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Coping with Government Audits

Author: Butler, Mary

Source: Journal of AHIMA - website

Publication Date: August 2014





The HIM Problem: Medicare Auditor Scrutiny of Inpatient Claims


This spring, the Centers for Medicare and Medicaid Services (CMS) issued its “two midnight rule” which was intended to define and clarify what Medicare considers to be criteria justifying an inpatient st....

HIPAA Breach Enforcement Roundup

Author: Cacciatore, Victoria; Downing, Katherine

Source: Journal of AHIMA

Publication Date: July 2014



Criminal attacks on healthcare systems have risen 100 percent since 2010, according to a recent Ponemon study.1 This makes it obvious that the privacy and security of patient health information is vulnerable and highly susceptible to data breach. The HIPAA Breach Notification Rule became e....

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....

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....

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....

New Tool Streamlines HIPAA Assessment Process

Author: Cohen, Kathleen

Source: In Confidence (newsletter)

Publication Date: August 02, 2003


How are you making sure that your organization is complying with the HIPAA privacy regulations? Many hospitals are doing HIPAA rounds with privacy officers, going from unit to unit to assess and document HIPAA compliance. But trying to make sense of the data collected during HIPAA rounds can....

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....

ABCs of Health Plan Audits

Author: Crump, Dawn; Hennum, Jeannie

Source: Journal of AHIMA - website

Publication Date: March 2015



The Affordable Care Act (ACA) has a dramatic ripple effect on the healthcare industry—and will continue to create seismic shifts for many years to come. One important change for health information management (HIM) professionals to understand is the impact of ACA on health plan audits. Alre....

Evaluating the Information Governance Principles for Healthcare: Compliance and Availability

Author: Datskovsky, Galina; Hedges, Ron; Empel, Sofia; Washington, Lydia

Source: Journal of AHIMA

Publication Date: June 2015



Editor’s Note: This is the third in a series of four articles that discuss the eight Information Governance Principles for Healthcare.


AHIMA’s new Information Governance Principles for Healthcare (IGPHC) provide a framework for healthcare organizations to leverage informati....

Clearing the HIPAA Cobwebs: New ONC Chief Privacy Officer Lucia Savage Focuses on Balancing Privacy and Security with Expanding Interoperable EHR Exchange

Author: Dimick, Chris

Source: Journal of AHIMA

Publication Date: April 2015



The spiders of time have been hard at work on the US healthcare privacy and security rules, to the point that their place in health IT interoperability has become fogged and is inhibiting their proper role in the meaningful exchange of health information, according to Lucia Savage, JD, th....

Year of the Audit

Author: Dimick, Chris

Source: Journal of AHIMA

Publication Date: March 2010


The healthcare forecast for 2010 includes a strong chance of audit. HIM professionals in many organizations will be busy responding to a shower of external record requests and internal compliance checks.

Stormy systems of audit programs, compliance initiatives, and fraud preventi....

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