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Taking a Closer Look at Physician-based Coding
Author: Kostick, Karen M.
Source: Journal of AHIMA - Coding Notes
Publication Date: October 2002
Since 1997, AHIMA has offered a Certified Coding Specialist--Physician-based credential (CCS-P) for HIM professionals who are employed in the physician setting. In recent interviews, an office manager, coding manager, coding coordinator, and two physician-based consultants shared their coding....
Laboratory Services Regulations Impact National Coverage Decisions, HIM
Author: Willard, Dianne
Source: Journal of AHIMA
Publication Date: October 2002
This is Part 2 of a two-part article on laboratory services regulations. Part 1, which appeared in the September Journal of AHIMA, dealt with the administrative policies contained in these regulations. Part 2 addresses the specific national coverage decisions that were developed as part of thi....
HIM and PEPP: an Opportunity to Promote Compliance
Author: Hrehor, Kimberly; Osterberg, Carol; Shearry, Joyce
Source: AHIMA Convention
Publication Date: September 23, 2002
Clinical Documentation Improvement: a Work in Progress
Author: Tadwalt, Bobbi; Jackson, Joy
Source: AHIMA Convention
Publication Date: September 23, 2002
Will You Be Ready? Preparing Now for ICD-10-PCS Implementation
Author: Powell, Sharon; Grant, Thelma M.
Source: AHIMA Convention
Publication Date: September 23, 2002
Keeping Home Coding Secure: the Marriage of Technology and HIM
Author: Friedman, Beth; Bahr, Dave
Source: AHIMA Convention
Publication Date: September 23, 2002
Giving Emergency Room Chargemasters a Needed Injection of Revenue
Author: Schuler, Glenda; Giddens, Jill
Source: AHIMA Convention
Publication Date: September 23, 2002
Designing, Implementing, and Monitoring a Remote Coding Program
Author: Thierry, Patty
Source: AHIMA Convention
Publication Date: September 23, 2002
Electronic Clinical Documentation System: the HIM Perspective
Author: Mangin, Wendy L
Source: AHIMA Convention
Publication Date: September 23, 2002
Evolution and Implementation of Clinical Documentation Improvement
Author: Russo, Ruthann; Dunleavy, Kathleen
Source: AHIMA Convention
Publication Date: September 23, 2002
Outpatient Cost and Compliance Management: Marching into Year Three with APCs
Author: Micheletti, Julie A.; Stegman, Melinda
Source: AHIMA Convention
Publication Date: September 23, 2002
Success Story: Transition from Traditional Dictation to Template-based
Author: Bartell, Laurie
Source: AHIMA Convention
Publication Date: September 23, 2002
Job Satisfaction among Clinical Coders in Ohio
Author: Wenning, Jay; Brodnik, Melanie S.
Source: AHIMA Convention
Publication Date: September 23, 2002
Key Compliance Strategies for the Physician Practice
Author: Campbell, Jennie
Source: AHIMA Convention
Publication Date: September 23, 2002
Monitoring and Evaluating Your Hospital's Inpatient Case Mix
Author: Wozniak, Lynn-Marie
Source: AHIMA Convention
Publication Date: September 23, 2002
Coding System Implementation Satisfied Both the Coders and Management
Author: University of Virginia Health System
Source: AHIMA Foundation
Publication Date: September 20, 2002
The University of Virginia Health System (UVAHS) was one of the first SoftMed clients to convert from ChartStat to ClinTrac, SoftMed's latest abstracting solution. Through this implementation, UVAHS took the opportunity to evaluate the current coding environment and implement other changes tha....
Change at Hand: How PDAs Can Transform Coding, Billing
Author: Stanfill, Mary H
Source: Journal of AHIMA - Coding Notes
Publication Date: September 2002
Have you ever had a physician ask if you can put the encounter form on her hand-held computer? Or maybe the physicians in your medical group have been offered free personal digital assistants (PDAs) if they use a certain application and they want you to find out if these devices can expedite c....
Communicating with Physicians: Something to Talk About
Author: Dunaway, M. Tray
Source: Journal of AHIMA
Publication Date: September 2002
Ask a physician: "Doctor, are your detailed history and physicals comprehensive?" Now ask: "Doctor, are your comprehensive history and physicals detailed?" Chances are, you'll get two affirmative replies. To a physician, detailed workups are comprehensive, and comprehensive workups are detaile....
New ICD-9-CM Committee Presents New Codes, Changes
Author: Prophet, Sue
Source: Journal of AHIMA
Publication Date: September 2002
This is part 1 of a two-part summary of proposals from the April 2002 ICD-9-CM Coordination and Maintenance Committee meeting and includes procedure proposals. Part 2 will include diagnosis proposals and will be published in the October Journal of AHIMA.
The ICD-9-CM Coordination and Main....
PPS for Long-Term Care Hospitals...; Final Rule
Author: U.S. Centers for Medicare & Medicaid Services
Source: Federal Register
Publication Date: August 30, 2002
Analysis of Final Rule for FY 2003 Revisions to the Medicare Hospital Inpatient Prospective Payment System
Author: AHIMA Policy and Government Relations Team
Source: AHIMA regulation analysis
Publication Date: August 02, 2002
The final rule regarding FY 2003 revisions to the Medicare hospital inpatient prospective payment system (PPS) was published in the August 1, 2002 issue of the Federal Register.
This rule becomes effective on October 1, 2002.This analysis will cover changes to DRG classificat....
ICD-10 on the Horizon
Author: Prophet, Sue
Source: Journal of AHIMA
Publication Date: July 2002
ICD-10 has taken hold around the globe, so why is the US still using ICD-9-CM? This article reviews the history of ICD-10 in the US.
Other countries are using it. Why aren't we? Coding professionals across the country and around the world are wondering why ICD-10-CM hasn't been....
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....
Revolution in Progress: How Technology Is Reshaping the Coding World
Author: Hagland, Mark
Source: Journal of AHIMA
Publication Date: July 2002
As clinical coding technology advances, coding professionals responsibilities and work environments are changing. Some coders are working from home, while others are taking on quality assurance roles. In all cases, a willingness to embrace change is a must.
Ask Pat Biesboer, R....
New PPS Proposed for LTC Hospitals
Author: Dougherty, Michelle
Source: Journal of AHIMA
Publication Date: July 2002
In the past 10 years, the number of new long-term care hospitals (LTCHs) in the United States has tripled. Because of this growth, LTCHs are the newest post-acute settings to face a change in the reimbursement system.
While there are only about 270 LTCHs in the United States, t....
E/M Coding Problems Plague Physicians, Coders
Author: King, Mitchell S.; Lipsky, Martin S; Sharp, Lisa
Source: Journal of AHIMA
Publication Date: July 2002
As the government turns its high beams on fraudulent billing, physician E/M coding is raising questions. With several studies spotlighting the difficulty physicians have in applying CPT E/M codes, the authors wanted to know if credentialed coders had the same problem. Heres what they fou....
AHIMA's Comments on CMS Proposed Changes to the Hospital Inpatient Prospective Payment Systems (PPS) and Fiscal Year 2003 Rates
Author: Rode, Dan
Source: AHIMA testimony and comments
Publication Date: July 01, 2002
AHIMA
233 N. Michigan Avenue, Suite 2150
Chicago, Illinois 60601-5519
Phone: 312.233.1115
Fax: 312.233.1090
E-mail: sue.prophet@ahima.org
July 1, 2002
Thomas A. Scully
Administrator
Centers for Medicare & Medicaid Services
Department of H....
Closer Look: the SNOMED Clinical Terms to ICD-9-CM Mapping
Author: Imel, Margo
Source: Journal of AHIMA - Coding Notes
Publication Date: June 2002
In the July/August 2001 Journal of AHIMA, SNOMED Takes the Next Step describes the terminologys structure, use in electronic patient records, the evolutions from SNOMED® RT and an overview of the mappings of SNOMED® CT. This article is an update on SNOMED, with a clo....
Testimony of the American Health Information Management Association to the National Committee on Vital and Health Statistics on ICD-10-CM
Author: Prophet, Sue
Source: AHIMA testimony and comments
Publication Date: May 29, 2002
May 29, 2002
Opening Comments
Chairman Cohn, members of the National Committee on Vital and Health Statistics (NCVHS) Standards and Security Subcommittee, ladies and gentlemen, good afternoon. I am Sue Prophet, director of coding policy and compliance of the American Health Informati....
Statement on Consistency of Healthcare Diagnostic and Procedural Coding
Author: AHIMA
Source: AHIMA position statement
Publication Date: May 18, 2002
American Health Information Management Association (AHIMA)
AHIMA’s Position
AHIMA believes the collection of accurate and complete coded data is critical to healthcare delivery, research and analysis, reimbursement, and policymaking. The integrity of coded data and the ability to tur....
ICD-9 Raises Concerns for Home Health Information Managers
Author: Abraham, Prinny
Source: Journal of AHIMA - Coding Notes
Publication Date: May 2002
Home health information managers need to keep a keen eye on the prospective payment system (PPS) for home health to avoid coding conflicts and even financial loss. Many agencies did not pay attention to the quality of ICD-9-CM coding data prior to October 2000 when Medicare implemented the....
Testimony of the American Health Information Management Association to the National Committee on Vital and Health Statistics on ICD-10-PCS
Author: Prophet, Sue
Source: AHIMA testimony and comments
Publication Date: April 09, 2002
April 9, 2002
Opening Comments
Chairman Cohen, members of the National Committee on Vital and Health Statistics (NCVHS) Standards and Security Subcommittee, ladies and gentlemen, good afternoon. I am Sue Prophet, director of coding policy and compliance of the American Hea....
Coding on the Home Front
Author: Zeisset, Ann M.
Source: Journal of AHIMA - Coding Notes
Publication Date: April 2002
Recently, a group of coders participated in a survey about their day-to-day experiences as remote, or at-home coders. The survey asked a series of questions related to the positives and negatives of coding at home versus coding in the more traditional office setting. Below is a summary of the....
ICD-9-CM Committee Proposes New Codes, Changes
Author: Prophet, Sue
Source: Journal of AHIMA - Coding Notes
Publication Date: March 2002
This is part one in a two-part summary of proposals from the November ICD-9-CM Coordination and Maintenance Committee meeting. Part 2 will be published in the April 2002 Journal of AHIMA.
The ICD-9-CM Coordination and Maintenance Committee, cosponsored by the National Center for Hea....
Quality at the Core
Author: Zender, Anne
Source: Journal of AHIMA
Publication Date: March 2002
Is your hospital getting ready for the Joint Commissions core measures project? Some hospitals are already transmitting the necessary data as part of the pilot project. Heres how they are handling the challenges and deriving benefits.
If youre an HIM director, you prob....
Help Wanted: Five Steps to Take Before You Hire
Author: Davis, Nadinia A.; Gentul, Marion K.
Source: Journal of AHIMA
Publication Date: March 2002
Are you hiring? This excerpt from AHIMAs new publication, Effective Management of Coding Services, offers basic guidelines that coding managers can use to assess their facilities needs when recruiting applicants to fill a vacancy in the HIM department.
Step One: Perform a Ne....
HIM's Role in Monitoring Patient Safety
Author: Romano, Patrick S.; Elixhauser, Anne; McDonald, Kathryn M; Miller, Marlene R
Source: Journal of AHIMA - Coding Notes
Publication Date: March 2002
Two years ago, the Institute of Medicine (IOM) published To Err Is Human, describing the enormous burden of medical errors in the United States.1 It was estimated that deaths due to medical errors exceeded deaths from motor vehicle accidents, breast cancer, or AIDS and that the cos....
Testimony of the American Health Information Management Association to the National Committee on Vital and Health Statistics on Medical Code Sets
Author: Prophet, Sue
Source: AHIMA testimony and comments
Publication Date: February 06, 2002
February 6, 2002
Opening Comments
Good morning Mr. Chairman, members and staff of the National Committee on Vital and Health Statistics (NCVHS) Standards and Security subcommittee, ladies and gentlemen. I am Sue Prophet, director of coding policy and compliance for the American Heal....
Best Practices for Medical Necessity Validation
Author: Scichilone, Rita A
Source: Journal of AHIMA
Publication Date: February 2002
To protect the Medicare Trust Fund from being drained, government health plans must provide coverage restrictions for unnecessary health services in vulnerable patient populations. One restriction mechanism is the provision of edits that look for valid reason-for-visit codes for selected servi....
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....
Solving LTC Coding Challenges
Author: Laakso, Roslyn C.; Gottschalk, Reesa; Uppena, Mary
Source: Journal of AHIMA - Coding Notes
Publication Date: February 2002
After an acute illness or injury, patients are often transferred from the hospital to a skilled care bed or nursing facility for continued care. In rural areas, the local hospital and skilled nursing facility are often located within the same building and may even be the very same bed (many r....
Closer Look at Cardiac Function and Resynchronization
Author: Bryant, Gloryanne H.; Gold, Robert S.
Source: Journal of AHIMA - Coding Notes
Publication Date: February 2002
by Gloryanne Bryant, RHIT, CCS, and Robert Gold, MD
Coding cardiac conditions and treatments can be difficult for coders, due both to the intricacies of the muscle and its workings and the lack of specificity and documentation in the medical record. This article reviews common cardiac....
AHIMA's Comments Regarding Proposed Diagnosis Code Modifications for ICD-9-CM
Author: Prophet, Sue
Source: AHIMA testimony and comments
Publication Date: January 03, 2002
AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION
233 North Michigan Avenue, Suite 2150
Chicago, Illinois 60601-1090
January 3, 2002
Donna Pickett, MPH, RHIA
Medical Classification Administrator
National Center for Health Statistics
Office o....
AHIMA's Comments Regarding APC Advisory Panel Discussion on Guideline for Medicare OPPS - Facility Coding of E/M Services
Author: Prophet, Sue
Source: AHIMA testimony and comments
Publication Date: January 03, 2002
AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION
233 North Michigan Avenue, Suite 2150
Chicago, Illinois 60601-1090
January 3, 2002
Paul M. Rudolf, MD, JD
Chairman
Medicare Advisory Panel on APCs
c/o Centers for Medicare & Medicai....
AHIMA's Comments Regarding Proposed Procedure Code Modifications for ICD-9-CM
Author: Prophet, Sue
Source: AHIMA testimony and comments
Publication Date: January 03, 2002
AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION
233 North Michigan Avenue, Suite 2150
Chicago, Illinois 60601-1090
January 3, 2002
Patricia Brooks, RHIA
Technical Assistant, Office of Hospital Policy
Division of Prospective Payment System
Centers fo....
Closer Look at All-Patient Refined DRGs
Author: Averill, Richard F.
Source: Journal of AHIMA
Publication Date: January 2002
Are you fluent in DRG? This article takes a look at the evolution of the three distinct DRG systems and spotlights the most recent iteration, All-Patient Refined DRGs. It also sheds light on how this system, when codes are properly applied, can help an organization study morbidity and mortalit....
Here Comes Rehab PPS!
Author: Grzybowski, Darice; Draper, Skeeter
Source: Journal of AHIMA
Publication Date: January 2002
Just when you thought it was safe to come up for air.
After Medicares introduction of the Outpatient Prospective Payment System (PPS, which brought us APCs), the Home Health PPS (with its HHRGs), and Skilled Nursing Facility PPS (with RUGS), another new reimbursement syst....
Anthrax: What Every Coder Should Know
Author: Stanfill, Mary H
Source: Journal of AHIMA - Coding Notes
Publication Date: January 2002
The inhalation anthrax identified by a Florida physician in October 2001, during the recent series of bioterrorist attacks, was the first case of reported inhalation anthrax in the United States in more than 25 years.1 With the threat of anthrax as a biological weapon, correct coding could be....
CPT Changes for 2002
Author: O'Hara, Karen
Source: Journal of AHIMA - Coding Notes
Publication Date: January 2002
Coders need to keep their resources currentincluding updating the Current Procedural Terminology (CPT) codes every year with the annual CPT book. This article provides a brief summary of the changes made to the CPT 2002 code set. The complete list of changes can be found in Appendix B of....
Inpatient Rehabilitation PPS Presents New Challenges, Opportunities
Author: Trela, Patricia
Source: Journal of AHIMA
Publication Date: January 2002
As of January 1, 2002, inpatient rehabilitation facilities will implement the Medicare Inpatient Rehabilitation Facilities Prospective Payment System (IRF PPS). What is covered under this system, what data collection tool is used, and why are many facilities enthusiastic about the new system?....
2002 DRG Updates Already in Effect
Author: Uppena, Mary
Source: Journal of AHIMA - Coding Notes
Publication Date: November 2001
The 2002 diagnosis related group (DRG) updates went into effect October 1, 2001. With the implementation of these changes to the hospital inpatient DRGs portion of the prospective payment system (PPS), there will be 499 DRGs in 25 Major Diagnostic Categories (MDCs).
Changes t....
ICD-9-CM Codes Ready for 2002
Author: Zeisset, Ann M.
Source: Journal of AHIMA - Coding Notes
Publication Date: November 2001
For those reporting ICD-9-CM codes for all diagnoses coding, and hospitals reporting ICD-9-CM volume III for procedures, fall is the time to review and implement the changes and revisions for fiscal year 2002.
The ICD-9-CM coding changes for fiscal year 2002 were released in the Augus....
APC Validation Audits ... The Nitty Gritty Details
Author: Knowles, Lisa
Source: AHIMA Convention
Publication Date: October 10, 2001
Ambulatory payment classifications (APCs) have been implemented, and APC validation audits are the next issue to contend with. Similar to DRGs, we must design and conduct APC validation audits. Whether the audit is performed in-house or by an external consulting firm, it is essential....
Start to Finish Medical Necessity Review
Author: Arner, Kathy
Source: AHIMA Convention
Publication Date: October 10, 2001
Purpose: To identify why rejections occur and where the problem areas are located.
Why are rejections occurring on the professional side?
Medicare and other insurances are implementing local medical review policies.
Ordering providers are not supply....
Implementing CORE Measures -- A Measurement System Perspective
Author: Hyde, Lynda
Source: AHIMA Convention
Publication Date: October 10, 2001
Introduction
In 1987, the Joint Commission on Accreditation of Healthcare Organizations introduced the Agenda for Change. This program was designed to streamline and update the accreditation process, and introduced for the first time the creation of a national performance mea....
When Good Chargemasters Go Bad
Author: Leeds, Erica
Source: AHIMA Convention
Publication Date: October 10, 2001
Introduction: What Is a Chargemaster?
A chargemaster is a master list of services, supplies, and drugs used for patient care. A chargemaster used by outpatient facilities (emergency rooms, clinics, same-day surgery centers, and so on) will have the associated HCPCS codes and rev....
APCs: A Hospital-wide Effort
Author: Neilson, Seana
Source: AHIMA Convention
Publication Date: October 10, 2001
For many healthcare providers, thriving under the Medicare outpatient prospective payment system (i.e., APCs) appears to be a distant goal not to be realized anytime soon. In fact, for the next year or so, most healthcare providers subject to APCs will most likely be satisfied with me....
Developing an Effective Compliance Audit Process Appendix E: Sample Paired DRG Table for Evaluation
Author: Scichilone, Rita A
Source: AHIMA Convention
Publication Date: October 10, 2001
All DRGs "with" and "without" CCs
For example:
007/008
089/090
099/100
110/111
138/139
144/145
277/278
448/479
In addition to:
DRG Pairs
Narrative
014/015
Specific Cerebrovascula....
Developing an Effective Compliance Audit Process Appendix D: Sample Indicators for DRG Evaluation
Author: Scichilone, Rita A
Source: AHIMA Convention
Publication Date: October 10, 2001
DRG pair 079/089
Numerator = all (Medicare) claims with DRG 079 Denominator = the sum of all (Medicare) claims with DRG 079 plus all claims with DRG 089
DRG pair 087/127
Numerator = all (Medicare) claims with DRG 087 Denominator = the sum of all (Medicare) claims....
Developing an Effective Compliance Audit Process Appx B
Author: Scichilone, Rita A
Source: AHIMA Convention
Publication Date: October 10, 2001
Developing an Effective Compliance Audit Process. Appendix C: Tracking and Analysis of Auditing Data
Author: Scichilone, Rita A
Source: AHIMA Convention
Publication Date: October 10, 2001
Sample format for tracking and analysis of auditing data-pictures work best!
Aggregate Data Findings from MEDPAR Database for XYZ Hospital Target DRGs DRG Cluster XYZ National Variance
Number of Discharges in _ DRG Total for Grou....
PRO-West's Payment Error Prevention Program
Author: Baron, Anne
Source: AHIMA Convention
Publication Date: October 10, 2001
Background
Beginning in 1997, the Office of the Inspector General (OIG) started conducting annual audits of Medicare billing practices. These audit results estimated that Medicare had paid more than $23 billion in incorrect payments in 1996 and more than $20 billion in 1997.....
Coding Beyond DRGs ... What That Means to You and Your Facility
Author: Bryant, Gloryanne H.
Source: AHIMA Convention
Publication Date: October 10, 2001
Introduction
Physicians and interdisciplinary staff document in the medical record but not in a manner that adequately reflects the acuity and severity of the patient's clinical presentation-often not accurately enough to reflect the detail of care being delivered, which resu....
Home Health Prospective Payment Systems (HH-PPSs)
Author: Abraham, Prinny
Source: AHIMA Convention
Publication Date: October 10, 2001
The National Association of Home Health reported that the number of Medicare certified home health agencies peaked in 1997 at 10,444 and declined to 8,080 in 1998, to 7,747 in 1999, and back up to 7,880 in 2000. Personal expenditures for home care were estimated at $36 billion in 1999, dow....
Developing an Effective Compliance Audit Process
Author: Scichilone, Rita A
Source: AHIMA Convention
Publication Date: October 10, 2001
Introduction
The dictionary definition of an audit is "a methodical examination and review." To monitor is to "watch, observe, or check, especially for a special purpose." Because of a variety of reasons in the current healthcare delivery market, assessment and....
Will Natural Language Processing Help Coders Anytime Soon?
Author: Warner, Homer R. Jr.
Source: AHIMA Convention
Publication Date: October 10, 2001
Abstract
Natural Language Processing (NLP) systems that aid the process of coding medical records for billing purposes are beginning to appear on the commercial market. NLP systems have the potential to favorably affect the whole medical record coding cost and work-flow equation....
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....
Developing Technical Applications for Coding Compliance
Author: Hammen, Cheryl
Source: AHIMA Convention
Publication Date: October 10, 2001
Introduction
Although high-risk DRG pairs have been audited to ensure compliance in hospitals over the past several years, there are still opportunities available for streamlining this time-consuming process. Monthly data review regarding the frequency of the high-risk pairs is only a....
Developing an Effective Compliance Audit Process Appx F
Author: Scichilone, Rita A
Source: AHIMA Convention
Publication Date: October 10, 2001
Sample Coding Incentive Plan
Author:
Source: Journal of AHIMA - Coding Notes
Publication Date: October 2001
Developing a Physician Query Process (2001)
Author: Prophet, Sue
Source: AHIMA practice brief | Journal of AHIMA
Publication Date: October 2001
This practice brief has been updated. See the latest version here. This version is made available for historical purposes only.
Final Rule on Use of Physician Query Forms
Author: U.S. Centers for Medicare & Medicaid Services
Source: Government (U.S.)
Publication Date: October 02, 2001
ISSUE: Use of Physician Query Forms
Background:
In January, 2001, we issued PRO TOPS 2001-03 which specified that PROs are not to accept coding summary forms (e.g., Physician Query Forms) as a substitute for documentation in the medical record for DRG validation purposes.
In....
CMS Policy Clarification on Coding Compliance--Use of Physician Query Forms
Author: U.S. Centers for Medicare & Medicaid Services
Source: Government (U.S.)
Publication Date: October 02, 2001
DEPARTMENT OF HEALTH & HUMAN SERVICES
Health Care Financing Administration
7500 SECURITY BOULEVARD
BALTIMORE MD 21244-1850
QIP TOPS CONTROL NUMBER: PRO 2001-13
DATE: October 11, 2001
FROM:
Director Quality Improvement Grou....
Outwit, Outlast, Outcode: Surviving in the Autocoding Era
Author: Schnitzer, Gregory L.; Stanfill, Mary H
Source: Journal of AHIMA - Coding Notes
Publication Date: October 2001
Nearly two years ago, the AHIMA Coding Futures Task Force predicted that coders would eventually need to go beyond assignment of diagnostic and procedural codes.1 The task force was right-and that future is now for coders in certain specialties. Natural language processing (NLP), in which comp....
CPT "Monopoly" To Be Examined
Author:
Source: Journal of AHIMA
Publication Date: October 2001
Senate Minority Leader Trent Lott (R-MS) has forwarded a letter to HHS Secretary Tommy Thompson criticizing the American Medical Association's "statutory monopoly" on current procedural terminology (CPT) codes. Lott said that Congress will look at the CPT issue when it considers....
Putting Productivity Plans to Work
Author: Dunn, Rose T
Source: Journal of AHIMA - Coding Notes
Publication Date: October 2001
This is the last in a series of three "Coding Notes" articles addressing productivity measurement and incentive plans for coding professionals. The April Journal of AHIMA (vol. 72, no. 4) article discussed the general principles of developing facility-specific productivity m....
AHIMA Letter to CMS on Proposed Changes to Medicare Outpatient PPS Rule
Author: Rode, Dan
Source: AHIMA testimony and comments
Publication Date: September 26, 2001
September 26, 2001
Thomas A. Scully
Administrator
Centers for Medicare and Medicaid Services
Department of Health and Human Services
Attention: CMS-1159-P
P.O. Box 8017
Baltimore, Maryland 21244-8017
RE: File Code CMS-1159-P
Medicare Prog....
Committee Debates ICD-10-PCS Implementation
Author: Prophet, Sue
Source: Journal of AHIMA - Coding Notes
Publication Date: September 2001
Proposed changes, if approved, would not become effective until October 1, 2002.
The ICD-9-CM Coordination and Maintenance Committee, cosponsored by the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS, formerly the Health Care Fina....
Informatics in Managed Care: HIM Adds Value to Data
Author: Stratton, Scott D.
Source: Journal of AHIMA
Publication Date: September 2001
The third installment of the Journal of AHIMA’s special series on managed care focuses on informatics-methods that add value to data, turning it into useful information. How do informatics and managed care fit together, and what is HIM’s role in this picture?
The HIM professional’s knowl....
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....
Look at Life on the Job for Mortality Data Reporters
Author: Terry, Glenda A.
Source: AHIMA Foundation | Journal of AHIMA
Publication Date: September 2001
Editor's note: This project was made possible through a grant from AHIMA's Foundation of Research and Education (FORE) Grant-in-Aid Award program. In 2001, FORE funded more than $50,000 in HIM research grants. For information on the 2001 Grant-in-Aid program visit www.ahima.org/fore/ [link....
AHIMA Testifies to CMS on Physician Query Forms
Author: AHIMA Policy and Government Relations Team
Source: AHIMA testimony and comments
Publication Date: July 27, 2001
On Friday, July 27, 2001, AHIMA presented testimony to the Centers for Medicare and Medicaid Services (CMS). As part of this testimony, AHIMA cited a new Practice Brief titled "Developing a Physician Query Process."
The practice brief is a keystone of AHIMA's recommendation to CM....
Solving the E/M Conundrum: a Special Report
Author: Scichilone, Rita A
Source: Journal of AHIMA
Publication Date: July 2001
Evaluation and Management (E/M) codes, introduced in 1992 for reporting physician visit services, are linked to a number of perplexing questions for coders. In different settings, they are used differently and with varying sets of criteria. Given the numerous coding and compliance issues relate....
Developing a Coding Compliance Policy Document (2001)
Author: AHIMA Coding Team
Source: AHIMA practice brief | Journal of AHIMA
Publication Date: July 2001
This practice brief has been updated. See the latest version here. This version is made available for historical purposes only.
Documentation Requirements for Reporting Professional Services
Author: Clark, Margi
Source: Brief Encounter
Publication Date: July 02, 2001
Here are some specific suggestions for improving the clarity and usefulness of physician record entries to support Evaluation and Management code levels.
History
Chief complaint with adjectives (8)
Site, description, severity, duration, timing (when) context (what is patient do....
E/M Options in the Outpatient Arena
Author: Jones, Lolita M.
Source: Journal of AHIMA
Publication Date: July 2001
Under the Medicare ambulatory payment classification (APC) system, hospitals must establish criteria for mapping the medical care rendered in the emergency department and hospital-based outpatient settings to appropriate CPT medical visit codes. Do you know how to establish a sound rationale f....
Review of E/M Guidelines
Author:
Source: Brief Encounter
Publication Date: July 02, 2001
The Evaluation and Management guidelines are found in the Medicare Carriers Manual in the following sections. You may download the entire manual from the Center for Medicare and Medicaid Services or CMS (formerly HCFA) Web site by going to http://www.hcfa.gov/, click on Medicare, select laws an....
Look at Modifiers for Hospital Use
Author: Philippou, Karla E.
Source: Brief Encounter
Publication Date: July 02, 2001
Modifiers have been a continuing problem in the hospital setting. Although modifiers were mandated for hospital use in June 1998, many hospitals were unable to comply until the implementation of Ambulatory Payment Categories, (APCs), on August 1, 2000. The initial problems were related to info....
Common E/M Documentation Issues
Author: Udell, Curtis
Source: Brief Encounter
Publication Date: July 02, 2001
One of the constant challenges facing managers today is evaluating physician documentation and then helping their physicians to improve the content of their patient notes, particularly for evaluation and management (E/M) services.
While physicians may have unique style or flair to t....
Navigating the Physician Services Maze
Author: Skurka, Margaret A.
Source: Journal of AHIMA
Publication Date: July 2001
As HIM professionals know, accurate and complete documentation is critical for providing care and supporting reimbursement. This is particularly true-and yet particularly problematic-in the area of E/M coding. Medical practices report and are paid for their services using E/M coding, yet there....
Know Your APCs: Data Analysis Made Simple
Author: Stegman, Melinda
Source: Journal of AHIMA
Publication Date: July 2001
You’ve adapted processes to the APC system, but do you really understand the financial impact of APCs on your organization? The author shows you how to analyze your billing data to assess the impact of APCs on your facility’s bottom line.
Since the implement....
AHIMA Testifies in Support of ICD-10
Author: Rode, Dan
Source: Journal of AHIMA
Publication Date: July 2001
The "replacement [of ICD-9-CM, Volume 3] with a new procedural coding system for inpatient services is absolutely necessary and ICD-10-PCS meets the criteria for such a replacement system," said Linda Kloss, MA, RHIA, AHIMA's executive vice president and CEO. Kloss also argued that &q....
Latest Look at Coding Trends
Author: Dunn, Rose T; Mainord, Christina
Source: Journal of AHIMA - Coding Notes
Publication Date: July 2001
The April Journal of AHIMA (vol. 72, no. 4) "Coding Notes," article "Developing Facility-specific Productivity Measures," serves as the backdrop to this report on the results of our national survey of current coding practices. In the April article, we argued that coding pro....
DRG Analysis Reveals Potential Problems, Trends
Author: Osborn, Carol E.
Source: Journal of AHIMA
Publication Date: July 2001
New Anemia Codes Address Chronic Illness
Author: Bryant, Gloryanne H.; Gold, Robert S.
Source: Journal of AHIMA - Coding Notes
Publication Date: July 2001
As of October 2000, there were three new codes for the assignment of Anemia of Chronic Disease. These codes are 285.21, Anemia in end-stage renal disease, 285.22, Anemia in neoplastic disease, and 285.29, Anemia of other chronic illness.
These three codes will help to better describe....
Implementing a Mobile Coding Solution
Author: Colgan, Peter
Source: In Confidence (newsletter)
Publication Date: July 02, 2001
Wireless computing technologies capable of enabling clinical and administrative decision support throughout the extended healthcare enterprise have arrived! Among the benefits of any wireless healthcare solution is the wide distribution of information throughout the enterprise. This benefit r....
Coding Under the HIPAA Umbrella
Author: Russo, Ruthann
Source: Journal of AHIMA - Coding Notes
Publication Date: June 2001
Although coding professionals are not ultimately responsible for ensuring appropriate release of patient-protected information, it is important that they understand that coded data is not only one of the most desired pieces of information in the patient’s record, it is also the....
AHIMA's Statement Regarding Replacement of ICD-9-CM Procedural Coding System
Author: Kloss, Linda L
Source: AHIMA testimony and comments
Publication Date: May 17, 2001
Thursday, May 17, 2001
Good morning, I am Linda Kloss, chief executive officer of the American Health Information Management Association (AHIMA). On behalf of the Association, I thank you for this opportunity to provide input on replacing the ICD-9-CM procedural coding system with ICD-10-....
Covering the Bases of Coding Compliance
Author: Hapner, Peggy
Source: Journal of AHIMA - Coding Notes
Publication Date: May 2001
As HIM professionals already know, data quality-one of the basic tenets of compliance-depends on comprehensive documentation and accurate code assignments. Because coding plays a major role in payment, reporting data accurately, managing data flow and data collection, and training st....
Trends to Watch in Home Health Compliance
Author: Abraham, Prinny
Source: Journal of AHIMA
Publication Date: May 2001
The implementation of the Home Health Prospective Payment System (PPS) on October 1, 2001, has presented some unique compliance risks for HIM and billing managers. This article will briefly describe some of the compliance-related issues on the OIG's agenda that are of interest to HIM....
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