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Ins and Outs of HCCs

Author: Fernandez, Valerie

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

Publication Date: June 2017



A Hierarchical Condition Category (HCC) is defined as a risk adjustment model that is used to calculate risk scores to predict future healthcare costs. The Centers for Medicare and Medicaid Services’ (CMS) CMS-HCC model is used to predict healthcare spending for Medicare Advantage Pl....

How MACRA Changes HIM

Author: Marron-Stearns, Michael

Source: Journal of AHIMA

Publication Date: March 2017



The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is widely viewed as one of the most significant and complex changes to Part B Medicare reimbursement in several decades. The Centers for Medicare and Medicaid Services (CMS) created the Quality Payment Program (QPP) that incl....

CY 2017 OPPS Update

Author: Comfort, Angie

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

Publication Date: February 2017



As last year drew to a close, facilities began the looming task of reviewing the Hospital Outpatient Prospective Payment System (OPPS) final rule to ensure their chargemaster and systems were up-to-date with the 2017 changes. The final rule for calendar year (CY) 2017 was released on Novem....

Role of HIM in MACRA

Author: Primeau, Debra

Source: Journal of AHIMA - website

Publication Date: December 01, 2016




As providers gear up to meet reporting requirements under the Medicare Access and CHIP Reauthorization Act’s (MACRA’s) new Quality Payment Program (QPP), health information management (HIM) stands to play a prominent role in the transition to value-based care.


Success un....

Moving Toward Value-Based Payment

Author: Easterling, Sharon

Source: CodeWrite

Publication Date: March 2016




As industry propels itself toward a shift in how providers are reimbursed, measured, and selected for care, providers have to be open, fluid, and deliberate in their plans over the next three years and beyond. The "CMS Quality Strategy 2016" was released by the Centers for Medicare an....

MACRA and the Role of Clinical Data Integrity

Author: Stearns, Michael

Source: Journal of AHIMA

Publication Date: January 2016



President Obama signed into law the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 on April 16, 2015. This legislation repealed the sustainable growth rate (SGR) but also introduced a number of provisions designed to compensate physicians and other healthcare professionals ba....

OIG Reveals Top Oversight Priorities for 2015

Author: AHIMA Advocacy and Policy Team

Source: Journal of AHIMA

Publication Date: March 2015

OIG's 90-page work plan for fiscal year 2015 (FY15) offers a high-level view of the office's continued monitoring of various HHS programs and initiatives, particularly those designed to ensure the appropriateness of Medicare and Medicaid payments. The work plan also outlines many of the government's activities in FY15 designed to ensure care quality and safety in hospitals and other healthcare settings.

Health Information Exchange – Our Successes and Challenges with the Virtual Lifetime Electronic Record

Author: Foley, Teresa; Gillen, Zachary; Teal, Jennifer

Source: AHIMA Convention

Publication Date: October 02, 2011

Background

In the spring of 2009, President Obama announced plans to create a joint Virtual Lifetime Electronic Record (VLER) to improve care and services between the Department of Veterans Affairs (VA), Department of Defense (DoD), and the private sector. President Obama directed the Dep....

Observation Services - Ensuring Every Dollar

Author: Canter, Kelly

Source: AHIMA Convention

Publication Date: October 02, 2011

Introduction

Inpatient medical necessity has become a very hot topic for the Recovery Audit Contractors (RACs) over the last 12 months. Due to the focus on medical necessity for inpatient admissions, proactive and reactive hospitals are scrutinizing their admission practices. Since there....

Coding for Medicare Advantage Plans

Author: Truscott, Tricia

Source: AHIMA Convention

Publication Date: October 02, 2011


Background


The Centers for Medicare and Medicaid Services (CMS) use a reimbursement methodology similar to the DRG system for coverage of Medicare patients enrolled in Medicare Advantage plans through private insurance companies. Using ICD codes from hospital and physician visit....

Three-Day Window Updates

Author: Garrett, Gail S.

Source: Journal of AHIMA - Coding Notes

Publication Date: June 2011


The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 was signed into law on June 25, 2010. One of its provisions revised the three-day payment policy, or the so-called "three-day DRG window."

This article highlights the changes to the three-da....

Payout: Reviewing Meaningful Use Payments

Author: Viola, Allison F.; Rode, Dan

Source: Journal of AHIMA

Publication Date: October 2010


CMS will pay meaningful use bonuses through three programs: Medicare Fee for Service (FFS), Medicare Advantage (MA), and Medicaid programs.
FFS Payments to Providers

For eligible professionals (EPs), understanding the payment system is especially important, because they must ch....

ICD-9-CM Coding Guidance for LTC Facilities. Appendix C: Regulatory Guidance for Reporting Diagnoses Related to Reimbursement

Author: AHIMA

Source: AHIMA practice brief attachment

Publication Date: October 2010


In August 2000, the HIPAA Transaction and Code Sets required the use of the ICD-9-CM code set. Subpart J, section §162.1002 Medical data code sets, states the adoption of the following code sets as standard medical data code sets:
ICD-9-CM, volumes 1 and 2 (including the "ICD-9-CM Official....

RAC Primer for LTC Facilities

Author: Leonard, Mary Ann

Source: Journal of AHIMA

Publication Date: January 2010



Last year the Centers for Medicare and Medicaid Services (CMS) began rolling out the Recovery Audit Contractor (RAC) program to all 50 states and all providers, including long-term care facilities. HIM professionals working in LTC facilities need to understand the basics of the program in....

CMS Eliminates Reimbursement for Consultations

Author: Nelson, Tanai S

Source: AHIMA newsletter

Publication Date: December 02, 2009


As proposed, the Centers for Medicare and Medicaid Services (CMS) finalized their decision to eliminate the use of all consultation codes (inpatient and office/outpatient codes for various places of service except for telehealth consultation G-codes). What does that mean? That means that CMS w....

Coding in Critical Access Hospitals

Author: Kostick, Karen M.

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2009


National health policy has been increasingly responsive to the healthcare needs of rural residents and providers. Rural America has a large percentage of the nation’s Medicare population, and this percentage continues to grow as residents born in the Baby Boomer generation begin to retir....

Graham: How e-HIM Forges Ahead at the VA

Author:

Source: AHIMA Today

Publication Date: October 06, 2009


The evolving world of health information technologies is changing the way HIM professionals work and presenting them with new challenges and opportunities. This is especially the case at the US Department of Veterans Affairs (VA), where the widespread use of electronic health records (EHRs) ha....

Understanding National Coverage Policies: Navigating the Maze of HACs, Serious Reportable Events, and Wrong Surgical Sites

Author: Cook, Jane; D'Amato, Cheryl; Garrett, Gail S.; Ruhnau-Gee, Becky; Hyde, Linda A.; Novak, Natalie

Source: Journal of AHIMA - Coding Notes

Publication Date: June 2009


Present on admission indicators, hospital-acquired conditions, serious reportable events, and “wrong” surgical events are each hot topics. However, they also can be a hot topic together, because a number of these reporting requirements are interrelated. HIM professionals must under....

ABCs of Medicare Advantage

Author: Hernandez, Jeannette

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2008


Although most Medicare beneficiaries receive their health coverage through the traditional Medicare Part A and B fee-for-service programs, more and more beneficiaries are enrolling in Medicare Part C, referred to as Medicare Advantage (MA), to manage their healthcare costs.

By June 2....

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....

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....

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....

Practice Toolkit: Medicare Billing in Long-term Care

Author: Sims, Michelle

Source: Journal of AHIMA

Publication Date: June 2005


In order to accurately bill for long-term care, an organization must achieve consistency between the minimum data set (MDS) and the UB-92. The first step is to ensure compliance with the completion of the MDS. It is helpful to have a system that identifies the assessment reference date span an....

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