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Quest for Quality and Comparability in the National Healthcare Database: Announcing A Payer’s Guide to Health Care Data Quality and Integrity

Author: AHIMA Coding Policy and Strategy Committee

Source: Journal of AHIMA - Coding Notes

Publication Date: September 1996


As the computer-based patient record slowly becomes a reality, the need has never been greater for a national cooperative effort to recognize and apply uniform terminology and coding guidelines for both the clinical community and fiscal intermediaries. AHIMA’s Coding Policy and Strategy Commit....

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....

Nursing Data, Classification Systems, and Quality Indicators: What Every HIM Professional Needs to Know

Author: Henry, Suzanne Bakken; Warren, Judith J.; Zielstorff, Rita D.

Source: Journal of AHIMA

Publication Date: May 1998

by Suzanne Bakken Henry, RN, DNSc, FAAN, Judith J. Warren, RN, PhD, FAAN, and Rita D. Zielstorff, RN, MS, FAAN

The nursing profession has developed a number of classification systems. What can HIM professionals learn from the processes and results? This article presents an overview of the....

Maximizing Data Quality of the Minimum Data Set

Author: Zender, Anne

Source: Journal of AHIMA

Publication Date: June 1998


HIM professionals who work in long term care settings are well acquainted with the Minimum Data Set 2.0 (MDS). Since 1990, it has been part of the standardized assessments that nursing homes participating in the Medicare and Medicaid programs must complete. Starting this summer, updated submis....

Comparative Data--Its Impact and Opportunities

Author: Bellile, Susan K.

Source: Journal of AHIMA

Publication Date: June 1998


A battle for control of medical management is now being waged among hospitals, managed care plans, insurers, employers, physician groups, and researchers—a battle in which data is the weapon of choice. Cumulative and comparative healthcare information is being used to eva....

Performance Improvement for Documentation

Author: Labak, Carol

Source: Journal of AHIMA

Publication Date: October 1998


We've all seen it before: that look of bewilderment on a physician's face when a discussion about documentation arises. While this is not the first incidence of this discussion between the physician and the health information manager, neither is it the first time the HIM professional ....

Clear Focus on Coding

Author: Moses, Rhona

Source: Journal of AHIMA

Publication Date: April 1999


For the past three years I have been manager of coding education and billing guidelines at Group Health Cooperative, a 600,000-member HMO. Group Health has 25 primary care clinics, four specialty centers, an ambulatory surgical center, and two hospitals. We have about 700 staff physic....

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.&....

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....

Code Sets: Improving the Quality of Coded Data

Author: Prophet, Sue

Source: HIPAA Conference 2000

Publication Date: March 14, 2000

2000 HIPAA Conference Presentation
Code Sets: Improving the Quality of Coded Data
The Healthcare Provider Perspective
Sue Prophet, RHIA, CCS
Director, Classification and Coding, AHIMA Current Problems with Use of Code Sets
Lack of acceptance of valid codes (e.g., V and E co....

Code Sets

Author: Brooks, Patricia E.

Source: HIPAA Conference 2000

Publication Date: March 14, 2000

2000 HIPAA Conference Presentation
Code Sets
Presented by Pat Brooks, RHIA
HCFA Standards for Electronic Transactions
HCFA-0149-P Published May 7, 1998 Final not yet published To be enacted 2 years after final notice (3 years for small plans)
Proposed Initial Standards for....

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 (11/00)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: November 02, 2000

Q: Where can I find a benchmark for coding accuracy?
A: It's difficult to establish an industry standard for coding accuracy because accuracy is measured differently in every facility. Some facilities compute their accuracy rate by taking the number of correctly coded records and divi....

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....

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....

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 (....

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....

Constructing a Coding Compliance Plan

Author: Hanna, Joette

Source: Journal of AHIMA

Publication Date: July 2002


The government has turned its attention to coding compliance. Do you have an effective program in place? Use the steps in this article to build a coding compliance program that protects your organization.


Coding compliance has become an integral part of every HIM department....

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