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SNF therapy contracts: Your risks and what you need to know Q&A

SNF therapy contracts: Your risks and what you need to know Q&A

Editor’s note: The following Q&A was written by Reginald Hislop III.


Q: When we receive proposals from various therapy companies, they all represented that they would increase our Part A and Part B billings. Should this somehow be incorporated into the ­contract?


A: Yes. Absolutely. If they’re willing to say that to you and they tell you, "That’s the reason why you’re going to go with us is because we’re going to do this," I am going to hold them accountable for that, and I first want to know how you determine that and how are you going to do that because I’m going to tell them right there before we even get to a contract, I’m going to say that they need to fundamentally prove it. How do you know it, how’s it going to happen, and be prepared because yeah, you’re going to put in the contract, you’re going to represent it, it’s going to be legal and you’re going to do it over what period of time? I’m then going to hold them accountable for it.

Otherwise, it becomes a common game of therapy contractors: "We’re going to make your world so much better than the last group that was in here." I’ve never seen a contractor come in and say, "We looked at your last experience with your last therapy contractor and the amount of stuff that they were doing, and by the way, we got to tell you, it really makes us nervous, and fundamentally if you go with us, we’re going to shrink your revenue by 15% because we think there’s a whole bunch of erroneous and falsely billed claims." I’ve never seen that happen. Everybody comes in and says, "Yes, we can improve your performance over this group, and we’re going to do it by a pretty impressive margin, and your revenue is going to go up, your claims are going to go up." I want to know how they’re going to do that, I want it in the contract, and I want full transparency. I want to know over what time period, because without that, they haven’t actually validated they will be able to do that. That’s a standard pitch, and they have never yet been expected in many cases to be accountable for those kind of numbers. It’s just a sales pitch, but, if they’re going to say it, I want it in the contract.


Q: Would the indemnification clause you mentioned, indemnification not just for the therapy component but the whole amount?how can the therapy company indemnify money they did not receive?


A: How can they indemnify money they did not receive? We’re not talking about necessarily indemnification for money they received. We’re talking about indemnification for services that they provided as part of the representation that all of our services that we provide are going to be compliant and in concert with the law. Since the SNF is responsible for that, my responsibility then is to negotiate with that company and say, "By the way, if in fact we’re involved in this work and you’re going to be part of this process and you’re going to have input in terms of what we RUG, what we bill, part of our triple check and all the rest of that other kind of stuff, there is dollars on the table, and anything that you did that was illegal, unethical, or improper that caused us to lose revenue as a result of your actions and your documentation, all those other kinds of things because you’re going to represent to me that you’re going to do this, you’re going to properly manage and supervise your employees and all those other kinds of things, that if in fact you didn’t do that, you’re going to be responsible not just for what we paid you but also for what your bad acts caused this facility." Yes, I can indemnify them for that because they are part and parcel to that. They’re going to represent to me that they’re going to do this the right way, and if they don’t, then they’re going to have shared risk for anything that occurs that they were responsible for or could be tied to them that cost my facility money or my organization money.


Q: How do we hold the therapy provider accountable for an 80% productivity level?


A: You actually monitor their productivity levels. Their treatment records should be open. Their minutes should be open. I should be able to see when they were on-site, what their time was spent on this site, what I was billed for because I’m being billed for their time. And I should be able to go to treatment logs and treatment records and look at what their billing time was and their documentation time was, and I can quickly do a simple calculation that says if I had a physical therapist here for eight hours and she was here for four days a week or five days a week, I ought to be able to convert that based on treatment records and treatment logs to what her productivity percentage was, what her care percentage time was, and it better not be more than 80%.


Q: Our present contract doesn’t include much of anything you mentioned. How do we change it or get the therapy provider to go along with your recommendation?


A: There are two ways to do that. One is basically to tell them you attended this seminar and their contract stinks and you want to renegotiate it. I don’t know what your out clauses look like in your contracts. Typically there will be some kind of out clause that will allow you some leverage. If not, when your contract comes up for renewal, make them well aware that these are all going to be key components of your RFP process. You’re going to put it out there, you’re going to bid them unless they’re going to come to the table and do it, they’re not going to have this contract anymore, and generally I have suggested providers to tell them this in advance, good advance. Tell them, "[We] might be six months away from when our contract renews, but here’s a list of the things that we’re going to require of you going forward. So, if you want to keep this contract, we can talk about this now or you can basically be assured that if you’re not going to do this now or have some conversation with us now, chances are relatively poor that you will retain this contract." I haven’t seen a contractor yet that won’t under certain circumstances if you raise most of these issues, at least be willing to start conversations with them about them.


Q: What tools do you suggest in guiding SNF therapists into making appropriate decisions regarding choosing a RUG?

A: Again, the best process for this is your triple check. There are some very good software programs out there, and I’m not going to try to pitch too many companies, but most software programs, AOD does a good job. Rehab Optima also does a good job. Develop a good triple-check process, have good education, make sure your MDS coordinator is certified, RAC certified as part of this process. The RAC certification and staying current on the certification is amajor help in terms of appropriate RUGs based on the documentation. Use your triple check, have everybody together in terms of being able to access and identify your MDSs, what your sections mean, what your documentation is to support your RUG categories. It’s not that difficult, but it does require some work, and it’s really critical that you have good software and a good MDS coordinator who’s RAC certified.

If you don’t have a good MDS coordinator or a coordinator that is RAC certified, rent one. There are services out there that you can go to that will in fact help you through that process on a monthly basis. It will cost you a little money up front, and in the interim get somebody on your staff RAC certified.


Q: Can you explain the in-house hybrid model in greater detail?

A: Sure. The in-house hybrid model works exactly like this: For all intents and purposes we bifurcate the issues. We say, "All right, what we need is we need staff therapists or we need access to staff therapists, and we can do that, but we don’t know how to do that as a facility." We’re not sure where to go, we’re not sure how to recruit, we don’t know how much they should be paid, job descriptions, all the rest of that other kind of stuff, and the one thing that we definitely don’t have expertise in maybe is managing a therapy department, is managing a therapy company. And we’ve heard horror stories about how hard it is to find good rehab directors, how much you pay, you know, all that kind of stuff.

What we do is essentially bifurcate the issues. We say, "All right, here’s the deal. Let’s go get a company who isn’t going to provide the therapy and has no interest in doing that or billing us for that, but is going to help us set up our program." So we’re going to go to one of the qualified companies that are out there that do this, and what they’re going to do is they’re going to come in, they’re going to do an assessment for us, which should be very low cost, to look at our operations, look at what we’re billing, look at our Medicare utilization, and give us a proposal that basically says, "Hey, here is what our department from our perspective would look like. Here’s how many PT hours you need, OT hours, speech therapy, staffing requirements, you know, rates of pay and all that other kind of stuff. We’re going to help you do that. We’re going to put this together and give you a pro forma, show you how this pays for itself and all this other kind of stuff.

"In the meantime, what we’re going to do as well is if you want to proceed down this path, we’re going to do that for you in concert with you. We will recruit, we will hire, we’ll give you job descriptions which we have. We have policies, we have procedures, we can give you a turn-key therapy company, and what we will do is we will be your therapy director fundamentally. We’ll be the folks who manage your therapists. We’ll watch those productivities. We’ll do the education. We’ll do all those kinds of things for you and in partnership with you, and the therapists that will be on site will be 100% your skilled nursing facility employees. They are your employees. You pay them. They’re your benefits. They’re subject to all your rules and regulations and all that kind of stuff, and we’ll just help you manage them. We’ll provide better oversight, and we’ll provide the infrastructure that’s necessary for a therapy department and a therapy program including ongoing education and RUG support and QA and all that kind of stuff. And we do that for a flat fee each month or a percentage of your ultimate therapy department revenue, etc." – Billing Alert for Long-Term Care

Know About Cissp Exam

CISSP stands for Certified Information Systems Security Professionals who work for the security of computer system and stop data theft. In fact computer security became a key question in last years of 1980s and requirement for data protection and network security became a primary concern. CISSP professionals work for protection of information from theft, corruption, natural disaster, etc. Additionally, along with protecting the precious data from unauthorized users, CISSP professionals are expected to enable authorized users have access to all the data or system. A concern which was local at the beginning became a global issue and in 1980s computer companies started to put consorted efforts towards standardization of the entire computer protection system.

Came November 1988 when the Special Interest Group for Computer Security (SIG-CS) which was an allied force of the Data Processing Management Association (DPMA) with the help of several other entities from around the world focused on the issue and formed the International Information Systems Security Certification Consortium (ISC). The ISC holds CISSP exams to offer membership to professionals who clear it. Over the time CISSP certification exam has become one of the popular one and candidates from various parts of the world participate to become one of the certified CISSP professional. CISSP certification not only helps candidates get recognition but gives edge to qualifications held by the candidate. Similarly, with due course of time a number of training organizations have come up which claim to train candidates clear CISSP certification exam.
A summary review of CISSP exam shows that the certification program requires a candidate to know about Access Control
, Application Security
, Business Continuity and Disaster Recovery Planning
, Cryptography
, Information Security and Risk Management
, Legal, Regulations, Compliance and Investigations
, Operations Security
, Physical (Environmental) Security, Security Architecture and Design
, Telecommunications and Network Security
, etc. amongst others. Notwithstanding, the issues are so complex that the candidates willing to take CISSP exam may require formal training to clear it. In order to clear CISSP exam a candidate must read and solve previous years’ CISSP exam questions so that familiarity with the genre of question is made possible.
Interestingly, the CISSP certification is valid for only three years. Therefore, after three years, the candidate has to appear for exam and clear it to become a CISSP. However, the re-examination can be avoided if the candidate undergoes 120 Continuing Professional Education (CPE) credits program which is conducted by the organization. With earning and submission of 120 CPEs, an existing member of CISSP can continue his membership even after three years of completion of the membership. The member is asked to pay an annual fee of US$ 85 during each year of the three-year certification cycle before the annual anniversary date. provides certified information systems security professional (CISSP) practice questions and study material. Over the years, the organization has gained credibility in offering study material and question bank for candidates writing CISSP exam.

What You Need to Know About Coding Using EMRs and Encoding Software

I haven’t been perusing as many coding sites and Facebook pages recently as I was a couple of years ago, but I did recently come across a post that captured my attention.  Someone was asking if there was a way to get trained in a popular electronic medical record (EMR) to help them meet the requirements of a job.  It seems many employers are looking for work experience with a certain EMR before considering a person for a position.  Is this fair?  Well, it may not seem fair if you’ve never worked as a coder, but if you have, chances are pretty good you’ve had exposure to some of the major EMR software vendors.  For those of you who don’t have any practical EMR experience, here’s what you need to know.

Is it reasonable to require EMR experience?
First of all, if you’ve never coded before and your coding school didn’t have a relationship with an EMR vendor allowing you to learn the system, any reasonable hiring manager is not going to expect you to have experience.  And if they aren’t reasonable, then you don’t want to work for them anyway (problem solved!).  If I pick up your resume and see you have taken some coding classes and have never worked in the healthcare field but are “proficient” in EMR software, I am going to have more than a few questions for you.  How did you get your EMR experience?  Which systems did you use?  What did you like or not like about it?  In other words, I won’t believe you have experience with it and I will try to weed that out of you.  Or even worse, I may be inundated with resumes and feel like you’re lying about something on the resume and I may not have the time or energy to do any investigating.  Your resume may be relegated to the “no” pile.

Fact: your employer will train you
Here’s a fun fact.  Even if you’ve worked as a coder for 2 years using a certain EMR software, you will have to have training at your new facility.  You may think you know everything there is to know about a certain EMR software, but they are all customizable.  As a consultant, I’ve used the same EMR software at several clients and they are all a little different.  You may find documents stored in different places.  Your favorite EMR feature at Hospital A may not have been “turned on” at Hospital B.  So expect to be trained on the same software you’ve already been using every time you change employers.

EMRs are from Mars, encoders are from Venus
EMRs aren’t the same as encoders.  Of course the EMR is where you will find the medical record documentation, but it is also where you will find financial information and abstracted data.  Encoders and computer assisted coding (CAC) software are usually separate from the EMR.  As a matter of fact, there aren’t a lot of EMR vendors who are also in the business of encoder software.  That makes two different kinds of systems you need to be aware of.  But have no fear: while it’s a plus if you have been trained on an encoder, you can expect your employer to train you there too.

You need to understand interfaces
Rather than obsessing over how to get trained on a particular EMR or encoder, here’s something more important for you to focus on: you need to understand software interfaces.  Because your EMR and encoder are coming from two different vendors and they have to talk to each other, they rely on interfaces.  How that’s set up is not important to you (although it’s very important to the information technology department), but how and why you enter data the way you do is based on interfaces.  I’ve coded for lots of hospitals with lots of different computer systems, but in general, here’s how it works:

  1. You pull up the patient in the EMR.
  2. If you work with a CAC product, you launch the CAC by clicking a button in the EMR.  This opens the CAC using an interface, so that it automatically pulls up the patient you are working on in the EMR and displays medical record documentation for coding.
  3. If you don’t have a CAC, you review the medical record documentation in the EMR and then launch the encoder using a button in the EMR.
  4. Once you are in the CAC/encoder, you code the record.  This software allows you to look up codes and save them to a list.  When you’re done, you click a complete button, and then you find yourself back in the EMR in the abstracting screens.
  5. If the interface is working properly, everything you entered in the CAC/encoder is shown on your abstracting screens.  This is also where you can assign surgeons and dates to procedures as well as any other abstracted data your facility chooses to collect.
  6. You send the account to billing in the EMR by indicating the account is complete.
(Most) EMRs don’t have grouper software
Groupers are the magic software that calculate DRGs and APCs based on assigned codes.  Grouper logic is something that is built into CAC/encoder software, but not into EMR software.  If you ever need to make a change to codes to rebill an account, you can’t just change the code in most EMRs.  It’s pretty standard practice to reopen the account, relaunch the CAC/encoder, make corrections, send them back to the EMR through the interface, and then send for rebill.  This concept is something that many coders don’t understand and, I would argue, this concept is more important than knowing the ins and outs of any particular EMR product as a new hire.
Knowing how to code is more important than anything
After all this, the most important thing you need to know to get a coding job is how to code.  Your employer can teach you everything I’ve mentioned above specific to your facility.  And they can also work with you on enhancing your coding skills.  But it’s more important for you to focus on coding, coding guidelines, and a cursory background in coding reimbursement than it is for you to know an EMR inside-out.  

Coder Coach

Medical coding & billing: Know the ICD-9 2011 changes

Every year, in October you come face with new ICD-9 codes that you need to add to your diagnosis arsenal. This time too it’s no exception what with the new estasia, congenital malformation, and body mass index (BMI) codes you’ll need to know. Here are some of the proposed changes that’ll impact your cardiology practice so that you are all geared up when the fall rolls around.

Your ectasia hunt will end at 447.7x

ICD 9 2011 adds four specific codes to aortic ectasia, which could be among the most significant changes for cardiology coders. By Estasia we mean dilation or enlargement and aortic ectasia often refers to an enlargement that is milder than an aneurysm. However, ICD-9 2010 doesn’t distinguish ectasia from aneurysm, linking aortic ectasia to 441.9 and 441.5. The proposed 2011 codes are specific to aortic ectasia.

New corrected congenital malformations code

Some of the just-in codes deal with congenital malformations of the heart and circulatory system. Code V13.65 will be very helpful to our practice.

The ICD-9 proposal has expanded the body mass index (BMI) codes to show higher BMIs with five just-in codes. From October 1, you will stop using V85.4 and start using more specific V codes in its place.

The advantage: BMI has become a key health tool and those codes will also provide more data.

With just a few days to go for October 1, you will benefit a lot if you sign up for an audio conference, more so as this CMS will not allow a grace period for using the 2011 diagnosis codes.

Such a conference will provide you with all possible medical coding & billing updates pertaining to ICD 9 2011 changes not just for cardiology, but for every specialty – be it the new codes, the revised ones or the deleted ones. Some audio conferences also offer you CEUs if you sign up for one.


Audioeducator offers medical coding audio conference and provides advanced Learning Opportunities about medical coding update through all types of audio conferences and exceptional series of training CD’s, DVD’s & Tapes.

Zika Virus – A Q&A Primer – Info on Zika is changing quickly – here’s what I know as of today (03/02/2016)

This is the most current article that I wrote for  It is also free to access on their website.  However, I suggest becoming a full-subscription member, as they have a huge amount of resources and information available.  🙂 


Zika Virus –  A Q&A Primer
by Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP
What is Zika?
According to the Center for Disease Control (CDC)  this is the officialdefinition:
The Zika virus is a mosquito-transmitted infection related to dengue, yellow fever and West Nile virus. It was discovered in the Zika forest in Uganda in 1947 and is common in Africa and Asia.  It did not begin spreading widely in the Western Hemisphere until last May, when an outbreak occurred in Brazil.
A bit of clinical background
This is information direct from the American Congress of Obstetricians and Gynecologists (ACOG)  and the Society of Maternal and Fetal Medicine  (SMFM)
The virus spreads to humans primarily through infected Aedes aegyti mosquitoes. Once a person is infected, the incubation period for the virus is approximately 3-12 days. Symptoms of the disease are non-specific but may include fever, rash, arthralgias, and conjunctivitis. It appears that only about 1 in 5 infected individuals will exhibit these symptoms and most of these will have mild symptoms. It is not known if pregnant women are at greater risk of infection than non-pregnant individuals.
Zika during pregnancy has been associated with birth defects, specifically significant microcephaly. Transmission of Zika to the fetus has been documented in all trimesters; Zika virus RNA has been detected in fetal tissue from early missed abortions, amniotic fluid, term neonates and the placenta. However, much is not yet known about Zika virus in pregnancy. Uncertainties include the incidence of Zika virus infection among pregnant women in areas of Zika virus transmission, the rate of vertical transmission and the rate with which infected fetuses manifest complications such as microcephaly or demise. The absence of this important information makes management and decision making in the setting of potential Zika virus exposure (i.e. travel to endemic areas) or maternal infection, difficult. Currently, there is no vaccine or treatment for this infection.
The ACOG and SMFM put forth guidelines for testing of pregnant women, and the laboratory tests are being done exclusively though the guidance of the CDC at the level of the local and state health departments.  Many states in the US are developing guidelines to help in identifying who has been exposed, and where an outbreak may take place. 
Currently the testing being done is a “Zika” serology IgM testing assay.  The reports have been being reported out as “likely positive”, “Inconclusive” and “likely negative”  .  Unfortunately, the labs do not know and gannot guarantee the sensitivity of the IgM assay.
Symptoms of Zika
 Below is a listing of all the known symptoms of Zika virus as put forth by the CDC, however, there may be more that are noted as the Zika Virus becomes more studied in all individuals. Zika is still a virus, and not a bacterial infection, and currently there is not vaccine to prevent it, or a specific medication or antibiotic to treat it with. 
• About 1 in 5 people infected with Zika virus become ill (i.e., develop Zika).

• The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. The incubation period (the time from exposure to symptoms) for Zika virus disease is not known, but is likely to be a few days to a week.
• The illness is usually mild with symptoms lasting for several days to a week.
• People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika.
• Zika virus usually remains in the blood of an infected person for about a week but it can be found longer in some people.
Risks of Zika in Pregnant Women and in their sexual  partners
Normally Zika virus is transmitted through a mosquito bite, however, the Zika virus can be transmitted from a pregnant mother to her unborn fetus during the time of pregnancy and possibly around the time of birth.  It has been noted that Zika virus has been noted in all trimesters of pregnant women, and may possibly be transmitted during the birth process.  Sexual transmission of the Zika virus can also occur, however there is limited data, but the CDC has stated that if the patient fears they are infected with the Zika virus to reduce the risk of sexual transmission via abstinence and/or usage of condoms.
Women are not the only ones at risk of contracting Zika virus.  Men who have traveled to an area of active Zika virus, or who live in these areas may become infected with the Zika virus too.  The CDC has not completely determined if the Zika virus can be transmitted sexually, so the recommendation for men is if you are symptomatic or have a confirmed case of Zika virus, condoms or abstinence is still a best practice.  However, it remains uncertain if the mirus persisits in semen even if no longer  detectible in the blood.
Fetal Evaluation for possible exposure to Zika
Ultrasound exami is the primary recommendation for pregnant mothers who have been exposed to zika virus.  The Ultrasound examinations should focus on development of the fetal brain with intracranial calcifications and microcephaly.  Micocephay has been the most frequently reported adverse fetal complication  in women who have had the virus while pregnant
SMFM is recommending not only blood tests for pregnant women who have been exposed, but also consider performing serial ultrasound, as frequently as every 3-4 weeks.   By obtaining the additional ultrasounds, this would be considered ongoing surveillance.  Considering the history of Zika virus and complications to the fetus  due to this infection is not known.  In addition,  the time from exposure and infection from Zika  to  exhibiting full-blown clinical manifestations is unknown.
The CDC, ACOG and SMFM have put out a number of clinical flow algorhythms for usage with patients’ that have been exposed or live in an area where Zika as been prevalent.  However, this is so new, that these recommendations may change very quickly.   
Case Study and Coding Consideration
Case #1:
An asymptomatic pregnant woman at 19 weeks gestation, presents to her OB office for her regularly scheduled OB prenatal visit.  She informs the receptionist of the possibility she has been exposed to Zika. She has a history of travel to Mexico between 16+0 and 16+5-weeks. She has noted mosquito bites over both legs (calf area).  The bites do not appear infected, and look as if they are resolving.  Patient states they no longer itch, and does not report any other complaints but her ongoing pregnancy related fatigue.  The physician performs a comprehensive history, a comprehensive exam, and will have labs drawn for Zika to be sent to the local district health office.  In addition, the physician decides to perform a baseline screening ultrasound exam to follow up from the patient’s first trimester ultrasound anatomy exam from 1 month ago. 
Coding Consideration: 
99214-25 E&M  – 
76816 Ultrasound 
36415 Venipuncture/Lab Draw
O26.812   Pregnancy related exhaustion and fatigue (2ndtrimester)
Z20.828    Contact with and (suspected) exposure to other viral communicable        diseases (Zika Virus)
S80.861A  Insect bite of rt lower leg initial encounter
S80.862A  Insect bite of lt lower leg initial encounter
Z3A.19      19 weeks gestation of pregnancy
Rationale:  The  E&M visit would be coded, as it is separately identifiable  “outside” the normal pregnancy antenatal care.  (A Zika virus exposure is not considered “normal obstetric care”)  the follow-up ultrasound/baseline ultrasound is coded for comparison to the previously performed 1st trimester ultrasound.  The venipuncture is the only thing chargeable, as the blood was drawn, and sent out to the health district for testing.  The sequencing of the pregnancy diagnosis is primary based upon the ICD-10 pregnancy guidelines.
ACOG’s Quick Zika Q&A
Q1.  True or False. Pregnant women are at greater risk of infection with the Zika virus than nonpregnant women.
A:   False – According to a practice advisory from ACOG and SMFM, “It is not known if pregnant women are at greater risk of infection than non-pregnant individuals.”
Q2.  Once a person is infected with the Zika virus, what is the approximate incubation period for the virus?
A:.   3 to 12 days – Following infection with the Zika virus, the incubation period is approximately 3 to 12 days
Q3.  The Zika virus spreads to humans primarily through infected Aedes aegypti mosquitoes. Which of the following symptoms may be associated with the virus?
All of the above       
A.   Although symptoms associated with the Zika virus are non-specific, they may include fever, rash, arthralgia, and conjunctivitis. (eg all of the above)
Q4. In which trimester(s) has transmission of Zika been documented?
A. All trimesters — The transmission of the Zika virus has been documented in all trimesters
Wrap up
At this time, there are still a number of unanswered questions in regard to the Zika virus.  However, there is no vaccine currently available, so it is recommended that precaution be taken to avoid exposure to mosquito bites from areas where the Zika virus is prevalent.  In the United States and worldwide expert epidemiologists are helping to set forth useful clinical guidelines for identifying and managing patients who have been exposed and currently have the Zika virus.  At this time, clinical guidelines are calling for blood tests to be run, and screening ultrasound should be performed on pregnant patients to screen for possible fetal anomalies related to fetal brain development in infected female patients.
When coding, carefully review to see if the physician or provider is stating whether the patient truly has the Zika virus as a diagnosis, or if they are only “screening” for the Zika virus in light of an exposure to the virus. (either through mosquito bite, or sexual transmission).  
In addition, currently, ICD-10 does not have a specific code to identify Zika virus. Usage of code B33.8 Other specified viral diseases, would be appropriate.  However, If the patient is diagnosed with the Zika virus and has fever with it, then it may be appropriate to use code A92.8 – Other specified mosquito-borne viral fevers.   If the patient is pregnant, then usage of ICD-10 code 098.5X “other viral diseases complicating pregnancy, childbirth and the puerperium,” (be sure to use the most specific trimester as the additional character) would be the most appropriate. 
If in doubt about the clinical documentation, be sure to query the provider to obtain clarity on the diagnosis noted in the medical record. 
Editor’s note: Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC and ICD10 cm/pcs Ambassador/trainer is an E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA Privacy specialist, with over 20 years of experience.  Lori-Lynne’s coding specialty is OB/GYN office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology, Urology, and general surgical coding.  She can be reached via e-mail at or you can also find current coding information on her blog site:  

Lori-Lynne’s Coding Coach Blog

How do I Know if a Medical Billing and Coding School is Accredited?

accrediIf you are contemplating a career in medical billing and coding, you may already know how important a sound education and work experience can be. What you may not already know is how to find an accredited program. The first step to finding an accredited medical coding and billing program is understanding what accreditation is. Accreditation is significantly important to all training, diploma and certificate medical coding programs because it ensures that the teaching institution meets the standards of excellence accrediting authorities require. In simpler terms, think of accreditation as a safe guard to both you, the educational institution, and your future employer because medical coding and billing accreditation requires programs to maintain a threshold of educational quality, industry innovations, and consistent improvement as both technology and medicine advance and evolve. The second step to know if a billing and medical coding program is accredited is to check with agencies considered national authorities on medical billing and coding, health information management, and health informatics.

These agencies include:
The American Academy of Professional Coders
The American Health Information Management Association

The third and final “safe guard” step to determining if a medical billing and coding school is accredited is to verify the institution of learning is accredited by national authorities on higher education. These authorities include:
The Southern Association of Colleges and Schools
The North Central Association of Colleges and Schools
The Middle States Association of Colleges and Schools
The Northwest Association of Schools and Colleges
The Western Association of Schools and Colleges

One final additional step you could take in knowing if a medical billing and coding school is accredited is by choosing a program from our rankings:
The 15 Best Remote Medical Coding Training Programs Online
The Top 10 Medical Billing and Coding Schools
The 10 Best Online Medical Coding Programs

Since we did the research and collected the most up to date information on top medical billing and coding schools, you can be certain the programs we list are not only accredited but great programs certain to provide you with the education, experience, and qualifications you need to succeed as a medical billing and coding professional.

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5 Things You Didn’t Know About Medical Billers and Coders in Teaching Hospitals

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Medical billers and coders are responsible for translating details in patients’ records to insurance companies for gaining proper reimbursement. Every healthcare organization depends on medical coding and billing staff to remain profitable. Yet teaching hospitals are one of the leading employers of HIT professionals. In general, teaching hospitals are nonprofit medical centers affiliated with a university to train clinicians. They provide round-the-clock care in various specialties, from pediatrics to neurology and cardiac care. Interns and residents treat patients under close supervision from attending physicians. For medical coding and billing graduates, working for a teaching hospital can provide both rewards and challenges. Read on to learn five things you should know about medical billers and coders in teaching hospitals.

1. Medical Coding and Billing Jobs Abound in Teaching Hospitals

The American Hospital Association reports that there are 5,627 registered U.S. hospitals total. Of these, 1,038 are teaching hospitals with high patient numbers. Some of the best are Yale-New Haven Hospital, NYU Langone Medical Center, and Johns Hopkins Hospital. Teaching hospitals employ more than 2.7 million healthcare professionals nationwide. It’s no surprise that medical billers and coders find less competition for jobs in teaching hospitals. After all, university-affiliated hospitals house 82 percent of the country’s ACS-designated Level I trauma centers. Teaching hospitals need large medical records management offices to protect inpatient and outpatient data. Medical coding and billing specialists can expect jobs in teaching hospitals to multiply because the field projects 10-year job growth at 15 percent.

2. Teaching Hospitals Provide Higher Salaries to Medical Coders and Billers

In comparison to several other healthcare settings, teaching hospitals grant above-average salaries to their medical billing and coding staff. According to the AAPC 2015 Salary Survey, medical billers and coders make $ 50,925 on average at inpatient teaching hospitals. That’s more than the $ 44,870 at mid-sized medical groups and $ 45,722 at independent physician offices. Teaching hospitals on the Pacific Coast from Hawaii to Washington report the highest medical coding and billing salaries nationwide at $ 57,021. Landing a job at a teaching hospital can considerably pad your paycheck, especially if overtime is offered. Due to their large size, teaching hospitals are also more likely to hire clinical coding directors with lucrative salaries.

3. Medical Billers and Coders Benefit from Learning Support

Teaching hospitals offer an academic-focused work environment where cutting-edge education and research is prioritized. Medical coding and billing jobs may require less post-graduation employment experience because on-the-job training is included. Teaching hospitals encourage staff to sharpen their skills with continuing education. For instance, Rush University Medical Center provides full-time employees with $ 5,000 in tuition assistance each year. This makes attending college online or during evenings more affordable. Medical coders and billers in teaching hospitals also join an active research community. Teaching hospitals receive approximately $ 2.2 billion in NIH research funding annually. Therefore, the HIM department will continually search for the latest tech advancements to streamline medical coding and billing.

4. Teaching Hospitals Require Extra Vigilance in Medical Coding and Billing

Being careful and attaining high accuracy is important for every medical coder. But those employed in teaching hospitals often have extra responsibility in checking over patient records. Teaching hospitals always experience new rotations of interns and residents who are unfamiliar with record protocols. New waves of med school students can mean patient records accessed by coders and billers are less orderly. One study found 10 percent reduced mortality risk at teaching hospitals, so they don’t compromise quality of care. However, clinical documentation can get muddled in the process. Teaching hospitals may hire experienced coders and billers to conduct medical auditing. Pursuing the AAPC’s Certified Professional Medical Auditor (CPMA) credential would come in handy here.

5. Medical Coders and Billers Frequently Process Larger Claims in Teaching Hospitals

Teaching hospitals typically charge more for medical services because they treat higher acuity patients with complex conditions. Funds are also included for the hospital’s research and academic instruction. For example, George Washington University Hospital charges $ 69,000 on average for lower joint replacement. Sibley Memorial Hospital, a nearby community hospital, charged under $ 30,000 in comparison. Medical coders and billers must be prepared to figure the dollar signs with higher hospital rates. Considerable time will be devoted to coding for diagnostic tests because teaching hospitals order 7.1 percent more tests than their non-academic counterparts. Medical billing specialists should be aware that teaching hospitals are largely urban and accommodate vast numbers of Medicaid or uninsured patients.

Related Links

    The 10 Best Online Medical Coding Programs
    Top 10 Medical Billing and Coding Schools
    15 Best Remote Medical Coding Training Programs Online

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