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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....

AHIMA Advocates for Physician Query Forms

Author: Rode, Dan

Source: Journal of AHIMA

Publication Date: May 2001




The Medicare program's reluctance to accept physician query forms has been fermenting for several years. Recently, the Health Care Financing Administration (HCFA) and the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) have argued that facilities u....

Working Smarter with APCs

Author: Thoman, Deborah J.

Source: Journal of AHIMA

Publication Date: May 2001




Are HIM professionals ready to make the most of APCs? This article suggests some strategies to improve the way we work with APCs, focus on complete and accurate coding, and improve our expertise.
Are HIM professionals ready for the next step in APCs? Are we ready to use APC data....

PEPP: Collaborating to Improve Quality

Author: Poole, Laurie

Source: Journal of AHIMA

Publication Date: April 2001




By collecting and analyzing information about Medicare payment errors, PEPP initiatives are making a contribution to healthcare quality efforts nationwide. Here's how one organization takes a collaborative approach to improving quality.
State Payment Error Prevention Programs (....

When Health Information and Fiscal Management Meet

Author: Dunn, Rose T

Source: Journal of AHIMA

Publication Date: January 2001




HIM professionals have skills that can allow them to contribute to the bottom line in many ways. The author describes areas where HIM expertise can make a difference in evaluating an organization's fiscal performance through analysis of services driven by health information.
HI....

First Annual Hospital OPPS Update Published

Author: Rode, Dan

Source: Journal of AHIMA

Publication Date: January 2001




The Health Care Financing Administration (HCFA) published its "annual" update to the hospital outpatient prospective payment system (OPPS) as an "interim final rule with comment" in the November 13, 2000, Federal Register.1 Due to delays in the original implementat....

Understanding HIPAA Transactions and Code Sets

Author: Rode, Dan

Source: Journal of AHIMA

Publication Date: January 2001


The recently published final regulations for transactions and code sets under HIPAA are the light at the end of the tunnel in the quest for uniform healthcare standards-and the first step on a long road to HIPAA implementation. What are the standard transactions and code sets? This article tak....

CPT Changes for 2001

Author: O'Hara, Karen

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2001




CPT 2001 Professional Edition (CPT® 2001) is complete and should be landing on your desk soon. As an introduction to the new book, this article provides a brief summary of the changes in 2001. A complete listing of the code and guideline changes can be found in CPT Changes 2001:....

New Approach to Chargemaster Management

Author: Richey, John

Source: Journal of AHIMA

Publication Date: January 2001

After examining their CDM management processes, HIM professionals, along with clinical and support departments, redesigned and automated several practice aspects with successful results. (FORE Best Practice, AHIMA Foundation)

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