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Closer Look at All-Patient Refined DRGs

Author: Averill, Richard F.

Source: Journal of AHIMA

Publication Date: January 2002


Are you fluent in DRG? This article takes a look at the evolution of the three distinct DRG systems and spotlights the most recent iteration, All-Patient Refined DRGs. It also sheds light on how this system, when codes are properly applied, can help an organization study morbidity and mortalit....

Make Clinical Research Top Priority

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: January 2002


Whenever biomedical or behavioral research is conducted and supported by government agencies, it’s critical to comply with federal regulations designed to protect human subjects. For compliance officers, this means understanding and constantly monitoring a number of federal laws, regulati....

Another Look at LOINC

Author: Herbst, Maida Reavis

Source: Journal of AHIMA

Publication Date: January 2002


We have all heard Logical Observation and Identifier Codes (LOINC) mentioned in the same breath with standards or medical vocabularies, but what are they exactly?

What Is LOINC?


LOINC is a niche vocabulary useful in reporting laboratory and clinical observations. The....

Here Comes Rehab PPS!

Author: Grzybowski, Darice; Draper, Skeeter

Source: Journal of AHIMA

Publication Date: January 2002


Just when you thought it was safe to come up for air.


After Medicare’s introduction of the Outpatient Prospective Payment System (PPS, which brought us APCs), the Home Health PPS (with its HHRGs), and Skilled Nursing Facility PPS (with RUGS), another new reimbursement syst....

Anthrax: What Every Coder Should Know

Author: Stanfill, Mary H

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2002


The inhalation anthrax identified by a Florida physician in October 2001, during the recent series of bioterrorist attacks, was the first case of reported inhalation anthrax in the United States in more than 25 years.1 With the threat of anthrax as a biological weapon, correct coding could be....

CPT Changes for 2002

Author: O'Hara, Karen

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2002


Coders need to keep their resources current—including updating the Current Procedural Terminology (CPT) codes every year with the annual CPT book. This article provides a brief summary of the changes made to the CPT 2002 code set. The complete list of changes can be found in Appendix B of....

Journal Q&A (11/01)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: November 02, 2001


Q: Where can I find the updated data elements and data definitions for the Uniform Hospital Discharge Data Set (UHDDS)?

A: At this time, the 1986 UHDDS data elements and definitions are not available electronically though the information is considered to be in the public domain. The fi....

On the Line: Professional Practice Solutions

Author: Dougherty, Michelle

Source: Journal of AHIMA

Publication Date: November 2001


Q: Where can I find the updated data elements and data definitions for the Uniform Hospital Discharge Data Set (UHDDS)?

Q: Where can I find an easy-to-use glossary for terms in the HIPAA regulations?

Michelle Dougherty (michelle.dougherty@ahima.org) is an HIM practice manager....

2002 DRG Updates Already in Effect

Author: Uppena, Mary

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2001



The 2002 diagnosis related group (DRG) updates went into effect October 1, 2001. With the implementation of these changes to the hospital inpatient DRGs portion of the prospective payment system (PPS), there will be 499 DRGs in 25 Major Diagnostic Categories (MDCs).


Changes t....

ICD-9-CM Codes Ready for 2002

Author: Zeisset, Ann M.

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2001


For those reporting ICD-9-CM codes for all diagnoses coding, and hospitals reporting ICD-9-CM volume III for procedures, fall is the time to review and implement the changes and revisions for fiscal year 2002.

The ICD-9-CM coding changes for fiscal year 2002 were released in the Augus....

APC Validation Audits ... The Nitty Gritty Details

Author: Knowles, Lisa

Source: AHIMA Convention

Publication Date: October 10, 2001




Ambulatory payment classifications (APCs) have been implemented, and APC validation audits are the next issue to contend with. Similar to DRGs, we must design and conduct APC validation audits. Whether the audit is performed in-house or by an external consulting firm, it is essential....

Start to Finish Medical Necessity Review

Author: Arner, Kathy

Source: AHIMA Convention

Publication Date: October 10, 2001



Purpose: To identify why rejections occur and where the problem areas are located.


Why are rejections occurring on the professional side?


Medicare and other insurances are implementing local medical review policies.

Ordering providers are not supply....

When Good Chargemasters Go Bad

Author: Leeds, Erica

Source: AHIMA Convention

Publication Date: October 10, 2001



Introduction: What Is a Chargemaster?

A chargemaster is a master list of services, supplies, and drugs used for patient care. A chargemaster used by outpatient facilities (emergency rooms, clinics, same-day surgery centers, and so on) will have the associated HCPCS codes and rev....

APCs: A Hospital-wide Effort

Author: Neilson, Seana

Source: AHIMA Convention

Publication Date: October 10, 2001




For many healthcare providers, thriving under the Medicare outpatient prospective payment system (i.e., APCs) appears to be a distant goal not to be realized anytime soon. In fact, for the next year or so, most healthcare providers subject to APCs will most likely be satisfied with me....

HIM & Ethical Decision Making: Complex Challenges

Author: Harman, Laurinda B.

Source: AHIMA Convention

Publication Date: October 10, 2001




The successful health information management (HIM) professional (RHIT and RHIA) must be simultaneously passionate about two things: (1) information management expertise and (2) ethical principles and professional values. Technical expertise without ethical principles and professional....

PRO-West's Payment Error Prevention Program

Author: Baron, Anne

Source: AHIMA Convention

Publication Date: October 10, 2001




Background

Beginning in 1997, the Office of the Inspector General (OIG) started conducting annual audits of Medicare billing practices. These audit results estimated that Medicare had paid more than $23 billion in incorrect payments in 1996 and more than $20 billion in 1997.....

Home Health Prospective Payment Systems (HH-PPSs)

Author: Abraham, Prinny

Source: AHIMA Convention

Publication Date: October 10, 2001



The National Association of Home Health reported that the number of Medicare certified home health agencies peaked in 1997 at 10,444 and declined to 8,080 in 1998, to 7,747 in 1999, and back up to 7,880 in 2000. Personal expenditures for home care were estimated at $36 billion in 1999, dow....

How Gaps in Data Quality Impact Reimbursement

Author: D'Amato, Cheryl

Source: AHIMA Convention

Publication Date: October 10, 2001




Introduction

Improving the quality and flow of data for outpatient services will impact how facilities fare financially under Medicare's outpatient prospective payment system (OPPS). This paper will provide practical advice on how to effectively evaluate and reengineer coding....

Developing Technical Applications for Coding Compliance

Author: Hammen, Cheryl

Source: AHIMA Convention

Publication Date: October 10, 2001


Introduction

Although high-risk DRG pairs have been audited to ensure compliance in hospitals over the past several years, there are still opportunities available for streamlining this time-consuming process. Monthly data review regarding the frequency of the high-risk pairs is only a....

NCVHS Groups Explore CPR, Privacy Rule Possibilities

Author: Rode, Dan

Source: Journal of AHIMA

Publication Date: October 2001




HIPAA's fifth anniversary was marked by meetings of two key subcommittees of the National Committee on Vital and Health Statistics (NCVHS): the standards (transactions) and security subcommittee and the privacy and confidentiality subcommittee. At the security subcommittee, experts fr....

Early Word on HIPAA Claims Attachments

Author: Dougherty, Michelle

Source: Journal of AHIMA

Publication Date: October 2001


If we could look into a crystal ball and see into the future, it would be much easier to prepare for HIPAA, particularly the electronic transaction standards. Because of the rarity of crystal balls these days, we must rely on other predictors at our disposal, such as the white paper issued by t....

Choosing Consultants Without Compromising Compliance

Author: Hammen, Cheryl

Source: Journal of AHIMA

Publication Date: October 2001




Auditing coding and DRG accuracy has become an important component in the daily operation of the HIM department. Many providers are choosing to contract with external coding consultants to perform this task. This can be an appropriate solution as long as the vendor meets the necessary....

CPT "Monopoly" To Be Examined

Author:

Source: Journal of AHIMA

Publication Date: October 2001


Senate Minority Leader Trent Lott (R-MS) has forwarded a letter to HHS Secretary Tommy Thompson criticizing the American Medical Association's "statutory monopoly" on current procedural terminology (CPT) codes. Lott said that Congress will look at the CPT issue when it considers....

Putting Productivity Plans to Work

Author: Dunn, Rose T

Source: Journal of AHIMA - Coding Notes

Publication Date: October 2001




This is the last in a series of three "Coding Notes" articles addressing productivity measurement and incentive plans for coding professionals. The April Journal of AHIMA (vol. 72, no. 4) article discussed the general principles of developing facility-specific productivity m....

CCS/CCS-P Credential Maintenance Frequently Asked Questions

Author:

Source: AHIMA

Publication Date: 2001

1. What are the requirements for maintenance of the CCS/CCS-P credential?

Each certified specialist must complete an annual self-assessment and pay the annual maintenance of certification fee to retain the credential.

2. When does my self-assessment begin and how will I know....

E-assistance for Coding Professionals

Author: Uppena, Mary

Source: Journal of AHIMA - Coding Notes

Publication Date: September 2001




Is the Web a part of your work day? Make sure it is. From purchasing products to distance learning to online coding, coding professionals can find all kinds of resources online to meet their needs.

A Look at the Future

In a recent survey, health system CEOs were ask....

Teaching Physician Guidelines

Author: Graff, Jean Stevens

Source: Brief Encounter

Publication Date: September 02, 2001


Working in an orthopedic clinic, I understand the great need for my newly created position. I am employed at a teaching hospital as a medical record auditor charged with the task of educating physicians on the art of coding and documentation. My job is to ensure compliance with the Medicare ma....

Journal Q&A (9/01)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: September 02, 2001

Q: I work in a home care agency and am developing a procedure on correcting errors on OASIS to comply with the Centers for Medicare and Medicaid Services' (CMS, formerly HCFA) new correction policy. Is it necessary to make a separate entry in the medical record? Our agency would like to make the co....

Critical Expeditions

Author: AHIMA

Source: AHIMA

Publication Date: August 2001


With the action items of Vision 2006 largely met and the image marketing campaign well underway, the Association is poised to undertake its next strategic venture—expeditions.

Through a series of critical expeditions, AHIMA will explore new ground for the HIM profession—from....

Solving the E/M Conundrum: a Special Report

Author: Scichilone, Rita A

Source: Journal of AHIMA

Publication Date: July 2001


Evaluation and Management (E/M) codes, introduced in 1992 for reporting physician visit services, are linked to a number of perplexing questions for coders. In different settings, they are used differently and with varying sets of criteria. Given the numerous coding and compliance issues relate....

E/M Options in the Outpatient Arena

Author: Jones, Lolita M.

Source: Journal of AHIMA

Publication Date: July 2001


Under the Medicare ambulatory payment classification (APC) system, hospitals must establish criteria for mapping the medical care rendered in the emergency department and hospital-based outpatient settings to appropriate CPT medical visit codes. Do you know how to establish a sound rationale f....

Review of E/M Guidelines

Author:

Source: Brief Encounter

Publication Date: July 02, 2001


The Evaluation and Management guidelines are found in the Medicare Carriers Manual in the following sections. You may download the entire manual from the Center for Medicare and Medicaid Services or CMS (formerly HCFA) Web site by going to http://www.hcfa.gov/, click on Medicare, select laws an....

Look at Modifiers for Hospital Use

Author: Philippou, Karla E.

Source: Brief Encounter

Publication Date: July 02, 2001


Modifiers have been a continuing problem in the hospital setting. Although modifiers were mandated for hospital use in June 1998, many hospitals were unable to comply until the implementation of Ambulatory Payment Categories, (APCs), on August 1, 2000. The initial problems were related to info....

Common E/M Documentation Issues

Author: Udell, Curtis

Source: Brief Encounter

Publication Date: July 02, 2001


One of the constant challenges facing managers today is evaluating physician documentation and then helping their physicians to improve the content of their patient notes, particularly for evaluation and management (E/M) services.

While physicians may have unique style or flair to t....

Can You Manage Managed Care?

Author: Willner, Sue

Source: Journal of AHIMA

Publication Date: July 2001


HIM professionals’ data management skills make them a hot property in many settings, but none more so than managed care. In this second installment of the Journal of AHIMA’s special series on managed care, the author describes the ways managed care organizations use data and how HIM....

Navigating the Physician Services Maze

Author: Skurka, Margaret A.

Source: Journal of AHIMA

Publication Date: July 2001


As HIM professionals know, accurate and complete documentation is critical for providing care and supporting reimbursement. This is particularly true-and yet particularly problematic-in the area of E/M coding. Medical practices report and are paid for their services using E/M coding, yet there....

Know Your APCs: Data Analysis Made Simple

Author: Stegman, Melinda

Source: Journal of AHIMA

Publication Date: July 2001



You’ve adapted processes to the APC system, but do you really understand the financial impact of APCs on your organization? The author shows you how to analyze your billing data to assess the impact of APCs on your facility’s bottom line.



Since the implement....

AHIMA Testifies in Support of ICD-10

Author: Rode, Dan

Source: Journal of AHIMA

Publication Date: July 2001


The "replacement [of ICD-9-CM, Volume 3] with a new procedural coding system for inpatient services is absolutely necessary and ICD-10-PCS meets the criteria for such a replacement system," said Linda Kloss, MA, RHIA, AHIMA's executive vice president and CEO. Kloss also argued that &q....

SNOMED Takes the Next Step

Author: Kudla, Karen M.; Blakemore, Margo

Source: Journal of AHIMA

Publication Date: July 2001


Healthcare terminologies SNOMED and the Read Codes have been around for a long time. Now, a new terminology combining the two promises to take the industry one step closer to realizing the vision of an electronic patient record. Here’s a sneak peek at SNOMED® CT.
As technology e....

Implementing a Mobile Coding Solution

Author: Colgan, Peter

Source: In Confidence (newsletter)

Publication Date: July 02, 2001


Wireless computing technologies capable of enabling clinical and administrative decision support throughout the extended healthcare enterprise have arrived! Among the benefits of any wireless healthcare solution is the wide distribution of information throughout the enterprise. This benefit r....

Another Career Avenue for HIM: Coding Compliance

Author: Lemire, Diane

Source: Journal of AHIMA

Publication Date: June 2001




If you're armed with a background in coding and management, a position in coding compliance may be an exciting next step in your HIM career. When I applied for coding compliance manager positions, many positions had been open for a year because facilities could not find individuals w....

Coding Under the HIPAA Umbrella

Author: Russo, Ruthann

Source: Journal of AHIMA - Coding Notes

Publication Date: June 2001





Although coding professionals are not ultimately responsible for ensuring appropriate release of patient-protected information, it is important that they understand that coded data is not only one of the most desired pieces of information in the patient’s record, it is also the....

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