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Tag Archives: Medical

Should a Medical Practice Join Group Purchasing Organization (GPO)?

The small and medium sized medical practice is finding its profit margin shrinking with every new compliance regulation and insurance readjustment. The opportunity to save money on the operations side may help grow a bottom line without having to levy new fees on patients or giving up office services. A group purchasing organization (GPO) leverages the power of numbers to lower prices for members without having to give up on the quality of the product.


Improving Medical Billing for Practices

Are Your Medical Billing Mistakes Costing Your Patients?

The low estimate on medical billing errors is $ 17 billion, according to a report from the Institute of Medicine. Even if the $ 29 billion they state as the top of the range is an overstatement, do you have your share of $ 17 billion to give back to patients and insurance companies? Furthermore, do you even want a part of the 250,000 patients who die each year because of medical errors (according to the medical journal BMJ) on your conscience?


Improving Medical Billing for Practices

7 Benefits of Outsourcing Your Medical Billing with ICD-10

It can be difficult deciding whether to outsource your medical billing or not. With ICD-10 coming in October, There are many benefits of outsourcing your revenue cycle functions. Let’s take a look at 7 of those benefits.

 
#1 Economy of Scale
A billing service will distribute their expenses through their complete client base, which provide an economy of scale. They are able to operate with lowers costs than what a single practice can and those savings are passed on to their clients, making them very competitive. A billing service is able to afford to hire top-notch staff so you are able to pay less and get more.

 

#2 Highly Trained Dedicated Specialists
The outsourcing team has just one purpose – its focus is to increase your practice’s profitability. They will review and post payments from the carriers to ensure that you are getting the correct amount and preventing adjustments that are incorrect. Every claim that’s outstanding will be tracked until it is paid in full. The team that handles all elements of your medical billing is the same staff to ensure cohesion.

 

#3 Gain Control
There’s a mistaken assumption that if you outsource your medical billing you will give up control. In fact, quite the opposite is true. You tend to gain more control. You have a team of dedicate professionals that are taking care of this consuming task. They have the headache of dealing with monthly reports and ensuring that payments are forthcoming in a timely manner and that billing is carried out correctly and with complete transparency.

 

#4 An Industry That’s Changing
The landscape of healthcare itself is rapidly changing and medical billing has been dragged into the middle of this upheaval. Keeping up with all the changes in the requirements and rules can be difficult. It requires continuous learning. The delete and added CPT codes come out years. Carrier rules and fee changes occur almost daily. Most people simply do not have the necessary time to dedicate to this continuous learning curve. Outsourcing to a team of professionals is very helpful.

 

#5 Get Paid Faster
Cash flow is the key to your successful practice. Accounts receivable collections have a significant impact on your revenue and your bottom line. This is where outsourcing your medical billing can be beneficial allowing for claims to be submitted faster and with fewer errors. That means you’ll receive your payments in shorter period of time. By outsourcing, you have a team of professionals that all billing to be carried out in a timely manner, and the turnaround time can be significantly reduced.

 

#6 Focus on What You do Best
You spent so many years going to university to become a doctor so that you can help people. The little free time you have, you probably hate spending on the intricacy of medical billing or maybe you hate having people on staff that cost you a fortune. A better option is outsourcing, where you get a team of professionals at a much lower cost than having your own staff.

 

#7 Reduced Stress and Increased Cash
A top-notch billing service will charge a percentage for collecting the money but compared to having to run your own billing office and staff it the fee is really quite nominal. You are suddenly getting the highest rate of return from your carriers, which means that you have more disposable income. Almost all practices that outsource their medical billing see an increase in their revenue and a decrease in their billing costs.

 

ICD-10 is complicated and the number of codes is rising from 13,000 to 68,000. That’s huge! This is going to lead to a significant increase in the number of payer denials and it is expected that there will be a decrease in cycle time. Outsourcing is a great way to save you time and money learning all of the new ICD-10 codes leaving it to a team of well trained professionals.

The post 7 Benefits of Outsourcing Your Medical Billing with ICD-10 appeared first on Outsource Management Group, LLC..

Outsourcing – Outsource Management Group, LLC.

Is It Time to Outsource Your Medical Billing?

If you are noticing your medical billing claims are taking longer and longer to be reimbursed or you are having denials, rejections, or only partial reimbursements on your medical billing claims, it may be time to look at outsourcing your medical billing claims. You may feel as though you would be giving up control of your cash flow when actually you will have more control than ever. In fact, outsourcing your medical billing and coding needs through a medical billing partner is one of the smartest business moves you can make.

The best company to handle your medical billing isn’t necessarily located around the corner from your practice or even in the same town. Thanks to the power of the Internet, secure Internet connections, and advances in software and computer networks that allow for secure transmission of sensitive data, the process of finding a medical billing company to handle your needs is just a mouse click away.

This will free up your staff immensely as they will no longer have to spend long hours at the copy machine getting claims ready to send in. Your claims will be transmitted computer to computer via secure network transmissions and you can get real-time information on your patient accounts at anytime. Furthermore, outsourcing your medical billing will insure that all your claims are properly coded and documented properly. Your medical billing partner can devote 100% of their time to handling your coding and claims. That way your cash flow is steady and you can concentrate on growing your practice.

The post Is It Time to Outsource Your Medical Billing? appeared first on Outsource Management Group, LLC..

Outsourcing – Outsource Management Group, LLC.

CPC, CANPC, CCVTC searching for a medical coding position

VINO C. MODY JR., COC®, CPC®, CCS-P, CANPC™, CCVTC™
6154 Black Mallard Place, El Paso, TX 79932; Karolinska Institutet, 171 77 Stockholm, Sweden; vinomodyjr13@gmail.com, v.mody@harvardbenefits.com, 678-427-6511 cell, 915-642-4269 home

GOAL: Medical administration including coding, billing, audit, compliance, analysis, and training.
Expertise in medical coding, billing, auditing, compliance and medical records administration with 4 years of experience as CPC, CANPC, CCVTC. Presently employed full-time. In addition, deep knowledge of anatomy, physiology, disease processes, surgery and medicine with 3 years in-patient hospital experience in medical care.

SUMMARY OF BACKGROUND:
Medical coding (ICD-9-CM, CPT, HCPCS), proficient coding with ICD-10-CM including Ophthalmology and Cardiology. Certified AAPC Anesthesia/pain Management Coder and Certified CCVTC Cardiovascular and Thoracic Surgery Coder. Expecting AAPC certifications in CCC Cardiology coding, CPMA, CPPM, CPHRM. Deep knowledge of anatomy, physiology, and disease management, expertise in use of medical coding software, professional conduct HIPAA and joint commission, Registered Health Information Administrator (RHIA) training, medical records analysis and management, HCC, Epic-like training, extensive clinical research and training experience, training in all areas of medicine and patient care. Well-versed in correct grammar and spelling, Excel, Word, PowerPoint, Outlook, and have strong work ethics, leadership, and self-management discipline.

EDUCATION AND PROFESSIONAL ORGANIZATIONS
Certified Cardiovascular and Thoracic Surgery Coder (CCVTC), American Academy of Professional Coders (AAPC), Salt Lake City, UT, March 2017
Passed CCVTC exam, American Academy of Professional Coders, Salt Lake City, UT, March 2017
Certificate, ICD-10-CM specialty cardiology code set training, American Academy of Professional Coders, Salt Lake City, UT, 9/2016
Certificate of Cardiology coding and Certificate of General Surgery and Anesthesia coding, Greenville Tech, 2/2016
MOOC certificate of attendance Health Data Analytics with MS Excel, St. Scholastica, MN, December, 2015
Certificate of Achievement, Coding-Baseline-ICD-10 Inpatient Diagnostic, Precyse University, USA December 4, 2015
Certified Anesthesia and Pain Management Coder (CANPC), American Academy of Professional Coders, August, 2015
Certified Outpatient Coder (COC), AAPC, June, 2015
Passed CANPC exam, AAPC, August, 2015
Passed COC exam, AAPC, June, 2015
Certified Professional Coder (CPC), AAPC, March, 2015
Passed CPC Exam, AAPC, October, 2013
Certified Coding Specialist-physician based (CCS-P) and passed exam, AHIMA, May, 2015
Certificate of ICD-10-CM proficiency, American Academy of Professional Coders (AAPC), January, 2014
Certificate of ICD-10-PCS proficiency, AAPC, January, 2015
Certificate of CPMA Medical Auditing, AAPC, December, 2015
Certificate of CPPM Practice Management, AAPC, January, 2016
Certified Medical Administrative Assistant (CMAA), National Health Career Associates (NHA), November, 2014
Certified Billing and Coding Specialist (CBCS), NHA, November, 2014
ICD-10-PCS Code set training (16 hours), American Academy of Professional Coders, Salt Lake City, UT, 1/2015
ICD-10-CM General code set training (16 hours), American Academy of Professional Coders, Salt Lake City, UT, 1/2014
Triple Certificate in administrative medical specialist, medical coding and billing, +medical terminology (360 Hours), University of Georgia, 3/2015
Graduate, Medical Coding Specialist Course (87% B average) (600 Hours), U.S. Career Institute, 2012-2013
Licentiate (M.S.) degree, Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, October, 2006
B.S. in Molecular Biology, Summa Cum Laude, Vanderbilt University, Nashville, TN, 1993

PROFESSIONAL EXPERIENCE
Remote Medical Coder and auditor for Altegra Health, USA, 1/2016 to present (gained equivalent of one year four months experience)
Performing coding medical records for clinics, doctors offices and hospitals including allergy, immunology, internal medicine, cardiology, dermatology, ophthalmology, pulmonology, pediatrics, OB/GYN, general surgery, orthopedic surgery, emergency medicine, radiology, anesthesia and pain management. Completed coder refresh and compliance training.
Remote medical coder, HGS USA, LLC, Peoria, IL, 9/2015 to 2/2016
Performed medical coding at 50 hospitals in USA. Coded electronic health records for inpatient and outpatient. Assignments from Hinsdale clinic services; Florida Waterman; Florida Hospital; and Tampa Hospital. Abstracted medical coding. Managed medical records. Utilized software Cerner, Dolbey, 3M Encoder Systems, Powerchart, and Sunport.
Medical coding trainee, CPC-A ICD-10 Practicum, American Academy of Professional Coders, 11/2015-7/2016
Performed coding utilizing ICD-10-CM codes for diagnosis. Did coding on 600 medical records with ICD-10-CM, CPT, and HCPCS for one year equivalent work experience. Abstracted codes from E/M encounters, hospitals, office visits, operating room, radiology reports, and pathology reports.
In-patient hospital rounds including ICU and CCU at Emory University School of Medicine, Yale-New Haven Hospital (Waterbury, CT), and Brown University/Lifespan Hospitals. 1995-1999.
Medical Researcher and Teacher at Karolinska Institutet, Stockholm, Sweden, 2000 to 2010
Proctor, National Board of Examiners in Optometry (NBEO), Stockholm, Sweden, 2003 to 2005

RECOGNITIONS:
Marquis Who’s Who in Medicine and Healthcare 2006-2007
Presented and planned lectures on cardiology, CANPC anesthesia and pain management coding, CCVTC cardiovascular and thoracic surgery coding to AAPC, Southwest University forums, and TXHIMA
Published a book on CANPC Anesthesiology coding essentials for successful anesthesiology coding through AAPC
Nominated for vice president AAPC local chapter in El Paso, TX

Medical Billing and Coding Forum – Resume Postings

Frequently Asked Questions for Medical Coding and Billing Students

Hello Professional Medical Coding and Billing Students! Here are some frequently asked questions and their answers to your program: Q: How do I navigate to the next module? A: The Program Modules navigation tool is on the left side of each page in the program. • Click the plus sign (+) to view the list of modules in the program. • Click the module name to navigate to the first page of that module. Use this menu each time you navigate from one module to the next. Refer to the Program Navigation unit of the Program Orientation module for more…
Career Step Coding and Billing Blog

The Medical Necessity Hot Button

Clearing up the confusion surrounding Medical Necessity!

by Lori-Lynne A. Webb, CPC, CCS-P, CCP, COBGC, CHDA  (originally printed through HCPro March 2017)

Understanding and determining medical necessity can be very complex for physicians, clinicians, coders, and billers.A physician or clinical provider of care may have a completely different understanding, interpretation, and definition of medical necessity than the patient or a patient’s family member. A third-party insurance payer may also have another completely different understanding and application of the term.

Defining medical necessity

So what is medical necessity? Coders or billers struggle to understand and sort out as the term, which leads to misinterpretation and misunderstanding of what needs to be communicated in a variety of areas.

CMS provides a specific definition under the Social Security Act:

… no Medicare payment shall be made for items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

In essence, the diagnosis drives medical necessity. Coders need to understand the diagnosis itself, as well as what services or treatment options are available to the provider.

Third-party payers add more confusion

Medical necessity can also be confusing when it comes to who is going to pay for the procedure or services. Many third-party payers have specific coverage rules regarding what they consider medically necessary or have riders and exclusions for specific procedures. Third-party payers may have a specific exclusion for procedures that they consider experimental, unproven for a specific diagnosis, or cosmetic.

One example is a surgeon using a daVinci robotic surgical device to perform a laparoscopic surgery. Upon pre-authorization for the surgery, the insurance payer states it will not pay for the surgery if the daVinci is used. The insurer’s policy includes a rider that deems the daVinci as an experimental surgical device. However, if the physician uses a traditional laparoscopic or open procedure, the third-party payer would reimburse. In this case, the insurance carrier is not stating that the surgery is not medically necessary, just that it will not reimburse for this surgery if the robotic device is used.

Even if a particular procedure or service is considered medically necessary, some payers impose limits on how many times a provider may render a specific service within a specified time frame. For Medicare and Medicaid, these limitations are known as National Coverage Determinations (NCD) and Local Coverage Determination (LCD). Private payers may simply refer to this type of limitation as a policy guideline or policy exclusion or rider.

Within these guidelines, payers may define where or when they will cover a specific service, but may limit coverage to a specific diagnosis. For example, insurance policies may have a wellness or preventive care benefit, but may only cover one such visit per year. Some payers may only reimburse for a single Prostate-Specific Antigen (PSA) test per year. The payer may require a documented screening diagnosis in coordination with the test.

If the patient underwent a PSA test January 1, 2012, for screening, his insurance may not pay for another test until 365 days (or one calendar year) have elapsed. However, if the patient undergoes a PSA blood test for screening and the test results are abnormal, the clinician may decide another PSA test is needed. The coder must submit that claim as a PSA blood test with the appropriate diagnosis for a sign, symptom, or abnormality, not as a screening.


Documenting medical necessity
Medical necessity continues to be open for interpretation by all parties involved. Many third-party payers have created lists of criteria they use to interpret medical necessity. These lists do not necessarily reflect all options, but payers include this reference in their policy guidelines.

Most providers have not developed a comprehensive listing of medically necessary qualifiers, so coders and clinicians must focus on good documentation and coding accuracy to communicate the medical necessity of services accurately to payers. If third-party payers deny reimbursement for medical services, physicians, clinicians, and coders need to rely on the formal appeal process.

Medical necessity documentation from a physician or provider should include the following:

§  Severity of the “signs and symptoms” or direct diagnosis exhibited by the patient. This is our diagnosis driver, and multiple diagnoses may be involved.

§  Probability of an adverse or a positive outcome for the patient, and how that risk equates to the diagnosis currently being evaluated. This is the medical risk vs. gain.

§  Need and/or availability of diagnostic studies and/or therapeutic intervention(s) to evaluate and investigate the patient’s presenting problem or current acute or chronic medical condition. In other words, does the facility, office, or hospital have what the provider or clinician needs to render care?

These bullet points reflect the basics of evaluation and management (E/M) guidelines that are currently in place from CPT®: the history, exam, and medical decision making processes. Coders will have an easier time evaluating medical necessity from this aspect. Of course, a good understanding of this integration of medical necessity within the E/M guidelines makes communicating this same principle to the providers much easier. Coders should encourage providers to continually enhance their documentation to improve overall coordination between the medical record, coding accuracy, and third-party payer reimbursement.

The third-party payers employ a wide spectrum of policies defining medical necessity is and should encompass. Physicians, clinical providers, and coders should review what these payers have established within their guidelines. Someone within the physician office, hospital, or medical facility should thoroughly scrutinize these guidelines before establishing a contractual relationship with a particular third party payer. This up-front communication will help avoid claim denials in the future.

Here are some examples of what some third party payers are currently including in their medically necessary verbiage:

§  Treatment is consistent with the symptoms or diagnosis of the illness, injury, or symptoms under review by the provider of care.

§  Treatment is necessary and consistent with generally accepted professional medical standards (i.e., not experimental or investigational).

§  Treatment is not furnished primarily for the convenience of the patient, the attending physician, or another physician or supplier.

§  Treatment is furnished at the most appropriate level that can be provided safely and effectively to the patient, and is neither more or less than what the patient is requiring at that specific point in time.

§  The disbursement of medical care and/or treatment must not be related to the patient’s or the third party payer’s monetary status or benefit.

Documentation of all medical care should accurately reflect the need for and outcome of the treatment.
Treatment or medical services deemed to be medically necessary by the provider of those services,(e.g., physician, therapist, clinician, etc.) does not imply or infer that the service(s) provided will be covered by or deemed a medically necessary service payable by a third-party insurance payer.

Medical Necessity Q&A

Q:  Could you give me some guidance on how I can instruct my MD’s on avoiding vague and/or subjective clinical documentation?
A:.  Ask your providers to adequately describe his/her skilled care providedand give a clear picture of the treatment and/or “next steps” to be taken.
Do not use vague or subjective descriptions like “tolerated treatment well,” “improving,” “caregiver instructed on med management,” or “continue with plan of care.”   “patient is here for follow up”
examples of more complete and compliant statements:
1.     Patient tolerated ROM exercises with a pain level of 6/10.
2.     Patient was able to verbalize understanding and importance of checking their blood sugars prior to administering insulin.
3.     Plan for next visit: to continue education on importance of daily inspection of feet for diabetic patient, provide wound care, etc.
Q  I work in dermatology and need to know what documentation is required for excisions?  We are struggling with getting paid  
A:  The provider should include the actual “size” of the lesion/mass they are going to excise.  Then they should document the area of the excision which needs to include the lesion + any margins.  (Height, Width, Depth) and if circular/elliptical etc… and denote the “why” it was performed that way.    If you have to appeal, the problem with using strictly the sizes from a pathology report, is that tissue “shrinks” once it is excised, and the would “enlarges” once the tissue is excised. 
Q.  What is the BEST way to document our time spent… the CPT codes state a vague “time” amount but the doctors struggle with this..  
A.  Notation of Time in/Time out is always very helpful…  it is also helpful if the provider “explains”  the time.  Eg –  spent 20 minutes of our 30 minute visit discussing how to properly use their new asthma inhaler.  Or  I was requested by Dr. Doe for “standby” for a possible cesarean section during vaginal delivery.  I entered the delivery room at 0800 and departed at 0915 status post a successful vaginal delivery.

Coders must understand the complex relationships between the physician, the patient, the medical record documentation, the coder, the biller, the insurance payer, and the communication between all of these entities to successfully guide the interpretation of medical necessity.

Lori-Lynne’s Coding Coach Blog

Online Review Sites: A Guide to Creating Compelling Physician and Medical Practice Profiles

 

How to Craft a Formidable Personal Statement for Your Review Site Profile

A Guide to Creating Compelling Physician and Medical Practice Online Profiles

Word-of-mouth referrals have long been the bread and butter of growing and maintaining a practice’s patient panel. Instead of face-to-face conversations though, much of this process now takes place publicly through online physician review sites like Vitals, ZocDoc, and Healthgrades.

So much so, that a recent survey by an online medical reviews firm Software Advice found that 84 percent of patients use online reviews to evaluate physicians. And a surprising 77 percent use these reviews as their very first step in scouting out a new physician.

To really harness the power of these online platforms and attract new patients, physicians have to be proactive and find a way to stand out.

Making Your Profile Stand Out

Medical Practice Online ReviewsWith so many patients flocking to online review sites, physicians need to create profiles that rise above the rest. One way to do this and leave a lasting first impression is to customize the physician and practice profiles as much as possible.

For example, there is often a part of the profile called the “practice statement” or “physician’s biography.” If these are optional fields — which is frequently the case — it can be tempting to skip over them and leave them blank. But filling these in can actually give prospective patients an insider view of your practice and personality — all things that can be the difference between them calling you first or someone else.

A Guide to Creating Captivating Profiles

Our friends over at InboundMD have just released a step-by-step guide for physicians interested in crafting powerful online profiles and personal statements. In it, you’ll find all of the information you need including:

  • The benefits of claiming your online profiles;
  • How to identify what makes your practice unique;
  • Do’s and don’ts of writing personal statements that actually connect with patients;
  • Adapting your message for each review site’s platform; and
  • A simple checklist covering the best practices for online review sites.

 

Why Choose You?
When it comes to writing a compelling, meaningful statement about you and your practice it’s best to think of your patient’s point of view – why should they choose you? Remember your writing should impress patients, not your peers.

How-to-Craft-a-Formidable-Personal-Statement-for-Your-Review-Site-Profile-Book-Cov

Download the Guide

You can download InboundMD’s complete guide How to Craft a Formidable Personal Statement for Your Review Site Profile for free here.

Have you claimed your online physician and practice profiles? How did you customize them? Please join the conversation below.

 

— This post Online Review Sites: A Guide to Creating Compelling Physician and Medical Practice Profiles was written by Manny Oliverez and first appeared on Capture Billing. Capture Billing is a medical billing company helping medical practices get their insurance claims paid faster, easier and with less stress allowing doctors to focus on their patients.

Capture Billing

Medical Symptoms Medical diagnosis With regard to Asthma

Asthma can be an issue that creates lack of breath and it is characterized by a coughing seem. This article offers you a quick and also to the point go through the health care signs or symptoms, diagnosis, brings about and also therapies linked to this specific typical inhaling disorder.

Bronchial asthma

Symptoms of asthma Signs typically begin in years as a child; nevertheless you will find instances of person onset. Signs incorporate frequent attacks associated with upper body tightness and also tough breathing in. Any wheezing sound is normally heard when the asthma suffering affected person is exhaling. The person might hint onward within an straight placement in an attempt to ease the particular breathing trouble. Some people may go through a new coughing, specially during the night, as well as the skin color may become bluish. A severe invasion can be extremely stressful as well as frightening for the person in addition to these all-around them.

Symptoms of asthma is actually the effect of a spasm with the bronchi, which can be the particular tubes transporting atmosphere in the lungs or simply by puffiness with the mucous filters coating the bronchi. This specific spasm response may possibly result of a good Hypersensitive reaction with an allergen including pollen, airborne dirt and dust, molds, foods, or perhaps canine dander. Some other triggers add a respiratory an infection (my spouse and i.at the. Respiratory disease), or perhaps problems for instance smoking or perhaps substances. Aspirin may well trigger a good start symptoms of asthma in most persons.

In the event the previously mentioned symptoms appear it could be important to seek an assessment by a medical professional straight away. The particular analysis can include a physical assessment, torso x-rays, blood checks, hypersensitivity exams, or perhaps lung operate analysis.

As for remedy severe attacks might have to have unexpected emergency medical help. If your start of symptoms of asthma was in the course of the child years, 50% of these sufferers will outgrow the actual dysfunction normally. Pertaining to treating asthma attack problems, doctor may possibly suggest the expectorant for you to release mucus secretions; bronchodilators to broaden airways; or even propose holding a nebulizer, that is medicine consumed simply by use of a tool that produces a great apply.

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