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Crossing the Bridge to ICD-10: Using the General Equivalence Mappings (GEMs) to Create a ICD-10 Ready Workplace. Applied Mapping Case Study: The GEMs and MS-DRG Conversion

Author: Butler, Rhonda R.

Source: AHIMA Convention

Publication Date: October 17, 2008

Introduction

ICD-9-CM (referred to hereinafter as I-9) codes are the present basis for many critical healthcare transactions in the U.S.: reimbursement, healthcare quality, and morbidity reporting, to name a few. When the U.S. updates its code set to ICD-101, all systems and applications....

MS-DRGs: One Year and Counting

Author: Perez, Mario A. III; Tully, Melinda

Source: AHIMA Convention

Publication Date: October 17, 2008




Introduction




The most important changes in the Medicare inpatient prospective payment system in 25 years were initiated October 1, 2007. CMS began paying for inpatient hospital services using the CMS-developed Medicare severity DRGs (MS-DRGs). MS-DRGs represent....

Comprehensive CDI: Making it Happen

Author: Pinson, Richard D.; Tang, Cynthia L.

Source: AHIMA Convention

Publication Date: October 17, 2008

Introduction

MS-DRGs were introduced by CMS on October 1, 2007 in an effort to incorporate severity of illness in adjusting hospital reimbursement for inpatient acute care. In response, as CMS predicted, clinical documentation integrity (or improvement) programs [CDI] are springing up eve....

ICD-10 Update

Author: Bowman, Sue E; Butler, Rhonda R.

Source: AHIMA Convention

Publication Date: October 17, 2008


Introduction


The ICD-9-CM classification system is obsolete and unable to meet current healthcare needs and cannot support the transition to interoperable health data exchange. The US is the only industrialized nation not using an ICD-10 based classification system for morbidit....

Why ICD-10 Can’t Wait

Author: Rode, Dan

Source: Journal of AHIMA

Publication Date: October 2008


In August the Department of Health and Human Services (HHS) published two notices of proposed rule making (NPRMs): one for the adoption of ICD-10-CM and ICD-10-PCS and one for an upgrade to the HIPAA transaction standard. Comments on the proposed rules are due on October 21. Once the comment p....

Impact of Creating a Pay for Quality Improvement (P4QI) Incentive Program on Healthcare Disparity: Leveraging HIT in Rural Hospitals and Small Physician Offices [Commentary]

Author: Hart-Hester, Susan; Jones, Warren A.; Watzlaf, Valerie J.M.; Fenton, Susan H.; Nielsen, Carol; Madison, Mary; Arthur, Chris; Marbury, David; Rudman, LeeAnn; Patterson, Randi; Reynolds, Rebecca; Rudman, William J.

Source: Perspectives in Health Information Management

Publication Date: September 2008

Introduction

Reducing health disparities and improving healthcare quality for all Americans has become a national priority. 1–4 Approximately 16 percent (or $4 trillion) of America's gross domestic product is spent on healthcare. 5–7 Despite spending twice as much on healthcare as other i....

Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates ...: Final Rule

Author: U.S. Department of Health and Human Services

Source: Government (U.S.)

Publication Date: August 19, 2008

[Federal Register: August 19, 2008 (Volume 73, Number 161)] [Rules and Regulations] [Page 48433-49083] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr19au08-13] [[Page 48433]] ----------------------------------------------------------------------- Part II Book 2 of 2....

Coding’s Biggest Challenges Today

Author: Heubusch, Kevin

Source: Journal of AHIMA

Publication Date: July 2008




Coding departments are hectic places in 2008, busy adapting to new requirements. To meet the challenges, they are seeking the right staffing, education, and coordination.



How many challenges does coding face today? Open positions, revenue cycle, MS-DRGs, POA, RACs,....

Skilled Knowledge Workers in Short Supply

Author: Kloss, Linda L

Source: Journal of AHIMA

Publication Date: July 2008


This is a demanding time for coders. MS-DRGs and present on admission requirements would have been challenging on their own; however, both came at virtually the same time, straining coders already stretched to meet their job requirements.

Recruitment and retention of coding staff is....

Clarifying Patient Status Code

Author: Bryant, Gloryanne H.

Source: Journal of AHIMA - Coding Notes

Publication Date: June 2008


The patient status code reflects the level of care a patient was discharged or transferred to when leaving an acute care hospital as an inpatient or outpatient (i.e., emergency department or emergency room). A recent Centers for Medicare and Medicaid Services MLN Matters publication provides a....

Key Issues in the 2008 OPPS Final Rule

Author: Clark, Andrea

Source: Journal of AHIMA

Publication Date: March 2008



The main objective of the Centers for Medicare and Medicaid Services (CMS) implementation of the 2008 Outpatient Prospective Payment System (OPPS) final rule was to address the recent explosion of growth in program expenditures for hospital outpatient services. CMS has created additional i....

ICD-10 Malaise: A Symptom of US Healthcare’s Ills

Author: Kloss, Linda L

Source: Journal of AHIMA

Publication Date: March 2008


Approximately 100 countries use some form of ICD-10 for clinical morbidity coding. That’s correct: 100 countries, and the US is not among them.

The World Health Organization released ICD-10 in 1990, and countries began implementing it in 1994. Most had fully implemented it by....

US Organizations Look Ahead

Author: Dimick, Chris

Source: Journal of AHIMA

Publication Date: March 2008


Transitioning to ICD-10-CM may seem like a distant problem. But SSM Integrated Health Technologies began its preparations about three years ago. Its reason is simple: “Something of this magnitude, you don’t want to be scurrying,” says Anne Stuckel, SSM’s manager of clini....

Bridging the Translation Gap from ICD-9

Author: Butler, Rhonda R.

Source: Journal of AHIMA

Publication Date: March 2008



A recurring theme in the ongoing ICD-10 implementation debate has been the need for a crosswalk between the old and new code sets to help the industry make the transition. The lack of an “official” mapping between ICD-9-CM and ICD-10-CM/-PCS has long been seen as a major challe....

Why ICD-10 Is Worth the Trouble

Author: Bowman, Sue E

Source: Journal of AHIMA

Publication Date: March 2008


Transitioning to ICD-10 is a major disruption that providers and payers may prefer to avoid. But it is an upgrade long overdue, and the benefits are far-reaching.

It has been nearly five years since the National Committee on Vital and Health Statistics recommended to the secretary o....

Coding Preventive Care Services

Author: Wilkinson, Dianne

Source: Journal of AHIMA - Coding Notes

Publication Date: March 2008


According to the Partnership for Prevention—a program-based organization of businesses, nonprofits, and government agencies—“the U.S. health care system suffers a quality deficit in part because too many patients do not get the effective preventive care they need when they ne....

New Focus on Process and Measure: Raising Data Quality with a Standard Coding Workflow and Benchmarks

Author: Wilson, Donna D; Hampton-Bagshaw, Kim; Jorwic, Therese M; Bishop, Jean; Giustina, Elizabeth

Source: Journal of AHIMA

Publication Date: March 2008




Establishing a standard coding workflow that incorporates continuous improvement and creating performance benchmarks is key to improving the quality of coded data.



HIM professionals who assign codes or manage coded data take responsibility for translating clinical....

ICD-10 Preparation Checklist

Author: Bowman, Sue E

Source: Journal of AHIMA

Publication Date: March 2008




The content in this checklist has been updated. More recent information is available here.



Preparing for ICD-10 is a monumental process. But like any large task, it can be broken down into discrete steps. A multiyear plan can be approached in four major phases, begi....

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