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Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates ...: Final Rule

Author: U.S. Department of Health and Human Services

Source: Government (U.S.)

Publication Date: August 19, 2008

[Federal Register: August 19, 2008 (Volume 73, Number 161)] [Rules and Regulations] [Page 48433-49083] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr19au08-13] [[Page 48433]] ----------------------------------------------------------------------- Part II Book 2 of 2....

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....

Medicare APCs 2007: Where We Are Seven Years Later

Author: Russell, Jean C.

Source: AHIMA Convention

Publication Date: October 10, 2007

Background

When the Centers for Medicare and Medicaid Services’ (“CMS”) implemented the Outpatient Prospective Payment System (“OPPS”) on August 1, 2000, it fundamentally changed the way hospitals are reimbursed for outpatient services. Since the inception of the Medicare program in the 1....

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....

Maximizing Data Quality of the Minimum Data Set

Author: Zender, Anne

Source: Journal of AHIMA

Publication Date: June 1998


HIM professionals who work in long term care settings are well acquainted with the Minimum Data Set 2.0 (MDS). Since 1990, it has been part of the standardized assessments that nursing homes participating in the Medicare and Medicaid programs must complete. Starting this summer, updated submis....

Mastering Pediatric Codes

Author: Walk, Gerri

Source: AHIMA Convention

Publication Date: September 26, 2010

Introduction

As we all know, children and adult healthcare issues are very different. This is why there are pediatric specialty hospitals; as well as, pediatric departments within acute care or outpatient facilities. The same goes for coding. General coding and pediatric coding are not t....

Managing Physician Queries in the EHR

Author: Wiedemann, Lou Ann

Source: Journal of AHIMA

Publication Date: July 2011


Federal incentives provided for the meaningful use program under the American Recovery and Reinvestment Act are encouraging hospitals to adopt electronic health records (EHRs). Eighty percent of hospitals are planning to become meaningful users of EHR technologies in 2011, and the healthcare i....

Managing Clinical Data: A Cancer Registries Update

Author: Watkins, Sue

Source: Journal of AHIMA

Publication Date: July 1997


Introduction
The American Cancer Society estimates that about 1.38 million new cancer cases will be diagnosed, and about 560,000 Americans will die of cancer, in 1997.1 These estimates do not include carcinoma in situ or basal and squamous cell skin cancer. To monitor trends in cancer i....

Managed Care: The Dominant Paradigm in US Healthcare

Author: Welch, Julie J.

Source: Journal of AHIMA

Publication Date: April 1998


What does "managed care" really represent -- and what effect has managed care had on the healthcare market? The author describes how managed care came to be a critical market force, offers a snapshot of its proliferation, and examines its effects on the traditional payment system.
It's....

Managed Care in the Age of Accountability

Author: Tercero, Wendy

Source: Journal of AHIMA

Publication Date: April 1999


Additionally, as managed care grows, quality and cost will reach equilibrium, and today's economically driven model will have stabilized, turning into one that truly balances cost and quality. Healthcare organizations of the future will need to implement information systems that support decisi....

Malignancy: Aftercare or Follow-Up?

Author: Parman, Cindy C

Source: CodeWrite | AHIMA newsletter article

Publication Date: May 2015




Physician documentation has always supported accurate diagnosis code reporting, but never more so than with the transition to ICD-10-CM codes. Specific terminology and the use of key words and phrases is essential, especially with terms such as "aftercare" and "follow-up," which phy....

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....

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....

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....

Look at Modifiers for Hospital Use

Author: Philippou, Karla E.

Source: Brief Encounter

Publication Date: July 02, 2001


Modifiers have been a continuing problem in the hospital setting. Although modifiers were mandated for hospital use in June 1998, many hospitals were unable to comply until the implementation of Ambulatory Payment Categories, (APCs), on August 1, 2000. The initial problems were related to info....

Long-term Acute Care: the Effect of PPS

Author: Smith, Pam

Source: Journal of AHIMA

Publication Date: October 2003


Just when I thought I’d seen and done it all in the HIM world, a new opportunity for coders appeared in long-term acute care hospitals (LTCHs). HIM professionals have been employed in LTCHs since the inception of long-term acute care, but the change from cost-based reimbursement to inclus....

Lessons Learned from the Bill Error Correction Process

Author: Davis, Nadinia A.

Source: AHIMA Convention

Publication Date: October 02, 2011

ABSTRACT

Front-end errors in registration and charge entry prevent billing problems that drive up the DNFB. These errors can lead to denials for incorrect billing or untimely filing. Bill error correction is typically housed in Patient Financial Services, in which case HIM staff are invol....

Leading the Transition to ICD-10

Author: AHIMA House of Delegates

Source: AHIMA HoD Resolution

Publication Date: June 18, 2010

Preamble

Whereas, October 1, 2013, has been set by the United States Department of Health and Human Services as the date for adopting the ICD-10-CM and ICD-10-PCS (ICD-10-CM/PCS);
Whereas, ICD-10-CM/PCS provides significant improvements in reporting diagnostic and procedural data an....

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....

Last Call for ICD-9-CM

Author: AHIMA

Source: Journal of AHIMA

Publication Date: October 2013


October 1, 2013 could be a day sentimental HIM veterans raise a glass to a longtime friend—or perhaps foe. For October 1 signifies the end of an era; it is the effective date of the final ICD-9-CM update before ICD-10-CM/PCS codes kick in on October 1, 2014.


In a statement t....

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....

Know Your APCs: Data Analysis Made Simple

Author: Stegman, Melinda

Source: Journal of AHIMA

Publication Date: July 2001



You’ve adapted processes to the APC system, but do you really understand the financial impact of APCs on your organization? The author shows you how to analyze your billing data to assess the impact of APCs on your facility’s bottom line.



Since the implement....

Key Points of the UB-04 (2010 update)

Author: AHIMA Clinical Terminology and Classification Practice Council; Garrett, Gail S.; Jorwic, Therese M; Novak, Natalie; Ruhnau-Gee, Becky; Safian, Shelly C; Zeisset, Ann M.

Source: AHIMA practice brief

Publication Date: April 2010


Editor’s note: This update replaces the October 2006 practice brief “Key Points of the UB-04.”

In 2005 the National Uniform Billing Committee (NUBC) approved the Uniform Bill (UB-04) paper claim and data set as the replacement to the UB-92 paper form.1 Currently, all paper claims must....

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....

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....

Keeping Up with the CPT/HCPCS Changes

Author: Bielby, Judy A

Source: CodeWrite | AHIMA newsletter article

Publication Date: September 2011



Although January 1 is regarded by many professional coders as the date when CPT®/HCPCS code changes are implemented, it is becoming increasingly important for professional coders to pay attention to those new CPT/HCPCS codes which are implemented throughout the year. There may be insta....

Keeping up to Date: 2005 CPT Surgery Changes

Author: Hull, Susan

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2005


CPT changes for 2005 affect all portions of the manual, although there are very few changes in the pathology and laboratory section. This article will focus on the changes for the surgery section. The January and February 2005 issues of CodeWrite (available through the Coding Community of Prac....

Journal Q&A (9/04)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: September 02, 2004


Q: We are having trouble with the discharge status codes on some of our claims. In order to get the claim paid, the fiscal intermediary (FI) requires the discharge status code be changed. If we change the code, it will not correspond with documentation in our medical record.
A: The Center....

Journal Q&A (9/04)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: September 02, 2004


Q: We are having trouble with discharge codes 03 and 04 for skilled nursing facility and intermediate care facilities. I don’t think we have skilled nursing facilities in our area, so we have used the discharge code for intermediate care facility when a patient goes to the nursing home. <....

Journal Q&A (9/01)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: September 02, 2001

Q: I work in a home care agency and am developing a procedure on correcting errors on OASIS to comply with the Centers for Medicare and Medicaid Services' (CMS, formerly HCFA) new correction policy. Is it necessary to make a separate entry in the medical record? Our agency would like to make the co....

Journal Q&A (7/03)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: July 02, 2003

Q: How can I find the Medicare manuals, program memorandums, and the Conditions of Participation on the new CMS Web site?

A: After the Health Care Financing Administration (HCFA) changed its name to CMS, it moved all its resources to its new site at www.cms.gov/manuals.


....

Journal Q&A (6/02)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: June 02, 2002

Q: Recently, a discharged patient fell two days after discharge from the inpatient rehab facility where I work. He went to the emergency room and was readmitted to the rehab facility within three days after discharge. Because we discharged the patient home without expecting a return, can we send in....

Journal Q&A (4/00)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: April 02, 2000

Q: I was under the impression that a new prospective payment system (PPS) was to be implemented on October 1, 2000, for Medicare patients in rehabilitation hospitals. Where can I locate the proposed rules?
A: The Balanced Budget Act of 1997 mandated that a PPS be implemented for rehab h....

Journal Q&A (11/02)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: November 02, 2002


Q: Where can I find federal regulations, interpretive guidelines, and Medicare manuals online?


A: The Centers for Medicare & Medicaid Services (CMS) has a number of manuals available online including the federal regulations for various settings, interpretive guidelines, Med....

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