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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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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.

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

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

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

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

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

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

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.

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

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

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.

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