coder/intake what are their duties

Intake RN duties.... part of my staffs job description:

1.. Initiates, reviews and accepts referrals based on appropriateness for homecare, agency acceptance policy and skilled/non skilled service requirements.

2. Maintains knowledge base of Medicare and Managed Care criteria for coverage of homecare services. Initiates insurance verification process to verify insurance coverage for homecare services and determines primary insurance coverage. Reviews patient referral information for Medicare Secondary Payer requirements prior to homecare admission.

3. Obtains initial homecare authorizations for all non -contracted managed care clients and timely follows-up on outstanding authorization requests using internet insurance websites, phone calls, or faxes to managed care companies/reviewers. Negotiates fees for homecare services per agency guidelines.

Works with insurance verification clerk to identify referrals primary diagnosis code and obtain contracted managed care authorizations.

4. Maintains extensive knowledge base of companies agency manages pertaining to their various insurances, covered services, referral sources, external and internal business associates.

5. Processes referrals in a timely manor. Notifies manager of problematic situations: unable to verify patients insurance or eligibility, difficulty obtaining authorizations, etc.

6. Directly enters data into agency database for phoned in referrals and completes/reviews paper referral received via fax. Enters computer referral paying attention to details and completes work accurately. Effectively utilizes computer database.

7. Participates in Utilization Review and Performance Improvement activities.

8. Utilizes business telephone etiquette. Maintains and projects a professional and courteous demeanor to patients, families, referral sources, staff healthcare professionals and external business associates....

Add to that Coding responsibilities:

1. Review each admission chart to ensure meets guidelines for admission.

2. Appropriately assign ICD 9 diagnosis codes based on admission documentation forms /OASIS.

3. Notify clinical staff missing info on admission/OASIS form, discrepency or needing completion so you can assign diagnosis code.

4. Educate/explain Medicare coding regs have you assigning different primary diagnosis /financial impact to agency and have staff signoff they agree to change.

5. Respond to Medicare 488 audit requests on monthly basis.

If you provide infusion services, each referral averages one hour to tie up documentation compared to 5-10 minutes rountine referral.

Now if one adds staff scheduling to that list ----IMPOSSIBLE to keep sane head unless small agency with about 25 admissions per week. Then you are expected to help GROW the business..... If you can roll with the punches, are adventuresome, see glass as half full and insist on coding training ASAP it is possible.

Last year my staff of 24 affected the lives of 22,000 patients with homecare referrals. It is challeange and rewarding, especially when behind the scenes you get services covered after 6 calls to doctors and insurance companies knowing just the right healthcare buzz words to use.

Good Luck in what you decide.