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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....

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....

Growing ICD-10: Seedling Transition Programs Take Root

Author: Dimick, Chris

Source: Journal of AHIMA

Publication Date: June 2011


There are two basic approaches to the ICD-10 transition: (1) a late, mad scramble to get systems converted before the deadline; or (2) an intentional cultivation that uses the transition to improve business processes, documentation, and clinical care. Three organizations offer a picture of the....

Group Health Plan's Glossary

Author:

Source: AHIMA web extra

Publication Date: March 02, 2003


Administrative requirements of the privacy rule include those to have personnel designations, training, safeguards, complaint handling, sanctions, mitigation of harm, and current policies and procedures. These are not required if only summary information is exchanged between the GHP and plan sp....

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....

Global Language for Pharmaceutical Regulation

Author: Rulon, Vera

Source: Journal of AHIMA

Publication Date: January 2000


What will facilitate medical product regulation and related electronic data interchange worldwide? For some regulatory authorities, the answer is the Medical Dictionary for Drug Regulatory Affairs—also known as MedDRA.

MedDRA (the name is a trademark of the International Federat....

Getting to ICD-10: the Road Ahead

Author: AHIMA

Source: AHIMA Advantage

Publication Date: August 2004


The clinical code set used to report healthcare diagnoses and procedures in the United States is fast becoming obsolete. The International Classification of Diseases, Ninth Revision, Clinical Modification, (ICD-9-CM) hampers efforts in research, public health reporting, quality assessment, and....

Getting the SNOMED Ball Rolling in Australia

Author: Moore, Helen

Source: Journal of AHIMA

Publication Date: November 2004

Letter to the Editor, Journal of AHIMA


After reading the July-August 2004 Journal of AHIMA, I wanted to express my interest in the article by Jack Bowie, “Four Options for Implementing SNOMED.” It was pleasing to read an article on SNOMED that focused on HIM operatio....

Getting the Best from Your ICD-10 Vendor

Author: Dimick, Chris

Source: Journal of AHIMA - website

Publication Date: May 2011



May 10, 2011


Payers and providers must work their way through the transition to ICD-10-CM/PCS only once, and by the end, few will likely choose to do it again. System vendors and consultants, however, will have been through many, many implementations before it’s all over.

Getting Ready for APCs

Author: Scichilone, Rita A

Source: Journal of AHIMA

Publication Date: September 1999


While most healthcare practitioners support accurate coding, the challenge remains for HIM professionals: how to achieve coding accuracy in a system of imperfect data capture methods and changing reimbursement methodologies. Greater emphasis on coding specificity and completeness for reimburs....

Getting Quality Clinical and Coded Data: How UMHS's CDIP Improved Clinical Coded Data and Clinical Staff Relationships

Author: Blackford, Gwendolyn; Whitehouse, Rosanne

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

Publication Date: October 2007


Obtaining codeable clinical documentation at the point of care in a large teaching facility can be challenging. However, the HIM department at the University of Michigan Health System (UMHS) in Ann Arbor, MI, took on the task, implementing a clinical documentation improvement program (CDI....

Gestational Diabetes

Author: Bielby, Judy A

Source: CodeWrite | AHIMA newsletter article

Publication Date: October 2011



Objective:  To discuss coding for gestational diabetes.


Coding scenarios: Patient A is 30 weeks pregnant and is seen for treatment of gestational diabetes. Patient B is seen for diabetes screening. Patient B is not currently pregnant, does not currently have a diagnosis....

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....

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,....

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....

FY 2012 Changes to the Hospital IPPS

Author: DeVault, Kathryn

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2011


The final rule for the FY 2012 Hospital Inpatient Prospective Payment System was released August 1, 2011. Changes in the rule went into effect with October 1, 2011, inpatient discharges.
MS-DRG Documentation and Coding Adjustment

The Centers for Medicare and Medicaid Services....

FY 2011 Changes to the Hospital IPPS

Author: DeVault, Kathryn

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2010


The final rule for the FY 2011 Hospital Inpatient Prospective Payment System was released July 30, 2010. Changes in the rule went into effect with October 1, 2010, inpatient discharges.

The changes to MS-DRGs and the complication and comorbidity (CC) and major complication and comorb....

FY 2010 Changes to the Hospital IPPS

Author: DeVault, Kathryn

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2009


The final rule for the FY 2010 Hospital Inpatient Prospective Payment System was released on July 31, 2009. Changes in the rule went into effect with inpatient discharges of October 1, 2009, and are reflected in Grouper Version 27.0.

The changes to MS-DRGs and the complication and co....

FY 2009 Hospital IPPS Final Rule

Author: Schwab, Linda

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2008


The final rule for the FY 2009 hospital inpatient prospective payment system (IPPS) went into effect October 1, 2008. Although there are relatively few changes to MS-DRGs and the complication and comorbidity (CC) and major CC (MCC) lists, the final rule signals that the Centers for Medicare an....

FY 2007 IPPS Overview: Comprehensive Changes in Effect for Inpatient Prospective Payment System

Author: Johnson, Laurie M.; Garrett, Gail S.

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

Publication Date: November 2006


The Inpatient Prospective Payment System (IPPS) final rule for fiscal year 2007 will prove challenging for inpatient providers. The rule (published in the August 18 Federal Register and available at www.access.gpo.gov/su_docs/fedreg/a060818c.html) includes some of the most comprehensive changes....

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

....

From Coder to Knowledge Engineer

Author: Zender, Anne

Source: Journal of AHIMA

Publication Date: July 2003

“Find a job that really holds your interest and one that will challenge you. If you’re not challenged daily, there’s something wrong.” —Judy Sample, RHIT, CCS, knowledge engineer
at Inference Systems International, Inc.
Combining her interests in coding and tec....

Fracture Treatment Poses Coding Challenge: Multiple Treatment Options Require Special Attention

Author: Hutchinson, Mark R.; Stanfill, Mary H

Source: Journal of AHIMA - Coding Notes

Publication Date: April 2003


There are 206 bones in the human body and each is susceptible to fracture. The choices in fracture management are complex and based on a number of issues including fracture type, fracture pattern, specific bone, age of fracture, age of patient, associated injuries, and physician preference. Co....

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....

Four Options for Implementing SNOMED

Author: Bowie, Jack

Source: Journal of AHIMA

Publication Date: July 2004


HIM departments looking to employ SNOMED terminology have fourbasic application options. The final choice depends heavily on their ITdepartments.
SNOMED CT offers significant benefits in the structured codification of clinical activity, and it will be the foundation of many emerging app....

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 $....

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....

Final Rule for FY 2008 IPPS: MS-DRGs and POA Top List in a Year of Major Change

Author: D'Amato, Cheryl; Garrett, Gail S.; Johnson, Laurie M.

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

Publication Date: November 2007



The final rule for the fiscal year 2008 inpatient prospective payment system (IPPS) went into effect October 1, 2007. The rule includes ICD-9-CM code changes, implementation of the new Medicare severity-adjusted (MS) DRG system, and a number of quality-related changes that affect how Medic....

Final Push to ICD-10 Implementation

Author: Birnbaum, Cassi L

Source: Journal of AHIMA

Publication Date: June 2015



Chills run up and down my spine as I write this article, knowing how hard we have worked as a profession, association, and industry to get to this red letter date for ICD-10-CM/PCS.


Just before I wrote this column, I was on the edge of my seat along with the rest of indust....

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....

External Cause Codes in ICD-10-CM

Author: Fuller, Jan C.

Source: CodeWrite | AHIMA newsletter article

Publication Date: August 2014



The increased specificity in ICD-10-CM is reflected in a substantial increase in external cause codes. The traditional “E code” has been replaced with V, W, X and Y codes. While the purpose of the codes remains the same, the ICD-10-CM codes provide a level of detail not possible in ICD-9-....

Experts Suggest Beginning ICD-10 Implementation Today

Author: AHIMA

Source: AHIMA Today

Publication Date: October 05, 2009


There is no time like the present to begin planning for the national coding switch to ICD-10-CM/PCS, according to several HIM professionals presenting here at convention.

Coding staff don’t need to start poring over new code books yet. But other preparations must be made for a facili....

Experts: Clinical Terminology Mapping Will Be Essential Tool

Author:

Source: Journal of AHIMA

Publication Date: January 2006


Clinical terminology mapping is essential for creating an effective nationwide health information infrastructure, Simon Cohn, MD, MPH, told attendees at the first-ever institute on clinical vocabulary mapping methods, held October 15. Cohn, chair of the National Committee for Vital and Health....

Evolution of HEDIS: 3.0 and Beyond

Author: Rulon, Vera; Sica, JoAnn

Source: Journal of AHIMA

Publication Date: June 1997


History of HEDIS
Employer Issues Leading to HEDIS
The Health Plan Employer Data and Information Set (HEDIS) is a set of standard performance measures designed to provide purchasers and consumers with the information they need to compare the performance of managed healthcare plans.....

Ethical Standards for Clinical Documentation Improvement (CDI) Professionals (2016)

Author: AHIMA

Source: AHIMA

Publication Date: June 2016

The AHIMA Ethical Standards for Clinical Documentation Improvement Professionals are intended to assist in decision making processes and actions, outline expectations for making ethical decisions in the workplace, and demonstrate the professionals' commitment to integrity. They are relevant to all clinical documentation improvement professionals and to those who manage the clinical documentation improvement (CDI) function, regardless of the healthcare setting in which they work.

Establishing a CDI Program: How One Organization Leveraged Nursing and Coding Skills to Improve Clinical Data

Author: Lopez, Barbara A

Source: Journal of AHIMA - Coding Notes

Publication Date: July 2010


Establishing a clinical documentation improvement (CDI) program is an organization-wide, transformational process that affects a hospital’s culture, reaching across all disciplines and touching every colleague and the way they perform their jobs. Many factors can lead healthcare organizations....

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