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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.&....

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....

Coding Radiology Services

Author: Walk, Gerri

Source: Journal of AHIMA - Coding Notes

Publication Date: January 2009


Because coding and radiology departments often share accountability for the quality of outpatient radiology coding, it is important that coding professionals share coding issues and charge capture expectations with radiology staff. This article outlines methods to improve the quality of coded....

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....

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....

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