Core Class Materials

AHIMA

American Health Information Management Association

Founded in 1928, AHIMA is the premier association of health information management (HIM) professionals worldwide. Serving 52 affiliated component state associations and more than 103,000 health information professionals, AHIMA is the leading authority for "HIM knowledge" and widely respected for its esteemed credentials and rigorous professional education and training.

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AHIMA Body of Knowledge

AHIMA's HIM Body of Knowledge™ provides resources and tools to advance health information professional practice and standards for the delivery of quality healthcare. Anchored by AHIMA-owned content and complemented by government resources and links to external web sites, the Body of Knowledge encompasses the theory and practice of health information management, and enables HIM professionals to access quickly and easily information needed to be successful.

Student Note: The majority of resources within AHIMA's Body of Knowledge (BOK) requires an AHIMA membership. It can be incredibly useful to have this access for assignments.

AHIMA Career Prep Tools

While health information is a rapidly growing field, finding the right entry-level position can be a challenge in any profession. The difficulty often lies not in acquiring the necessary skills or credentials, but rather integrating yourself into the professional community. To become a health information management (HIM) or health informatics professional, you'll have to think like one, and work with the collaborative nature of the industry.

Student Note: There is a Career Prep Workbook that requires an AHIMA membership in order to access. This is a great starter resource for getting started.

Career Map

AHIMA has an interactive career map that has four main sections:

  • Coding and Revenue Cycle
  • Informatics
  • Data Analytics
  • Information Governance

Check it out here.

AHIMA Certifications

The Commission on Certification for Health Informatics and Information Management (CCHIIM) is an AHIMA commission dedicated to assuring the competency of professionals practicing HIIM. CCHIIM serves the public by establishing, implementing, and enforcing standards and procedures for certification and recertification of HIIM professionals. CCHIIM provides strategic oversight of all AHIMA certification programs. This standing commission of AHIMA is empowered with the sole and independent authority in all matters pertaining to both the initial certification and ongoing recertification (certification maintenance) of HIIM professionals.

Student Note: The Health Information Management program at COCC prepares students for the RHIT and CCA certification exams. AHIMA offers more certifications for higher levels as well.

RHIT

Registered Health Information Technician

Professionals holding the RHIT credential are health information technicians who:

  • Ensure the quality of medical records by verifying their completeness, accuracy, and proper entry into computer systems.
  • Use computer applications to assemble and analyze patient data for the purpose of improving patient care or controlling costs.
  • Often specialize in coding diagnoses and procedures in patient records for reimbursement and research. An additional role for RHITs is cancer registrars - compiling and maintaining data on cancer patients.

With experience, the RHIT credential holds solid potential for advancement to management positions, especially when combined with a bachelor's degree.

Student Note: Finishing the Health Information Management program at COCC meets the eligibility requirements for taking the RHIT exam.

CCA

Certified Coding Associate

The CCA credential distinguishes coders by exhibiting commitment and demonstrating coding competencies across all settings, including both hospitals and physician practices. The US Bureau of Labor Statistics estimates a shortage of more than 50,000 qualified HIM and HIT workers by 2015. Becoming a CCA positions you as a leader in an exciting and growing market. CCAs:

  • Exhibit a level of commitment, competency, and professional capability that employers are looking for
  • Demonstrate a commitment to the coding profession
  • Distinguish themselves from non-credentialed coders and those holding credentials from organizations less demanding of the higher level of expertise required to earn AHIMA certification 

Based upon job analysis standards and state-of-the-art test construction, the CCA designation has been a nationally accepted standard of achievement in the health information management (HIM) field since 2002. More than 8,000 people have attained the certification since inception.

Student Note: In addition to being able to take the RHIT exam after completing the Health Information Management program at COCC, students are also eligible to take the CCA exam.



HHS

Health & Human Services

It is the mission of the U.S. Department of Health & Human Services (HHS) to enhance and protect the health and well-being of all Americans. We fulfill that mission by providing for effective health and human services and fostering advances in medicine, public health, and social services.

Read more here.

HIPAA

Health Insurance Portability and Accountability Act of 1996

To improve the efficiency and effectiveness of the health care system, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, included Administrative Simplification provisions that required HHS to adopt national standards for electronic health care transactions and code sets, unique health identifiers, and security. At the same time, Congress recognized that advances in electronic technology could erode the privacy of health information. Consequently, Congress incorporated into HIPAA provisions that mandated the adoption of Federal privacy protections for individually identifiable health information.

Read more here.

CMS

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS).

We pledge to put patients first in all of our programs – Medicaid, Medicare, and the Health Insurance Exchanges. To do this, we must empower patients to work with their doctors and make health care decisions that are best for them.

This means giving them meaningful information about quality and costs to be active health care consumers. It also includes supporting innovative approaches to improving quality, accessibility, and affordability, while finding the best ways to use innovative technology to support patient-centered care.

Medicare

The Centers for Medicare & Medicaid Services (CMS) is the federal agency that runs the Medicare Program. CMS is a branch of the Department of Health and Human Services (HHS). CMS also monitors Medicaid programs offered by each state.

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Getting Started with Medicare

Whether you’re new to Medicare, getting ready to turn 65, or preparing to retire, you’ll need to make several important decisions about your health coverage. If you wait to enroll, you may have to pay a penalty, and you may have a gap in coverage.

Read more here.

Part A Costs

Premium-free Part A

You usually don't pay a monthly Premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes for a certain amount of time while working. This is sometimes called "premium-free Part A."

Most people get premium-free Part A.

Read more here.

Part A Coverage

In general, Part A covers:

  • Inpatient care in a hospitalS
  • Skilled nursing facility care
  • Inpatient care in a skilled nursing facility (not custodial or long-term care)
  • Hospice care
  • Home health care

Read more here.

Part B Costs

Part B premiums

You pay a premium each month for Part B. Your Part B premium will be automatically deducted from your benefit payment if you get benefits from one of these:

  • Social Security
  • Railroad Retirement Board
  • Office of Personnel Management

If you don’t get these benefit payments, you’ll get a bill.

Read more here.

Part B Coverage

Part B covers 2 types of services

Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

Read more here.

Medicare Advantage (Part C) Costs

Each year, plans set the amounts they charge for premiums, deductibles, and services. The plan (rather than Medicare) decides how much you pay for the covered services you get. What you pay the plan may change only once a year, on January 1.

Read more here.

Medicare Advantage Plan Coverage

Medicare Advantage Plans must cover all of the services that Original Medicare covers. However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies. In all types of Medicare Advantage Plans, you're always covered for emergency and Urgently needed care.

The plan can choose not to cover the costs of services that aren't Medically necessary under Medicare. If you're not sure whether a service is covered, check with your provider before you get the service.

Read more here.

Part D Costs

Your actual drug plan costs will vary depending on:

  • The drugs you use
  • The plan you choose
  • Whether you go to a pharmacy in your plan's Network
  • Whether the drugs you use are on your plan's Formulary
  • Whether you get Extra Help paying your Medicare Part D costs

Read more here.

Part D Coverage

Each Medicare drug plan must give at least a standard level of coverage set by Medicare. Plans can vary the list of prescription drugs they cover (called a formulary) and how they place drugs into different "tiers" on their formularies.

Read more here.

Other Medicare Health Plans

Some types of Medicare health plans that provide health care coverage aren't Medicare Advantage Plans but are still part of Medicare. Some of these plans provide Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, while most others provide only Part B coverage. Some also provide Medicare prescription drug coverage (Part D).

Read more here.

Report Fraud & Abuse

Medicare fraud wastes a lot of money each year and results in higher health care costs and taxes for everyone. There are con artists who may try to get your Medicare Number or personal information so they can steal your identity and commit Medicare fraud.

Read more here.



Medicaid

The Center for Medicaid and CHIP Services (CMCS) is one of six Centers within the Centers for Medicare & Medicaid Services (CMS) , an agency of the U.S. Department of Health and Human Services (HHS) .

CMCS serves as the focal point for all the national program policies and operations for three important, state-based health coverage programs:

  • Medicaid provides health coverage to low-income people and is one of the largest payers for health care in the United States.
  • The Children's Health Insurance Program (CHIP) provides federal matching funds to states to provide health coverage to children in families with incomes too high to qualify for Medicaid, but who can't afford private coverage.
  • The Basic Health Program (BHP) allows states an option to provide affordable coverage and better continuity of care for people whose income fluctuates above and below Medicaid and CHIP eligibility levels.
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Medicaid Basic Health Program

Section 1331 of the Affordable Care Act gives states the option of creating a Basic Health Program (BHP), a health benefits coverage program for low-income residents who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace. The Basic Health Program gives states the ability to provide more affordable coverage for these low-income residents and improve continuity of care for people whose income fluctuates above and below Medicaid and Children's Health Insurance Program (CHIP) levels.

Through the Basic Health Program, states can provide coverage to individuals who are citizens or lawfully present non-citizens, who do not qualify for Medicaid, CHIP, or other minimum essential coverage and have income between 133 percent and 200 percent of the federal poverty level (FPL). People who are lawfully present non-citizens who have income that does not exceed 133 percent of FPL but who are unable to qualify for Medicaid due to such non-citizen status, are also eligible to enroll.

Read more here.

Medicaid Program History

The Center for Medicaid and CHIP Services (CMCS) serves as the focal point for all national program policies and operations related to Medicaid, the Children's Health Insurance Program (CHIP), and the Basic Health Program (BHP). These critical health coverage programs serve millions of families, children, pregnant women, adults without children, and also seniors and people living with disabilities.

Read more here.

Medicaid State Overviews

Every state’s Medicaid and CHIP program is changing and improving – most states are expanding coverage for low-income adults; all states are modernizing their Medicaid/CHIP eligibility, enrollment and renewal processes and systems, and taking advantage of many of the new flexibilities provided by the Affordable Care Act. Finally, states are coordinating the application and enrollment process with the messaging and policies for the Health Insurance Marketplace operating in their state to ensure that there is no wrong door to coverage. 

Read more here.

Medicaid & CHIP in Oregon

Explore key characteristics of Medicaid and CHIP in Oregon, including documents and information relevant to how the programs have been implemented by Oregon within federal guidelines.

Read more here.



HealthIT

About ONC

The Office of the National Coordinator for Health Information Technology (ONC) is at the forefront of the administration’s health IT efforts and is a resource to the entire health system to support the adoption of health information technology and the promotion of nationwide health information exchange to improve health care. ONC is organizationally located within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS).

ONC is the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. The position of National Coordinator was created in 2004, through an Executive Order, and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009.

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Privacy, Security, and HIPAA

Health information technology promises a number of potential benefits for individuals, health care providers, and the nation’s health care system.

It has the ability to advance clinical care, improve population health, and reduce costs. At the same time, this environment also poses new challenges and opportunities for protecting individually identifiable health information.

Federal policies and regulations are in place to help protect patient privacy and guide the nation’s adoption of health information technology.

Read more here.

Laws, Regulation, and Policy

The Office of the National Coordinator for Health Information Technology’s (ONC) work on health IT is authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act.

The HITECH Act established ONC in law and provides the U.S. Department of Health and Human Services with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health IT, including electronic health records (EHRs) and private and secure electronic health information exchange.

Read more here.

Interoperability

The Office of the National Coordinator for Health IT (ONC) is responsible for advancing connectivity and interoperability of health information technology (health IT).

ONC’s 10 year plan for advancing interoperability is laid out in a document entitled Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap version 1.0 (Roadmap).

Read more here.

HealthIT Playbook

With the nationwide focus on value and quality in health care and incentives for clinicians to transform their practices and care delivery, investing in health information technology (health IT) is an imperative. Yet the question of how to get health IT to work efficiently and effectively in practice remains a challenge for many.

Making digital information resources available in an easy-to-navigate format is one way to address this question and ease the burden of implementing and using health IT. Which is why the Office of the National Coordinator (ONC) within the U.S. Department of Health and Human Services (HHS) created the Health IT Playbook.

In this Playbook, you’ll find strategies, recommendations, and best practices — extensively researched and gleaned from a variety of clinical settings — to help you find the support you need. Taking these steps will help reduce the pain of implementing and using health IT in your practice to advance care information and delivery.

Check it out here.