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HFMA Tackles Hospital Billing Chaos

Author: Jeffries, Jane

Source: Journal of AHIMA

Publication Date: January 2001




Hospital bills are lengthy, often incorrect, and potentially confusing-to no one's surprise. A hospital bill is the result of a long process with numerous participants, beginning at pre-intake and ending with final collections.

Richard L. Clarke, FHFMA, president and CEO o....

Payers Guide Articles

Author: AHIMA

Source: AHIMA bibliography

Publication Date: 2001


The Quest for Quality and Comparability in the National Healthcare Database: Announcing A Payer’s Guide to Health Care Data Quality and Integrity
by AHIMA’s Coding Policy and Strategy Committee

Summary of ICD-9-CM Coordination and Maintenance Committee Meeting
by Sue Prop....

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....

Building a Better CPT

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: November 2000


The Health Insurance Portability and Accountability Act (HIPAA) presents numerous challenges to HIM processes and systems. Not least among these areas is coding. Among the concerns is whether the CPT system will be sufficient to meet the demands of HIPAA. The American Med....

ICD-9-CM Code Revision for 2001

Author: Prophet, Sue

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2000


Effective October 1, 2000, 100 new ICD-9-CM diagnosis codes and nine new ICD-9-CM procedure codes have been implemented. Because there were no ICD-9-CM revisions last year, these new codes are the result of two years’ worth of revisions. Coding professionals should familiarize themselves with....

HCFA Addresses Inpatient Payments, SNFs

Author:

Source: Journal of AHIMA

Publication Date: October 2000


HCFA's recently published interim final rule concerning the "Provisions of the Balanced Budget Refinement Act of 1999; Hospital Inpatient Payments and Rates and Costs of Graduate Medical Education" will provide a 2.3 percent increase in payment rates for most acute care hospital....

HCFA Publishes Final Home Health PPS Rule

Author: Asmonga, Donald D.

Source: Journal of AHIMA

Publication Date: September 2000


The Health Care Financing Administration (HCFA) published the final rule for the prospective payment system (PPS) for home health agencies in July. This rule, which takes effect October 1, 2000, replaces the retrospective reasonable-cost-based system used to pay for home health service....

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....

Catching Up with PEPP

Author: Bryant, Gloryanne H.; Fletcher, Robin

Source: Journal of AHIMA

Publication Date: September 2000


A year ago, the Journal of AHIMA reported on the newly created Payment Error Prevention Program (PEPP), which went into effect in August 1999. What has happened since then?
Best Billing Practices

PEPP was created to reduce Medicare prospective payment system (PPS) ....

Making a Proactive Transition to APCs

Author: Willett, Lyn

Source: Journal of AHIMA

Publication Date: July 2000


There's no doubt APCs are going to change the way your facility operates, but do you know how? By taking a look at your existing systems, you'll get a better idea of how to prepare for changes. This article spotlights specific functions to consider and optimize for the new outpatient prospect....

Dot-com Coder

Author: Zender, Anne

Source: Journal of AHIMA

Publication Date: July 2000


For many people, working with artificial intelligence may sound like something out of a science fiction movie. But for Amy Davis, RHIA, it's just part of the job.

Davis is coding specialist and knowledge engineer at DocCode.com, a company based in Jacksonville, FL. Davis's....

Coding for APCs: Case Studies

Author: Scichilone, Rita A

Source: Journal of AHIMA - Coding Notes

Publication Date: July 2000


When APC implementation begins on August 1, HIM professionals can expect increased complexity when coding outpatient encounters. Examining case studies in selected areas subject to APC payment may help coding professionals better understand the APC reporting process. Although coding guidelines....

Journal Q&A (6/00)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: June 02, 2000

Q: How are hospitals reducing or maintaining low numbers of delinquent medical records?
A: Maintaining low numbers of delinquent records has long been a challenge for HIM professionals. Following are a few places from which to glean ideas: The AHIMA practice brief "Best Practices in Medical R....

Boosting Efficiency in Home Health Record Systems

Author: Abraham, Prinny

Source: Journal of AHIMA

Publication Date: April 2000


The growing pains of the past decade have led to medical record backlogs and record retrieval crises for many home healthcare agencies. These problems have pushed more than one agency director into enlisting the skills of an HIM professional to evaluate the medical record systems in pl....

Clarifying Selected CPT Modifiers

Author: Scichilone, Rita A

Source: Journal of AHIMA - Coding Notes

Publication Date: April 2000


Coding for professional services is complicated enough when coding professionals are charged with assisting the physician to select the best five-digit number for the services rendered. It becomes even more complex when circumstances of the case require the CPT code to be modified. Add....

Journal Q&A (4/00)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: April 02, 2000

Q: I was under the impression that a new prospective payment system (PPS) was to be implemented on October 1, 2000, for Medicare patients in rehabilitation hospitals. Where can I locate the proposed rules?
A: The Balanced Budget Act of 1997 mandated that a PPS be implemented for rehab h....

Resolving Confidentiality Barriers in Research Data Collection

Author: Houser, Shannon H.; Engle, Molly; Schumacher, Joseph E; Caldwell, Ellen; Kohler, Connie L; Phelan, Sharon T; Raczynski, James M; Reynolds, Kim D

Source: Journal of AHIMA

Publication Date: March 2000


How can HIM professionals ensure data collection consistency without access to earlier records? When protecting patient anonymity posed a challenge in a research study, HIM professionals took a team approach to abstracting records that maintained quality without compromising confidentiality.

Steering Quality Improvement in Healthcare

Author: Schoenfelt, Suzanne

Source: Journal of AHIMA

Publication Date: February 2000


"Quality" is a multi-industry buzzword, but what does it really mean in today's healthcare climate? We asked the experts for their views on the state of quality improvement in healthcare and what lies in store for HIM professionals as QI evolves.
For decades, healthcare has concerned its....

Using CPT Modifier -25 for Professional Billing

Author: Yoder, Lois M.

Source: Journal of AHIMA

Publication Date: January 2000


You may want to consider a focused review of how your practice assigns CPT modifier -25, "a significant, separately identifiable Evaluation & Management (E&M) service by the same physician on the same day of the procedure or other service."1 The Health Care Financing Admini....

Crystal Ball for Coding

Author: Johns, Merida L.

Source: Journal of AHIMA

Publication Date: January 2000


What will the future of coding look like? A special AHIMA task force has several ideas. What will really happen depends on how coders choose to respond. Here's an overview of the task force's findings, plus suggestions on how readers can make the most of possible career opportunities.
It....

Off-Site Coding Success Story

Author: Kramer, Lynette; Meeks, Richard

Source: Journal of AHIMA

Publication Date: January 2000


If you asked HIM professionals about key success factors that substantially impact timely and accurate coding, three of the most common answers might be:
availability of the record immediately after the patient visit
availability of the complete record....

Trend Watch: Coding for Nonphysician Services

Author: Hill, Emily

Source: Journal of AHIMA

Publication Date: January 2000


From physician assistants to nurse practitioners, the number of healthcare professionals offering patient care services has increased dramatically in recent years. With this increase comes a challenge to coders—accurately reporting the services provided by these prof....

Coding Crosses into the Future

Author:

Source: AHIMA Advantage

Publication Date: December 1999


With all that's on your desk today, it's difficult to anticipate what changes are headed your way in the next year, let alone 10 years from now. But for a moment, as distant as it seems, consider what coding practice may look like on January 1, 2010.

It's a staggering question, one th....

Mobilizing to Do Adaptive Work

Author: Fletcher, Donna M.

Source: Journal of AHIMA

Publication Date: November 1999


Can our visionary leaders solve our problems? Sometimes. But more often, the reality is the power to solve problems lies with us. This is the fundamental assumption of the "adaptive work" concept presented in this article—along with some real-life examples of HIM adaptive work in action.....

Brief History of ICD-10-PCS

Author: Mullin, Robert L.

Source: Journal of AHIMA - Coding Notes

Publication Date: October 1999


The International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) was developed as a replacement for the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) volume 3, Procedures. This version of ICD, in use since J....

Compliance Efforts Get Some PEPP

Author: Bryant, Gloryanne H.

Source: Journal of AHIMA

Publication Date: September 1999


Earlier this year, the Office of the Inspector General (OIG) informed the Health Care Financing Administration (HCFA) that "the DRG system is vulnerable to abuse by providers who wish to increase reimbursement inappropriately through upcoding, particularly so within certain DRGs.&....

Getting Ready for APCs

Author: Scichilone, Rita A

Source: Journal of AHIMA

Publication Date: September 1999


While most healthcare practitioners support accurate coding, the challenge remains for HIM professionals: how to achieve coding accuracy in a system of imperfect data capture methods and changing reimbursement methodologies. Greater emphasis on coding specificity and completeness for reimburs....

PPS + New Technology = Growing Pains

Author: Blumenthal, Jane E

Source: Journal of AHIMA

Publication Date: September 1999


It's been a little more than a year since the prospective payment system (PPS) came into play in skilled nursing facilities. The post-acute PPS, initiated by the federal government under the 1997 Balanced Budget Act, was set in place to reduce the federal government's healthcare expend....

Automated Coding: The Next Step?

Author: Beinborn, Julie

Source: Journal of AHIMA

Publication Date: July 1999


Automated coding technology may be key to the evolution of the coding and billing processes. How do these systems work, and how will they change the role of the coder? The author offers a preview.
Technology is changing many aspects of healthcare, and coding is no exception.

R....

After Automated Coding, What?

Author:

Source: Journal of AHIMA

Publication Date: July 1999


As technology progressively automates more processes, what will HIM jobs look like in the future? In 1998, AHIMA published Evolving HIM Careers, which offers in-depth looks at seven new roles for HIM professionals, including the role of the clinical data specialist. Here are som....

Coders and Physician Liaisons: a Winning Combination

Author: Stavely, Starla

Source: Journal of AHIMA

Publication Date: July 1999


Never have so many HIM professionals had so much to worry about in the area of coding. Combine the need to keep an eye on case mix and a vigilant effort to prevent fraud and abuse, throw in a lack of physician documentation, increasingly stiff competition for the chart on nursing units, and co....

Where We've Been, Where We're Going

Author: Scichilone, Rita A

Source: Journal of AHIMA

Publication Date: July 1999



As conditions in the healthcare industry have become more challenging, many jobs have evolved. Not least among them in the HIM world is the role of the coder. In more ways than one, coding professionals are making their mark in the industry. And today, changes in coding requirements are pa....

Best Practices: What Works

Author: Carrier, Danielle

Source: Journal of AHIMA

Publication Date: July 1999




Medical record accuracy, record completion time, physician satisfaction—all of these are indicators of how well an HIM department is performing. The findings of a UHC benchmarking study may point the way to best practices that can be shared and adapted.

What....

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....

Sign of the Changing Times: CPT 1999

Author: Mallett, Sherri; Smith, Gail I.

Source: Journal of AHIMA

Publication Date: June 1999


This year brought with it 686 changes to CPT. While this is a moderate number in comparison to previous years, several of the changes have significant impact on code assignment. The purpose of this article is to highlight some of the areas of significant change. (See "1999 CPT Revisions" in t....

Imagine the Future of Coding

Author:

Source: AHIMA Advantage

Publication Date: June 1999


How will coding be different in the year 2010? Pondering the coding practices of tomorrow is the job of AHIMA's Coding Futures Task Force. And though there's no crystal ball involved, trends that will have a substantial impact on the future can be identified today.

Remember the word p....

Post-acute PPS: Changing the Way We Code

Author: Dougherty, Michelle

Source: Journal of AHIMA

Publication Date: June 1999


HIM professionals in post-acute care are reinventing their roles to accommodate the new coding demands of a prospective payment system. Here are some of the developments that are creating new interest in coding issues for post-acute settings.
Three major forces -- the prospective payment....

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