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Coding for Medicare Advantage Plans

Author: Truscott, Tricia

Source: AHIMA Convention

Publication Date: October 02, 2011


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....

Observation Services - Ensuring Every Dollar

Author: Canter, Kelly

Source: AHIMA Convention

Publication Date: October 02, 2011


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....

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


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....

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....

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....

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....

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