Syllabus
HIM 190
Compliance and Supervision
Credit Hours 2
DEPARTMENT: School of Health Sciences
COURSE DESCRIPTION
This required course will focus on two AHIMA domains of learning including: human resource management
and supervision, and coding compliance. Guidelines on performing coding compliance reviews and
developing a coding compliance program will be the focus, with discussions on the differences between
coding and billing, medical necessity, reviewing techniques, educational guides and coding compliance
strategies.
Emphasis is placed on case study and problem solving. Students must have completed at least one coding
course in order to be able to assimilate the coding compliance theories that are the focus of this course.
Prerequisite: HIM 100, HIM 130
REQUIRED TEXTBOOKS
Please note: the student should already own the first two textbooks required for this course.
Health Information Management Technology: An Applied Approach, 4th Edition,
Nanette Sayles
AHIMA Press
ISBN 9781584263524
Key Features
• Introduces new professionals to hybrid records, EHR systems, and electronic
document management systems
• implementation
• Real-world case studies
• Meaningful use and breach notifications
• Appendix on Ethical Standards for Clinical Documentation Improvement
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Quality and Performance Improvement in Healthcare, 5th Edition
ISBN # : 9781584263104
Publisher: AHIMA Press
Author: Shaw
Key Features:
Covering trends in healthcare quality control and performance, it also serves as a solid source on Performance
Improvement (PI) foundations, fundamentals, and core principles. Quality and Performance Improvement in
Healthcare includes updated information on:
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•
•
Developing Staff and Human Resources
Organizing for Performance Improvement
Managing the Human Side of Change
Guide to Coding Compliance, 1st Edition
Joanne M. Becker
ISBN 9781435439214
Cengage 2010
Key Features
•
•
•
•
Case studies
Audit tools
StudyWare CD
30-day free trial of Encoder Pro
REQUIRED RESOURCES
ICD-9-CM and ICD-10-CM/PCS Encoders: by 3M
2
Coder’s Desk Reference Collection (accessible through 3M encoders)
COURSE OBJECTIVES
Upon completion of this course, the Health Information Technology student will be able to:
•
•
•
•
•
•
•
•
•
Apply fundamentals of team leadership
Participate in teams and committees
Manage/supervise employees
Monitor staffing productivity
Use tools and techniques to monitor and improve HR resources
Make recommendations for items to include in budgets and contracts.
Comply with local, state, and federal coding compliance regulations
Identify national regulations for coding and billing compliance (i.e. NCCI)
Assess reliability and validity of clinical data in support of accurate coding
STUDENTS WITH DISABILITIES:
Students with documented disabilities (physical, emotional, learning and/or others) who believe
that they may need accommodations in this class are encouraged to contact the Coordinator for
Student Disability Services in Room 139, extension 120, as soon as possible to arrange for such
accommodations.
LIBRARY INFORMATION:
Articles:
As an MWCC student, you have access 24 hours a day to more than 80 LaChance Library online
article databases. To get to these resources and find articles scholarly/academic journals,
magazines, newspapers, reference books, and e-books, visit the Library web page,
http://library.mwcc.edu, and click FIND ARTICLES. In order to access the Library’s online
research databases from an off-campus location, you will be prompted to log-in with your library
barcode number or student ID number and last name in all CAPITAL LETTERS.
Books, Videos, CDs, etc.:
In order to find books, videos, etc. on a topic, you will need to use the Library catalog, located on
the Library’s webpage (http://library.mwcc.edu). Look for the FIND BOOKS & MORE link.
You may arrange to pick up items at either the LaChance Library or your public library.
For assistance in locating articles, books or other information sources please contact us:
• By telephone: 1-888-884-6922 (toll free)
• Via email: library@mwcc.mass.edu (account is checked at least once daily at 7:30 am,
Mon-Fri)
• Using chat: Visit the ASK A LIBRARIAN page at: http://subjectguides.mwcc.edu/ask
• In person, at the LaChance Library (Gardner Campus), Leominster Student Success
Center and the Devens Learning Center when open. Hours can be found at:
http://mwcc.edu/lib/about/hours/.
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ACADEMIC SUPPORT CENTER INFORMATION:
Tutoring: Students in need of tutorial services are encouraged to contact the Academic Support
Center. Tutorial services are provided free of charge to enrolled students and include face-to-face
and e-tutoring (online tutoring), drop in help with math and writing, subject tutoring (sciences,
business, accounting, etc.) as well as other services. If you have questions, or wish to set up an
appointment, you may contact:
Administrative Assistant, Academic Support Center, 978-630-9333.
ETutoring is available to students through iConnect and provides tutoring in subjects such as
writing, math, biology, chemistry, anatomy & physiology, statistics and accounting. Assistance
is available via chat, email and also an online writing lab where students can upload drafts of
papers and receive feedback. To see the current schedule of eTutoring visit:
http://www.etutoring.org/public/schedule.cfm?sys=91.
For information about either library or tutoring services please contact Heidi McCann, Dean of
Library and Academic Support Services – hmccann@mwcc.mass.edu or 978-630-9126.
ACADEMIC HONESTY & PLAGIARISM:
Students are responsible for knowing Mount Wachusett Community Colleges' policy on
academic honesty and plagiarism, found at http://mwcc.edu/catalog/academic-and-gradingpolicies/. In sum, it is against policy to submit work with the deliberate intent to deceive or to
cheat. Plagiarism is not tolerated at the College.
WITHDRAWAL FROM A COURSE:
You may formally withdraw from this course through the 60% point of the semester/cycle as
indicated on the academic calendar – the academic calendar is posted at
http://mwcc.edu/academic/academic-calendar/. A grade of “W” will be recorded on your
transcript. A grade of “W” will count as credits attempted but not completed, but will not impact
QPA. You are required to speak to me or your assigned advisor before withdrawing from this
course. The procedure for course withdrawal includes getting the proper form from the Advising
Center in Gardner or from the receptionist at our branch campuses (Leominster, Devens,
Burbank), bringing the form to me or your assigned advisor, and returning the signed form to the
Advising Center or branch campus. Please be advised that ceasing to attend a class may result
in me initiating the withdrawal from a class prior to the 60% point of the semester/cycle.
Course withdrawals will not be processed after the 60% point of the semester/cycle. If you stop
attending after the 60% point of the semester/cycle, you will receive an F grade. F’s are averaged
into the QPA for all students. Any withdrawal may affect progress toward degree and future
eligibility to receive financial aid. Contact the record’s office for information on your student
records. Administrative action Forms are available for withdrawal after the 60% point of the
semester/cycle as a result of extenuating circumstances. Student may obtain an Administrative
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Action form in the records office or online at http://mwcc.edu/wpcontent/blogs.dir/1/files/2013/01/Administrative-Action.pdf. Documentation of the extenuating
circumstance must be submitted with the form for this appeal to be reviewed.
PERFORMANCE ASSESSMENT
AHIMA Academic Domains/Sub domains
The following Domains, Subdomains, and Task Competencies of the health information technology
profession are addressed in this course. With a minimum accuracy of 76%, the student must demonstrate
acceptable performance via application exercises, quizzes and exams.
A.
Domain 1: Healthcare Data
Subdomain 1a: Data Structure, Content and Use
Task 1.a.3: Assist in the facility’s billing processes.
Task 1.a.4: Validate coding accuracy using clinical information found in the
health record.
Subdomain 1b: Clinical Classification Systems-ICD-10 CM/PCS Coding
Task 1.b.1: Assign diagnosis/procedure codes using ICD-10 CM/PCS.
Subdomain 1.c: Clinical Classification Systems-CPT coding
Task 1.c.1 Assign procedure codes using
B.
Domain 2: Health Information Analysis
Task 2.1: Abstract records for department indices/databases/registries.
C.
Domain 3: Healthcare Environment
Task 3.a.1:Interpret and apply laws and accreditation, licensure and
certification standards, monitor changes and communicate informationrelated changes to other people in the facility.
Subdomain 3.c: Healthcare Information Requirements and Standards.
Task 3.c.5: Ensure facility-wide adherence to health
information services’ compliance with regulatory requirements (e.g., ICD9-CM) Cooperative Parties coding guidelines, CMS (formerly HCFA)
Compliance Plan, Correct Coding.
Subdomain B: Quality Management & Performance Improvement
Organize and coordinate facility-wide quality management and performance
improvement program
Analyze clinical data to identify trends
Analyze and present data for healthcare decision-making (such as demonstrating
quality, safety and effectiveness of healthcare).
Domain V: Organization and Management
Subdomain C: Strategic Planning & Organizational Development
Demonstrate and apply principles of organizational behavior to facilitate team
building, negotiation, and change management.
• Change management (4)
• Organizational assessment and benchmarking (4)
COURSE OUTLINE
A. ICD-10 PCS structure of code numbers
B. Medical and Surgical Sections
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C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.
R.
S.
T.
Obstetrics Section
Placement Section
Administration Section
Measurement and Monitoring Section
Extracorporeal Assistance and Performance and Extracorporeal Therapies Section
Osteopathic, Other Procedures, and Chiropractic Section
Imaging, Nuclear Medicine, and Radiation Oncology Sections
Physical Rehabilitation and Diagnostic Audiology Section
Mental Health and Substance Abuse Treatment
Apply fundamentals of team leadership
Participate in teams and committees
Manage/supervise employees
Monitor staffing productivity
Use tools and techniques to monitor and improve HR resources
Make recommendations for items to include in budgets and contracts.
Define key terms associated with the healthcare financial environment.
Recommend cost savings and efficient means of achieving work processes and goals
Comply with local, state, and federal labor regulations
COURSE REQUIREMENTS
A.
B.
C.
D.
Completion of all assignments prior to coming to class.
Attendance in classes per institution policy.
Pass exams and quizzes.
Class participation.
EVALUATION
Course grade will be determined as follows:
A. Weekly Quizzes
20%
B. Exams
25%
C. Assignment
30%
D. Discussion Board
25%
Grading Scale:
The college uses the following grading system:
Letter Quality
Grade Points
A
4.00
A3.70
B+
3.30
B
3.00
B2.70
C+
2.30
C
2.00
C1.70
D+
1.30
D
1.00
D0.70
F
0.00
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Active Engagement Rubric
Each week, the class will focus on a given topic to discuss and
investigate. Students will participate either through in-class
debates, or by posting discussions in the learning management
system. Possible grade is between 100 and 0. Below is an example
of how student gets from F to A on active participation/course
discussion
Grade
Organization
100 points
Comments are well
organized and reflect
student has read
materials
80 points
Comments can be
followed, but may be
based on experience or
reflects responding to
others
Comments show
student is trying to
relate topic to weekly
readings.
60 points
Comments/participation/
is disorganized or sporadic
Quality of
Information
Comments
demonstrate student
understands the topic
information. New
information or insights
are offered.
Sources
Comments are
supported by one or
more referenced
citations - supports
ideas with facts/quotes
May use a citation, or
makes reference to
personal work
experience to support
an idea
Makes a post but it is
unsupported by citation or
experience, and is very
brief.
Participation
Student participates
four or more times
during the discussion
period
Student participates at
least twice with an
original comment and
at least one
reply/reaction to
another student.
Student comments or
posts once.
Non-participation = 0
Comments drift from topic,
tend to be generic and add
little or no value to the
dialogue.
HIT 190 Course Outline (15 Modules)
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HIT 190
Lecture & Topics
MODULE 1: CODING AND BILLING
DIFFERENCES & SIMILARITIES
- The Purpose of Coding and Billing.
- The Importance of Accurate Data in the
Healthcare Environment.
- Case Studies.
HIT 190
Readings
HIT 190
Assignments & Quizzes
Read CH 1 Becker
- Install the CD ROM “Studyware”
Review CH 1 Slides
- Complete CH 1 Quiz in “immediate
feedback” mode.
- Complete CH 1 Case Studies 1 - 5
Topic of the Week: In your own words describe
the differences between medical billing and
medical coding.
MODULE 2: CODING COMPLIANCE
- Defining Fraud and Abuse.
- Complying with Regulations.
- "Official" Coding Guidelines.
- Federal Regulations.
- Payer Guidelines.
- Coding Guidance from Professional
Associations.
- Coding "Behavior". Standards of Ethical
Read CH 2 Becker
- Complete CH 2 Case Studies 1-5
Review CH 2 Slides
- Complete CH 2 Quiz
Read CH 3 Becker
- Complete CH 3 Case Studies 1-5
Topic of the Week: Visit www.ahima.org and
download a copy of the Coding Code of Ethics –
select one of the items and discuss in your own
words what this means to you.
MODULE 3: THE IMPORTANCE OF
DOCUMENTATION
- Documentation as the Key Resource. - - - Review CH 3 Slides
Documentation Standards.
- The Purpose of the Encounter Form.
Querying – A Process Within a Process. Corrections in the Medical Record
Topic of the Week: Explain how cut and paste
can cause problems in EHRs – see if you can find
a citation to support your opinion.
- Complete CH 3 Quiz
- Load the Ingenix Encoder Pro CD
(found in the back of the book). You
can use this encoder as an alternative
to the 3M encoder to help you find
your codes to complete the coding
questions.
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MODULE 4: CODING AND MEDICAL
Read CH 4 Becker
NECESSITY
Review CH 4 Slides
- Defining Medical Necessity.
- National and Local Coverage Decisions. Advance Beneficiary Notices of Noncoverage
(ABNs).
- Billing for Medical Necessity.
- Coding Compliance Issues.
- Compliance Activities
- Complete Case Studies 7-10
- Complete CH 4 Quiz
- Exam #1 (Chapters 1,2, & 3)
Topic of the Week: Find an article or video on
Medical Necessity and summarize what you
find.
MODULE 5 DEVELOPING A CODING
COMPLIANCE PROGRAM
- Integrating Coding and Corporate Compliance. Quality Coding and Accurate
Claim Submission.
- OIG Compliance Guidelines.
Developing Policies and Procedures. Staffing Coding Professionals
Read CH 5 Becker
Review CH 5 Slides
- Complete CH 5 Chapter Review
questions 1-10
- Complete CH 5 Quiz
Topic of the Week: OMG - it’s the OIG! Explain
why this might be a reaction from an outpatient
clinic.
MODULE 6: AUDITING AND
PREVENTION
- Assessing Areas of Risk.
- Sampling and Audit Methods and Design.
- Prospective and Retrospective Reviews. Auditing Tools & Resources.
- . Reporting the Results.
- Assessing the Appropriate Preventive
Measures.
- Education and Re-training.
- Benefits of a Well-Designed Program
Read CH 6 Becker
Review CH 6 Slides
- Complete CH 6 Chapter Review
questions 1-10
- Complete CH 6 Quiz
Topic of the Week: A big complaint with RACs is
how they are paid – do some web research and
summarize what you find, and do you agree or
disagree with how they are paid?
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MODULE 7: EMERGING
Read CH 7 Becker
- Encoders – Friend or Foe?
- Automated Code Assignment Technology
- Balancing Quality and Quantity
Review CH 7 Slides
TECHNOLOGIES
- HCOs Structures,
- Jobs and Positions,
- Groups & Teams
Topic of the Week: After winning the state
lottery you decide to open a free service to help all
people to better understand their medical records
and how to become more responsible in their own
care by reading and studying their medical
records. Create a mission and vision statement for
your new company, and use images in your
statement. The Sayles' chapter reading will instruct
you in what goes into a mission and vision
statement, and how they differ.
MODULE 9: Staff Supervision:
- Recruitment, training, retention,
Performance measurement,
- Conflict management
-
- Complete CH 7 Quiz
- Exam # 2 (CH 4,5,6,& 7)
Topic of the Week : As we say goodbye to Coding
Compliance – do you see yourself in this role in
the future? Why, why not?
MODULE 8: Organizational Structures:
- Complete CH 7 Chapter Review
questions 1-8
Read Sayles CH 18
Appendix A
Review Slides
- Job Description Assignment
Note: we cover CH 18
over three weeks.
Read Sayles CH 18
Review Slides
Handouts
- Progressive Discipline Assignment
Topic of the Week Flexible Work
Schedules: As a manager, you have the
authority to sign off on flexible work plans
such as: telecommute, job share, work flex
time, or compressed shifts of 10 hour days 4 days
per week. Would you use flex scheduling in your
department, or would you avoid it? Explain your
reasons.
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MODULE 10 Departmental Planning:
- Strategic planning,
- Operational planning,
- Expenses, supply management
Read Sayles CH 18
Appendix B
Review Slides
Handouts
- Employee Development
Assignment
Topic of the Week: Keeping employees happy
helps to keep productivity up. If you can’t give
pay raises, think of some other things you could
do in the workplace to have happy and
productivity staff.
MODULE 11 Legal Issues in the Workplace Read Sayles CH 13
- Federal Legislation Protecting Workers,
- ADA, and state based labor Laws
Review Slides
Handouts
- Labor Law Training Part I
- Labor Law Training Part II
Topic of the Week: Coaching: Think of someone
from your past who coached you to success. What
qualities did the coach possess or what skills did
the coach employ to assist you? How did the
coach communicate goals? How did the coach
evaluate your efforts and give feedback? What
reward or recognition did you receive? How you
could use these elements as a supervisor?
Module 12 Financial Management:
- Accounting
- Budgeting
Handouts
- Budget Cuts Assignment
- Capital Request Assignment
Read Shaw CH 13
Review Slides
- Emergency Policy & Procedure
Assignment
Topic of the Week: As a first year department
manager you have been selected to sit on a
committee to build a budget manual because too
many of the newer managers are struggling with
the process. List some things you would like to
see in a budget manual that would help those new
to budgets:
Module 13 Developing Staff & Human
Resources
- performance appraisal
- managing physicians and professional staff
Exam #3 (Sayles CH 18, 13, handouts)
Topic of the Week: The competence of medical
staff needs to be evaluated annually. What role
does HIM fill in this responsibility?
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Module 14 Organizing for Performance
Improvement
- Role of leaders in PI activities
- Effective communication examples
Read Shaw CH 14
Review Slides
- Coder Performance Measurement
Assignment
Topic of the Week: If you have had a negative
experience with performance appraisals, what
did you learn from that experience that you can
use as a supervisor?
Module 15 Managing the Human Side of Change Read Shaw CH 18
- Applying change management to PI
Review Slides
- Best Practice Guide Assignment
- The three phases of change
- The key steps in change management
Topic of the Week: The HIM field is always
changing, what is your personal 5 year plan to
stay “one step ahead” in your HIM career?
Finals Week
Course Evaluation
Complete Exam #4 (Shaw CH 13, 14, 18)
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