AHIMA Health Information Management

An internal audit of knee arthroscopy procedures has identified the following:

29880 and 29876 are being coded together for the same knee

1. Based on NCCI edits, elaborate on the appropriateness of this coding practice.

2. Develop a process to ensure that NCCI arthroscopy guidelines are followed.

References: Castro, A.B. and E. Forrestal. 2015. Principles of Healthcare Reimbursement, 5th edition. Chicago,:AHIMA

Centers for Medicare and Medicaid Services (2015). NCCI Policy Manual for Medicare Services. Link:

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

Hazelwood, A. and C. Venable. 2016. Reimbursement Methodologies. Chapter 7 in Health Information Management: Concepts, Principles, and Practice, 5th ed. Oachs, P. and A. Watters, eds. Chicago: AHIMA

GRADING CRITERIA

AHIMA Health Information Management Cases Studies.

Appropriate elaboration of coding practice, double-spaced.

9 points

Explain in each paragraph using analysis and scholarly thought with assertions supported by evidence.

9 points

Use proper quotation and APA citation rules

2 points

Provide URL with use of APA format

2points

Use proper spelling and grammar

3 points

TOTAL

25 points

This assignment comes from 2016 AHIMA Health Information Management Cases Studies.

CAHIIM Subdomain V.B.1

Number of Pages: 2 Pages

UNDERSTANDING NURSING MANAGEMENT AND ORGANIZATIONS

? Statistical—built from a scientific approach ? Case study—an in-depth analysis used to translate to other clinical situations ? Nonexperimental design research—gathering factors related to a clinical condition ? Quasi-experimental design research—a study limited to one group of subjects ? Randomized control trial—uses both experimental and control groups to determine the

effectiveness of an intervention

While all forms of evidence are useful for clinical decision making, a randomized control design and statistical evidence are the most rigorous (Hader, 2010).

Magnet® Certification The Magnet Recognition Program® designates organizations that “recognize health care orga- nizations that provide nursing excellence” (ANCC, 2011). To qualify for recognition as a mag- net hospital the organization must demonstrate that they are:

? Promoting quality in a setting that supports professional practice ? Identifying excellence in the delivery of nursing services to patients/residents ? Disseminating “best practices” in nursing services.

Becoming a magnet hospital requires a significant investment of time and financial resources. Research shows, however, that patient safety is improved when nurse staffing meets Magnet standards (Lake et al., 2010).

Systems involving participatory management and shared governance create organizational environments that reward decision making, creativity, independence, and autonomy. These orga- nizations retain and recruit independent, accountable professionals. Organizations that empower nurses to make decisions will better meet consumer requests. As the health care environment continues to evolve, more and more organizations are adopting consumer-sensitive cultures that require accountability and decision making from nurses.