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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....

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....

Medical Identity Theft and the Red Flags Rule

Author: Apgar, Chris

Source: Journal of AHIMA - website

Publication Date: April 2009


Continuing our Health Information Privacy and Security Week series, today Chris Apgar, CISSP, president of Apgar & Associates LLC, takes a look at medical identity theft within the context of the Red Flags Rule.

Much is reported in the news about identity theft including new cat....

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....

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....

Managing Governmental Audits

Author: Wilson, Donna D

Source: AHIMA Convention

Publication Date: September 26, 2010


Background

Congress’ attention is now clearly focused on healthcare reform. With that said, the year of 2010 brought the “much anticipated” Recovery Audit Contractors (RACs) requesting medical records from many of the Medicare Fee for Service providers (complex reviews). Data-mining....

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....

Low-Tech Threats in a High-Tech World

Author: Rollins, Genna

Source: Journal of AHIMA - website

Publication Date: April 2011



Despite the rise of health IT, healthcare providers still face daily privacy and security risks of the mundane variety—paper records are misplaced, improperly disclosed, or released without confidential information redacted. No matter the opportunities and risks that technology bring....

Linking Anti-fraud and Legal EHR Functions

Author: Dougherty, Michelle

Source: Journal of AHIMA

Publication Date: March 2007


The following statement could easily come from any material written on the legal electronic health record: “EHRs and information available through the NHIN [nationwide health information network] must fully comply with applicable federal and state law and meet the requirements of reliability an....

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....

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....

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....

Laboratory Services Regulations Carry HIM Implications

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: September 2002


This is Part 1 of a two-part article on national coverage and policies for clinical diagnostic laboratory services payable under medicare Part B. Part 1 concentrates on the administrative policies. Part 2, which will appear in the October issue of the Journal, will focus on the national covera....

Kick Starting the Security Risk Analysis

Author: Amatayakul, Margret

Source: Journal of AHIMA

Publication Date: July 2004


Many covered entities are just now starting to approach the compliance aspects of the HIPAA security rule. Why discuss “compliance aspects” and not standards or controls, as we did when preparing for the privacy rule? Privacy and security are long-standing concepts to healthcare,....

Keeping HIPAA Education Fresh

Author: Dimick, Chris

Source: Journal of AHIMA

Publication Date: January 2009

Get hip with HIPAA.

That’s just one tagline attached to Sharp Healthcare’s HIPAA education modules. Photos from the age of hip—the late 1960s and early 1970s—permeate the online HIPAA training modules. Musicians Jimi Hendrix and Bob Dylan and era-TV icons like the....

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....

Journal Q&A (7/03)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: July 02, 2003

Q: How can I find the Medicare manuals, program memorandums, and the Conditions of Participation on the new CMS Web site?

A: After the Health Care Financing Administration (HCFA) changed its name to CMS, it moved all its resources to its new site at www.cms.gov/manuals.


....

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....

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....

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....

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 (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 (6/00)

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....

Journal Q&A (5/03)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: May 02, 2003


Q: What is an organized health care arrangement (OHCA) and what are its advantages?


A: The privacy rule defines an OHCA as:

a clinically integrated care setting in which individuals typically receive healthcare from more than one healthcare provider

an org....

Journal Q&A (5/02)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: May 02, 2002

Q: In light of HIPAA restrictions on protected health information, I’m concerned about our HIM department’s practice of accepting HIM students for professional practice experience. What should be considered in deciding whether to continue this practice?


A: HIPAA’s pr....

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....

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: 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....

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 (4/02)

Author: AHIMA Staff

Source: AHIMA Q and A

Publication Date: April 02, 2002

Q: I have been asked to identify all of my organization’s business associates so we can update their contracts prior to the April 2003 HIPAA privacy rule compliance date. Unfortunately, existing contracts are not maintained in one place. How should I tackle this project?


A: At....

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 (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....

Journal Q&A (11/02)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: November 02, 2002


Q: Where can I find federal regulations, interpretive guidelines, and Medicare manuals online?


A: The Centers for Medicare & Medicaid Services (CMS) has a number of manuals available online including the federal regulations for various settings, interpretive guidelines, Med....

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 ....

Journal Q&A (7/03)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: July 02, 2003

Q: When is a new history and physical (H&P) needed when moving a patient between an acute care bed to a swing bed?

A: The key to determining when an H&P is needed is to find out how the swing bed is being used and the regulations that apply. Section 1883 of the Social Security Ac....

It's Time to Finalize Your Privacy Policies

Author: Dougherty, Michelle

Source: Journal of AHIMA

Publication Date: November 2002


You've attended seminars, read articles, outlined systems, and developed forms for implementing the privacy rule, but there is still one step left--actually writing the policies and procedures. For many practitioners, policies and procedures are important but are often put off, then forgotten.....

Is the FCA Effectively Fighting Healthcare Fraud?

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: May 2002


How effective has the False Claims Act (FCA) been in reducing healthcare fraud? A recent six-month study conducted by New Directions for Policy for Taxpayers Against Fraud sought to determine just that.1 What the study found is that the FCA is very effective in fighting fraud and should not be....

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 Comprehensive Outpatient Rehabilitation Facilities

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

Source: Government (U.S.)

Publication Date: April 02, 1989

State Operations Manual
Appendix K - Interpretive Guidelines for Comprehensive Outpatient Rehabilitation Facilities

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....

Industry Awaits Phase 2 of HIPAA Audit Program

Author: Asmonga, Donald D.

Source: Journal of AHIMA

Publication Date: January 2015



The wait for the second round of mandated privacy and security audits from the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) continues. OCR is currently working through final details for the revised audit plan as they await finalization of new technolog....

Implementing HIPAA One Step at a Time

Author: Bettendorf, Jim

Source: Journal of AHIMA

Publication Date: March 2002


Many in the healthcare industry are facing the difficulty of incorporating HIPAA into their organizations. As a newly appointed privacy officer for a healthcare clearinghouse, I, too, was presented with the challenge of assimilating HIPAA into our organization.

Always Ask Questions<....

Implementing Electronic Signatures - Retired

Author: AHIMA Task Force

Source: AHIMA practice brief

Publication Date: October 2003

Implementing Electronic Signatures (AHIMA Practice Brief)
Editor's note: The following information supplants information contained in the practice brief "Electronic Signatures (Updated)" published in the October 1998 Journal of AHIMA.
Electronic health records may provide the ability to....

H&P Requirements Become More Uniform

Author: Hughes, Gwen

Source: Journal of AHIMA

Publication Date: May 2002


Until recently, the Medicare Conditions of Participation required that histories and physicals (H&Ps) be performed no more than seven days prior to hospital admission. This particular requirement was much stricter than the Joint Commission’s, which allows H&Ps to be performed as m....

How to Safely Recycle PCs

Author: Quinsey, Carol Ann

Source: Journal of AHIMA

Publication Date: June 2005


Securing the privacy of both protected health information and personal information should be a primary concern when personal computers have outlived their usefulness. Recycling or disposing of a computer safely can be a challenge.

It’s not enough to simply give an old computer....

How Small Organizations Handle HIPAA Compliance

Author: Primeau, Debra

Source: Journal of AHIMA

Publication Date: April 2017



Smaller healthcare facilities typically lack the resources and expertise to address the constant flow of competing priorities, forcing leadership to wear many hats in a fragmented environment. Few have a designated privacy, security, or compliance officer, let alone the corporate support s....

How an Integrated Delivery System Organized, Approached, and Monitored HIPAA Privacy Compliance: a Case Study

Author: Miller, Judith A.

Source: In Confidence (newsletter)

Publication Date: November 02, 2003


Advocate Health Care is a large, fully integrated not-for-profit healthcare delivery system in metropolitan Chicago. Many months prior to the April 14, 2003, deadline, Advocate began preparing for the HIPAA privacy compliance deadline.When April 14 arrived, Advocate’s associates and physician....

Hot Spots in the 2002 OIG Work Plan

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: March 2002


Organizational compliance programs are never static. Rather, they must continually be refined and updated to respond to changes in healthcare delivery and system vulnerabilities. The 2002 Work Plan of the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) pr....

HITECH Security – A Practical Approach

Author: Rudloff, Rob

Source: AHIMA Convention

Publication Date: September 28, 2010


Background


HITECH has introduced new security requirements around HIPAA including new breach requirements and associated penalties. This paper addresses the information security and privacy requirements and provides practical solutions to address them. Many organizations already....

HITECH Frequently Asked Privacy, Security Questions: Part 3

Author: Rose, Angela Dinh; Greene, Adam H

Source: Journal of AHIMA | AHIMA Q and A

Publication Date: March 2014

This article concludes a three-part series discussing the most commonly asked questions regarding compliance requirements surrounding the final HITECH Omnibus Rule, released in January 2013. It highlights the updated requirements and provides answers to questions regarding decedent protected health information (PHI), the release of immunization records to schools, and the enhanced request for restrictions requirements.

HIPAA Violation? Sue Me

Author: AHIMA

Source: Journal of AHIMA

Publication Date: March 2011


This is a true story that occurred recently in Indiana. Failing to collect payment for treatment, a medical group sent a patient to collections. In providing the unpaid bills to the collections attorney, practice staff failed to redact sensitive information. When the attorney filed the bills wi....

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