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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....

ABNs--Always Been Neglected

Author: Dunn, Rose T

Source: AHIMA community resource

Publication Date: November 14, 2003


For something that has been around for nearly 2 decades and supported by regulation since 1965, Advance Beneficiary Notices (ABNs) continue to cause headaches today. The use of written notices has been available since the enactment of PL 92-603 in 1972. The specific format called an Advance B....

Analysis of Final Rule for 2003 Revisions to the Medicare Hospital Outpatient Prospective Payment System

Author: AHIMA Policy and Government Relations Team

Source: AHIMA regulation analysis

Publication Date: November 24, 2002

The final rule regarding calendar year 2003 revisions to the Medicare hospital outpatient prospective payment system (PPS) was published in the November 1, 2002 issue of the Federal Register.   This rule becomes effective on January 1, 2003.   This analysis will cover significant....

Analysis of Final Rule for 2004 Revisions to the Medicare Hospital Outpatient Prospective Payment System

Author: AHIMA Policy and Government Relations Team

Source: AHIMA regulation analysis

Publication Date: December 02, 2003


The final rule regarding calendar year 2004 revisions to the Medicare hospital outpatient prospective payment system (PPS) was published in the November 7, 2003 issue of the Federal Register (the proposed rule was published in the August 12, 2003 issue). This rule becomes effective on January....

Benchmarking Project Harvests Ideas for Network

Author: Zender, Anne

Source: Journal of AHIMA

Publication Date: November 1998


It started as a simple benchmarking project. But when Patricia Rhodes, RRA, Carol Keller, MPA, and their team finished, the project had taken them across the country, opened up lines of communication with staff members at nine other facilities, and helped them improve their....

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....

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....

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 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....

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....

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....

Documentation Errors Result in Medicare Overpayment

Author: Hammen, Cheryl

Source: Journal of AHIMA

Publication Date: July 2000



The objective of the Office of the Inspector General's (OIG) fiscal year 1999 audit was to determine whether medical fee-for-service claims complied with Medicare rules and regulations. The OIG examined claims for accurate documentation and coding, medical necessity, and to ensure that c....

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