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Adapting Enterprise Workflow for ICD-10-CM/PCS

Author: Clark, Jill S

Source: Journal of AHIMA

Publication Date: June 2013



During her speech at the 2013 HIMSS Annual Conference, the Centers for Medicare and Medicaid Services’ Acting Administrator Marilyn Tavenner said the healthcare industry should proceed full steam ahead on preparing to implement ICD-10-CM/PCS. The message conveyed is that CMS is 100 p....

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....

Key Issues in the 2009 OPPS Final Rule

Author: Clark, Andrea

Source: Journal of AHIMA - Coding Notes

Publication Date: March 2009


The final rule for the 2009 Outpatient Prospective Payment System (OPPS) includes multiple revisions that hospitals must address in their practices, policies, and operations. Hospitals should develop strategies for analyzing the financial impact and operational challenges by reviewing the foll....

Provider’s Condensed Resource for Revenue Cycle, Coding Tools, and More

Author: Clack, Crystal; Freeman, Rae; Lewis, Laquette

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: January 2017


A cyclone of regulatory requirements for providers has officially touched down in the United States. The Affordable Care Act (ACA), Medicare Access and CHIP Reauthorization Act (MACRA), patient-centered medical home (PCMH), and value-based purchasing (VBP) initiatives are contributing to dramat....

FY 2016 CPT Updates

Author: Clack, Crystal

Source: Journal of AHIMA - Coding Notes | Journal of AHIMA

Publication Date: February 2016



When the first edition of the Current Procedural Terminology (CPT) was released in 1966, there were only 3,554 codes. In 2016, CPT, published by the American Medical Association (AMA), is celebrating its 50th birthday with 10,000 CPT codes. This year’s CPT updates include 140 codes added,....

Ten More Questions for CAC Vendors

Author: Cassidy, Bonnie S.

Source: Journal of AHIMA - website

Publication Date: March 2013





Today’s HIM and coding professionals are faced with multiple challenges to increase documentation accuracy and specificity due to new rules and regulations. They also face financial pressure to accelerate billing processes, which can lead to errors and fraudulent c....

Embracing the ICD-10 Transition

Author: Cassidy, Bonnie S.

Source: Journal of AHIMA

Publication Date: June 2011


Now is the time to embrace ICD-10 adoption and plan for your personal success and the future state within your organization. Healthcare organizations are depending on the HIM profession to do the heavy lifting and prepare the industry for ICD-10.

We will never walk this path again. T....

Major Changes for Heart Failure Codes in 2003: New Codes Put Sharper Focus on Diagnosing, Preventing Heart Failure

Author: Casey, Patricia E.; Zeisset, Ann M.

Source: Journal of AHIMA - Coding Notes

Publication Date: February 2003


Are you up to date with the latest revisions to the heart failure codes? A revision of the heart failure codes, effective October 1, 2002, was originally presented at the May 2001 ICD-9-CM Coordination and Maintenance Committee meeting. At that meeting, representatives from Kaiser Permanente e....

Medical Necessity under OPPS: a Look at the Challenges

Author: Carter, Darren

Source: Journal of AHIMA

Publication Date: February 2002


The outpatient prospective payment system (OPPS) has dramatically changed claims processing by introducing an automated system. Medical necessity validation has also been automated as a result, leaving hospitals with increased rejections. This article explores how OPPS impacts the medical nece....

Best Practices: What Works

Author: Carrier, Danielle

Source: Journal of AHIMA

Publication Date: July 1999




Medical record accuracy, record completion time, physician satisfaction—all of these are indicators of how well an HIM department is performing. The findings of a UHC benchmarking study may point the way to best practices that can be shared and adapted.

What....

Coder Education: Will Demand, Will Deliver

Author: Carol, Ruth

Source: Journal of AHIMA

Publication Date: July 2004


As the bar rises for coding, healthcare organizations require more education from coders—and they are willing to deliver it, too.
The bar has always been high for mdical coding, but recent years have seen it boosted higher. As a result, healthcare organizations need more from code....

Opportunities for HIM in Revenue Cycle Management

Author: Campbell, Thea

Source: Journal of AHIMA

Publication Date: November 2003


The pressure on all healthcare organizations for improved financial performance continued to grow in 2003. Many healthcare organizations experienced a financial loss in the first quarter of 2003, and disproportionate reimbursement-to-expenditure ratios in healthcare are straining all organizat....

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....

CPT Updates for CY 2015

Author: Buttner, Patty

Source: Journal of AHIMA - Coding Notes | Journal of AHIMA

Publication Date: February 2015



On January 1, 2015, the updates to the American Medical Association’s Current Procedural Terminology (CPT) went into effect. The updates include 276 new codes, including three new Category II codes and 39 new Category III codes. There are a total of 129 revised codes and 137 deleted codes....

Reading the Fine Print on ICD-10 Conversions: Even Highly Automated Conversions Require Review

Author: Butler, Rhonda R.; Mills, Ronald E; Averill, Richard F.

Source: Journal of AHIMA

Publication Date: June 2011


Automation is a major help in converting to the ICD-10 code set, but it is not a magical solution. In fact, skipping a human review of converted systems exposes an organization to legal and financial risk.

People who are secondary users of coded medical records-who see only the resul....

ICD-10 Reimbursement Mappings: New Mappings from CMS Help Organizations in the Transition to ICD-10

Author: Butler, Rhonda R.; Mills, Ronald E

Source: Journal of AHIMA - Coding Notes

Publication Date: April 2009


Starting October 1, 2013, healthcare claims will be submitted to payers using ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes. Some payers such as the Centers for Medicare and Medicaid Services (CMS) are converting their reimbursement systems to use ICD-10 codes directly. However, som....

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....

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....

Analyzing Eight Months of ICD-10

Author: Butler, Mary

Source: Journal of AHIMA

Publication Date: June 2016



Teachers know there are two kinds of students. Student A studies and does their assigned reading throughout the whole semester, earning extra credit where they can. When the final exam rolls up, they’re anxious but prepared—they did their homework. Student B, on the other hand, has the sa....

ICD-10 Two Weeks In: How’s it Going?

Author: Butler, Mary

Source: Journal of AHIMA - website

Publication Date: October 2015




Two-plus weeks into the transition to ICD-10-CM/PCS, the chaos predicted by many groups that protested the code sets’ implementation for years has not come to fruition. In fact, preliminary reports from providers, commercial payers, and coding consultants indicate quite the oppo....

Choosing the Right Coding Credential

Author: Buck, Stacie L

Source: AHIMA community resource

Publication Date: January 02, 2007


As the demand for qualified coders has increased, so has the number of coding programs and coding certifications available to coding professionals seeking to demonstrate their coding proficiency. The business of offering credentials is indeed a lucrative one with many organizations competing....

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) ....

Testimony of Gloryanne Bryant to the Health Subcommittee of the Committee on Ways and Means, U.S. House of Representatives

Author: Bryant, Gloryanne H.

Source: AHIMA testimony and comments

Publication Date: April 06, 2006


April 6, 2006

Chairman Johnson, Congressman Stark, members of the Health Subcommittee, ladies and gentlemen, good afternoon. I am Gloryanne Bryant, corporate director for coding and Health Information Management (HIM) compliance with Catholic Healthcare West (CHW). I speak to you tod....

Compliance Efforts Get Some PEPP

Author: Bryant, Gloryanne H.

Source: Journal of AHIMA

Publication Date: September 1999


Earlier this year, the Office of the Inspector General (OIG) informed the Health Care Financing Administration (HCFA) that "the DRG system is vulnerable to abuse by providers who wish to increase reimbursement inappropriately through upcoding, particularly so within certain DRGs.&....

Ensuring Proper Wound Care Service Coding: OIG Highlights Need for Organizations to Assess Wound Care Coding Practices

Author: Bryant, Gloryanne H.

Source: Journal of AHIMA - Coding Notes | Journal of AHIMA

Publication Date: November 2007



This year the Office of Inspector General (OIG) issued two reports relating to wound care services and Medicare payments. As the OIG has included wound care services as part of its 2007 work plan, coding and HIM professionals should review each report and re-assess their organization̵....

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....

Editorial: The Need for Mentoring and Training

Author: Brownfield, Cathy

Source: CodeWrite

Publication Date: October 2015




The current demand for coders is extremely high, making it more important than ever for new coders to enter our industry. Many of us are asked, "How do I get into coding?" We then see posts on message boards from students who just graduated saying they can't find a job because they ha....

Speaker: SNOMED Promises to Change HIM Practice

Author: Brouch, Kathy L.

Source: Journal of AHIMA

Publication Date: January 2004


How will SNOMED CT change the way health information is managed? An educational session captured the basic concepts that HIM professionals need to know.

It’s important to understand the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) because it is increasingly being....

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....

Testing ICD-10-PCS

Author: Brooks, Patricia E.

Source: Journal of AHIMA

Publication Date: May 1998



HCFA conducted a formal test of ICD-10-PCS (procedure coding system) in order to determine if it would be a practical replacement for the current ICD-9-CM, Procedures. This coding system was developed after an open competition contract was awarded to 3M/HIS. In order to avoid any con....

Code Sets

Author: Brooks, Patricia E.

Source: HIPAA Conference 2000

Publication Date: March 14, 2000

2000 HIPAA Conference Presentation
Code Sets
Presented by Pat Brooks, RHIA
HCFA Standards for Electronic Transactions
HCFA-0149-P Published May 7, 1998 Final not yet published To be enacted 2 years after final notice (3 years for small plans)
Proposed Initial Standards for....

Problem-Centered Care Delivery: How Interface Terminology Makes Standardized Health Information Possible

Author: Bronnert, June; Masarie, Chip; Naeymi-Rad, Frank; Rose, Eric; Aldin, Greg

Source: Journal of AHIMA

Publication Date: July 2012




Terminologies ensure that the 'languages of medicine' can be understood by both humans and machines.



Electronic health records (EHRs) are the industry standard for documenting patient care. Industry initiatives and government legislation have facilitated EHR i....

Optimizing Data Representation Through the Use of SNOMED CT

Author: Bronnert, June; Daube, Julie L; Jopp, Gretchen; Peterson, Kathleen; Rihanek, Theresa; Scichilone, Rita A; Tucker, Vanna

Source: Journal of AHIMA

Publication Date: March 2014

Electronic health records (EHR) have changed the landscape for data representation. For many years health information management (HIM) professionals have relied on classifications for data representation and the support of clinical documentation. SNOMED CT is a data standard frequently used in electronic systems and has been included in the requirements for the Centers for Medicare and Medicaid Services’ (CMS) “meaningful use” EHR Incentive Program. SNOMED CT is maintained and distributed by the International Health Terminology Standards Development Organisation (IHTSDO). SNOMED CT is recognized throughout the world, and the terminology is available at no cost. The National Library of Medicine (NLM) serves as the US release center and the IHTSDO member country representative.

Preparing for the CAC Transition

Author: Bronnert, June

Source: Journal of AHIMA - Coding Notes

Publication Date: July 2011


One of the biggest technology advancements to influence coding since encoding systems is computer-assisted coding. CAC is the "use of computer software that automatically generates a set of medical codes for review, validation, and use based upon clinical documentation provided by healthcare p....

Coding Pregnancy

Author: Bronnert, June

Source: Journal of AHIMA - Coding Notes | Journal of AHIMA

Publication Date: October 2006


While science and research have shed light on the various stages of fetal development, the process is still fascinating. This article details each month of a fetus’s development and reviews common delivery complications and where related information may be documented in the record.
....

Coding Ethically

Author: Bronnert, June

Source: Journal of AHIMA - Coding Notes

Publication Date: October 2005


With the many reimbursement issues and regulatory requirements surrounding coding, it is sometimes necessary for coders to refamiliarize themselves with what it means to code ethically. AHIMA’s Coding Policy and Strategy Committee developed the Standards of Ethical Coding, which were app....

Vanishing Supervisor

Author: Brandt, Mary D.

Source: Journal of AHIMA

Publication Date: March 2004


The bottom line is calling. Here’s how to decide if your HIM department has the right number of supervisors.
Down-sizing, right-sizing, streamlining. It doesn’t really matter what you call it, but it has had a significant impact on healthcare operations and staffing. Organizat....

Transactions Standards

Author: Braithwaite, Bill

Source: HIPAA Conference 2000

Publication Date: March 14, 2000

2000 HIPAA Conference Presentation
Transactions Standards

Presented by Bill Braithwaite, MD, PhD, FACMI, Senior Advisor on Health Information Policy, US Dept. of HSS
Transaction Standards
NPRM published in 1998 (5/7/98 - 7/6/98) Adopts ASC X12N standards for transactions (e....

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