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Communicating with Physicians: Something to Talk About

Author: Dunaway, M. Tray

Source: Journal of AHIMA

Publication Date: September 2002


Ask a physician: "Doctor, are your detailed history and physicals comprehensive?" Now ask: "Doctor, are your comprehensive history and physicals detailed?" Chances are, you'll get two affirmative replies. To a physician, detailed workups are comprehensive, and comprehensive workups are detaile....

New ICD-9-CM Committee Presents New Codes, Changes

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: September 2002


This is part 1 of a two-part summary of proposals from the April 2002 ICD-9-CM Coordination and Maintenance Committee meeting and includes procedure proposals. Part 2 will include diagnosis proposals and will be published in the October Journal of AHIMA.
The ICD-9-CM Coordination and Main....

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

Author: AHIMA Policy and Government Relations Team

Source: AHIMA regulation analysis

Publication Date: August 02, 2002


The final rule regarding FY 2003 revisions to the Medicare hospital inpatient prospective payment system (PPS) was published in the August 1, 2002 issue of the Federal Register.



This rule becomes effective on October 1, 2002.This analysis will cover changes to DRG classificat....

ICD-10 on the Horizon

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: July 2002


ICD-10 has taken hold around the globe, so why is the US still using ICD-9-CM? This article reviews the history of ICD-10 in the US.


Other countries are using it. Why aren't we? Coding professionals across the country and around the world are wondering why ICD-10-CM hasn't been....

Constructing a Coding Compliance Plan

Author: Hanna, Joette

Source: Journal of AHIMA

Publication Date: July 2002


The government has turned its attention to coding compliance. Do you have an effective program in place? Use the steps in this article to build a coding compliance program that protects your organization.


Coding compliance has become an integral part of every HIM department....

New PPS Proposed for LTC Hospitals

Author: Dougherty, Michelle

Source: Journal of AHIMA

Publication Date: July 2002


In the past 10 years, the number of new long-term care hospitals (LTCHs) in the United States has tripled. Because of this growth, LTCHs are the newest post-acute settings to face a change in the reimbursement system.


While there are only about 270 LTCHs in the United States, t....

Testimony of the American Health Information Management Association to the National Committee on Vital and Health Statistics on ICD-10-CM

Author: Prophet, Sue

Source: AHIMA testimony and comments

Publication Date: May 29, 2002

May 29, 2002
Opening Comments

Chairman Cohn, members of the National Committee on Vital and Health Statistics (NCVHS) Standards and Security Subcommittee, ladies and gentlemen, good afternoon. I am Sue Prophet, director of coding policy and compliance of the American Health Informati....

Testimony of the American Health Information Management Association to the National Committee on Vital and Health Statistics on ICD-10-PCS

Author: Prophet, Sue

Source: AHIMA testimony and comments

Publication Date: April 09, 2002


April 9, 2002

Opening Comments

Chairman Cohen, members of the National Committee on Vital and Health Statistics (NCVHS) Standards and Security Subcommittee, ladies and gentlemen, good afternoon. I am Sue Prophet, director of coding policy and compliance of the American Hea....

Coding on the Home Front

Author: Zeisset, Ann M.

Source: Journal of AHIMA - Coding Notes

Publication Date: April 2002


Recently, a group of coders participated in a survey about their day-to-day experiences as remote, or at-home coders. The survey asked a series of questions related to the positives and negatives of coding at home versus coding in the more traditional office setting. Below is a summary of the....

Quality at the Core

Author: Zender, Anne

Source: Journal of AHIMA

Publication Date: March 2002


Is your hospital getting ready for the Joint Commission’s core measures project? Some hospitals are already transmitting the necessary data as part of the pilot project. Here’s how they are handling the challenges and deriving benefits.
If you’re an HIM director, you prob....

Testimony of the American Health Information Management Association to the National Committee on Vital and Health Statistics on Medical Code Sets

Author: Prophet, Sue

Source: AHIMA testimony and comments

Publication Date: February 06, 2002

February 6, 2002
Opening Comments

Good morning Mr. Chairman, members and staff of the National Committee on Vital and Health Statistics (NCVHS) Standards and Security subcommittee, ladies and gentlemen.   I am Sue Prophet, director of coding policy and compliance for the American Heal....

Best Practices for Medical Necessity Validation

Author: Scichilone, Rita A

Source: Journal of AHIMA

Publication Date: February 2002


To protect the Medicare Trust Fund from being drained, government health plans must provide coverage restrictions for unnecessary health services in vulnerable patient populations. One restriction mechanism is the provision of edits that look for valid reason-for-visit codes for selected servi....

Medical Necessity under OPPS: a Look at the Challenges

Author: Carter, Darren

Source: Journal of AHIMA

Publication Date: February 2002


The outpatient prospective payment system (OPPS) has dramatically changed claims processing by introducing an automated system. Medical necessity validation has also been automated as a result, leaving hospitals with increased rejections. This article explores how OPPS impacts the medical nece....

Closer Look at All-Patient Refined DRGs

Author: Averill, Richard F.

Source: Journal of AHIMA

Publication Date: January 2002


Are you fluent in DRG? This article takes a look at the evolution of the three distinct DRG systems and spotlights the most recent iteration, All-Patient Refined DRGs. It also sheds light on how this system, when codes are properly applied, can help an organization study morbidity and mortalit....

Here Comes Rehab PPS!

Author: Grzybowski, Darice; Draper, Skeeter

Source: Journal of AHIMA

Publication Date: January 2002


Just when you thought it was safe to come up for air.


After Medicare’s introduction of the Outpatient Prospective Payment System (PPS, which brought us APCs), the Home Health PPS (with its HHRGs), and Skilled Nursing Facility PPS (with RUGS), another new reimbursement syst....

Anthrax: What Every Coder Should Know

Author: Stanfill, Mary H

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2002


The inhalation anthrax identified by a Florida physician in October 2001, during the recent series of bioterrorist attacks, was the first case of reported inhalation anthrax in the United States in more than 25 years.1 With the threat of anthrax as a biological weapon, correct coding could be....

CPT Changes for 2002

Author: O'Hara, Karen

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2002


Coders need to keep their resources current—including updating the Current Procedural Terminology (CPT) codes every year with the annual CPT book. This article provides a brief summary of the changes made to the CPT 2002 code set. The complete list of changes can be found in Appendix B of....

2002 DRG Updates Already in Effect

Author: Uppena, Mary

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2001



The 2002 diagnosis related group (DRG) updates went into effect October 1, 2001. With the implementation of these changes to the hospital inpatient DRGs portion of the prospective payment system (PPS), there will be 499 DRGs in 25 Major Diagnostic Categories (MDCs).


Changes t....

ICD-9-CM Codes Ready for 2002

Author: Zeisset, Ann M.

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2001


For those reporting ICD-9-CM codes for all diagnoses coding, and hospitals reporting ICD-9-CM volume III for procedures, fall is the time to review and implement the changes and revisions for fiscal year 2002.

The ICD-9-CM coding changes for fiscal year 2002 were released in the Augus....

APC Validation Audits ... The Nitty Gritty Details

Author: Knowles, Lisa

Source: AHIMA Convention

Publication Date: October 10, 2001




Ambulatory payment classifications (APCs) have been implemented, and APC validation audits are the next issue to contend with. Similar to DRGs, we must design and conduct APC validation audits. Whether the audit is performed in-house or by an external consulting firm, it is essential....

Start to Finish Medical Necessity Review

Author: Arner, Kathy

Source: AHIMA Convention

Publication Date: October 10, 2001



Purpose: To identify why rejections occur and where the problem areas are located.


Why are rejections occurring on the professional side?


Medicare and other insurances are implementing local medical review policies.

Ordering providers are not supply....

When Good Chargemasters Go Bad

Author: Leeds, Erica

Source: AHIMA Convention

Publication Date: October 10, 2001



Introduction: What Is a Chargemaster?

A chargemaster is a master list of services, supplies, and drugs used for patient care. A chargemaster used by outpatient facilities (emergency rooms, clinics, same-day surgery centers, and so on) will have the associated HCPCS codes and rev....

APCs: A Hospital-wide Effort

Author: Neilson, Seana

Source: AHIMA Convention

Publication Date: October 10, 2001




For many healthcare providers, thriving under the Medicare outpatient prospective payment system (i.e., APCs) appears to be a distant goal not to be realized anytime soon. In fact, for the next year or so, most healthcare providers subject to APCs will most likely be satisfied with me....

PRO-West's Payment Error Prevention Program

Author: Baron, Anne

Source: AHIMA Convention

Publication Date: October 10, 2001




Background

Beginning in 1997, the Office of the Inspector General (OIG) started conducting annual audits of Medicare billing practices. These audit results estimated that Medicare had paid more than $23 billion in incorrect payments in 1996 and more than $20 billion in 1997.....

Home Health Prospective Payment Systems (HH-PPSs)

Author: Abraham, Prinny

Source: AHIMA Convention

Publication Date: October 10, 2001



The National Association of Home Health reported that the number of Medicare certified home health agencies peaked in 1997 at 10,444 and declined to 8,080 in 1998, to 7,747 in 1999, and back up to 7,880 in 2000. Personal expenditures for home care were estimated at $36 billion in 1999, dow....

How Gaps in Data Quality Impact Reimbursement

Author: D'Amato, Cheryl

Source: AHIMA Convention

Publication Date: October 10, 2001




Introduction

Improving the quality and flow of data for outpatient services will impact how facilities fare financially under Medicare's outpatient prospective payment system (OPPS). This paper will provide practical advice on how to effectively evaluate and reengineer coding....

Developing Technical Applications for Coding Compliance

Author: Hammen, Cheryl

Source: AHIMA Convention

Publication Date: October 10, 2001


Introduction

Although high-risk DRG pairs have been audited to ensure compliance in hospitals over the past several years, there are still opportunities available for streamlining this time-consuming process. Monthly data review regarding the frequency of the high-risk pairs is only a....

CPT "Monopoly" To Be Examined

Author:

Source: Journal of AHIMA

Publication Date: October 2001


Senate Minority Leader Trent Lott (R-MS) has forwarded a letter to HHS Secretary Tommy Thompson criticizing the American Medical Association's "statutory monopoly" on current procedural terminology (CPT) codes. Lott said that Congress will look at the CPT issue when it considers....

Putting Productivity Plans to Work

Author: Dunn, Rose T

Source: Journal of AHIMA - Coding Notes

Publication Date: October 2001




This is the last in a series of three "Coding Notes" articles addressing productivity measurement and incentive plans for coding professionals. The April Journal of AHIMA (vol. 72, no. 4) article discussed the general principles of developing facility-specific productivity m....

Informatics in Managed Care: HIM Adds Value to Data

Author: Stratton, Scott D.

Source: Journal of AHIMA

Publication Date: September 2001

The third installment of the Journal of AHIMA’s special series on managed care focuses on informatics-methods that add value to data, turning it into useful information. How do informatics and managed care fit together, and what is HIM’s role in this picture?

The HIM professional’s knowl....

Teaching Physician Guidelines

Author: Graff, Jean Stevens

Source: Brief Encounter

Publication Date: September 02, 2001


Working in an orthopedic clinic, I understand the great need for my newly created position. I am employed at a teaching hospital as a medical record auditor charged with the task of educating physicians on the art of coding and documentation. My job is to ensure compliance with the Medicare ma....

Solving the E/M Conundrum: a Special Report

Author: Scichilone, Rita A

Source: Journal of AHIMA

Publication Date: July 2001


Evaluation and Management (E/M) codes, introduced in 1992 for reporting physician visit services, are linked to a number of perplexing questions for coders. In different settings, they are used differently and with varying sets of criteria. Given the numerous coding and compliance issues relate....

E/M Options in the Outpatient Arena

Author: Jones, Lolita M.

Source: Journal of AHIMA

Publication Date: July 2001


Under the Medicare ambulatory payment classification (APC) system, hospitals must establish criteria for mapping the medical care rendered in the emergency department and hospital-based outpatient settings to appropriate CPT medical visit codes. Do you know how to establish a sound rationale f....

Review of E/M Guidelines

Author:

Source: Brief Encounter

Publication Date: July 02, 2001


The Evaluation and Management guidelines are found in the Medicare Carriers Manual in the following sections. You may download the entire manual from the Center for Medicare and Medicaid Services or CMS (formerly HCFA) Web site by going to http://www.hcfa.gov/, click on Medicare, select laws an....

Look at Modifiers for Hospital Use

Author: Philippou, Karla E.

Source: Brief Encounter

Publication Date: July 02, 2001


Modifiers have been a continuing problem in the hospital setting. Although modifiers were mandated for hospital use in June 1998, many hospitals were unable to comply until the implementation of Ambulatory Payment Categories, (APCs), on August 1, 2000. The initial problems were related to info....

Common E/M Documentation Issues

Author: Udell, Curtis

Source: Brief Encounter

Publication Date: July 02, 2001


One of the constant challenges facing managers today is evaluating physician documentation and then helping their physicians to improve the content of their patient notes, particularly for evaluation and management (E/M) services.

While physicians may have unique style or flair to t....

Navigating the Physician Services Maze

Author: Skurka, Margaret A.

Source: Journal of AHIMA

Publication Date: July 2001


As HIM professionals know, accurate and complete documentation is critical for providing care and supporting reimbursement. This is particularly true-and yet particularly problematic-in the area of E/M coding. Medical practices report and are paid for their services using E/M coding, yet there....

Know Your APCs: Data Analysis Made Simple

Author: Stegman, Melinda

Source: Journal of AHIMA

Publication Date: July 2001



You’ve adapted processes to the APC system, but do you really understand the financial impact of APCs on your organization? The author shows you how to analyze your billing data to assess the impact of APCs on your facility’s bottom line.



Since the implement....

AHIMA Testifies in Support of ICD-10

Author: Rode, Dan

Source: Journal of AHIMA

Publication Date: July 2001


The "replacement [of ICD-9-CM, Volume 3] with a new procedural coding system for inpatient services is absolutely necessary and ICD-10-PCS meets the criteria for such a replacement system," said Linda Kloss, MA, RHIA, AHIMA's executive vice president and CEO. Kloss also argued that &q....

Implementing a Mobile Coding Solution

Author: Colgan, Peter

Source: In Confidence (newsletter)

Publication Date: July 02, 2001


Wireless computing technologies capable of enabling clinical and administrative decision support throughout the extended healthcare enterprise have arrived! Among the benefits of any wireless healthcare solution is the wide distribution of information throughout the enterprise. This benefit r....

Coding Under the HIPAA Umbrella

Author: Russo, Ruthann

Source: Journal of AHIMA - Coding Notes

Publication Date: June 2001





Although coding professionals are not ultimately responsible for ensuring appropriate release of patient-protected information, it is important that they understand that coded data is not only one of the most desired pieces of information in the patient’s record, it is also the....

Covering the Bases of Coding Compliance

Author: Hapner, Peggy

Source: Journal of AHIMA - Coding Notes

Publication Date: May 2001




As HIM professionals already know, data quality-one of the basic tenets of compliance-depends on comprehensive documentation and accurate code assignments. Because coding plays a major role in payment, reporting data accurately, managing data flow and data collection, and training st....

Trends to Watch in Home Health Compliance

Author: Abraham, Prinny

Source: Journal of AHIMA

Publication Date: May 2001




The implementation of the Home Health Prospective Payment System (PPS) on October 1, 2001, has presented some unique compliance risks for HIM and billing managers. This article will briefly describe some of the compliance-related issues on the OIG's agenda that are of interest to HIM....

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