall respond with the action to be taken within 48 hours of notification. If the contractor and MTF continue to disagree, the Navy Medicine Region (East or West) will review and make the final decision on the appropriate code(s). The Region’s decision will be sent to the contractor and the code shall be changed at no cost to the government.
The contractor shall obtain physician documentation for any clinical condition or procedure to support the appropriate severity of illness, expected risk of mortality and complexity of care of the patient prior to coding the medical record.
The contractor shall advise members of the patient care team, to include the attending physicians, allied health practitioners, nurses and case managers, regarding documentation guidelines.
The contractor shall work with the MTF clinical champions, AHLTA Sustainment Trainers/Consultants, directors and department heads to develop best practices for outpatient and inpatient coding to provide educational services.
The contractor shall follow the MTF Standard Operating Procedures (SOPs) when the government systems are unavailable due to system issues.
Qualifications: 2 Years’ experience with Associates Degree in Healthcare or affiliated specialty
Required Skills : Medical Coding, medical records, medical terminology, HIPAA Compliance, Auditing, ICD-10 Coding
Required Certification: CPMA Preferred or RHIT, CDIP, CCS, CPCO, CIC, COC, CPC-H, CEMC