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RN auditor/coder

Quality Improvement   (11,693 Views 18 Comments)
by Rachel2932 Rachel2932 (New Member) New Member

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NurseEvolution has 19 years experience and works as a Quality Improvement/Informatics RN.

726 Visitors; 9 Posts

Hi RHIA RN - sorry for the delay!

We are not yet concurrent, but we have taken months of core measure (CM) retroactive abstraction down to about being only 2 or so weeks behind. This has become easier in the last 6 months as many of the CMs have been removed, per CMS. We just have to wait for our online vendor to drop in the cases to the web tool so we can begin abstraction.

Unfortunately, our EHR is not quite robust enough yet for us to complete realtime abstraction. We do have CMRNS who concurrently review charts on the floor to do do realtime education and have clinicians complete documentation and ordering to meet the measures.

We're getting there - I hope this is helpful :)

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NurseEvolution has 19 years experience and works as a Quality Improvement/Informatics RN.

726 Visitors; 9 Posts

Can you explain what is abstract Core Measures

Yes - it is auditing patient charts while they are either still in the hospital or have gone home.

The purpose is to gather data mainly for The Joint Commission or The Center for Medicare and Medicaid Services (CMS). They want to see that hospitals are providing the "right" care to patients based on a particular disease or medical problem, such as those with heart attacks, those who smoke or those that come in for a surgery - in order to improve their outcomes. They have measure sets, such as "AMI - Heart Attack" and the indicators are the specific actions the clinician needs to complete, such as "Did the patient receive an aspirin within 24 hours of arrival to the hospital". If they did, they pass the measure, if not, it is considered a failure/variance and the hospital gets dinged by either TJC or CMS for it.

Collecting core measures (both inpatient and outpatient) are required federal programs, and with CMS, some indicators have financial impact for the hospital on how well they do on core measures. Also, the hospital data collected is publicly reported, so patients can look at how well a hospital is doing on core measures, to make an informed decision if they want to seek care at that hospital. Clinical core measures are one of the indicators of quality care in a facility.

Core measure abstraction is interesting and very detailed work. It is a great way to support quality care in a healthcare organization.

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knurse8 has 25 years experience and works as a RN.

1,609 Visitors; 16 Posts

After reading about data abstraction and applying for a few positions I discovered on another thread that these jobs will slowly disappear due to real time extractions being coded into software(?). It's really helpful when those on the "inside" can provide insight and guidance. I having been doing a lot a research trying to decide how to best transition into a REMOTE/ WFH- work from home- position. It appears that 20years of nursing with diverse clinical background (NICU, Ped's, Home Health/Hospice, case management, QUAPI, and admin experience is not enough to crack the door open. So time to pursue some certifications in Coding and Auditing. I'm trying to decide between the 2 organizations: AHIMA: CCA- Certified Coding Associate and then follow with CDIP- Clinical Doc Improvement Practitioner. Or AAPC: CPC- Cert Professional Coder and CDEO Cert Documentation Expert. When I search these keywords on Indeed the credentials seem in demand, just hope the extra time effort and money translates into a landing a good job! Any insider direction, insights or pointers WELCOMED!!

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197 Visitors; 6 Posts

Hi Knurse8

This thread is a couple years old but I am curious if you decided to pursue the CCA/CDIP Certifications or the CPC/CDEO. I am like you in regards to 30+ years diverse nursing experience primarily as Clinical, Adult Critical Care, and Endoscopy nurse and need to transition my career. I am presently enrolled in AHIMA Basic Coding 1 and hoping to move into a medical coding role to start and progress from there. Any suggestions welcome by anyone! Thanks in advance ..

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197 Visitors; 6 Posts

This thread is a couple years old but I am curious if anyone has decided to pursue the CCA/CDIP Certifications or the CPC/CDEO. I have 30+ years diverse nursing experience primarily as Clinical, Adult Critical Care, and Endoscopy nurse and need to transition my career. I am presently enrolled in AHIMA Basic Coding 1 and hoping to move into a medical coding role to start and progress from there. Any suggestions welcome by anyone! Thanks in advance ..

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knurse8 has 25 years experience and works as a RN.

1,609 Visitors; 16 Posts

I know this is a very late reply but I did land an ICD coding position without earning my CPC. This company preferred nurses over non clinical coders (CPC' CCS). They provided in-house training that was very organized and structured. But equally designed to progressivly squeeze out nurses that did not meet thier high production quotas & standards. Im glad I did not invest in getting my CPC license because I learned even though I could do it, I REALLY REALLY disliked it. Most recently I took a on line HEDIS training course and combined with my QA/Admin experience landed a position for the 2019 season. Down side is it is non salary IC and pays strickly per chart/review. Think Ill do better and be more productive on good old self motivation vs pressure of high quotas. Id love to hear an update on what yor doing, we all have to find our niche. WFH is hard work, all those physical skills get flipped into added mental strain. I dont miss comutting in traffic and enjoy the perks of my dog laying at my feet while sipping my coffee in PJ's. Hope your doing the same

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