In what was perhaps an effort to remind providers to consider medical record retention as they move to EHRs, CMS released MLN Matters SE1022, which addresses medical record retention limits and media formats.
With the end of the year approaching, you, along with many of your HIM director and manager colleagues, may soon be tasked with conducting annual staff evaluations. Chances are it isn’t your favorite task of the year. But it needs to be done.
Present-on-admission (POA) indicators, hospital-acquired conditions (HAC), and never events have been around for a while. However, they still seem to cause compliance conundrums, says Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS, director of HIM and coding at HCPro, Inc., in Marblehead, MA.
It should come as no surprise that medical record documentation made the list for top standards noncompliance for the first half of 2010. Our old favorites just won’t go away.
MRB recently asked several advisory board members for crucial tips that new HIM managers and directors should know as they learn their way around their job and department.
