Saturday, July 31, 2010

What does an RHIT do?

When you're a new RHIT, recently graduated with little more experience than your six-week clinicals, you expect to take the first entry-level job available, as many new graduates in any field do. Many of my friends in my graduating class have gotten jobs as medical records file clerks. File clerks work in hospitals, doctor's offices, health plans... anywhere medical records are stored. Basically, it's their job to maintain order in the area where the files are stored, make sure they get to where they need to go, for instance if a doctor needs them, then keep track of where they are so they can be accessed at a moment's notice, and finally correctly re-file them when they are done. File clerks are also sometimes responsible for "purging." That is knowing the state laws and your organizations requirements for how long charts are kept past the patients last visit. Usually it's a bout ten years, but it varies from state to state and organization. If a record is older than that date, the record can legally be destroyed and a record is made that it was disposed of. File clerks usually earn between ten to twelve dollars an hour. There aren't usually benefits, but in today's economy, a full-time job is a full-time job.

Some RHIT's start out as receptionists. The important thing is to break into the field with your first job. RHIT's who accept entry-level positions usually don't stay there long because upward movement is easy to be had once you get a little experience. The benefit of getting in at the bottom is that when positions you're more interested in within the organization open up, employees usually have the first opportunity to apply. And even if you work for one organization, and your dream job opens up at another organization, you have a better chance of being hired for it because now you have not only your degree and credential, which carry a lot of weight on their own, but in addition you have experience in the field.

So what are the "bigger" jobs within the Health Information Management field? There are many different jobs in a hospital HIM department. During my clinical experience at Sacred Heart, I learned that each person in the HIM department does one job, that is one small piece of the HIM pie. We'll start with the quantitative analysts. Quantitative Analysis is the process of receiving the chart of a patient that has recently been released from the hospital and making sure that each document, such as discharge summaries and progress notes are signed correctly, with the provider's name, credentials (M.D. or A.R.N.P) the date, and the time of the entry. If something is missing, the analyst notes it, (usually in a computer program) marks it with a sticky note and sends it back to the provider for completion. There are laws and requirements for accreditation that apply to documentation, and it is the responsibility of everyone in the HIM field to ensure that documentation is complete and compliant with those laws and requirements.

The next process the chart goes through is called assembly. The chart has to be in the correct order so that providers and other authorized users can find all the information they need quickly. The assembly person puts each document in the record in it's proper place. There is a somewhat universal order that hospital charts go in, but each facility tweaks it a little bit.

Coding is what many RHIT's aspire to, because it is highly technical, RHIT's are specifically certified to do it, and it's one of the higher paid jobs in the HIM field. Coders use ICD-9-CM codes which are based on the patient's diagnosis and treatments in an inpatient setting. Doctor's visits, or any out-patient care are assigned CPT codes. If a doctor has documented in the chart that a patient has bronchitis, the coder uses the ICD-9 codebook to look up bronchitis. Then the coder chooses the correct code in the bronchitis section, which could be influenced by many factors and documents the code selection. To put it very simply, the coder assigns the codes, then based on those codes, insurance companies reimburse the hospital and/or doctors clinic, etc. There are many different areas of coding an RHIT can go into.

Emergency coding could be considered the most simple. A patient comes into the emergency room with one major problem, an acute condition, and that's usually all that is coded: what the condition was, how it was treated and weather the patient was admitted to the hospital or released.

Inpatient coding can sometimes be the most complicated. When I was at Sacred Heart, I saw a chart for one patient that was the entire length of the shelf. Inpatient charts often have multiple diagnoses and many, many treatments. An inpatient coder really has to know their stuff, including the rules for combination codes (When there are related conditions such as hypertension and chronic kidney disease) and, for instance, that when a patient undergoes surgery, even though each step is meticulously documented in the operative report, you don't code (therefore charging for) the closure of the incision. Or when there is a diagnosis of bronchitis, you only code the bronchitis, not the cough.

Finally, outpatient coding is also done in a hospital, as well as in doctor's offices, ambulatory surgery centers, etc. using CPT codes. The coding supervisor over all the coders in the HIM department is often an RHIT. Coding can also be done from home, which is my eventual dream-job. Remote coding is becoming more prevalent as organizations seek to cut things like overhead costs. However, if you're coding at home there is no one to stand over your shoulder to answer questions and check your work, so you have to be a fairly experienced coder.

One big thing affecting coding is the adoption of ICD-10-CM. The rest of the world is already using ICD-10. America has been behind the 8-ball for a long time. But we are adopting it on Oct. 1st, 2013. ICD-10 is more complicated in a lot of ways, but will also be more accurate. It will be super-important for the coder to have a thorough knowledge and understanding of anatomy and physiology in order to properly use ICD-10.

Release of Information is a very important area in which an RHIT can work. Again, there are many laws and requirements an organization must follow in regard to who can access health records and under what circumstances. Patients often request to see or have copies of their medical records, outside providers often need that information for continuity of care, sometimes law enforcement wants health information on a particular person, lawyers involved in law-suits often want records and they want EVERYTHING. It is one of the most important jobs an RHIT does, protecting health information. If you work in that area you need to know exactly what the laws and requirements are. There can be major consequences if you do something wrong, knowingly or not, including law suits against you or your employer, fines and loss of the facilities accreditation.

No matter where you work, RHIT's are the experts on requirements for documentation, legal issues surrounding it, and we are in a perfect position to write policies and procedures for our organizations and be advisers concerning new laws, such as ARRA, which is causing quite a stir right now, and the adoption of EHR's, (Electronic Health Records.)

In my job at the prison, I run the medical records department, so my job includes everything. I make sure the records get where they need to go, that they have all the required documentation, I do a lot of release of information, and the coding... I work with the providers to make the documentation part of their job easier, and because I'm an RHIT, I have the knowledge and skills to be able to do all that, and I'm part of a huge, nationwide family of professionals just like me. So that is in a nutshell what an RHIT does.

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