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Spring Training for Outpatient Hospital Coding Compliance
Author: Scichilone, Rita A
Source: Journal of AHIMA - Coding Notes
Publication Date: May 2001
While this month's first "Coding Notes" article covers the bases of coding compliance across the continuum of care, this article offers some hard-hitting rules for playing the compliance game in outpatient hospital coding and reporting.
Staying abreast of all of the regulat....
AHIMA Advocates for Physician Query Forms
Author: Rode, Dan
Source: Journal of AHIMA
Publication Date: May 2001
The Medicare program's reluctance to accept physician query forms has been fermenting for several years. Recently, the Health Care Financing Administration (HCFA) and the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) have argued that facilities u....
Working Smarter with APCs
Author: Thoman, Deborah J.
Source: Journal of AHIMA
Publication Date: May 2001
Are HIM professionals ready to make the most of APCs? This article suggests some strategies to improve the way we work with APCs, focus on complete and accurate coding, and improve our expertise.
Are HIM professionals ready for the next step in APCs? Are we ready to use APC data....
HCFA Guidelines on Consultations
Author:
Source: Brief Encounter
Publication Date: April 02, 2001
reprinted from Medicare Intermediary Manual
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 (....
CPT-5 Supports Performance Measurement, Technology
Author: Beebe, Michael
Source: Journal of AHIMA - Coding Notes
Publication Date: April 2001
Among the needs the CPT-5 Project addresses are changes to enhance the use of CPT by practicing physicians, managed care and other payer organizations, and researchers. The project has made recommendations for improvements in the structure and processes of the CPT codes with deliberate emphasi....
Physician Query Forms -- Status Report
Author: AHIMA Policy and Government Relations Team
Source: AHIMA testimony and comments
Publication Date: April 02, 2001
Report Date: April 2, 2001
Current Situation:
The Health Care Financing Administration (HCFA) has suspended its previous instructions to the Peer Review Organization (PRO) requiring them to ignore facilities’ physician query forms as a source of docum....
Developing Facility-specific Productivity Measures
Author: Dunn, Rose T
Source: Journal of AHIMA - Coding Notes
Publication Date: April 2001
Coder productivity has become a popular topic among coders and HIM department managers and is frequently discussed on bulletin boards and listservs. Unfortunately, during the last few years, especially with the advent of APCs, it has become more difficult to establish productivity m....
Physician Query Forms -- Status Report. Attachment D
Author: AHIMA Policy and Government Relations Team
Source: AHIMA
Publication Date: March 21, 2001
DEPARTMENT OF HEALTH & HUMAN SERVICES
Health Care Financing Administration
7500 SECURITY BOULEVARD
BALTIMORE MD 21244-1850 QIP TOPS CONTROL NUMBER: PRO 2001-06
DATE: March 21, 2001
FROM:
Director
Quality Improvement Group
Off....
Documentation Requirements for the Acute Care Inpatient Record (2001)
Author: Smith, Cheryl M.
Source: AHIMA practice brief | Journal of AHIMA
Publication Date: March 2001
This practice brief has been updated. See the latest version here. This version is made available for historical purposes only.
New PPS Proposed for Inpatient Rehabilitation Facilities
Author: Dougherty, Michelle
Source: Journal of AHIMA
Publication Date: March 2001
It's time to take a look at HCFA's published proposed rules for a new prospective payment system (PPS) for inpatient rehabilitation facilities (IRFs).1,2 This new payment system applies to both rehabilitation hospitals and hospital-based rehab units for cost report periods beginning o....
Committee Considers ICD-9-CM Changes for 2002
Author: Prophet, Sue
Source: Journal of AHIMA - Coding Notes
Publication Date: March 2001
by Sue Prophet, RHIA, CCS
The ICD-9-CM Coordination and Maintenance Committee, cosponsored by the National Center for Health Statistics (NCHS) and the Health Care Financing Administration (HCFA), met on November 17, 2000, in Baltimore, MD. Donna Pickett, RHIA, from NCHS, and Patri....
Physician Query Forms -- Status Report. Attachment C
Author: AHIMA Policy and Government Relations Team
Source: AHIMA
Publication Date: February 12, 2001
February 12, 2001
Timothy J. Cuerdon, Ph.D., Director
Timothy J. Carr
Division of Program Management and Evaluation
Quality Improvement Group, OCSQ
Health Care Financing Administration
Mail Stop S3-02-01
7500 Security Boulevard
Baltimo....
Communication, Collaboration, and Compliance
Author: Zarybnicky, Rosalie; Coltrin, Kaelyn; Colwell, Holly; Lam, Donna
Source: Journal of AHIMA
Publication Date: February 2001
Best practices are the result of professionals developing practical ways to improve processes and quality. Medicare peer review organization and state Payment Error Prevention Program (PEPP) organizer PRO-West recognized this when it looked to state hospitals for methods to improve do....
Another Look at Home Care PPS
Author: Youmans, Karen; Scichilone, Rita A; Dougherty, Michelle
Source: Journal of AHIMA - Coding Notes
Publication Date: February 2001
In the October 2000 Journal of AHIMA, we outlined the new home health care prospective payment system (PPS).1 Coding professionals working with home health providers have learned new terms and additional guidelines for reporting. However, confusion remains concerning code assignments, because s....
New APCs for a new year: more OPPS changes
Author: Averill, Richard F.; Grant, Thelma M.; Bonazelli, Janice A.
Source: Journal of AHIMA
Publication Date: February 2001
The January 1, 2001, update to the Outpatient Prospective Payment System (OPPS) contained significant changes. These changes fall into three categories: modifications to the definition of the APCs
policy changes that affect the claims adjudication process or payment....
Physician Query Forms -- Status Report. Attachment B
Author: AHIMA Policy and Government Relations Team
Source: AHIMA
Publication Date: January 22, 2001
Attachment B (Physician Query Forms -- Status Report)
DEPARTMENT OF HEALTH & HUMAN SERVICES Health Care Financing Administration
7500 SECURITY BOULEVARD
BALTIMORE MD 21244-1850
....
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....
First Annual Hospital OPPS Update Published
Author: Rode, Dan
Source: Journal of AHIMA
Publication Date: January 2001
The Health Care Financing Administration (HCFA) published its "annual" update to the hospital outpatient prospective payment system (OPPS) as an "interim final rule with comment" in the November 13, 2000, Federal Register.1 Due to delays in the original implementat....
Understanding HIPAA Transactions and Code Sets
Author: Rode, Dan
Source: Journal of AHIMA
Publication Date: January 2001
The recently published final regulations for transactions and code sets under HIPAA are the light at the end of the tunnel in the quest for uniform healthcare standards-and the first step on a long road to HIPAA implementation. What are the standard transactions and code sets? This article tak....
Ten Steps to Successful Chargemaster Reviews
Author: Drach, Maureen; Davies, Alethea; Sagrati, Carmen
Source: Journal of AHIMA
Publication Date: January 2001
Is your chargemaster current, compliant, and comprehensive? In the age of APCs, healthcare facilities would do well to answer these questions regularly. Here’s how an HIM professional can help.
On every front, healthcare is advancing by leaps and bounds. At the same time, providers a....
CPT Changes for 2001
Author: O'Hara, Karen
Source: Journal of AHIMA - Coding Notes
Publication Date: January 2001
CPT 2001 Professional Edition (CPT® 2001) is complete and should be landing on your desk soon. As an introduction to the new book, this article provides a brief summary of the changes in 2001. A complete listing of the code and guideline changes can be found in CPT Changes 2001:....
Sorting Out the Inpatient Rehabilitation PPS
Author: Youmans, Karen
Source: Journal of AHIMA - Coding Notes
Publication Date: January 2001
FRGs, RIC, CMGs, FIM, MDS-PAC, IRF, RPPS, UDSMR...What do these letters mean? They are all part of the inpatient rehabilitation prospective payment system (RPPS). This article will explain the history and key pieces of this system.
A Brief History of PPS
As we know,....
Payer’s Guide to Healthcare Diagnostic and Procedural Data Quality
Author: AHIMA Coding Policy and Strategy Committee
Source: AHIMA report
Publication Date: January 02, 2001
New Approach to Chargemaster Management
Author: Richey, John
Source: Journal of AHIMA
Publication Date: January 2001
After examining their CDM management processes, HIM professionals, along with clinical and support departments, redesigned and automated several practice aspects with successful results. (FORE Best Practice, AHIMA Foundation)
Coding and Documentation of Intimate Partner Violence
Author: Rudman, William J.; Hewitt, Calvin R.
Source: Educational Perspectives (AOE)
Publication Date: January 02, 2001
Calvin R. Hewitt, MBA, Assistant Professor,
School of Nursing,
University of Mississippi Medical Center
Abstract: This paper examines the role of the health information management (HIM) professional in the early detection of intimate partner violence (IPV). Sp....
HFMA Tackles Hospital Billing Chaos
Author: Jeffries, Jane
Source: Journal of AHIMA
Publication Date: January 2001
Hospital bills are lengthy, often incorrect, and potentially confusing-to no one's surprise. A hospital bill is the result of a long process with numerous participants, beginning at pre-intake and ending with final collections.
Richard L. Clarke, FHFMA, president and CEO o....
How the DSM-IV-TR and Current ICD-9-CM Revisions Affect Behavioral Health Documentation and Coding
Author: Albaum-Feinstein, Andrea L.
Source: Behavioral Health
Publication Date: January 02, 2001
Introduction
The textbook DSM-IV-TR (Diagnostic Statistical Manual-Text Revision, 4th Edition) by the American Psychiatric Association was published in July 2000. The 2000 ICD-9-CM Addendum (effective October 1, 2000) was published again after a one-year absence. Both these publications....
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....
Physician Query Forms -- Status Report. Attachment A
Author: AHIMA Policy and Government Relations Team
Source: AHIMA
Publication Date: November 21, 2000
Attachment A (Physician Query Forms -- Status Report)
November 21, 2000
Timothy J. Carr
OIG-Payment Error Prevention Team
Office of Clinical Standards and Quality
Health Care Financing Administration....
Next Generation of E/M Guidelines
Author: Hill, Emily
Source: Journal of AHIMA - Coding Notes
Publication Date: November 2000
Few non-clinical issues have inspired as much discussion, revision, and anxiety as the evaluation and management (E/M) services and their accompanying documentation guidelines. E/M services have produced a cottage industry focused on ensuring that medical records contain necessary docu....
New APCs and More: Changes to the Outpatient Prospective Payment System
Author: Averill, Richard F.; Grant, Thelma M.; Steinbeck, Barbara A.
Source: Journal of AHIMA
Publication Date: November 2000
The Outpatient Prospective Payment System (OPPS) went into effect on August 1, 2000. However, as a result of continuing comments from hospitals and the initial experience with the operation of the system, HCFA has made some substantial changes to OPPS. These changes fall into three categories:....
Building a Better CPT
Author: Prophet, Sue
Source: Journal of AHIMA
Publication Date: November 2000
The Health Insurance Portability and Accountability Act (HIPAA) presents numerous challenges to HIM processes and systems. Not least among these areas is coding. Among the concerns is whether the CPT system will be sufficient to meet the demands of HIPAA. The American Med....
ICD-9-CM Code Revision for 2001
Author: Prophet, Sue
Source: Journal of AHIMA - Coding Notes
Publication Date: November 2000
Effective October 1, 2000, 100 new ICD-9-CM diagnosis codes and nine new ICD-9-CM procedure codes have been implemented. Because there were no ICD-9-CM revisions last year, these new codes are the result of two years’ worth of revisions. Coding professionals should familiarize themselves with....
HCFA Addresses Inpatient Payments, SNFs
Author:
Source: Journal of AHIMA
Publication Date: October 2000
HCFA's recently published interim final rule concerning the "Provisions of the Balanced Budget Refinement Act of 1999; Hospital Inpatient Payments and Rates and Costs of Graduate Medical Education" will provide a 2.3 percent increase in payment rates for most acute care hospital....
Natural Language Processing: A Coding Professional's Perspective
Author: Schnitzer, Gregory L.
Source: Journal of AHIMA - Coding Notes
Publication Date: October 2000
Despite understandable skepticism from the medical community, natural language processing (NLP) is slowly emerging as a viable rival to human coding professionals’ speed and accuracy. NLP autocoding software teaches computers to "understand" English well enough to "read" p....
APC Checklist (2000)
Author: Scichilone, Rita A
Source: AHIMA practice brief
Publication Date: September 2000
This practice brief has been updated. See the latest version here. This version is made available for historical purposes only.
HCFA Publishes Final Home Health PPS Rule
Author: Asmonga, Donald D.
Source: Journal of AHIMA
Publication Date: September 2000
The Health Care Financing Administration (HCFA) published the final rule for the prospective payment system (PPS) for home health agencies in July. This rule, which takes effect October 1, 2000, replaces the retrospective reasonable-cost-based system used to pay for home health service....
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) ....
Can Natural Language Processing Aid Outpatient Coders?
Author: Warner, Homer R. Jr.
Source: Journal of AHIMA - Coding Notes
Publication Date: September 2000
As HIM vendors strive to perfect automated coding, one supporting technology has reached an exciting stage of development. Natural language processing (NLP) is a major challenge for the computer industry because of the complexity and variability of human speech. NLP differs from simple word s....
Home Health Prospective Payment System (HHPPS) Phase-In Plan, Contingency Plan, and Instructions (Transmittal A-00-59)
Author: U.S. Health Care Financing Administration
Source: Government (U.S.)
Publication Date: August 31, 2000
Standards for Electronic Transactions...Final Rule and Notice
Author: U.S. Centers for Medicare & Medicaid Services
Source: Federal Register
Publication Date: August 17, 2000
Making a Proactive Transition to APCs
Author: Willett, Lyn
Source: Journal of AHIMA
Publication Date: July 2000
There's no doubt APCs are going to change the way your facility operates, but do you know how? By taking a look at your existing systems, you'll get a better idea of how to prepare for changes. This article spotlights specific functions to consider and optimize for the new outpatient prospect....
Preparing for the Outpatient Prospective Payment System
Author: Averill, Richard F.; Grant, Thelma M.; Steinbeck, Barbara A.
Source: Journal of AHIMA
Publication Date: July 2000
Are you ready for the outpatient prospective payment system? This special report tells you what you need to know. First, take a look at aspects of the new system that most directly affect HIM professionals. then, an expert offers advice on how to make aproactive transition to the new system.....
Dot-com Coder
Author: Zender, Anne
Source: Journal of AHIMA
Publication Date: July 2000
For many people, working with artificial intelligence may sound like something out of a science fiction movie. But for Amy Davis, RHIA, it's just part of the job.
Davis is coding specialist and knowledge engineer at DocCode.com, a company based in Jacksonville, FL. Davis's....
Coding for APCs: Case Studies
Author: Scichilone, Rita A
Source: Journal of AHIMA - Coding Notes
Publication Date: July 2000
When APC implementation begins on August 1, HIM professionals can expect increased complexity when coding outpatient encounters. Examining case studies in selected areas subject to APC payment may help coding professionals better understand the APC reporting process. Although coding guidelines....
AHIMA's Comments re: 42 CFR Parts 411 and 489: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities-Update
Author: Kloss, Linda L
Source: AHIMA testimony and comments
Publication Date: June 08, 2000
June 8, 2000
Health Care Financing Administration
Department of Health and Human Services
Room 443-G
Hubert H. Humphrey Building
200 Independence Avenue, SW
Washington, DC 20201
Re: 42 CFR Parts 411 and 489: Medicare Program; Prospective
Payment Syste....
Who Answers the Medical Necessity Question?
Author: Gregg, Cheryl A.; Mallett, Sherri
Source: Journal of AHIMA
Publication Date: June 2000
Medical necessity issues can lead to reimbursement and billing difficulties. Here are some basic principles to help you master this hot-button issue.
How many rejected claims are sitting on your desk waiting for you to play the appeals game? If medical necessity is the culprit, th....
Outpatient Prospective Payment Becomes A Reality
Author: Scichilone, Rita A
Source: Journal of AHIMA - Coding Notes
Publication Date: June 2000
Do you know your APCs? July 1, 2000, is the start date for the Ambulatory Payment Classification (APC) prospective payment system for Medicare reimbursement. CPT coding skills will directly affect revenue as the current Ambulatory Surgery Center (ASC) methodology is abandoned and mor....
Keys to Auditing Hospital and Professional Fee Coding
Author: Driggs, Rachel Commons; Zupko, Mary J.
Source: Journal of AHIMA
Publication Date: June 2000
A good audit program can save a provider from sanctions or fines. Whether you work on the hospital or physician side, here are some tips for better auditing practices.
Coded data is increasingly used for reimbursement, financial planning, clinical research, and evaluating quality of car....
Journal Q&A (6/00)
Author: AHIMA Staff
Source: AHIMA Q and A
Publication Date: June 02, 2000
Q: How are hospitals reducing or maintaining low numbers of delinquent medical records?
A: Maintaining low numbers of delinquent records has long been a challenge for HIM professionals. Following are a few places from which to glean ideas: The AHIMA practice brief "Best Practices in Medical R....
How to Code Symptoms and Definitive Diagnoses
Author: Prophet, Sue
Source: Journal of AHIMA - Coding Notes
Publication Date: June 2000
Determining when a symptom, definitive diagnosis, or both should be coded can be challenging for coding professionals. This challenge is complicated by the varying rules regarding the coding of symptoms versus definitive diagnoses, according to the type of encounter and the particular service r....
Understanding the Complexities of Coding for Mental Disorders
Author: Albaum-Feinstein, Andrea L.
Source: Journal of AHIMA - Coding Notes
Publication Date: June 2000
Editor's note: This is the second part in a two-part series on diagnostic coding for mental healthcare.
Documentation differences between DSM-IV and ICD-9-CM continue to challenge coders in mental health settings. Efforts to minimize these differences are evident in curren....
Mental Disorders Pose Coding Challenges
Author: Albaum-Feinstein, Andrea L.
Source: Journal of AHIMA - Coding Notes
Publication Date: May 2000
Because coding for professional services in mental health settings requires an understanding of numerous and complex treatment options and settings, a periodic review of Physicians Current Procedural Terminology (CPT) is essential. For many mental healthcare patients, a psychiatrist pr....
Long Term Care: Keeping the Promise, Today and Tomorrow
Author: Roadman, Charles H. II
Source: Journal of AHIMA
Publication Date: May 2000
As we prepare to address the challenges and opportunities ahead, providing compassionate, quality care to residents in long term care settings must remain our top priority. The 21st century is an opportunity for the long term care community to work on behalf of elderly and disabled cit....
Reviewing Diagnostic Coding for Mental Disorders
Author: Albaum-Feinstein, Andrea L.
Source: Journal of AHIMA - Coding Notes
Publication Date: May 2000
Editor's note: This is the first part in a two-part series on diagnostic coding for mental healthcare. Part II will discuss the differences between DSM-IV and ICD-9-CM coding systems.
Coding and documentation and the development and implementation of an effective HIM compliance pro....
Boosting Efficiency in Home Health Record Systems
Author: Abraham, Prinny
Source: Journal of AHIMA
Publication Date: April 2000
The growing pains of the past decade have led to medical record backlogs and record retrieval crises for many home healthcare agencies. These problems have pushed more than one agency director into enlisting the skills of an HIM professional to evaluate the medical record systems in pl....
Modifier Usage for Hospital Outpatient Services
Author: Zeisset, Ann M.
Source: Journal of AHIMA - Coding Notes
Publication Date: April 2000
Implementing the processes for CPT modifier usage in the outpatient hospital setting has been a topic on everyone's "to do" list since HCFA announced the change. There are many variables in executing this change, such as updating or changing computer systems, training staff, and developing chan....
Clarifying Selected CPT Modifiers
Author: Scichilone, Rita A
Source: Journal of AHIMA - Coding Notes
Publication Date: April 2000
Coding for professional services is complicated enough when coding professionals are charged with assisting the physician to select the best five-digit number for the services rendered. It becomes even more complex when circumstances of the case require the CPT code to be modified. Add....
Journal Q&A (4/00)
Author: AHIMA Professional Practice Team
Source: AHIMA Q and A
Publication Date: April 02, 2000
Q: I was under the impression that a new prospective payment system (PPS) was to be implemented on October 1, 2000, for Medicare patients in rehabilitation hospitals. Where can I locate the proposed rules?
A: The Balanced Budget Act of 1997 mandated that a PPS be implemented for rehab h....
Reviewing the Details of Coding Septicemia
Author: Limjoco, Cesar M.; Youmans, Karen
Source: Journal of AHIMA - Coding Notes
Publication Date: March 2000
In March 1999, the Office of Inspector General (OIG) released an executive summary on "Medicare Payments for Septicemia." The Health Care Financing Administration (HCFA) contracted with two clinical data abstraction centers to validate a national random sample of claims from all Medicare inpat....
Resolving Confidentiality Barriers in Research Data Collection
Author: Houser, Shannon H.; Engle, Molly; Schumacher, Joseph E; Caldwell, Ellen; Kohler, Connie L; Phelan, Sharon T; Raczynski, James M; Reynolds, Kim D
Source: Journal of AHIMA
Publication Date: March 2000
How can HIM professionals ensure data collection consistency without access to earlier records? When protecting patient anonymity posed a challenge in a research study, HIM professionals took a team approach to abstracting records that maintained quality without compromising confidentiality.
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....
National Correct Coding Initiative Affects CPT Reporting
Author: Cooper, Mary; Ahern, Kitty; Dietz, Linda S.
Source: Journal of AHIMA - Coding Notes
Publication Date: February 2000
This article has been abstracted from the AHIMA Nov. 4, 1999 audio seminar "National Correct Coding Initiative" conducted by the authors. For a copy of the complete 90-minute seminar tape, contact AHIMA at (312) 233-1100.
Since 1996, the Health Care Financing Administration (HCFA) has us....
Sharing Resources for Coding Quality Improvement
Author: Mills, Sharon
Source: Journal of AHIMA - Coding Notes
Publication Date: February 2000
Hospital leaders who truly understand the challenge of achieving high-quality coding and are willing to commit resources to promote continuous quality improvement can be difficult to find. However, four years ago, visionary leaders in a not-for-profit healthcare system recognized that....
Coders Join Forces with Physicians to Improve Clinical Outcomes
Author: Noller, Janice R.
Source: Journal of AHIMA
Publication Date: January 2000
To investigate high complication rates, coders at this facility found themselves working to improve communication, physician understanding of coder issues, and data quality. (FORE Best Practice, AHIMA Foundation)
Using CPT Modifier -25 for Professional Billing
Author: Yoder, Lois M.
Source: Journal of AHIMA
Publication Date: January 2000
You may want to consider a focused review of how your practice assigns CPT modifier -25, "a significant, separately identifiable Evaluation & Management (E&M) service by the same physician on the same day of the procedure or other service."1 The Health Care Financing Admini....
Crystal Ball for Coding
Author: Johns, Merida L.
Source: Journal of AHIMA
Publication Date: January 2000
What will the future of coding look like? A special AHIMA task force has several ideas. What will really happen depends on how coders choose to respond. Here's an overview of the task force's findings, plus suggestions on how readers can make the most of possible career opportunities.
It....
Ten Down Under: Implementing ICD-10 in Australia
Author: Innes, Kerry; Peasley, Karen; Roberts, Rosemary
Source: Journal of AHIMA
Publication Date: January 2000
Coders in Australia have already made the change to coding an Australian modification of ICD-10. What was the process of conversion like, and what lessons can we learn from it? Here's a step-by-step account of the change process.
While no definite date for making the change....
Incentive Programs Offer Aid to Increase Coding Productivity
Author: Gleberman, Amy L.
Source: Journal of AHIMA - Coding Notes
Publication Date: January 2000
Incentive programs can be a good tool for increasing productivity while maintaining coding quality. Employees who are rewarded for extra production will likely perpetuate higher levels of productivity. High coding productivity can improve a healthcare organization's bottom line by sh....
Off-Site Coding Success Story
Author: Kramer, Lynette; Meeks, Richard
Source: Journal of AHIMA
Publication Date: January 2000
If you asked HIM professionals about key success factors that substantially impact timely and accurate coding, three of the most common answers might be:
availability of the record immediately after the patient visit
availability of the complete record....
CPT Changes for 2000
Author: Kirschner, Celeste G.; Zeisset, Ann M.
Source: Journal of AHIMA - Coding Notes
Publication Date: January 2000
The American Medical Association's CPT 2000 Coding Symposium was held recently in Chicago to discuss the more than 300 revisions in the 2000 Current Procedural Terminology (CPT). Here is a brief summary of the changes.
A complete listing of the code and guideline changes can be foun....
Trend Watch: Coding for Nonphysician Services
Author: Hill, Emily
Source: Journal of AHIMA
Publication Date: January 2000
From physician assistants to nurse practitioners, the number of healthcare professionals offering patient care services has increased dramatically in recent years. With this increase comes a challenge to codersaccurately reporting the services provided by these prof....
Coding Crosses into the Future
Author:
Source: AHIMA Advantage
Publication Date: December 1999
With all that's on your desk today, it's difficult to anticipate what changes are headed your way in the next year, let alone 10 years from now. But for a moment, as distant as it seems, consider what coding practice may look like on January 1, 2010.
It's a staggering question, one th....
Mobilizing to Do Adaptive Work
Author: Fletcher, Donna M.
Source: Journal of AHIMA
Publication Date: November 1999
Can our visionary leaders solve our problems? Sometimes. But more often, the reality is the power to solve problems lies with us. This is the fundamental assumption of the "adaptive work" concept presented in this articlealong with some real-life examples of HIM adaptive work in action.....
Leading Change in a Laboratory Compliance Program
Author: Rupp, Cheryl
Source: Journal of AHIMA
Publication Date: November 1999
In any situation, there is a positive side and a negative side. At any moment, I decide.
author unknown
Compliance has become the trendy buzzword in almost every industry these days, but perhaps nowhere is it quite as prevalent as....
Back to Basics: Coding for Physician Services
Author: Scichilone, Rita A; Zeisset, Ann M.
Source: Journal of AHIMA
Publication Date: November 1999
How many times have you asked the question "How do you code ___?" We never seem to have all of the answers involving new techniques or unusual cases. With accurate, correct data so critical, it is vital that we know the answers. Included in this article are several commonly asked questions wit....
Steps to Internal Audits for Physician Office Records
Author: Zeisset, Ann M.; Scichilone, Rita A
Source: Journal of AHIMA - Coding Notes
Publication Date: October 1999
Physician offices face the challenge of submitting correct coding information through the billing process. Ensuring timely reimbursement at the highest level for which services were provided, correct coding also proves there are no fraudulent activities occurring at the facility. Performing a....
Concurrent Process to Enhance Coding Compliance
Author: Scott, Judith A.; Clary, Karen J.; Smith, Marlene J.E.
Source: Journal of AHIMA
Publication Date: October 1999
Medicare fraud. These two words can strike fear in the hearts of healthcare professionals. In the wake of recent federal investigations alleging fraudulent billing practices at hospitals across the nation,1 this fear may be justified. In recent years, there have been an unprecedented....
Brief History of ICD-10-PCS
Author: Mullin, Robert L.
Source: Journal of AHIMA - Coding Notes
Publication Date: October 1999
The International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) was developed as a replacement for the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) volume 3, Procedures. This version of ICD, in use since J....
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.&....
Getting Ready for APCs
Author: Scichilone, Rita A
Source: Journal of AHIMA
Publication Date: September 1999
While most healthcare practitioners support accurate coding, the challenge remains for HIM professionals: how to achieve coding accuracy in a system of imperfect data capture methods and changing reimbursement methodologies. Greater emphasis on coding specificity and completeness for reimburs....
PPS + New Technology = Growing Pains
Author: Blumenthal, Jane E
Source: Journal of AHIMA
Publication Date: September 1999
It's been a little more than a year since the prospective payment system (PPS) came into play in skilled nursing facilities. The post-acute PPS, initiated by the federal government under the 1997 Balanced Budget Act, was set in place to reduce the federal government's healthcare expend....
Reimbursement at Your Fingertips: A Glossary of Terms
Author: Fletcher, Donna M.
Source: Journal of AHIMA
Publication Date: September 1999
From the onset of DRGs in 1983 through today's proliferation of prospective payment systems (PPS) and managed care efforts, the number of terms related to reimbursement has increased significantly. The following are some of those terms and abbreviations, including those r....
Care and Maintenance of Charge Masters (1999)
Author: Rhodes, Harry B.
Source: AHIMA practice brief
Publication Date: July 1999
This practice brief has been updated. See the latest version here. This version is made available for historical purposes only.
Coding in the World of Compliance: the OIG's Perspective
Author: Lemanski, Susan
Source: Journal of AHIMA
Publication Date: July 1999
As statistics from a recent survey attest,1 compliance programs are on the forefront of many providers' agendas. In the wake of compliance program guidances2 issued by the Office of Inspector General (OIG) of the Department of Health and Human Services, many healthcare providers have devoted a....
Automated Coding: The Next Step?
Author: Beinborn, Julie
Source: Journal of AHIMA
Publication Date: July 1999
Automated coding technology may be key to the evolution of the coding and billing processes. How do these systems work, and how will they change the role of the coder? The author offers a preview.
Technology is changing many aspects of healthcare, and coding is no exception.
R....
Diagnostic Services Coding Tips for Physician Offices
Author: Scichilone, Rita A
Source: Journal of AHIMA
Publication Date: July 1999
Coding for diagnostic services performed in physician offices and clinics requires an understanding of some special reporting guidelines. Here are some helpful tips.
The Question of Ownership
Reporting laboratory and radiology procedures depends on ownershi....
After Automated Coding, What?
Author:
Source: Journal of AHIMA
Publication Date: July 1999
As technology progressively automates more processes, what will HIM jobs look like in the future? In 1998, AHIMA published Evolving HIM Careers, which offers in-depth looks at seven new roles for HIM professionals, including the role of the clinical data specialist. Here are som....
Coders and Physician Liaisons: a Winning Combination
Author: Stavely, Starla
Source: Journal of AHIMA
Publication Date: July 1999
Never have so many HIM professionals had so much to worry about in the area of coding. Combine the need to keep an eye on case mix and a vigilant effort to prevent fraud and abuse, throw in a lack of physician documentation, increasingly stiff competition for the chart on nursing units, and co....
Where We've Been, Where We're Going
Author: Scichilone, Rita A
Source: Journal of AHIMA
Publication Date: July 1999
As conditions in the healthcare industry have become more challenging, many jobs have evolved. Not least among them in the HIM world is the role of the coder. In more ways than one, coding professionals are making their mark in the industry. And today, changes in coding requirements are pa....
Best Practices: What Works
Author: Carrier, Danielle
Source: Journal of AHIMA
Publication Date: July 1999
Medical record accuracy, record completion time, physician satisfaction—all of these are indicators of how well an HIM department is performing. The findings of a UHC benchmarking study may point the way to best practices that can be shared and adapted.
What....
Group Builds Consensus on Laboratory Test Policies
Author: Prophet, Sue
Source: Journal of AHIMA
Publication Date: July 1999
The Balanced Budget Act of 1997 (BBA) mandated that the Health Care Financing Administration (HCFA) use a negotiated rulemaking process to develop national administrative and coverage policies for clinical diagnostic laboratory tests under Medicare Part B. The BBA stipulates that the p....
Coding Compliance Tips for Hospital Outpatient Observation Services
Author: Manning, Susan C.
Source: Journal of AHIMA
Publication Date: July 1999
The Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) continues in its efforts to promote voluntarily developed and implemented compliance programs for the healthcare industry. Fundamentally, compliance efforts must be designed to establish a culture th....
Three Perspectives on Coding
Author: Scichilone, Rita A; Stavely, Starla; Lemanski, Susan
Source: Journal of AHIMA
Publication Date: July 1999
It isn't just about assigning codes any more. These days, coders are breaking new ground in their profession. Three authors offer different perspectives on the role of the coder in today's healthcare environment -- from their evolution in the world of HIM to broader connections with physicians....
Sign of the Changing Times: CPT 1999
Author: Mallett, Sherri; Smith, Gail I.
Source: Journal of AHIMA
Publication Date: June 1999
This year brought with it 686 changes to CPT. While this is a moderate number in comparison to previous years, several of the changes have significant impact on code assignment. The purpose of this article is to highlight some of the areas of significant change. (See "1999 CPT Revisions" in t....
Imagine the Future of Coding
Author:
Source: AHIMA Advantage
Publication Date: June 1999
How will coding be different in the year 2010? Pondering the coding practices of tomorrow is the job of AHIMA's Coding Futures Task Force. And though there's no crystal ball involved, trends that will have a substantial impact on the future can be identified today.
Remember the word p....
Post-acute PPS: Changing the Way We Code
Author: Dougherty, Michelle
Source: Journal of AHIMA
Publication Date: June 1999
HIM professionals in post-acute care are reinventing their roles to accommodate the new coding demands of a prospective payment system. Here are some of the developments that are creating new interest in coding issues for post-acute settings.
Three major forces -- the prospective payment....
Post-acute Prospective Payment: What You Should Know
Author: Keillor, Ann; Nutten, Sandra
Source: Journal of AHIMA
Publication Date: June 1999
Post-acute prospective payment is one of the latest reimbursement changes to affect healthcare. How does it work, and how will it affect HIM professionals? The authors offer an overview of the new system.
Volumes have been written about the spiraling healthcare expenditure crisis and the....
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