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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....

Building a One-stop Shop for Ideas

Author: Thompson, Nancy A.

Source: Journal of AHIMA

Publication Date: July 2000




If you feel like you've ever reinvented the wheel when changing or improving processes, the Department of Veterans Affairs may have the answer. Read on to learn more about the Virtual Learning Center, an online knowledge base of healthcare solutions.



We all have....

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 This legislation repealed the sustainable growth rate (SGR) but also introduced a number of provisions designed to compensate physicians and other healthcare professionals ba....

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....

Experiences of a VHA Privacy Officer

Author: Putt, Stephanie H.

Source: In Confidence (newsletter)

Publication Date: November 02, 2001


Being the privacy officer for one of the world’s largest healthcare delivery systems is often a daunting responsibility, yet it offers an opportunity to make a difference and face new challenges. The Veterans Health Administration, or VHA, is part of the Department of Veterans Affairs (VA). T....

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....

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....

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....

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....

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....

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