MILESTONE TEST- rhit

1. MILESTONE TEST-rhit REMEDIATON SESSION May 2015 Professor Crossley

2. Remediation Presentation agenda Purpose of Remediation A. Study and Test Taking Skills B. Cover key Concepts of RHIT Domains Covered on Milestone Test (Domain 6 and 7) • Multiple Choice Exam (MCE) Test Taking Tips A. Briefly review the MCE Test Taking Tips found in Doc Sharing/Course Home B. Budget your their time both studying and taking future tests. • Domain and Test Results Review A. Review of the Domain(s) covered on the Milestone Test (Broad Topic Review) B. Test specific topic review including brief overview of most commonly missed concepts. • Resource Tools A. Textbook(s) –Which books to use in preparing for Milestone Tests B. RHIT Exam Prep Book (PRG Study Guide) • Q & A • Closing A. Remediation Presentation Attendance Link Password B. Remediation Attendance Link Instructions

3. Purpose • Purpose of Remediation A. Study and Test Taking Skills B. Cover key Concepts of RHIT Domains Covered on Milestone Test

4. Domains •This test covers Domain 6 (Legal) and Domain 7 (Revenue Cycle). Each Domain is worth 11% on the RHIT Exam.

5. General tips • Get organized with materials to study prior to the test. • Set aside time to study; • avoid all-night study sessions. • Allow yourself the full allotted time to take your test. • Use any references or resources that are authorized for the test

6. Ten Steps To Reduce Test Anxiety 1. Prepare for the exam ahead of time. Cramming is a big cause of test anxiety. 2. Get plenty of rest and sleep the night before the exam. 3. Don't forget to eat on the day of the exam—preferably something nutritious. 4. Avoid arriving too early or late to the exam. 5. Avoid last-minute studying; remember that you are already prepared. 6. Avoid listening to others or discussing the exam with others while you wait for the exam. The anxiety of others can rub off, and you can suddenly begin to doubt yourself. 7. Don't forget to breathe! Take deep breaths to help you relax. Don't worry, nobody will notice!

7. Ten steps slide 2 • While you are taking deep breaths, replace any negative thoughts with positive thoughts. For example, you may find it useful to repeat positive statements to yourself such as the following: "I am relaxed," "I am prepared," or "I am a good student." “ I am going to pass” Make up your own! • Don't get bogged down and worry about questions you don't know. Move on instead. Later, the answer may come to you or you may get clues from other exam questions. 10. Reward yourself when you are finished with the exam.

8. Tips For Multiple Choice Tests • Read the question, then try to guess the answer before you look at what's there. • Begin the elimination process immediately. If you can write on the test, strike out the wrong answers so that if you have to come back to this question, you will not have to process the wrong answers again. • Be careful not to read too much into questions. You can try to second-guess the test preparers, get too elaborate, and then ruin the answer. • Underline key words. • If a question deals with any sort of cause and effect that has several steps in it, draw or write down the steps very quickly using abbreviated words or symbols. This helps you see any missing pieces. • If two choices are very similar, you must look at other qualifiers, such as always versus sometimes. If only one or two words are different, one is possibly correct.

9. Tips for multiple choice tests slide two • If two choices are opposite, one of them is probably correct. • Don't go against your first impulse unless you are sure you were wrong. (Sometimes you're so smart you scare yourself.) • Check for negatives and other words that are there to throw you off. ("Which of the following is not...") • The answer is usuallywrong if it contains all, always, never, or none. • The answer has a great chance of being right if it has sometimes, probably, or some. • When you don't know the right answer, look for the wrong one. Start the elimination process rolling. • Don't eliminate an answer unless you actually know what every word means. Here is where knowing what all the acronyms means. • Read every answer (unless you are wildly guessing and there is no penalty). Remember that you are to choose the best answer. Even if you choose B and B is a correct answer, it gets nuked by an "All of the above" for E if every other answer is also correct.

10. Milestone exam info • Average Highest Score 66 Points or 94% • Average Lowest Score 32 Points or 45% • Average of 47 Points = Will receive up to 30 points for viewing this presentation

11. Milestone exam info • VI. Legal (11%) • 1. Ensure confidentiality of the health records (paper and electronic) • 2. Adhere to disclosure standards and regulations (HIPAA privacy, HITECH Act, breach notifications, etc.) at both state and federal levels • 3. Demonstrate and promote legal and ethical standards of practice • 4. Maintain integrity of legal health record according to organizational bylaws, rules and regulations • 5. Follow state mandated and/or organizational record retention and destruction policies • 6. Serve as the custodian of the health records (paper or electronic) • 7. Respond to Release of Information (ROI) requests from internal and external requestors • 8. Work with risk management department to provide requested documentation • 9. Identify potential health record related risk management issues through auditing • 10. Respond to and process patient amendment requests to the health record • 11. Facilitate basic education regarding the use of consents, healthcare Power of Attorney, Advanced Directives, DNRs, etc. • 12. Represent the facility in court related matters as it applies to the health record (subpoenas, depositions, court orders, warrants) • Chapters Legal chapters of the HIM Technology Textbook - Entire Dana McWay – Legal Aspects of Health Information Management Book

12. Milestone exam info • VII. Revenue Cycle (11%) • 1. Communicate with providers to discuss documentation deficiencies (i.e. queries) • 2. Participate in clinical documentation improvement programs to ensure proper documentation of health records • 3. Collaborate with other departments on monitoring accounts receivable (i.e. unbilled, uncoded) • 4. Provide ongoing education to healthcare providers (i.e. regulatory changes, new guidelines, payment standards, best practices, etc.) • 5. Identify fraud and abuse • 6. Assist with appeal letters in response to claim denials • 7. Monitor claim denials/over-payments to identify potential revenue impact • 8. Prioritize the work according to accounts receivable, patient type, etc. • 9. Distribute the work according to accounts receivable, patient type, etc. • 10. Maintain the chargemaster • 11. Ensure physicians are credentialed with different payers for reimbursement Chapter on Revenue Cycle in the HIM Technology book and entire Book for Health Insurance and Reimbursement (Principles of Healthcare Reimbursement by Anne B. Casto and Elizabeth Layman

13. Common Concepts Missed • DN6) A patient has come to the release of information office to obtain her records. She is told that there are some records she cannot have access to. These records are most likely _____. Choose the best answer • a psychotherapy notes • b. alcohol and drug records • c. AIDS records • d. a mental health assessment

14. Sample questions and answers • DN6) A patient has come to the release of information office to obtain her records. She is told that there are some records she cannot have access to. These records are most likely _____. Choose the best answer • a psychotherapy notes 66% chose this • b. alcohol and drug records • c. AIDS records • d. a mental health assessment

15. Sample questions and answers • DN6) Mountain Hospital has a security breach. Someone hacked into the system and viewed 30 medical records. According to ARRA, what is the responsibility of the covered entity? • a. ARRA does not address this issue. • b. All individuals must be notified within 30 days. • c. All individuals must be notified within 60 days. • d. ARRA requires oral notification.

16. Sample questions and answers • DN6) Mountain Hospital has a security breach. Someone hacked into the system and viewed 30 medical records. According to ARRA, what is the responsibility of the covered entity? • a. ARRA does not address this issue. (no one chose this) • b. All individuals must be notified within 30 days. • c. All individuals must be notified within 60 days. • d. ARRA requires oral notification.

17. Domain VI – LegalKey Terms to know ONC – Office of National Coordinator for HIT HIPAA Privacy Rule – 2 key goals To provide individuals with more rights to their health information. To provide greater privacy protection for one’s health information (limit access) PHI – Protected Health Information is defined as Individual’s identifiable health information ARRA - American Recovery & Reinvestment Act 2009

18. Key terms to know Covered entity (CE) – healthcare providers, health plans, healthcare clearinghouses, etc. Business Associate (BA) person or organization, other than an employee of the CE, that performs activities on behalf of the CE that involves disclosure of PHI. Examples include consultants, transcription companies, accounting firms and law firms

19. KEY TERMS to know Minimum Necessary – applies to limiting access to PHI based on job responsibilities TPO or Treatment, Payment and Operations – No patient consent is required to release PHI in the provision of meeting TPO De-identified Information – PHI that does not identify an individual, all identifying information has been deleted or eliminated PHI Disclosure – know when an authorization is needed.

20. LEGAL ISSUES The ownership of the information contained in the physical medical/health record is considered to be the patient’s . In electronic records, authentication may be achieved by digital signature .

21. LEGAL ISSUES, CONTINUED To be admitted into court as evidence, medical records and health information are introduced as business records or exception to hearsay rule Apatient has come to the release of information office to obtain her records. She is told that there are some records she cannot have access to. These records are most likely: psychotherapy notes . A patient has asked to view his medical record. The record is stored offsite. How long does the facility have to provide the record to him to view? 60 days

22. Domain VII – Revenue Cyclekey terms to know Key to Accurate coding is physician documentation • Coder is the expert in coding • Physician is the expert in clinical services Query – Communicating with the provider to clarify and substantiate clinically valid diagnoses supported by the patient’s medical record documentation. CDI – Clinical Documentation Improvement – must have collaboration between the coders and the physicians. EOB – Explanation of Benefits

23. Domain VII – Revenue Cyclekey terms to know Compliance Program should address Fraud and Abuse. Two examples are: Upcoding – Coding medically unnecessary services Unbundling – Using multiple codes that describes individual components of a procedure rather than an appropriate single code that groups all steps of the procedure performed.

24. Domain VII – Revenue Cyclekey terms to know Chargemaster – or charge description master (CDM) contains information about the organization healthcare services and transaction provided to patients. As services are orders and posted, the chargemaster posts the charge to the patient’s account It must be maintained and updated routinely • Improper maintenance can impact the fiscal health by either overpayments, underpayments, claim rejection or fines and penalties.

25. Domain VII – Revenue Cycle The following coding system(s) is (are) utilized in the MS-DRG prospective payment methodology for assignment and proper reimbursement.ICD-9-CM The following groups of healthcare providers contracts with the employer to provide healthcare services? Health maintenance organization

26. Reimbursement, continued These are financial protections to ensure that certain types of facilities (e.g., children’s hospitals) recoup all of their losses due to the differences in their APC payments and the pre-APC payments. hold harmless The following apply to radiological and other procedures that include professional and technical components and are paid as a lump sum to be divided between physician and healthcare facility?Global payments

27. Reimbursement, continued Home health agencies are reimbursed on a prospective payment system (PPS) for Medicare patients. This PPS is called home health resource groups (HHRGs) Upon which criterion is Medicaid eligibility based? Income Criteria for Medicare is what?

28. resources • Resource Tools • Textbook(s) –Which books to use in preparing for Milestone Tests Health Information Management Technology: An Applied Approach is our main book for HIT • RHIT Exam Prep Book (PRG Study Guide) • AHIMA Website – www.ahima.org – Go to the certification page.

29. What we reviewed • Purpose of Remediation A. Study and Test Taking Skills B. Cover key Concepts of RHIT Domains Covered on Milestone Test-HIPAA, Legal and Reimbursement Items.

30. Words of encouragement There are no secrets to success. It is the result of preparation, hard work and learning from failure. General Colin Powell

31. The END • In Week 3 of this course you are given the opportunity to attend a Milestone Exam Remediation Presentation to discuss the areas related to the Domains covered in the Milestone Test. Please note that this is an optional assignment, however you may earn additional points based on your attendance. The Remediation Presentation is an opportunity to earn points lost in your Milestone Exam. • How to Attend • To attend the live presentation or listen to the recording, go the iConnect Present (Online Only) and click on the link. • Password Required • During the iConnect Webinar, the password required to register your attendance was presented. Type the password into the box above in order to start the attendance confirmation process. If you did not make a note of the password, please review the presentation a second time via the recording. • Confirm Attendance • 1.After you have typed in the password, “FUTURERHIT”clickon the "Begin Remediation Presentation Attendance Quiz" button. An instructional screen will appear. • 2.Click "Begin Remediation Presentation Attendance Quiz" and a screen will appear with one question: • 3.The question is: "Did you attend the Remediation Presentation" Answer the question and click submit.your Milestone Exam grade will be adjusted and will be posted to the gradebook