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GEMs Target to Source Exercise
Author: Foster, MeShawn
Source: CodeWrite | AHIMA newsletter article
Publication Date: October 2011
In order to use the General Equivalence Mappings (GEMs) effectively, it is imperative that both the forward and backward techniques are employed. GEM users will find that they are presented with a myriad of options when there is a “one-to-many” or “many-to-one” scen....
Framework for Human Functioning: The ICF in Australia
Author: Fortune, Nicola
Source: Journal of AHIMA - Coding Notes
Publication Date: July 2004
The International Classification of Functioning, Disability, and Health (ICF) provides a framework for the conceptualization, classification, and measurement of human functioning and disability. The World Health Assembly endorsed the ICF in May 2001.1 It is now recognized as a reference membe....
Using Severity Adjustment Classification for Hospital Internal and External Benchmarking
Author: Fontaine, P
Source: IFHRO Congress | AHIMA Convention
Publication Date: October 15, 2004
Introduction
Governments and patients evaluate a hospital's quality of care by looking at performance data. In many countries, the data used to compare and evaluate outcomes is frequently based on Diagnosis Related Groups (DRGs). Since 1994, the government of Belgium has been using AP-DR....
Translation Please: Mapping Translates Clinical Data between the Many Languages That Document It
Author: Foley, Margaret M.; Hall, Candace; Perron, Kathryn; D'Andrea, Rachael
Source: Journal of AHIMA
Publication Date: February 2007
Clinical mapping is essential because healthcare has no single medical terminology, making it difficult to understand and translate meanings across the different terminologies developed for different uses. Mapping allows the capture of data in the electronic health record (EHR) with the t....
Code Ahead: Key Issues Shaping Clinical Terminology and Classification
Author: Foley, Margaret M.; Garrett, Gail S.
Source: Journal of AHIMA
Publication Date: July 2006
Coding is changing quickly. HIM professionals can keep a step ahead by following eight issues shaping clinical terminology and classification.
Coded data go farther and do more than ever before, making it imperative that HIM professionals stay abreast of many rapid changes. One of t....
DRG Grouping and ICD-10-CM/PCS
Author: Foley, Margaret M.
Source: Journal of AHIMA - Coding Notes | Journal of AHIMA
Publication Date: July 2015
Prior to the October 1, 2015 implementation of ICD-10-CM/PCS, every hospital must examine how the new code set will impact MS-DRG reimbursement. A recent Centers for Medicare and Medicaid Services (CMS) analysis indicates the overall effect of the transition to ICD-10 on hospital reimburs....
Communication with a Side of Encouragement, Please: Effective Communication Strategies for a Smooth CDI Program implementation Transition
Author: Flood, Diana
Source: Journal of AHIMA - Coding Notes
Publication Date: June 2012
Clinical documentation improvement (CDI) programs are spreading rapidly across the United States-and for good reason. They help facilities improve the level of documentation that goes into the patient medical record, leading to fewer errors and an overall improvement for continuity of care. Bu....
Pay for Performance (P4P) via IT Investments in California Medical Groups
Author: Flick, Jeff
Source: External web site
Publication Date: March 08, 2005
presentation at the HIT Summit West, San Francisco, CA
Injection and Infusion Coding Offers High Stakes: Outpatient Coders Must Play Their Cards Right
Author: Flewelling, Charles
Source: Journal of AHIMA - Coding Notes | Journal of AHIMA
Publication Date: June 2015
With the consistently rising value of highly skilled outpatient coders, numerous HIM departments are moving to a staffing model that employs coding professionals who are well versed in coding both inpatient and outpatient encounters. Coders in the profession today should possess a mastery....
Outcome Assessment Information Set (OASIS) for Home Care
Author: Fletcher, Donna M.
Source: Journal of AHIMA
Publication Date: September 1997
On March 10, 1997, the Health Care Financing Administration (HCFA) published a proposal that would require the use of the Outcome Assessment Information Set (OASIS) in its revision to the Medicare home health Conditions of Participation. The proposal is designed so that home care quality moni....
Mobilizing to Do Adaptive Work
Author: Fletcher, Donna M.
Source: Journal of AHIMA
Publication Date: November 1999
Can our visionary leaders solve our problems? Sometimes. But more often, the reality is the power to solve problems lies with us. This is the fundamental assumption of the "adaptive work" concept presented in this article—along with some real-life examples of HIM adaptive work in action.....
Achieving Data Quality: How Data from a Pediatric Health Information System Earns the Trust of Its Users
Author: Fletcher, Donna M.
Source: Journal of AHIMA
Publication Date: November 2004
One such program exists at the Child Health Corporation of America (CHCA), a business alliance of 41 of the largest not-for-profit children’s hospitals and healthcare systems in the US and Canada. The alliance represents more than 20,000 physicians, 98,000 employees, and $11 billion in r....
Reimbursement at Your Fingertips: A Glossary of Terms
Author: Fletcher, Donna M.
Source: Journal of AHIMA
Publication Date: September 1999
From the onset of DRGs in 1983 through today's proliferation of prospective payment systems (PPS) and managed care efforts, the number of terms related to reimbursement has increased significantly. The following are some of those terms and abbreviations, including those r....
Computer-Assisted Coding: What's Here, What's Ahead
Author: Flanagan, James R.; Doyle, Karen
Source: Journal of AHIMA
Publication Date: July 2006
Automated coding is already expediting billing. That may be just the first step in applying the technology to information-based medicine.
More and more you hear and read about computer-assisted coding (CAC). What is it, and why do we need it? What should we expect in the years to come? <....
Defining the Standards for Automated E&M Coding Through Coding Consistency Methodology
Author: Flanagan, James R.; dos Santos, Mariana
Source: AHIMA Computer-Assisted Coding Meeting
Publication Date: October 05, 2007
Industry White Paper. The Physician Revenue Cycle: a Gold Standard Study
Author: Fischer, Terri
Source: AHIMA Convention
Publication Date: October 07, 2009
Note: This conference paper is largely derived from the report Physician Revenue Cycle Gold Standard Study. The original report is available here.
INDUSTRY OVERVIEW
Key Trends:
Healthcare, the largest component of our nation’s gross dom....
Evaluation and Management Documentation and Coding: Results from an Exploratory Study
Author: Fenton, Susan H.; Gamm, Larry D.
Source: AHIMA Foundation | AHIMA eContent
Publication Date: May 02, 2007
Who's Coding and How in Physician Practices: a Survey of E/M Documentation and Coding Practices
Author: Fenton, Susan H.; Gamm, Larry D.
Source: Journal of AHIMA
Publication Date: July 2007
A survey of physician practices finds that most use multiple documentation and coding methods, few of them involving new technologies.
Evaluation and Management Documentation and Coding Technology Adoption
Author: Fenton, Susan H.; Gamm, Larry D.
Source: AHIMA Computer-Assisted Coding Meeting
Publication Date: October 05, 2007
Introduction to the Unified Medical Language System
Author: Fenton, Susan H.
Source: Journal of AHIMA - Coding Notes
Publication Date: May 2005
Coded data is the basis for knowledge transfer in 21st-century healthcare. The Unified Medical Language System (UMLS) is often called the Rosetta stone of international terminologies used in healthcare worldwide.
The purpose of the UMLS is to “facilitate the development of com....
Clinical Vocabularies: Essential to the Future of Health Information Management
Author: Fenton, Susan H.
Source: IFHRO Congress | AHIMA Convention
Publication Date: October 15, 2004
Introduction
The field of clinical vocabularies is incredibly dynamic. In this paper you will find topics and research from the past that support the principle of a clinical vocabulary as essential. The presentation at the conference will include the latest information regarding the avai....
Understanding How to Analyze Case Mix
Author: Fennick, Kathy
Source: AHIMA Convention
Publication Date: October 21, 2005
Introduction
Case mix analysis has been an ongoing challenge for hospital chief executive officers, chief financial officers, HIM directors, and case managers since the implementation of diagnostic related groups (DRGs) and the Medicare prospective payment system (PPS). Because no better....
Laying the Foundation for the NHII
Author: Featheringham, Meg
Source: Journal of AHIMA
Publication Date: May 2004
The news is spreading across the country about the need for a national healthcare information infrastructure (NHII). HIM professionals are crucial to getting the word out and moving this initiative forward. Gail Graham, RHIA, is at the forefront of the charge to implement an NHII. As director....
Use of the Delphi Method to Generate a Gold Standard for the Medical Coding Industry
Author: Familant, M. Elliott; Covit, Stuart; Covit, Andrew B.
Source: AHIMA Computer-Assisted Coding Meeting
Publication Date: October 05, 2007
Bringing Down Denials: Successfully Managing Denials in Medical Practices
Author: Fahrenholz, Cheryl Gregg
Source: Journal of AHIMA
Publication Date: August 2009
Resolving past denials and preventing future ones takes work. But making denials management a part of the practice’s daily work pays off on the bottom line.
When accounts receivables are not what they used to be, the reasons vary from practice to practice. Ho....
What Happened to PEPP?: QIOs Plan for Hospital Payment Monitoring Program
Author: Estrella, Renato
Source: Journal of AHIMA
Publication Date: July 2003
Efforts to boost the quality of care provided to Medicare patients aren’t new, but CMS’ latest plan will require additional efforts from hospitals. Learn more about the Hospital Payment Monitoring Program and how Quality Improvement Organizations are here to help.
Wondering wh....
HIM's Impact on Enhancing Data Quality and Integrity in the Home Health Setting
Author: Ervin, Johnna M.
Source: Journal of AHIMA
Publication Date: January 1998
Home health care is not a new concept, but it is definitely an evolving one. The roots of the home care industry go back to the Visiting Nurse Associations, which appeared in the US in the late 1880s. The early Visiting Nurse Associations were charitable organizations that primarily se....
Importance of Technology in CDI
Author: Ericson, Cheryl E; Wieczorek, Michelle M.
Source: CodeWrite | AHIMA newsletter article
Publication Date: July 2016
The fact that more than 80 percent of organizations staff clinical documentation improvement (CDI) professionals, despite it being a supplemental business function, is an indication of the undeniable benefits of CDI programs. Organizations have been slow, however, to invest in technology d....
Advances in Burn Reconstruction Complicate Coding: Get Familiar with Terminology, Techniques for Accurate Coding
Author: Erhardt, Walter L.; Medal, Diana
Source: Journal of AHIMA - Coding Notes
Publication Date: September 2003
Recent advances in the science of wound healing are making an impact on the treatment of burns. This is particularly evident not only in the way burn wounds are being managed initially, but also in how these wounds are being reconstructed. While these scientific advances make this field an exc....
Anatomy of a Physician Coder: Small, medium, and large physician practices all feature these multi-tasking, multi-responsibility coders
Author: Eramo, Lisa A
Source: Journal of AHIMA
Publication Date: November 2012
An analysis of the “physician coder” anatomy would reveal a cornucopia of responsibilities nestled under this one succinct title.
They are equal parts clinical documentation improvement specialist, office manager, patient counselor, physician process tracker, coder... the list goes....
The Final Countdown: Industry Moves Closer to ICD-10-CM/PCS Implementation Deadline
Author: Eramo, Lisa A
Source: Journal of AHIMA
Publication Date: June 2013
The clock is ticking, and in only 16 months the healthcare industry will begin to use, process, and exchange ICD-10-CM/PCS (ICD-10) codes. Readiness varies throughout the industry, with some stuttering after the Centers for Medicare and Medicaid Services delayed the ICD-10 implementation d....
Peeking Over the Fence: a Look at Canadian Coding and CDI Processes, and How They Differ From the US Due to Varied Financial Structures
Author: Eramo, Lisa A
Source: Journal of AHIMA
Publication Date: February 2014
Even with different payment models, Canada and the US are both working to reform healthcare with pay-for-performance and quality measurement reforms. Though using a single payer system, Canada still struggles with many of the same US HIM concerns—coding accuracy, clinical documentation improvement, and proper reimbursement.
Don’t Deny the Denials: Experts Recommend Implementing a Strong Claims Denial Strategy to Offset ICD-10-based Coder Productivity Loss
Author: Eramo, Lisa A
Source: Journal of AHIMA
Publication Date: June 2014
As organizations prepare for the implementation of ICD-10-CM/PCS next year, many are looking for creative strategies to mitigate anticipated decreases in coder productivity that will come with the switch. Some are ramping up education, others hiring additional staff members or implementin....
CDI Opportunities for HIM Professionals
Author: Endicott, Melanie; Gardner, Amy
Source: Journal of AHIMA - Coding Notes
Publication Date: October 2009
The HIM field continues to expand and change, opening up more opportunities for HIM practitioners to move out of the HIM department and into other areas of the hospital. Recent initiatives, such as ICD-10-CM/PCS, MS-DRGs, Hospital-Acquired Conditions, and Present on Admission reporting, have b....
Mentally Prepare for Psychiatric Classification Changes: Industry Moving to DSM-5 Revision
Author: Endicott, Melanie; Fletcher, Kathi
Source: Journal of AHIMA - Coding Notes
Publication Date: October 2013
A history of attempts to classify mental illness dates back to the 1840 US census, when the government included an entry to record the frequency of “insanity” in a family. This early record was strictly statistical in nature. In 1948—following World War II—the World....
CPT Receives Update for 2014
Author: Endicott, Melanie
Source: Journal of AHIMA - Coding Notes
Publication Date: February 2014
On January 1, 2014, the American Medical Association’s Current Procedural Terminology (CPT) was updated with additions, revisions, and deletions. In total, 175 new codes were added, 107 codes were revised, and 47 codes were deleted. In addition, editorial changes and coding guideline addi....
Pain-free Wound Care Coding
Author: Endicott, Melanie
Source: Journal of AHIMA
Publication Date: January 2010
Wound care diagnoses and procedures can be challenging to code. In order for coders to code them correctly, clinicians must document diagnoses and procedures appropriately and thoroughly. Open communication between coders and clinicians can help facilitate better documentation.
Inpa....
New ICD-9-CM Diagnosis Codes for FY 2012
Author: Endicott, Melanie
Source: Journal of AHIMA - Coding Notes
Publication Date: September 2011
The new ICD-9-CM diagnosis codes go into effect October 1, 2011. This date marks the last regular annual update to the ICD-9-CM code set before the partial code freeze. On October 1, 2012, there will be only limited code updates to ICD-9-CM to capture new technology and new diseases. There wil....
Hypertension Coding Review
Author: Endicott, Melanie
Source: CodeWrite | AHIMA newsletter article
Publication Date: May 2011
Does coding hypertension elevate your blood pressure? There are several terms related to hypertension that may cause confusion among coders and require some clarification. This article will define terminology related to hypertension and review the coding guidelines associated with combina....
2012 CPT® Coding Changes
Author: Endicott, Melanie
Source: CodeWrite | AHIMA newsletter article
Publication Date: February 2012
January 1 marked a new year as well as several additions, deletions, and revisions to the CPT® code set. All six sections, the introduction, and Appendix A, underwent changes in 2012. Coding professionals should review Appendix B of the CPT codebook for a complete listing of all change....
Unraveling Sepsis Coding in ICD-9-CM and ICD-10-CM
Author: Endicott, Melanie
Source: CodeWrite | AHIMA newsletter article
Publication Date: October 2012
Coding scenario
An 89-year-old female was taken to the emergency department after being found semi-conscious with markedly abnormal vital signs—a fever of over 101 degrees Fahrenheit, a heart rate of 100 beats per minute, and a respiratory rate of 22 breaths per minu....
Maintaining Productivity During the Transition to ICD-10
Author: Endicott, Melanie
Source: AHIMA blog post | Journal of AHIMA - website
Publication Date: July 08, 2015
Coding productivity is predicted to take a dip during the transition to ICD-10. That dip can be a minor speed bump or a gigantic crater, depending on many factors—which can be mitigated in these last few months leading up to implementation.
Training
The most ef....
Preparing for 2011 CPT Coding Updates
Author: Endicott, Melanie
Source: CodeWrite | AHIMA newsletter article
Publication Date: December 2010
January 2011 will bring immense changes to CPT codes. Are you ready? Here is a quick snapshot of some of the changes to look forward to:
Evaluation and Management
Subsequent Observation Care (99224, 99225, 99226) – New codes for subsequent observation care have....
Know Your Numbers: Accurate Cardiac Coding
Author: Endicott, Melanie
Source: CodeWrite | AHIMA newsletter article
Publication Date: February 2011
February is American Heart Month and the American Heart Association is encouraging all to “Know Your Numbers” to have a healthy heart. Below is an excerpt from the Go Red for Women Web site:
Factor
Goal
....
2011 ICD-9-CM Updates
Author: Endicott, Melanie
Source: CodeWrite | AHIMA newsletter article
Publication Date: October 2010
The 2011 ICD-9-CM code set includes numerous additions, revisions, and deletions. These codes take effect October 1, 2010.
Below are the 130 new diagnosis codes for FY 2011:
237.73
Schwannomatosis
<....
Defining Difficult Modifiers
Author: Endicott, Melanie
Source: CodeWrite | AHIMA newsletter article
Publication Date: April 2011
The assignment of modifiers is often an area of frustration for outpatient coders. The purpose of this article is to help define some of those difficult modifiers and provide examples of appropriate modifier usage.
Modifiers are used to indicate any of the following situatio....
2011 ICD-9-CM Code Updates
Author: Endicott, Melanie
Source: CodeWrite | AHIMA newsletter article
Publication Date: October 2010
The 2011 ICD-9-CM code set includes numerous additions, revisions, and deletions. These codes take effect October 1, 2010.
Below are the 130 new diagnosis codes for FY 2011:
237.73
Schwannomatosis
237.79
Ot....
Effects of ICD-10 on Coding Productivity
Author: Endicott, Melanie
Source: AHIMA blog post | Journal of AHIMA - website
Publication Date: March 10, 2016
In the years leading up to ICD-10-CM/PCS implementation, doomsdayers chanted horror stories of expected productivity losses of up to 50 percent. Now that we are nearly six months post-implementation, I’ve yet to hear about an instance where such a prediction came true.....
ICD-10 Transition: It’s All About the Guidelines
Author: Endicott, Melanie
Source: AHIMA blog post | Journal of AHIMA - website
Publication Date: November 11, 2015
Now that ICD-10-CM/PCS has finally been implemented and everyone is using these new code sets, the questions are rolling in. AHIMA’s Engage community is overflowing with questions from coding professionals seeking advice on how to code this or that. Many of the question....
ICD-9-CM Refresher
Author: Endicott, Melanie
Source: AHIMA blog post | Journal of AHIMA - website
Publication Date: June 11, 2014
Focus has been on training in ICD-10-CM/PCS for the past few years. With yet another delay, many organizations are slowing down their ICD-10 training and changing their focus back to ICD-9-CM.
The first quarter of 2014 was historic in “coder world” since t....
Coding Breast Procedures with CPT
Author: Endicott, Melanie
Source: Journal of AHIMA | Journal of AHIMA - Coding Notes
Publication Date: May 2014
There are a multitude of CPT codes available to report breast procedures, including incision, excision, introduction, mastectomy, repair, and reconstruction. The correct application of these codes requires an in-depth analysis of the notes associated with codes 19000-19396 and an understa....
Taking the Sting out of Injection and Infusion Coding
Author: Endicott, Melanie
Source: Journal of AHIMA - Coding Notes
Publication Date: November 2012
Injection and infusion coding is a challenging area, thanks to vast instructional notes, hierarchy rules, and payer-specific policies.
Current Procedural Terminology (CPT) defines the terms “injection” and “infusion” as:
Injection—delivers a dosage in one “shot,” r....
Nervous System Coding in ICD-10-CM/PCS
Author: Endicott, Melanie
Source: Journal of AHIMA - Coding Notes
Publication Date: June 2011
ICD-10-CM/PCS will capture a greater level of specificity for nervous system coding. This article highlights some of the new features in coding central and peripheral nervous system cases with ICD-10-CM/PCS.
Nervous System ICD-10-CM Diagnosis Coding
Nervous system diagnosis cod....
Coding Hip Fractures
Author: Endicott, Melanie
Source: Journal of AHIMA - Coding Notes
Publication Date: June 2010
Hip fractures are most commonly seen in elderly patients. They are a serious concern for this population because they can lead to a decreased quality of life, extended hospitalizations, or admission to nursing facilities.
Two of the most common causes for fractures are falls and ost....
Developing a Coding Quality Improvement Program
Author: Endicott, Melanie
Source: Journal of AHIMA - Coding Notes
Publication Date: March 2012
The increased need for accurate coded data for healthcare delivery, reimbursement, compliance, and regulatory accountability has brought about a corresponding need for data quality monitoring and regular evaluation programs. Maintaining data quality is an ongoing effort that affects many aspec....
Coding Root Operations with ICD-10-PCS: Understanding Division, Release, Control, and Repair
Author: Endicott, Melanie
Source: Journal of AHIMA - Coding Notes
Publication Date: July 2013
Editor’s note: This is the fourth in a series of 10 articles discussing the 31 root operations of ICD-10-PCS.
The transition to ICD-10-CM/PCS on October 1, 2014 is much more than just the customary annual update of codes. The ICD-10-CM code set is very similar in struc....
Flowing with Coding’s Changing Tide: The Evolving Role of Coders
Author: Endicott, Melanie
Source: Journal of AHIMA - Coding Notes
Publication Date: July 2013
With the oncoming swell of ICD-10-CM/PCS (ICD-10) and computer-assisted coding (CAC), coders may be wondering what the future holds for their career. Some worry that the transition to ICD-10 will be very challenging for long-term coders who have been using ICD-9-CM for several decades. The....
DIY: Grow Your Own Coders. Organizations Develop Programs to Internally Cultivate Coders
Author: Endicott, Melanie
Source: Journal of AHIMA - Coding Notes | Journal of AHIMA
Publication Date: April 2014
There are two major challenges currently plaguing the coder workforce. The first is new graduates are finding it difficult to land jobs due to a lack of experience. Second, healthcare organizations are struggling to recruit experienced coders to fill vacancies.
Recruiting....
New Toolkit Details CAC Implementation Steps
Author: Eminger, Heather; Owens, Jannifer
Source: Journal of AHIMA
Publication Date: April 2014
With the ICD-10-CM/PCS compliance deadline looming, acute care and ambulatory coding staff continue to focus on discovering new mitigation strategies to offset the anticipated loss of productivity that is expected to come with ICD-10 implementation. One strategy, implementing computer-ass....
Computer-Assisted Coding and Beyond
Author: Eminger, Heather
Source: AHIMA Convention
Publication Date: September 28, 2010
Introduction to CAC
Whether you're a facility reviewing the Computer-Assisted Coding (CAC) technologies because of coding challenges such as the ever evolving CMS requirements and backlogs, or preparing for ICD-10 CM. You will learn there is much more that Computer-Assisted Coding....
Compliance Issues in Practice: Shore-Up Your Program Before Auditors Hit the Door
Author: Emery, Steven; McDavid, Jan P; Robb, Deborah
Source: AHIMA Convention
Publication Date: September 25, 2010
Introduction
Nearly ten years since the Office of Inspector General (OIG) first issued guidance for physician practices on compliance with federal legislation, many physician practices still lack a proactive, cost-effective approach to achieving compliance. Taking this critical step can....
Compliance in Practice: Mitigating Risk in Clinics and Physician Practices
Author: Emery, Steven; McDavid, Jan P; Robb, Deborah
Source: Journal of AHIMA
Publication Date: March 2010
Managing compliance can be a challenge for physician practices short on staff and budget.
Reducing risk and capturing benefits begins with a focus on the areas of greatest concern.
The Office of Inspector General (OIG) first issued guidance for physician practices on compliance....
Coding and Billing Compliance Project #4
Author: Elizian, Jan
Source: AHIMA Convention
Publication Date: October 10, 2007
Compliance and Financial Effects of Specialty Coders in Cardiology and Interventional Radiology Arena
Author: Eleizian, Jan
Source: AHIMA Convention
Publication Date: October 10, 2007
The rapidity of change in the cardiac catheterization/EP and interventional radiology arenas due to advanced new technology, OPPS regulations, and the promise of severity DRGs challenge a coder’s expertise and knowledge base. The OIG has cited these areas as high risk for compliance (acc....
Data Abstraction Unplugged: Taking Trauma Registry to the Point of Care with Wireless Technology
Author: Eisenhower, Cynthia; McElwee, Karen; Wargo, Christina; Woodruff, Tracy
Source: Journal of AHIMA
Publication Date: July 2005
Central to Geisinger Medical Center’s success with concurrent abstraction is wireless technology that enables registrars to work at the point of care.
Registry abstraction can have trouble keeping up with technology. Often located away from IT-intensive clinical departments and oper....
Physician Office Billing Compliance Program
Author: Eisenhauer, Sue
Source: Journal of AHIMA
Publication Date: October 1997
Physician offices try to adhere to the coding and billing guidelines as defined by Medicare. However, claims to commercial insurance carriers frequently are not handled as precisely. The passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) has brought to our atte....
Maintaining a Legally Sound Health Record: Paper and Electronic
Author: E-HIM Work Group on Maintaining the Legal EHR
Source: AHIMA practice brief | Journal of AHIMA
Publication Date: November 2005
This practice brief has been retired. It is made available for historical purposes only.
Collecting Root Cause to Improve Coding Quality Measurement
Author: e-HIM Work Group on Benchmark Standards for Clinical Coding Performance Measurement. Quality Subgroup
Source: AHIMA practice brief
Publication Date: March 2008
This practice brief has been retired. It is made available for historical purposes only.
Preparing for RAC Prepayment Reviews
Author: Easterling, Sharon; Wilson, Donna D
Source: Journal of AHIMA - website
Publication Date: August 2012
We are now midway through 2012, and still awaiting the start of RAC prepayment reviews. The program was originally scheduled to start shortly after January 1, 2012, but has been pushed back until sometime during the summer of 2012. In the meantime, we are in the midst of struggling to....
Use Data Mining Findings as a Tool to Support CDI Education
Author: Easterling, Sharon; Endicott, Melanie; Lojewski, Tedi; Maccariella-Hafey, Patricia C; Martin, Ginny
Source: Journal of AHIMA - Coding Notes | Journal of AHIMA
Publication Date: July 2014
Clinical validation involves the clinical review of a case to determine whether or not the patient truly possesses the conditions documented in the health record. Productivity and coding quality often suffer when the health record lacks accurate documentation to support the claim, and cur....
Forgotten Denial: Automated
Author: Easterling, Sharon
Source: CodeWrite | AHIMA newsletter article
Publication Date: September 2013
With the never-ending volume of complex medical necessity denials and inpatient coding denials, automated denials get lost in the shuffle. We cannot forget the importance of these denials, which require intense energy, research, and effort, often only to yield a line item charge total of $....
Documentation and Coding in a Risk-based Environment: Obstacles to Be Aware Of
Author: Easterling, Sharon
Source: CodeWrite | AHIMA newsletter article
Publication Date: September 2015
With the implementation of the Value-Based Purchasing Model (VBP) and, more recently, statements in the Sustainable Growth Rate (SGR) fix, it remains clear that healthcare is going through a time of change. We must recognize risk in not only patient health management and outcomes, bu....
What's Up With Sepsis ... Again: The Role of Coding Professionals and CDI
Author: Easterling, Sharon
Source: CodeWrite | AHIMA newsletter article
Publication Date: September 2016
Coding professionals, along with clinical documentation improvement (CDI) professionals, have a tremendous role in reviewing documentation and clinical indicators in the assignment of sepsis, severe sepsis, and shock. Both types of professionals support the physician in addressing diagnose....
RAC Forensics 101. Part 1: Medical Record Requests and the Discussion Period
Author: Easterling, Sharon
Source: Journal of AHIMA - Coding Notes
Publication Date: January 2011
Thirteen months after the Recovery Audit Contractor (RAC) process was implemented nationwide, healthcare organizations are still learning how to best manage the audit process. The initial reviews were automated, but since that time RACs have also begun complex coding reviews and medical necess....
Busy Year for the RACs
Author: Easterling, Sharon
Source: Journal of AHIMA
Publication Date: March 2012
Learning from last year's denials and preparing for what's ahead will help providers avoid being stung in 2012.
When the Recovery Audit Contractor (RAC) permanent program began in 2009, providers were hopeful that the process for identifying underpayments and overpayments w....
RAC Forensics 101: Part 2: The Results Letter and the Discussion Call
Author: Easterling, Sharon
Source: Journal of AHIMA - Coding Notes
Publication Date: February 2011
Healthcare organizations are still struggling to manage the Recovery Audit Contractor (RAC) process implemented last year. This article is the second in a series that discusses the provider portal, the discussion period, and the review results letter. Part 1, published in the January issue, di....
RAC Forensics 101Part 3: Denials Management
Author: Easterling, Sharon
Source: Journal of AHIMA - Coding Notes
Publication Date: March 2011
The denials management process is the final step in the RAC process and can be the most time-consuming portion, depending on the circumstances of each case. Providers may appeal a RAC decision either through the discussion period or the formal Medicare Appeals Process.
Becoming know....
Implementation of the Clinical Documentation Program at Carroll Hospital Center, Westminster, MD
Author: Durbin, Pamela A.
Source: AHIMA Convention
Publication Date: October 10, 2007
Biography
I graduated from Old Dominion University in May 1991. I married a wonderful man in the U.S. Army. As we have moved around the country, I have taken the opportunity to explore different areas of nursing. I have experience in ED, ICU, PACU, home health, and Med/Surg. I am a....
Latest Look at Coding Trends [graphics]
Author: Dunn, Rose T; Mainord, Christina
Source: Journal of AHIMA - Coding Notes
Publication Date: July 2001
Latest Look at Coding Trends
Author: Dunn, Rose T; Mainord, Christina
Source: Journal of AHIMA - Coding Notes
Publication Date: July 2001
The April Journal of AHIMA (vol. 72, no. 4) "Coding Notes," article "Developing Facility-specific Productivity Measures," serves as the backdrop to this report on the results of our national survey of current coding practices. In the April article, we argued that coding pro....
Checks, Balances, and Ethics: Implementing Financial Controls for Associations
Author: Dunn, Rose T; Klaver, Jill Callahan; Rinehart-Thompson, Laurie A.
Source: Journal of AHIMA - website
Publication Date: November 2014
Health information management (HIM) professionals are recognized for their compliance-focused activities. Coding professionals, for example, assign codes based on the available documentation and the rules that define proper code application. When hospital coders are asked to resequence a condit....
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....
Improving Cash Flow in a Down Economy: How HIM Can Help Reduce Denials
Author: Dunn, Rose T
Source: Journal of AHIMA
Publication Date: March 2009
Maybe HIM professionals can’t ease tight credit or reduce bad debt, but they can make sure their organizations get full, correct reimbursement on the first submission. HIM professionals help improve cash flow by contributing to revenue cycle management.
In these tough economic....
Developing Facility-specific Productivity Measures
Author: Dunn, Rose T
Source: Journal of AHIMA - Coding Notes
Publication Date: April 2001
Coder productivity has become a popular topic among coders and HIM department managers and is frequently discussed on bulletin boards and listservs. Unfortunately, during the last few years, especially with the advent of APCs, it has become more difficult to establish productivity m....
ABNs--Always Been Neglected
Author: Dunn, Rose T
Source: AHIMA community resource
Publication Date: November 14, 2003
For something that has been around for nearly 2 decades and supported by regulation since 1965, Advance Beneficiary Notices (ABNs) continue to cause headaches today. The use of written notices has been available since the enactment of PL 92-603 in 1972. The specific format called an Advance B....
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....
Communicating with Physicians: Something to Talk About
Author: Dunaway, M. Tray
Source: Journal of AHIMA
Publication Date: September 2002
Ask a physician: "Doctor, are your detailed history and physicals comprehensive?" Now ask: "Doctor, are your comprehensive history and physicals detailed?" Chances are, you'll get two affirmative replies. To a physician, detailed workups are comprehensive, and comprehensive workups are detaile....
Coding Echocardiography Services in the Pediatric Setting
Author: Duffy, Michelle; Martinez, Richard M.
Source: AHIMA Convention
Publication Date: October 10, 2007
Introduction/Background
Most often, we think that heart disease occurs in adults who suffer from high blood pressure or those with high risk behaviors such as smoking or high cholesterol fatty diets. In our society, there is much emphasis on how to maintain a healthy lifestyle to avoid....
Keys to Auditing Hospital and Professional Fee Coding
Author: Driggs, Rachel Commons; Zupko, Mary J.
Source: Journal of AHIMA
Publication Date: June 2000
A good audit program can save a provider from sanctions or fines. Whether you work on the hospital or physician side, here are some tips for better auditing practices.
Coded data is increasingly used for reimbursement, financial planning, clinical research, and evaluating quality of car....
National Correct Coding Initiative: A Valuable Resource in Outpatient Coding Compliance
Author: Drake, Suzanne P
Source: Journal of AHIMA - Coding Notes | Journal of AHIMA
Publication Date: May 2015
The organizations health information management professionals serve are reliant on their understanding of outpatient coding and reporting conventions to ensure that the reimbursement received by facilities is accurate and not subject to improper payment audits.
The National....
Ten Steps to Successful Chargemaster Reviews
Author: Drach, Maureen; Davies, Alethea; Sagrati, Carmen
Source: Journal of AHIMA
Publication Date: January 2001
Is your chargemaster current, compliant, and comprehensive? In the age of APCs, healthcare facilities would do well to answer these questions regularly. Here’s how an HIM professional can help.
On every front, healthcare is advancing by leaps and bounds. At the same time, providers a....
The ICD-10 2011 To-Do List
Author: Dowling, Alan F.; Wisdom, Theresa A
Source: Journal of AHIMA
Publication Date: September 2010
As the ICD-10 conversion deadline approaches, its implementation is likely to become a healthcare facility's most significant objective. It presents HIM professionals with an opportunity to demonstrate their expertise and assume a leadership role within their institutions as they lead this....
Foot in the Door: How Post-Graduate Apprenticeship Programs Can Help Organizations Prepare for ICD-10
Author: Dover, Kayce; Phillips, Chloe
Source: Journal of AHIMA
Publication Date: January 2015
It’s a constant dilemma—new health information management (HIM) graduates struggle to find jobs because they lack experience, yet it’s difficult to get that coveted experience without having a job. Even despite an increasing demand for coders, many new graduates cannot find employers will....
Study Reveals Hard Facts on CAC
Author: Dougherty, Michelle; Seabold, Sandra; White, Susan E
Source: Journal of AHIMA
Publication Date: July 2013
As the healthcare industry begins to move toward new care delivery and payment models, the importance of high quality data to support decision-making, modeling, and quality reporting has become integral to emerging systems. Diagnostic data has always been key for clinical, billing, and rep....
Getting Better Data from the MDS: Improving Diagnostic Data Reporting in Long-term Care Facilities
Author: Dougherty, Michelle; Mitchell, Sue
Source: Journal of AHIMA
Publication Date: November 2004
Reporting diagnoses consistently can be a challenge in nursing homes. Analysis of the MDS by AHIMA suggests future improvements, but there are also ways to improve reporting today.
Consider the following scenario: a patient in a long-term care facility has many diagnoses, including one fo....
On the Line: Professional Practice Solutions
Author: Dougherty, Michelle; Hughes, Gwen
Source: Journal of AHIMA
Publication Date: September 2001
Q: My facility's records contain a variety of psychiatric documentation including therapists' notes from their treatment sessions with patients. How can I determine what requires special protection under HIPAA? Do I need to separate some of the documentation from the medical record? C....
New PPS Proposed for Inpatient Rehabilitation Facilities
Author: Dougherty, Michelle
Source: Journal of AHIMA
Publication Date: March 2001
It's time to take a look at HCFA's published proposed rules for a new prospective payment system (PPS) for inpatient rehabilitation facilities (IRFs).1,2 This new payment system applies to both rehabilitation hospitals and hospital-based rehab units for cost report periods beginning o....
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....
Validating MDS and OASIS Data with DAVE
Author: Dougherty, Michelle
Source: Journal of AHIMA
Publication Date: March 2004
In January 2004 the Center for Medicare and Medicaid Services (CMS) launched a new initiative to improve the accuracy and reliability of Minimum Data Set (MDS) data in long-term care. The Data Assessment and Verification program (DAVE) is a collaborative effort between multiple CMS program ar....
Post-acute PPS: Changing the Way We Code
Author: Dougherty, Michelle
Source: Journal of AHIMA
Publication Date: June 1999
HIM professionals in post-acute care are reinventing their roles to accommodate the new coding demands of a prospective payment system. Here are some of the developments that are creating new interest in coding issues for post-acute settings.
Three major forces -- the prospective payment....
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