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Where Are They Now? CPR Leaders Assess Their Progress

Author: Zender, Anne

Source: Journal of AHIMA

Publication Date: September 2000


Five years ago the first recipients of the Davies awards showed us successes of CPR systems across the country. Where are they now? This article catches up with these CPR leaders.
Is your job exactly the same as it was five years ago? For most HIM professionals, the answer....

Web FAQ

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: October 2002

What are the documentation requirements for Observation Patients?
It is interesting to note that the observation service (OBS) did not originate from the government but by the healthcare marketplace in response to PPS/DRG conditions. When hospitals are not sure whether a patient will meet admi....

Web FAQ

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: October 2002

What guidance is available for determining an organization's definition of "attending physician" or "physician of record"?
The Department of Health, Education, and Welfare adopted the UHDDS (Uniform Hospital Discharge Data Set) as department policy for Medicare and Medicaid patient populations....

Web FAQ

Author: AHIMA Coding Team

Source: AHIMA Q and A

Publication Date: October 2002

Where Can I Find the Regulations on Medicare Payment Methodologies Used in Non-acute Care Settings?


http://www.hcfa.gov/medicare/payment.htm is a site that provides links to pages on Medicare payment methodologies. On these pages you will find helpful information on various payment....

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....

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....

Teach Your Attorney Healthcare Contracting

Author: Le, Huan N.

Source: Journal of AHIMA

Publication Date: February 2003


Medicare regulations, HIPAA compliance, and the threat of litigation have made it impossible to draft a one-page healthcare contract. Standard language alone now extends to up to four pages. It’s a good idea to hire an attorney for contract negotiations and drafting, but even then, you mi....

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....

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....

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....

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....

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.

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....

Next Generation of E/M Guidelines

Author: Hill, Emily

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2000


Few non-clinical issues have inspired as much discussion, revision, and anxiety as the evaluation and management (E/M) services and their accompanying documentation guidelines. E/M services have produced a cottage industry focused on ensuring that medical records contain necessary docu....

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....

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....

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....

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....

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....

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....

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....

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 (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....

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