ahima-perspectives > Paper Categories > Coding & Reimbursement

Coding & Reimbursement

Leveraging an Innovation Model to Facilitate ICD-11 Implementation

Kathy L. Giannangelo, MA, RHIA, CCS, FAHIMA, Michael B. Pine, MD, MBA, Christopher P. Tompkins, PhD

This manuscript proposes an innovation model to facilitate the implementation of ICD-11 by the US. The model introduces ICD-11 Comprehensive Clinical Linearization, Evolution and Response, or C-CLEAR, a fully coded comprehensive clinical linearization and syntactical rules for combining these...
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Predicting Hospital Readmission in Medicaid Patients with Heart Failure Using Administrative and Claims Data

By Jaehyeon Yun, Vishal Ahuja, Daniel F. Heitjan

Given the scope of Medicaid and the distinctive characteristics of the covered population, there is a need for readmission models that are designed for this set of patients. Here, the authors address this gap by using a large Medicaid claims database to develop a novel model for predicting the...
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Current Challenges in Sepsis Documentation and Coding: A Review of the Literature

By Jaime Sand, EdD, RHIA, CCS, CAHIMS and Alba Kuqi, MD, MSHIM

Challenges arise in sepsis billing due to the variety of definitions of the condition and changing clinical indicators impacting documentation and coding. This article reviews the literature related to the diagnosis, documentation, coding, and billing of sepsis since the more widespread...
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Risk of Duplicate ICD Codes for Orthopedic and Injury Related Research

By Gregory Benes, BS

The World Health Organization’s International Classification of Diseases (ICD) has become the international standard diagnostic classification for reporting morbidity and mortality. In 2015, the United States transitioned from the 9th to 10th Revision. The update was necessary due to major...
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Resident and Family Physician Perspectives on Billing: An Exploratory Study

By Serena Chin, MBA, MD; Toni Li, BSc; Maximilien Boulet, MD; Kelly Howse, MD; and Akshay Rajaram, MMI, MD

Within revenue cycle management, billing is an important activity for physicians with financial implications across remuneration models. We assessed the self-reported billing confidence of residents and attending physicians practicing at an academic family health team in a single payer...
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The Natural History of CDI Programs: A Metric-Based Model

By Howard Rodenberg, MD, MPH, and James D. Campbell, MD

The success or failure of a clinical documentation integrity (CDI) program is often evaluated using a designated set of metrics. However, these metrics change over time, and an understanding of these changes is critical to properly judge the efficacy of the CDI effort. The authors propose a...
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