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Transactions Delay Prompts Concern Among Covered Entities

Author: Rode, Dan

Source: Journal of AHIMA

Publication Date: March 2002


AHIMA recently attended a meeting of healthcare providers, payers, and staff representatives of the National Committee on Vital and Health Statistics (NCVHS) and the Centers for Medicare and Medicaid Services (CMS). Organized by the Association for Electronic Health Care Transactions, the meet....

AHIMA Comments on Proposed Changes to the Medicare Prospective Payment System (PPS) and Consolidated Billing for Skilled Nursing Facilities (SNFs) for fiscal year 2006

Author: Rode, Dan

Source: AHIMA testimony and comments

Publication Date: July 08, 2005


July 8, 2005

Mark McClellan, MD, PhD
Administrator
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1282-P
PO Box 8016
Baltimore, Maryland 21244-8016
Dear Dr. McClellan:
The purpose of this let....

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....

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....

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....

Taking the Next Step Forward for ICD-10

Author: Rode, Dan

Source: Journal of AHIMA

Publication Date: January 2004


In November 2003 the National Committee on Vital and Health Statistics (NCVHS) agreed to recommend that the secretary of Health and Human Services (HHS) adopt the ICD-10-CM and the ICD-10-PCS classification standards as replacement for the ICD-9-CM classification currently used in the US.

Avoiding a War of Words (and Numbers): the Uncertain Future of Terminologies and Classifications

Author: Roberts, Rosemary; Innes, Kerry; Walker, Sue; Scott, Peter

Source: Journal of AHIMA

Publication Date: October 2004


With major changes under way worldwide, the evolving roles and relationships of classifications and terminologies are uncertain. But the future lies in collaboration, not competition.
Classifications and clinical terminologies have coexisted for decades. Both use clinical language, but t....

CY 2012 OPPS Update

Author: Rihanek, Theresa

Source: Journal of AHIMA - Coding Notes

Publication Date: February 2012


The final rule for calendar year 2012 Hospital Outpatient Prospective Payment System (OPPS) was released on November 30, 2011. The rule went into effect for outpatient hospital-based services January 1, 2012.

This article outlines the updates in the final rule.
Financial Impact....

FY 2012 ICD-10-PCS Updates

Author: Rihanek, Theresa

Source: Journal of AHIMA - Coding Notes

Publication Date: April 2012


Limited updates were made to ICD-10-PCS for fiscal year 2012 as set forth under the partial code freeze established by the ICD-9-CM Coordination and Maintenance Committee.1 The freeze is intended to aid the transition to the new code set by limiting updates for 2012 and 2013 to essential chan....

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)

Using Intrinsic and Extrinsic Metrics to Evaluate Accuracy and Facilitation in Computer-Assisted Coding

Author: Resnik, Philip; Niv, Michael; Nossal, Michael; Schnitzer, Gregory L.; Stoner, Jean; Kapit, Andrew; Toren, Richard

Source: AHIMA Computer-Assisted Coding Meeting

Publication Date: September 06, 2006

Computer-assisted coding (CAC) evaluation can be viewed from two related but distinct perspectives: accurately identifying codes, and more generally facilitating the process of human coding and information flow within and among healthcare organizations. The first perspective calls for intrinsic metrics, grounded in comparison with a gold standard. The second perspective calls for extrinsic techniques, grounded in the real-world task. We discuss this distinction and present an experimental evaluation of CAC using both intrinsic and extrinsic measures.

Four-Year Experience with Severity-Based DRGs: Vanderbilt University Medical Center

Author: Reeves, Mary G; Scott, Freda; Hallock, Kathy; Hays, Stephanie A.

Source: AHIMA Convention

Publication Date: October 10, 2007

Background

We implemented concurrent usage of severity -based software and a Clinical Documentation Program to facilitate improvement in our Risk of Mortality (ROM) and Severity of Illness (SOI) scores. We wanted to stay ahead of the regulatory reforms and also understand the proposed ch....

Myocardial Infarctions: Frequently Asked Questions

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: July 1996

Myocardial Infarctions

Many coders still have questions regarding the correct coding and sequencing of myocardial infarctions (MI), particularly in relation to the use of the fifth digits, transfers, underlying diagnosis, and performance of procedures. The following information is provide....

Rheumatoid Arthritis

Author: Prophet, Sue

Source: Journal of AHIMA - Coding Notes

Publication Date: November 1998


Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, and other organs in the body. An autoimmune disease is one in which the body tissues are mistakenly attacked by the body's own immune system. Patients have antibodies in....

Code Sets: Improving the Quality of Coded Data

Author: Prophet, Sue

Source: HIPAA Conference 2000

Publication Date: March 14, 2000

2000 HIPAA Conference Presentation
Code Sets: Improving the Quality of Coded Data
The Healthcare Provider Perspective
Sue Prophet, RHIA, CCS
Director, Classification and Coding, AHIMA Current Problems with Use of Code Sets
Lack of acceptance of valid codes (e.g., V and E co....

FY1999 Inpatient PPS Changes: ICD-9-CM Revisions

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: October 1998


All of the inpatient DRG and other inpatient Prospective Payment System (PPS) changes described below became effective with discharges occurring on or after October 1, 1998. Complete details of these changes can be found in the Federal Register.1
Transfers to Postacute Settings

....

Disorders of the Breast

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: May 1996

Carcinoma

Breast cancer is the most common form of cancer in women. Risk factors include a personal or family history of breast cancer, delayed childbearing, and personal history of benign breast disease.
A tumor may be identified by mammogram or self-examination. Many tumors are d....

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....

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....

ICD-10 on the Horizon

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: July 2002


ICD-10 has taken hold around the globe, so why is the US still using ICD-9-CM? This article reviews the history of ICD-10 in the US.


Other countries are using it. Why aren't we? Coding professionals across the country and around the world are wondering why ICD-10-CM hasn't been....

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....

ICD-9-CM Revisions -- Effective October 1, 1996

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: October 1996


The revisions to ICD-9-CM became effective with discharges occurring on or after October 1, 1996. Highlights of the changes are summarized below. Since not every revision is described in this article, it is important to review the official authorized addendum published in a special edition of....

Testimony of the American Health Information Management Association to the National Committee on Vital and Health Statistics on ICD-10-PCS

Author: Prophet, Sue

Source: AHIMA testimony and comments

Publication Date: April 09, 2002


April 9, 2002

Opening Comments

Chairman Cohen, members of the National Committee on Vital and Health Statistics (NCVHS) Standards and Security Subcommittee, ladies and gentlemen, good afternoon. I am Sue Prophet, director of coding policy and compliance of the American Hea....

Coding Compliance: Practical Strategies for Success

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: January 1998


"Fraud," "abuse," "upcoding," "unbundling," and "compliance" have all become buzzwords in the news media. Eliminating healthcare fraud and abuse has become a top priority for the federal government. Government investigations are on the rise and providers everywhere tremble at the thought of b....

Hypertensive Disorders of Pregnancy

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: September 1997


Hypertension complicates at least 10 percent of all pregnancies. The hypertensive disorder of pregnancy most likely to result in significant adverse clinical outcomes is preeclampsia.

Preeclampsia
Preeclampsia is unique to pregnancy and is characterized by elevated blood press....

ICD-9-CM Revisions (effective 10/1/97)

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: November 1997


The revisions to ICD-9-CM became effective with discharges occurring on or after October 1, 1997. Highlights of the changes are summarized below. Since every revision is not described in this article, it is important to review the Official Authorized Addendum. The complete addendum is publish....

New ICD-9-CM Committee Presents New Codes, Changes

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: September 2002


This is part 1 of a two-part summary of proposals from the April 2002 ICD-9-CM Coordination and Maintenance Committee meeting and includes procedure proposals. Part 2 will include diagnosis proposals and will be published in the October Journal of AHIMA.
The ICD-9-CM Coordination and Main....

Stevens-Johnson Syndrome

Author: Prophet, Sue

Source: Journal of AHIMA - Coding Notes

Publication Date: March 1998


The term "erythema multiforme" was first used by von Hebra in 1866 to describe a disease characterized by symmetrically distributed, pleomorphic, evolving cutaneous lesions, located primarily on the extremities, and by a proclivity for recurrence. In 1922, Stevens and Johnson....

Group Builds Consensus on Laboratory Test Policies

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: July 1999


The Balanced Budget Act of 1997 (BBA) mandated that the Health Care Financing Administration (HCFA) use a negotiated rulemaking process to develop national administrative and coverage policies for clinical diagnostic laboratory tests under Medicare Part B. The BBA stipulates that the p....

Testimony of the American Health Information Management Association to the National Committee on Vital and Health Statistics on ICD-10-CM

Author: Prophet, Sue

Source: AHIMA testimony and comments

Publication Date: May 29, 2002

May 29, 2002
Opening Comments

Chairman Cohn, members of the National Committee on Vital and Health Statistics (NCVHS) Standards and Security Subcommittee, ladies and gentlemen, good afternoon. I am Sue Prophet, director of coding policy and compliance of the American Health Informati....

Laboratory Services Regulations Carry HIM Implications

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: September 2002


This is Part 1 of a two-part article on national coverage and policies for clinical diagnostic laboratory services payable under medicare Part B. Part 1 concentrates on the administrative policies. Part 2, which will appear in the October issue of the Journal, will focus on the national covera....

Testimony of the American Health Information Management Association to the National Committee on Vital and Health Statistics on Medical Code Sets

Author: Prophet, Sue

Source: AHIMA testimony and comments

Publication Date: February 06, 2002

February 6, 2002
Opening Comments

Good morning Mr. Chairman, members and staff of the National Committee on Vital and Health Statistics (NCVHS) Standards and Security subcommittee, ladies and gentlemen.   I am Sue Prophet, director of coding policy and compliance for the American Heal....

What is Gulf War Syndrome (Part II)

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: September 1998


Presidential Advisory Committee on Gulf War Veterans' Illnesses

President Clinton established the Presidential Advisory Committee on Gulf War Veterans' Illnesses in May 1995 to ensure an independent, open, and comprehensive examination of health concerns related to Gulf War service....

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