Certification Pathways. Additional Business Office Certifications

Transcription

1 Certification Pathways PAC: Patient Access Certification PAS: Patient Access Specialist Cert Annual Patient Access Recertification Billing Prerequisite BC: Billing Certification BSC: PFS/Billing Specialist Certification Annual Billing Specialist Recertification PAC: Patient Access Certification PAS: Patient Access Specialist Certification BC: Billing Certification BSC: PFS/Billing Specialist Certification Annual Billing Specialist Recertification Additional Business Office Certifications 1. Visit 2. Click the blue Register For Free Button. 3. Create a User Account by following the prompts. 4. Click on Course Catalog on the top menu bar, and explore the courses available! We look forward to working with you to customize the programs available to meet your organization s needs. If you have any questions, please contact a member of our HTHU team. Kristy Thomson Meghan Williams Jennie Price

2 Patient Access Certification (PAC) This certification is the first level of training for patient access representatives. The Patient Access Representative is accountable for all front end functions involved in the patient admission process, including but not limited to preregistration, registration, insurance verification, notification to key financial departments of patient's admission/ registration and collections. The Patient Access Representative is the front door to the facility and is usually the first point of contact for the patient and their families. The Patient Access Representative plays a key role in the hospital's revenue cycle; and, their attention to accuracy and high level of quality patient claims data is vital to the hospital's financial success. LEARNING OUTCOMES: Upon completion of this course, student will be able to: Patient Access Services Define the needs and expectations of the 21st century patient. 2. Record correct and accurate patient claims data to produce clean claims. 3. Explain the importance of accuracy. 4. Identify appropriate forms during the registration process. 5. Describe the codes that must be entered as a part of the registration process. What does HCAHPS mean for Patient Access? 1. Define HCAHPS. 2. List the goals of the HCAHPS program. 3. Explain the basics of Value Based Purchasing. 4. Restate the composite questions that are directly related to HCAHPS and how the scores are obtained. 5. Describe how Patient Access personnel can affect the facilities HCAHPS scores. Patient Flow, Teamwork & Quality Patient Care 1. Recognize the how variant patient flow can affect patient access services. 2. Outline how patient flow can be improved. 3. List ways in which efficient patient flow can influence quality healthcare. 4. Identify ways in which teamwork can be used to improve patient flow. Professional Conduct in Healthcare 1. Define what communication means. 2. List barriers to effective communication in healthcare. 3. Identify techniques for improving communication in healthcare. 4. Distinguish between typical groups of customers and how this impacts our approach to their care. 5. Outline ways to assist patients with Special Needs. 6. Identify basic safety needs in your facility. 7. Review the key aspects of HIPAA. 8. Recognize the key aspects of patient rights. 9. Identify laws and policies that mandate ethical conduct in healthcare. 10. Apply these legal and ethical terms to the role of patient access. Health Insurance Basics 1. Define key terms for insurance. 2. Review the different types of insurance. 3. Distinguish managed care plans. 4. Explain timely filing, explanation of benefits (EOB) and pre-certification/pre-registration. EMTALA Law 1. Define EMTALA. 2. Restate the steps that must be taken to maintain general compliance with EMTALA regulations. 3. Define Dedicated Emergency Department, Emergency Medical Condition and an Appropriate Medical Screening. 4. Recognize the appropriate and compliant time to request Financial and Registration information. Keys to Successful Collections 1. State reasons why upfront collection is of benefit to both hospital and patient. 2. Identify techniques for effective upfront collection. 3. Identify ways to offer care while addressing the requirement for payment. 4. Outline ways to address and overcome objections. Your Role in the Revenue Cycle 1. Outline the key areas of the Revenue Cycle. 2. Identify the 4 C's of the Revenue Cycle Team and the importance of being a team player. 3. Explain proven methods to improve results. 4. Express the "Do It Right the First Time" mentality. In order to receive your Patient Access Certification, along with 0.7 CEUs/7 credit hours, you must complete all of the required courses listed here and all assignments within each course. Patient Access Certification (FINAL) No Prerequisite required.

3 Patient Access Specialist Certification (PAS) This certification is the next level of training for patient access representatives, following the Patient Access (PA) certification. The Patient Access Specialist plays a key role in the Patient Access Department and works as a strong team member in a dynamic, fast-paced, patient-focused environment. The Patient Access Specialist willingly accepts additional responsibilities, as requested, and demonstrates the ability to work and make decisions without supervision. LEARNING OUTCOMES: Upon completion of this course, student will be able to: Next Generation of Patient Access - Outline some of the main challenges to financial clearance. - Recognize how technology can aid the financial clearance process. - List technologies that have been developed to assist patient access with the financial clearance process. Addressing Patient Centered Care in your Business Office - Define what Patient Centered Care means in health care today. - Summarize the relevance of patient centered care in the patient access role. - List the benefits of patient centered care. - List ways to meet the challenge of integrating patient centered care. Registration Quality - Describe General Registration Functions. - Recognize the value of Accuracy Rate Monitoring. - Restate primary items to audit during Account Audits. - Express how peer review is useful in healthcare. Advanced Customer Service - Define Internal vs. External Customers. - Recognize where Customer Service begins. - Restate the difference between burn out and stress. - Discuss ideas for relieving employee burnout. MSP - Medicare Secondary Payer - Define MSP provisions. - Recognize types of insurances where Medicare would be a secondary payer. - Identify insurances and situations where Medicare would be a secondary payer. - Discuss the MSP questionnaire. Improving Performance in Healthcare - List common Key Performance Indicators for healthcare in general and patient access specifically. - Describe how benchmarking can be applied to patient access. - Outline tools that can be used to measure and improve performance such as Balanced Scorecards, benchmarking etc. Standards of Compliance: Promoting a Culture of Patient Security and Privacy - Outline the oversight agencies responsible for HIPAA compliance. - Explain the implications of non-compliance of HIPAA. - Give examples of ways of developing a culture of patient privacy and security in hospitals. Code of Conduct in Healthcare - State reasons why hospitals have a code of conduct. - List elements that should be included in a code of conduct. - Outline initiatives to ensure a code of conduct is a document that is actively used and respected. ABN - Advanced Beneficiary Notice - Define ABN. - Recognize when and how to obtain an ABN. - List what services may require an ABN. - Restate the components of an ABN. - Discuss the specific billing requirements when an ABN is issued. Medical Terminology - Understand the 3 main elements of medical terms. - Define common words. - Identify medical abbreviations. Patient Access Specialist Certification (FINAL) In order to receive your Patient Access Specialist Certification, along with 1.1 CEU/11 credit hours, you must complete all of the required courses listed here and all assignments within each course.

4 Billing Certification (BC) This certification is the first level of training for hospital billers. Hospital Billers are accountable for the compliant and correct billing of claims generated through multiple services provided by the hospital. The Hospital Biller plays a key role in the hospital's revenue cycle; and, their attention to detail, follow-up and CMS billing guidelines is vital to the hospital's financial success. 1) Billing Certification Introduction - Explain the purpose of this Billing Certification. 2) BC501-13: Introduction to Hospital Billing - Describe your role as a biller. - Recite the history of the UB04. - Recognize why electronic billing is so much faster and better than paper billing. - Identify payers. 3) BC551-13: Understanding and Utilizing the UB-04 - Complete a UB04. - Describe the form locators on the UB04. - Restate UB04 requirements. - Identify the payer. 4) BC510-13: What Are My Services? How Do I Bill For Them? - Determine the type of service a patient received - Determine bill types - Complete FL based on service and TOB - Complete FL based on service and TOB 5) BC540-13: Health Care Billing Compliance - Define compliance as it relates to health care and identify the agencies that are responsible for making the rules. - Summarize and give examples of the False Claims Act. - Summarize the Anti-Kickback Statues, The Stark Law and EMTALA. - Discuss the various payment methods used by Medicare that are target areas for fraud and abuse investigations. - Outline components of an effective compliance program. 6) BC470-13: 3 Day Window Rule - Explain the 3 day window rule. - Define the differences in diagnostic and non-diagnostic services. - Identify services which are subject to the rule. - Understand the recent changes in the rule. 7) BC570-13: Medicare Consolidated Billing - Explain when/why consolidated billing was implemented. - Discuss what is included and excluded from SNF and HHA consolidated billing payments. - Recognize admission source codes and discover why they are important. - Restate what hospital registration responsibilities are and why they are important if a patient is in a PPS stay. 8) BC560-13: Observation Billing Guidelines - Define and explain what Observation services are. - Explain what documentation is needed and how to calculate hours for Observation services. - Discuss how to charge for and what the billing requirements are for Observation services. 9) BC450-13: Swing Bed Admission & Billing Guidelines - Describe swing beds, why they are utilized, who is eligible, and how the swing bed program is documented. - Identify which patients qualify for the swing bed program. - Explain the difference in ""acute care"" and ""skilled care"" and determine which qualifies for the swing bed program. - Discuss how Medicaid and Medicare provide reimbursement for the swing bed program. 10) Billing Certification Final - Explain final Billing Certification activities. Learning Outcomes Standard: Based upon requirements set by Centers for Medicare & Medicaid Services (CMS Billing Manual, CMS Transmittal 796, CMS website), Federal Register, Hospital Billing Guidelines, Ingenix UB Editor, and expert billing knowledge. You will receive 0.8 CEUs/8 credit hours for this course when all Learning Outcomes Conditions have been met. *PREREQUISITE: You must take the Patient Access Certification and the Patient Access Specialist Certification; or, if you prefer, you can take the Billing Prerequisite course. You will not be allowed to pass this course until you have completed PAC & PAS or Billing Prerequisite.

5 Billing Specialist Certification (BSC) This certification is the second level of training for hospital billers, after the Billing Certification. The PFS/Billing Specialist Certification includes more advanced billing courses designed to offer you more in depth knowledge of the association between billing, medical terminology, denial management, policy and procedure, and basic coding. Considering the constant changes in healthcare billing, these courses will give you the tools you will need to stay current with billing specifications and help you obtain maximum reimbursement from your payers. This certification is the financial key to your facility's revenue cycle management success. Once you complete this certification, make sure to watch for new courses that will keep you up to date with the on-going changes in reimbursement. REQUIRED COURSES & LEARNING OUTCOMES: Upon completion of this certification, student will be able to: 1) PFS/Billing Specialist Certification Introduction - Explain the purpose of this certification. 2) BSC511-13: Insurance Follow up - Effectively collect payments from insurance companies. - Follow up on claims more efficiently. - Increase your facility's revenue by using your improved knowledge for handling claims and complications. 3) BSC513-13: Remittance Advice, Cash Posting & Credit Balances - Read Remittance Advices from multiple payers. - Decide which information on these remittances needs to be posted into a patient's account. - Research credit balances on your patients' accounts with a focus on Medicare Credit Balance. - Define the role of the Denial Management Team. 4) BSC515-13: Denial Management - Explain how denials affect most every department in your facility. - Set up your own Denial Management Team. - Track and monitor denials. - Utilize the appeal process more effectively. 5) BSC331-13: Medical Terminology II - Explain the building blocks of medical terminology. - Understand combining vowels and pronunciation of words. - Complete Fahrenheit to Celsius conversions. - Utilize conversion tables for metric to non-metric measurements. - Recognize descriptive medical terms and eponyms. - Decipher more medical terms than ever before. 6) BSC580-13:Coding for the Non-coder - Discuss what medical coding involves. - Recognize what CPT/HCPCS codes are used for. - Explain why, when and how codes are applied. - Identify how coding is connected to reimbursement. - Describe how codes are linked to medical necessity. - Identify ICD coding and how it is different from HCPCS/CPT coding. 7) BSC572-13: Medicare Modifiers - Identify the most commonly used modifiers as well and know when and how to use them. - Explain how utilizing modifiers can affect your reimbursement. - Integrate specifics on which modifier to use with the most common OCE edits. - Analyze how improper use of modifiers can put you at risk. 8) BSC582-13: Billing & Coding for IV Drug Administration - Explain the complicated rules of IV drug administration. - Identify the three categories of IV infusions and injections. - Discuss the hierarchy of CPT reporting. - Utilize the rules for initial, sequential and concurrent injections and infusions. - Explain the importance of documentation and related documentation rules. 9) BSC574-13: Evaluation and Management (E/M) Services - Explain what an E/M code is at your facility and know when to use them. - Describe the different models available for E/M assignment. - Interpret CMS requirements under OPPS. - Outline your own internal guidelines. 10) BSC990-13: Business Office Policy & Procedure - Establish new or update existing policies and procedures in your business office. - Explain the importance of keeping policies and procedures current. - Describe Financial Policy, Charity Care & Financial Discount Policy, and Policy on Billing Practices. 11) PFS/Billing Specialist Certification (FINAL) You will receive 1 CEU/10 credit hours for this course when all Learning Outcomes Conditions have been met. PREREQUISITE: You must complete the Billing Certification (BC) before taking this PFS/Billing Specialist Certification. You will not be allowed to pass this certification until you have completed Billing Certification, which can be found in the Course Catalog.

6 Financial Counselor Certification (FCC) Financial Counselors play an integral role in hospital cash collections. They assist patients in locating funding, securing payment and funding sources, and determine the best financial solution available. The Financial Counselor Certification (FCC) includes the following lessons: 1) Financial Counseling: Overview 2) Financial Counselor: Collections 3) Financial Counseling: Insurance Basics 4) Financial Counseling: Funding Sources 5) Financial Counseling: ICTF 6) Financial Counseling: Legal Remedies LEARNING OUTCOMES: Upon completion of this course, student will be able to: - Explain what a financial counselor does. - Identify qualities of a good financial counselor. - Describe the process you would follow if a patient provided untrue or questionable statement - Recognize patient cues. - Explain various insurance terms to your patients to accurately convey estimated patient liability at time of service. - Interpret your facilities insurance contracts to calculate expected patient liability. - Describe the role the Prompt Payment Law plays in the payment of insurance claims. - Discuss when and how Health Savings Accounts are used. - Describe the Medicaid Eligibility Process. - Explain the Disability Application Process. - Identify whether or not your facility can enroll in Section Discuss what options a self pay patient has if they do not qualify for any program. - Explain the requirements of the ICTF. - Discuss the conditions for deposit and transfer of funds to ICTF. - Define the requirements for free and reduced care. - Restate the Public Notification requirement. - Explain the purpose of a judgment lien. - Describe when and how garnishments are applied. - Define hospital liens. - Identify the different types of bankruptcy. Learning Outcomes Standard: Based upon current rules, regulations and duties defined for a hospital financial counselor. You will receive 0.6 CEU/6 credit hours for this course when all Learning Outcomes Conditions have been met.

7 Certified Healthcare Hospitality Specialist (CHHS) This Certified Healthcare Hospitality Specialist certification is designed for all healthcare personnel from clinical to business associates. Whether you are dealing directly or indirectly with patients and visitors or interacting with staff and personnel within your facility, quality interactions can positively contribute to patient and visitor satisfaction with your facility as well as create a positive and productive working environment. This certification will provide the student, regardless of their position, with basic fundamental knowledge of Customer Service, Telephone Etiquette, HIPAA Privacy and best practice solutions for serving your facility. When you apply the guidelines provided in these courses, you'll find that others treat you with more respect and are willing to go out of their way to assist you. Patients and visitors are ultimately positively affected by staff and personnel who apply these guidelines to their working environment. The healthcare environment demands a professional staff and this certification is designed to help you achieve a proper level of professionalism. LEARNING OUTCOMES: Upon completion of this certification, student will be able to: 1) Customer Service and You - Recognize the importance of good customer service in the healthcare setting. - Identify ways of leaving a good impression with customers. - Describe methods of dealing the challenges of customer service. - Appraise your own approach to customers and how it may be improved. 2) Telephone Etiquette - List basic telephone procedures and ways to sound professional. - Identify strategies that reduce customer complaints regarding phone interaction. - Employ methods for developing good habits for automation and voic . - Employ methods for making successful phone calls. 3) Advanced Customer Service - Define Internal vs. External Customers. - Recognize where Customer Service begins. - Restate the difference between burn out and stress. - Discuss ideas for relieving employee burnout. 4) Dealing with the Difficult - Define difficult coworkers and put into action strategies that will change the bad situation into to a good one. - Recognize health issues that cause patients to be difficult to deal with. - Implement Do's & Don'ts in our everyday relationships with the difficult patients that will result in positive outcomes for both facility staff and patient. - Whether with coworker or patient, demonstrate conflictresolution skills that transform negative behaviors into positive ones. - Identify negative procedures in the workplace that result in negative attitudes. - Discuss 10 positive workplace behaviors and evaluate the positive impact that those behaviors have on staff. 5) HIPAA Privacy - Apply privacy standards brought about by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. - Identify the medical record as protected and confidential information. - Apply the hospital's policy on patient confidentiality. - Reorganize examples and repercussions of patientconfidentiality breaches. - Identify what information can be released without prior approval from the patient. 6) HIPAA Security - Recognize what the HIPAA Security Rule requires at your facility. - Identify where to go for questions and answers. - Define the basic security concepts at your facility. - Apply security ʺbest practicesʺ to safeguard electronic protected health information (ephi). - Apply security policies related to your job. - Recognize that all staff play a role in protecting ephi. 7) Spiritual Care - Listen actively for clues to patients' spiritual preferences, being sensitive to their background and affiliation. - Notify the physician of anxiety or depression that may require pharmacologic or psychiatric intervention. - Recognize the value spiritual leaders can contribute to the needs of patients or fellow team members. - Provide referrals (with patient's permission) to an appropriate spiritual leader. - Recognize that a spiritual leader is part of the interdisciplinary team who can support the patient's family in times of grief or despair. 8) What is HCAHPS? - Explain HCAHPS: Hospital Consumer Assessment of Healthcare Providers and Systems. In order to receive your CHHS Certification, along with 0.7 CEU/7 credit hours, you must complete all of the required courses listed above and all assignments within each course.

8 Certification Pathways PAC: Patient Access Certification PAS: Patient Access Specialist Cert Annual Patient Access Recertification Billing Prerequisite BC: Billing Certification BSC: PFS/Billing Specialist Certification Annual Billing Specialist Recertification PAC: Patient Access Certification PAS: Patient Access Specialist Certification BC: Billing Certification BSC: PFS/Billing Specialist Certification Annual Billing Specialist Recertification Additional Business Office Certifications 1. Visit 2. Click the blue Register For Free Button. 3. Create a User Account by following the prompts. 4. Click on Course Catalog on the top menu bar, and explore the courses available! We look forward to working with you to customize the programs available to meet your organization s needs. If you have any questions, please contact a member of our HTHU team. Kristy Thomson Meghan Williams Jennie Price