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Covering the Bases of Coding Compliance

Author: Hapner, Peggy

Source: Journal of AHIMA - Coding Notes

Publication Date: May 2001




As HIM professionals already know, data quality-one of the basic tenets of compliance-depends on comprehensive documentation and accurate code assignments. Because coding plays a major role in payment, reporting data accurately, managing data flow and data collection, and training st....

Trends to Watch in Home Health Compliance

Author: Abraham, Prinny

Source: Journal of AHIMA

Publication Date: May 2001




The implementation of the Home Health Prospective Payment System (PPS) on October 1, 2001, has presented some unique compliance risks for HIM and billing managers. This article will briefly describe some of the compliance-related issues on the OIG's agenda that are of interest to HIM....

AHIMA Advocates for Physician Query Forms

Author: Rode, Dan

Source: Journal of AHIMA

Publication Date: May 2001




The Medicare program's reluctance to accept physician query forms has been fermenting for several years. Recently, the Health Care Financing Administration (HCFA) and the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) have argued that facilities u....

Working Smarter with APCs

Author: Thoman, Deborah J.

Source: Journal of AHIMA

Publication Date: May 2001




Are HIM professionals ready to make the most of APCs? This article suggests some strategies to improve the way we work with APCs, focus on complete and accurate coding, and improve our expertise.
Are HIM professionals ready for the next step in APCs? Are we ready to use APC data....

PEPP: Collaborating to Improve Quality

Author: Poole, Laurie

Source: Journal of AHIMA

Publication Date: April 2001




By collecting and analyzing information about Medicare payment errors, PEPP initiatives are making a contribution to healthcare quality efforts nationwide. Here's how one organization takes a collaborative approach to improving quality.
State Payment Error Prevention Programs (....

Who's Covered by HIPAA (HIPAA on the Job)

Author: Rode, Dan

Source: Journal of AHIMA

Publication Date: March 2001




One of the mysteries of the administrative simplification section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is determining who is covered or comes under the requirements of the act. This article will examine HIPAA to unravel some of the mystery of &quo....

Conduct is Their Business

Author: Byrd, Katherine

Source: Journal of AHIMA

Publication Date: March 2001




Suppose you were asked to do something unethical on the job. What if you were asked by your supervisor to hide delinquent charts just prior to a Joint Commission survey? What would you do?

As a profession, HIM professionals understand our moral obligation to the patient to p....

Final ERISA Rules Published

Author:

Source: Journal of AHIMA

Publication Date: February 2001


The Department of Labor published two final rules in November 2000 that will affect the information received and the appeals available to those receiving healthcare benefits under the Employee Retirement Income Security Act of 1974 (ERISA).

The two final rules are "Amend....

Preparing the Physician Office for HIPAA

Author: Uppena, Mary

Source: Journal of AHIMA - Coding Notes

Publication Date: February 2001




Change has been a constant factor in coding and reimbursement with the intensified focus on billing, compliance, and cost control. Out of necessity, coding professionals in physician settings have learned to be organized, adaptable, and armed with the latest information. The mandates....

On the Line: Professional Practice Solutions

Author: Smith, Cheryl M.

Source: Journal of AHIMA

Publication Date: February 2001




Q: Where can I find information on the interpretation of Joint Commission on Accreditation of Healthcare Organization standards?

Q: How does the Health Insurance Portability and Accountability Act of 1996 (HIPAA) define health information in the final rule for healthcare elec....

Quick Take on Clearinghouses

Author: McLaughlin, Mark

Source: Journal of AHIMA

Publication Date: January 2001




HIPAA's provisions have brought healthcare clearinghouses into the spotlight. What is a clearinghouse, and how is its role affected by the new regulations? This article answers these questions.

A clearinghouse is typically used to collect, validate, and distribute insurance c....

When Health Information and Fiscal Management Meet

Author: Dunn, Rose T

Source: Journal of AHIMA

Publication Date: January 2001




HIM professionals have skills that can allow them to contribute to the bottom line in many ways. The author describes areas where HIM expertise can make a difference in evaluating an organization's fiscal performance through analysis of services driven by health information.
HI....

First Annual Hospital OPPS Update Published

Author: Rode, Dan

Source: Journal of AHIMA

Publication Date: January 2001




The Health Care Financing Administration (HCFA) published its "annual" update to the hospital outpatient prospective payment system (OPPS) as an "interim final rule with comment" in the November 13, 2000, Federal Register.1 Due to delays in the original implementat....

Understanding HIPAA Transactions and Code Sets

Author: Rode, Dan

Source: Journal of AHIMA

Publication Date: January 2001


The recently published final regulations for transactions and code sets under HIPAA are the light at the end of the tunnel in the quest for uniform healthcare standards-and the first step on a long road to HIPAA implementation. What are the standard transactions and code sets? This article tak....

CPT Changes for 2001

Author: O'Hara, Karen

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2001




CPT 2001 Professional Edition (CPT® 2001) is complete and should be landing on your desk soon. As an introduction to the new book, this article provides a brief summary of the changes in 2001. A complete listing of the code and guideline changes can be found in CPT Changes 2001:....

New Approach to Chargemaster Management

Author: Richey, John

Source: Journal of AHIMA

Publication Date: January 2001

After examining their CDM management processes, HIM professionals, along with clinical and support departments, redesigned and automated several practice aspects with successful results. (FORE Best Practice, AHIMA Foundation)

HFMA Tackles Hospital Billing Chaos

Author: Jeffries, Jane

Source: Journal of AHIMA

Publication Date: January 2001




Hospital bills are lengthy, often incorrect, and potentially confusing-to no one's surprise. A hospital bill is the result of a long process with numerous participants, beginning at pre-intake and ending with final collections.

Richard L. Clarke, FHFMA, president and CEO o....

Payers Guide Articles

Author: AHIMA

Source: AHIMA bibliography

Publication Date: 2001


The Quest for Quality and Comparability in the National Healthcare Database: Announcing A Payer’s Guide to Health Care Data Quality and Integrity
by AHIMA’s Coding Policy and Strategy Committee

Summary of ICD-9-CM Coordination and Maintenance Committee Meeting
by Sue Prop....

Next Generation of E/M Guidelines

Author: Hill, Emily

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2000


Few non-clinical issues have inspired as much discussion, revision, and anxiety as the evaluation and management (E/M) services and their accompanying documentation guidelines. E/M services have produced a cottage industry focused on ensuring that medical records contain necessary docu....

HHS Releases Final Rules for HIPAA Transactions, Code Sets

Author: Rode, Dan

Source: Journal of AHIMA

Publication Date: November 2000


HIM professionals have new HIPAA challenges to prepare for: this summer, the Department of Health and Human Services (HHS) released the highly anticipated final rule for certain transaction sets and codes.1 The rule was effective on October 16, 2000, and under HIPAA legislation, most....

Building a Better CPT

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: November 2000


The Health Insurance Portability and Accountability Act (HIPAA) presents numerous challenges to HIM processes and systems. Not least among these areas is coding. Among the concerns is whether the CPT system will be sufficient to meet the demands of HIPAA. The American Med....

Journal Q&A (11/00)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: November 02, 2000

Q: Where can I find a benchmark for coding accuracy?
A: It's difficult to establish an industry standard for coding accuracy because accuracy is measured differently in every facility. Some facilities compute their accuracy rate by taking the number of correctly coded records and divi....

ICD-9-CM Code Revision for 2001

Author: Prophet, Sue

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2000


Effective October 1, 2000, 100 new ICD-9-CM diagnosis codes and nine new ICD-9-CM procedure codes have been implemented. Because there were no ICD-9-CM revisions last year, these new codes are the result of two years’ worth of revisions. Coding professionals should familiarize themselves with....

HCFA Addresses Inpatient Payments, SNFs

Author:

Source: Journal of AHIMA

Publication Date: October 2000


HCFA's recently published interim final rule concerning the "Provisions of the Balanced Budget Refinement Act of 1999; Hospital Inpatient Payments and Rates and Costs of Graduate Medical Education" will provide a 2.3 percent increase in payment rates for most acute care hospital....

Using Internal and External Resources to Negotiate Contracts

Author: Kane, Cheri

Source: Brief Encounter

Publication Date: October 02, 2000


Managed care is here to stay and it is incumbent upon the health plan and the providers to develop positive long-term relationships. These agreements are only limited by the creativity of the provider and the health plan. Financial arrangements may take a variety of forms, from fee for servic....

New Home Care PPS Brings Major Changes

Author: Dougherty, Michelle

Source: Journal of AHIMA

Publication Date: October 2000


The home care industry will undergo a significant shift in reimbursement methodology when HCFA implements a new prospective payment system (PPS) for Medicare claims on October 1, 2000. Under the new system, a Medicare beneficiary receiving covered home care services will be reimbursed for a 6....

HCFA Publishes Final Home Health PPS Rule

Author: Asmonga, Donald D.

Source: Journal of AHIMA

Publication Date: September 2000


The Health Care Financing Administration (HCFA) published the final rule for the prospective payment system (PPS) for home health agencies in July. This rule, which takes effect October 1, 2000, replaces the retrospective reasonable-cost-based system used to pay for home health service....

Medicare Data Study Spotlights Coding Errors

Author: Cottrell, Carlton

Source: Journal of AHIMA

Publication Date: September 2000



Coding quality for Medicare claims is an area of constant concern. Coding errors can have far-reaching effects in the healthcare universe, and coders are experiencing increased scrutiny from both regulators and hospitals looking to control costs. As a follow-up to results of a Medica....

Catching Up with PEPP

Author: Bryant, Gloryanne H.; Fletcher, Robin

Source: Journal of AHIMA

Publication Date: September 2000


A year ago, the Journal of AHIMA reported on the newly created Payment Error Prevention Program (PEPP), which went into effect in August 1999. What has happened since then?
Best Billing Practices

PEPP was created to reduce Medicare prospective payment system (PPS) ....

Where in the World Is ICD-10?

Author: Brouch, Kathy L.

Source: Journal of AHIMA

Publication Date: September 2000




Where and how is ICD-10 being used? Learn how countries all over the world have adapted to the newest version of this coding system and how coders in the US can prepare for an eventual transition.


Are you ready for ICD-10? If you're a coder in the United State....

Where Are They Now? CPR Leaders Assess Their Progress

Author: Zender, Anne

Source: Journal of AHIMA

Publication Date: September 2000


Five years ago the first recipients of the Davies awards showed us successes of CPR systems across the country. Where are they now? This article catches up with these CPR leaders.
Is your job exactly the same as it was five years ago? For most HIM professionals, the answer....

Making a Proactive Transition to APCs

Author: Willett, Lyn

Source: Journal of AHIMA

Publication Date: July 2000


There's no doubt APCs are going to change the way your facility operates, but do you know how? By taking a look at your existing systems, you'll get a better idea of how to prepare for changes. This article spotlights specific functions to consider and optimize for the new outpatient prospect....

Dot-com Coder

Author: Zender, Anne

Source: Journal of AHIMA

Publication Date: July 2000


For many people, working with artificial intelligence may sound like something out of a science fiction movie. But for Amy Davis, RHIA, it's just part of the job.

Davis is coding specialist and knowledge engineer at DocCode.com, a company based in Jacksonville, FL. Davis's....

Coding for APCs: Case Studies

Author: Scichilone, Rita A

Source: Journal of AHIMA - Coding Notes

Publication Date: July 2000


When APC implementation begins on August 1, HIM professionals can expect increased complexity when coding outpatient encounters. Examining case studies in selected areas subject to APC payment may help coding professionals better understand the APC reporting process. Although coding guidelines....

Documentation Errors Result in Medicare Overpayment

Author: Hammen, Cheryl

Source: Journal of AHIMA

Publication Date: July 2000



The objective of the Office of the Inspector General's (OIG) fiscal year 1999 audit was to determine whether medical fee-for-service claims complied with Medicare rules and regulations. The OIG examined claims for accurate documentation and coding, medical necessity, and to ensure that c....

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