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Interpretive Guidelines for Life Safety

Author: U.S. Centers for Medicare & Medicaid Services

Source: Government (U.S.)

Publication Date: October 02, 1986

State Operations Manual
Appendix I - Interpretive Guidelines for Life Safety

Interpretive Guidelines for Physical Therapists in Independent Practice

Author: U.S. Centers for Medicare & Medicaid Services

Source: Government (U.S.)

Publication Date: February 02, 1987

State Operations Manual. Appendix F
Interpretive Guidelines, Physical Therapists in Independent Practice

Fraud and Abuse Implications for the HIM Professional

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: April 1997

Healthcare Fraud and Abuse Legislation

On August 21, 1996, President Clinton signed into law the Health Insurance Portability and Accountability Act. This law addresses several issues including the creation of a Health Care Fraud and Abuse Control Program. This program is intended to com....

Coding Compliance: Practical Strategies for Success

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: January 1998


"Fraud," "abuse," "upcoding," "unbundling," and "compliance" have all become buzzwords in the news media. Eliminating healthcare fraud and abuse has become a top priority for the federal government. Government investigations are on the rise and providers everywhere tremble at the thought of b....

Fraud and Abuse: What You Can Do

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: January 1998



During AHIMA's National Convention, HIM professionals convened to network and share practical ideas on issues pertaining to fraud and abuse. While most of the participants worked in hospitals, other work settings, including colleges, consulting firms, and government agencies were als....

Sentinel Event Procedures Undergo Scrutiny

Author: Fuller, Sandra R.

Source: Journal of AHIMA

Publication Date: February 1998


Substantial changes were made to the Joint Commission on Accreditation of Healthcare Organizations' Sentinel Event Procedures at the November 1997 Board of Commissioners meeting. With an implementation date scheduled for April 1, 1998, all Joint Commission accredited healthcare organiz....

Benchmarks as the Signposts Along the Fraud Case Trail

Author: Kaldal, Karen

Source: Journal of AHIMA

Publication Date: November 1998


Traditionally, payers in the healthcare industry have relied on external tips or complaints for starting points for fraud investigations. But recently the number of leads on fraud activity has increased as the public becomes more aware of the issue. To combat this problem, payers have begun to....

Proposed Rule Mandates Fraud Data Bank

Author:

Source: Journal of AHIMA

Publication Date: January 1999


On October 30, 1998, the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) published a Notice of Proposed Rulemaking titled "Health Care Fraud and Abuse Data Collection Program: Reporting of Final Adverse Actions." The notice states that....

In Pursuit of Healthcare Fraud

Author: King, Ellen

Source: Journal of AHIMA

Publication Date: January 1999


How broad is the scope of healthcare fraud and abuse? Here's a look at the many ways the Federal Bureau of Investigation is tackling the problem.

Healthcare fraud takes billions of dollars away from federally funded healthcare programs. These programs, particularly Medicare and Med....

Teamwork and Compliance Go Hand in Hand

Author: Ruppersburg, Patricia L.

Source: Journal of AHIMA

Publication Date: April 1999



Compliance is an issue that has earned much respect from healthcare professionals. It has become imperative to all HIM professionals to focus on providing the best possible solution for compliance. The ultimate goal: to create a scenario in which compliance supports the existing heal....

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.&....

Dual Accreditation Presents Challenges, Opportunities

Author: Zender, Anne

Source: Journal of AHIMA

Publication Date: February 2000


While most HIM professionals are acquainted with participating in a facility's Joint Commission accreditation processes, a small but significant number work in facilities that are also accredited by the American Osteopathic Association (AOA). Though the organizations have....

Conference Handouts

Author: AHIMA

Source: HIPAA Conference 2000

Publication Date: March 13, 2000






 

Conference Handouts


If you weren't able to attend the HIPAA Conference in March, you can review the text of handouts and presentations provided at the sessions.

....

HIPAA Compliance: Is Outsourcing the Answer?

Author: Watkins, Larry

Source: HIPAA Conference 2000

Publication Date: March 14, 2000

2000 HIPAA Conference Presentation
HIPAA Compliance: Is Outsourcing the Answer?
Larry Watkins, Director, Electronic Commerce -- Per-Se Technologies EDI in Health Care-HIPAA Legislation
Mandated Standards 9 Electronic Transaction Standards Standardization of Supporting Codes Standard....

Legal Pitfalls of HIPAA

Author: Waller, Adele A.

Source: HIPAA Conference 2000

Publication Date: March 14, 2000

2000 HIPAA Conference Presentation
Legal Pitfalls of HIPAA
Presented by Adele A. Waller, Bell, Boyd & Lloyd LLC Overview
Business Payoffs Planning for New Technology Needs Contractual Strategies for Compliance Policies and Procedures Integrating HIPAA into Corporate Compliance Progra....

Fundamentals for the Newly Initiated

Author: Amatayakul, Margret

Source: HIPAA Conference 2000

Publication Date: March 14, 2000

2000 HIPAA Conference Presentation
Fundamentals for the Newly Initiated
Margret Amatayakul, Margret\A Consulting, LLC Session Objectives
Get an overview of the original legislation, processes, and timelines Examine the scope and impact of the new regulations Review ongoing HIPAA impl....

HIPAA Compliance: Is Outsourcing the Answer?

Author: McLaughlin, Mark

Source: HIPAA Conference 2000

Publication Date: March 14, 2000

2000 HIPAA Conference Presentation
HIPAA Compliance: Is Outsourcing the Answer?
Mark McLaughlin, Informatics Standards Liaison, McKessonHBOC Compliance Depends on You!: HIPAA Components for Outsourcing
Transactions Processing Auditing Security Disaster Recovery
Consultants and....

What's Next?

Author: Braithwaite, Bill

Source: HIPAA Conference 2000

Publication Date: March 14, 2000

2000 HIPAA Conference Presentation
What's Next?
Presented by Bill Braithwaite, MD, PhD, FACMI, Senior Advisor on Health Information Policy, US Dept. Of HSS Hospital Systems Affected
Laboratory Pharmacy Radiology Registration (ADT) Orders Results Data Warehouse Management Master Perso....

Journal Q&A (4/00)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: April 02, 2000

Q: When are rubber-stamp signatures acceptable? I read in a Part A newsletter that Medicare no longer accepts rubber-stamp signatures on documents that certify, order, or justify a service billed to Medicare. The newsletter cited the Medicare Conditions of Participation for hospitals (42CFR482.....

Journal Q&A (5/00)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: May 02, 2000

Q: Does the Joint Commission require an RHIT or RHIA to be employed in a hospital's HIM department?
A: The Joint Commission does not specifically require that a RHIT or an RHIA be employed in the HIM department. However, in the Accreditation Manual for Hospitals, standard IM.4 require....

Journal Q&A (5/00)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: May 02, 2000

Q: Is electronic record storage legal?
A: HCFA authorizes computerized health records as long as they are maintained in a form that can be reproduced legally. In addition, the Medicare Conditions of Participation for Hospitals, Medical Records Services specify that hospitals must use....

Journal Q&A (5/00)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: May 02, 2000

Q: Within what time frame are verbal orders required to be authenticated?
A: The Joint Commission on Accreditation of Healthcare Organizations' standard IM.7.7 for hospitals requires that "each verbal order must be dated and identified by the names of the individuals who gave it and....

Learning the Laws Behind Compliance

Author: Wagg, Dorothy Grandolfi

Source: Journal of AHIMA

Publication Date: May 2000


With Vision 2006, AHIMA's Board of Directors challenged members to expand our knowledge base and professional horizons. One role that several HIM professionals have been asked to fill is compliance officer or manager. Generally, this role has led us down a familiar path—using our....

Journal Q&A (6/00)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: June 02, 2000

Q: Where I can access the Medicare Conditions of Participation online?
A: You can access the Medicare Conditions of Participation at www.access.gpo.gov/nara/cfr/index.html.    Then, Select "Search or browse your choice of CFR titles and/or volumes"

From the "Available CFR....

Compliance Efforts Lead to Process Improvements

Author: Swope, Shana

Source: Journal of AHIMA

Publication Date: June 2000




After Medicare regulations and the accompanying paperwork threatened to overwhelm an outpatient rehabilitation center, staff took steps to simplify the recertification process. The result was improved efficiency plus increased commitment to the electronic medical record. He....

Journal Q&A (7/00)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: July 02, 2000

Q: My state's laws say that health information may be made available to researchers who provide written evidence of approval of their projects by an institutional review board (IRB).

What is an IRB?
A: An IRB is any board, committee, or other group formally designated by....

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) ....

Journal Q&A (10/00)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: October 02, 2000

Q: What is the retention period for billing records, such as explanations of benefits, charge slips, invoices, etc.?
A: Most states have established a retention period for medical records, but many have not addressed other type of records like billing documents. The Medicare program m....

Journal Q&A (10/00)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: October 02, 2000

Q: Can an emergency room exam serve as an inpatient history and physical?
A: It's important to understand the intent of the standards and regulations for hospitals and the practice standards for content of a history and physical (H&P) exam. The 2000 Joint Commission on Accreditation ....

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....

High Cost of Privacy

Author: Rhodes, Harry B.

Source: In Confidence (newsletter)

Publication Date: January 02, 2001


Cost: how much money needs to be invested? By now, most of us have discussed the implementation of the Health Insurance Portability and Accountability Act (HIPAA) final rules with our administrators, and naturally the question has been raised, “Just how much is this going to cost me?”Most lik....

Journal Q&A (2/01)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: February 02, 2001

Q: Where can I find information on the interpretation of Joint Commission on Accreditation of Healthcare Organization standards?

A: Information on the interpretation or intent of Joint Commission standards can be found in each accreditation program manual. The accreditation manual provides....

Preparing the Physician Office for HIPAA

Author: Uppena, Mary

Source: Journal of AHIMA - Coding Notes

Publication Date: February 2001




Change has been a constant factor in coding and reimbursement with the intensified focus on billing, compliance, and cost control. Out of necessity, coding professionals in physician settings have learned to be organized, adaptable, and armed with the latest information. The mandates....

Measuring HIPAA's Impact (HIPAA on the Job)

Author: Fuller, Sandra R.

Source: Journal of AHIMA

Publication Date: February 2001




As children, most of us stood against a door frame while our parents recorded our height and the date on the wall. These marks climbed each year as reminders of the changes we were experiencing. When relatives visited, we proudly showed off our progress to adulthood.

These....

Journal Q&A (5/01)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: May 02, 2001

Q: Does the new HIPAA privacy rule require hospitals to obtain patient consent prior to sending copies of dictated reports and test results to the patient's physician?

A: Unless the HIPAA privacy rule published on December 28, 2000 (45 CFR Parts 160 through 164) is modified by the Bush ad....

On the Line: Professional Practice Solutions

Author: Smith, Cheryl M.

Source: Journal of AHIMA

Publication Date: June 2001



Q: Are there new Joint Commission hospital standards that address patient safety?


Q: What are the Joint Commission definitions of a sentinel event and root cause analysis?


Q: Where can I find information on completion of the medical record statistics form to det....

Journal Q&A (6/01)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: June 02, 2001

Q: What are the Joint Commission definitions of a sentinel event and root cause analysis?

A: The Joint Commission defines a sentinel event as "an unexpected occurrence involving death or serious physical or psychological injury, or risk thereof. Serious injury specifically includes loss o....

Journal Q&A (6/01)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: June 02, 2001

Q: Are there new Joint Commission hospital standards that address patient safety?

A: The Joint Commission's Board of Commissioners recently approved standards focused on patient safety and medical and healthcare error reduction in hospitals. These new standards are in addition to the curr....

Journal Q&A (6/01)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: June 02, 2001

Q: Where can I find information on completion of the medical record statistics form to determine compliance with Joint Commission standard IM.7.6?

A: Standard IM.7.6 of the Joint Commission Accreditation Manual for Hospitals requires that medical record data and information are managed in....

Journal Q&A (7/01)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: July 02, 2001


Q: How does a healthcare organization deal with conflicting directives between HCFA regulations and Joint Commission standards when obligated to abide by both?


A: While one doesn't preclude the other, HCFA coordinates with accrediting organizations (Joint Commission, AOA, AAAHC....

Guidelines for Cost-effective HIPAA Compliance

Author: Siren, Bill

Source: Brief Encounter

Publication Date: July 02, 2001


Most of us are acutely aware of the events that took place on December 31, 1999, at midnight. There were some who thought that in five seconds, the lights would go off and all computer systems would cease to function. In the healthcare world, concerns were prevalent regarding whether medical e....

Journal Q&A (7/01)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: July 02, 2001


Q: It's difficult to research and write organizational policies because of the myriad external forces governing the same healthcare issues. Do you have guidelines to help ensure we don't miss any mandates?


A: A healthcare organization is normally obligated to simultaneously fol....

Psychotherapy Notes under HIPAA

Author: Dougherty, Michelle

Source: In Confidence (newsletter) | AHIMA Q and A

Publication Date: July 02, 2001


Q: I work in a non-psychiatric facility covered by HIPAA. On occasion, a patient may receive a psychological evaluation and possibly treatment for a short period of time. Our medical record does not include a copy of the psychotherapist’s “notes,” but a report that summarizes the psychologist....

Journal Q&A (9/01)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: September 02, 2001

Q: I work in a home care agency and am developing a procedure on correcting errors on OASIS to comply with the Centers for Medicare and Medicaid Services' (CMS, formerly HCFA) new correction policy. Is it necessary to make a separate entry in the medical record? Our agency would like to make the co....

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....

Marketing Privacy: HIPAA's New Sales Pitch

Author: Rhodes, Harry B.

Source: AHIMA Convention

Publication Date: October 10, 2001



Background

Direct marketing is the direct contact between a seller and a consumer. This type of targeted marketing has gained wide popularity as a marketing strategy in the late 20th century because it can be addressed directly. With increasing amounts of specific information avai....

Leading the HIPAA Privacy Risk Assessment

Author: Callahan-Dennis, Jill

Source: AHIMA Convention

Publication Date: October 10, 2001




Introduction and Background

As part of their preparations for compliance with the Health Insurance Portability and Accountability Act (HIPAA), healthcare organizations need to compare their current information-handling and information-disclosure practices to the requirement....

Experiences of a VHA Privacy Officer

Author: Putt, Stephanie H.

Source: In Confidence (newsletter)

Publication Date: November 02, 2001


Being the privacy officer for one of the world’s largest healthcare delivery systems is often a daunting responsibility, yet it offers an opportunity to make a difference and face new challenges. The Veterans Health Administration, or VHA, is part of the Department of Veterans Affairs (VA). T....

"SNIP"ping Away at HIPAA

Author: Bettendorf, Jim

Source: In Confidence (newsletter)

Publication Date: November 02, 2001


Consider this a resource guide from a fellow privacy official trying to make sense of it all. I am of course referring to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). By now, we are all familiar with HIPAA’s content, but not quite sure what path to take when it com....

On the Line: Professional Practice Solutions

Author: Burrington-Brown, Jill

Source: Journal of AHIMA

Publication Date: January 2002


Q: A couple were on vacation in my city when the husband suddenly became ill and died in our facility. The wife requested copies of the record to take home with her. She had listed herself as next of kin. Was it correct to give her a copy of the record?

Q: I am a manager of several d....

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....

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