Healthcare Administrative Professionals’ Role with Monitoring Healthcare Data

As a medical coding and clinical documentation improvement/integrity specialist, I was able to collaborate with healthcare IT professionals to merge the back-end clinical and coding data with the appropriate IT software application configurations in order to provide the most appropriate front-end diagnoses for the documentation within the health record encounter.

The collaborations also consisted of several meetings and training with the end-user/staff who usually will perform these back-end tasks with the documentation to support the diagnosis and/or procedures selected within the software applications. The front-end completed documentation data will then be reviewed by the front-end medical coding and clinical documentation improvement professional for accuracy and diagnosis appropriateness monitoring.

Therefore, understanding how each role impacts the revenue cycle and software system applications for the organization or facility is an important factor with monitoring data while it interfaces with health information software systems and applications.

Each healthcare professional has a different role here:

• Medical Billing Professionals: This role consists of navigating the medical record data output for confirming the proper claim-supporting details.
  
  
• Medical Coding Professionals: This role consists of entering the medical diagnosis into the system from the medical record encounter. Medical coding professionals are also responsible for communication with the physician when clarification is required regarding medical record diagnosis decision making. The clarification is often requested using a facility standard query form.
  
  
• Clinical Documentation Improvement/Integrity Specialists: This role is to determine the most appropriate diagnosis for medical record documentation and resources used to validate the clinical criteria for each encounter. A query is initiated for clarification while the physician is navigating the medical decision making determination and the diagnosis for continuing resources support. Clinical documentation improvement/integrity specialists provide additional documentation strategies with physicians and team members using educational tools to further enhance the knowledge and criteria for improvement initiatives.  
  
  
• Physician: The physician's role is also a key component of the medical record documentation application and system processes. The system administrators are the major components for inputting the medical coding data for the physician to obtain diagnoses in the medical decision making process. Healthcare administrator professionals' knowledge of the organization's medical record data and system interfaces creates a consistent foundation and balance for continuing support to demonstrate the most appropriate outcome and to also maintain a successful healthcare administration department.
  
  
• Healthcare Administrator Professionals: This role ensures compliance with the healthcare data to properly monitor while interfacing with the health information software systems and applications while providing expert level knowledge for continuing collaborations with other organization or facility administrators, stakeholders, directors, or for individual departments regarding systems and/or application issues that may arise. Software applications and systems may have technical issues at times that may possibly be due to organization or facility operational function disruptions. Organization or facility challenges and barriers may be mitigated by healthcare administrative professionals to maintain proper interfacing of the data through the healthcare software applications and systems using a monitored standard office procedure protocol.

It is always a best practice for healthcare administrators to collaborate with interdepartmental professionals within the organization or facility for peer-to-peer and group discussions, which will allow the most appropriate real-time knowledge of the organization or facility documentation for clarifications and/or resource management.

Source: Tamela Rodgers-Phillips, RHIT, CPC, is an administrative healthcare professional with over 20 years of experience in the revenue cycle, including medical billing, medical coding, clinical documentation improvement, process improvement, medical coding instructing, public speaking engagements, and mentoring for stewardship within the health information management community.

Tamela is a graduate of DeVry University and holds two certifications: RHIT (Registered Health Information Technician) and CPC (Certified Professional Coder). She can be contacted at her email: Kendrica25@yahoo.com