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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."

HCPro.com – Billing Alert for Long-Term Care

What documentation do I need to bill 93010?

Hello,

I’m trying to find documentation for what needs to be documented in the office visit when an EKG is done. Patient will see our provider and if he feels an EKG need to be done he will tell his MA. MA will hook the patient up and print the report. Report is than handed to provider provider to review. Patient at this time is still in the clinic. What is happening is provider is not mentioning in his document that EKG was done. So trying to find out if we can go back using the EKG reports and see what EKG’s where missed. But if they provider does not mention the reading or the results of the EKG can we code 93010. We are an RHC clinic so we can only charge 93010. We can not use 93000. Any help on this would be greatly appreciated. Also I have read that MDCR can only be charged once a year for the 93010 and has to be done a their MDCR Wellness Visit. Is this true also.

Thanks again,

Nichole

Medical Billing and Coding Forum – Family Practice

Do we need to code venogram separately?

ULTRASOUND GUIDANCE FOR VENOUS ACCESS

SUPERIOR VENA CAVAGRAM

TUNNELLED CVC INSERTION

DESCRIPTION OF PROCEDURE:

Realtime ultrasonography of the right neck was performend demonstrating
patency of the internal jugular vein which was then chosen for access;
ultrasound images were archived.

A large area of the right neck and upper chest was prepped and draped in
sterile fashion.

Using 1% lidocaine for local anesthesia and under real-time ultrasonic
guidance, a 21ga. micropuncture set was used to access the right internal
jugular vein at the base of the neck. Ultrasound images were archived.

A small incision was made at the puncture site. The wire could not be
advanced much into the vessel and for this reason a 4 French catheter was
advanced over the wire. Contrast material was injected and digital
angiograms were obtained demonstrating occlusion of the superior vena cava
just beyond the confluence of the azygos vein. Flow in the azygos vein is
retrograde.

Over a wire, the tract was dilated and an introducer sheath was advanced into
the vein.

A tract of subcutaneous tissue, leading from the incision at the puncture
site to the anterior right chest below the clavicle, was then infiltrated
with local anesthetic. A small incision was made at the chest end of the
tract. A flexible tunneler was then used to pull an 8 cm long dual-lumen
catheter through the subcutaneous tunnel. The tunneler was disconnected and
the catheter was then advanced through the sheath until its tip reached the
central portion of the patent superior vena cava ; as mentioned above the
catheter could not advance be advanced into the right atrium since the cava
is occluded more centrally.

Fluoroscopy of the air at demonstrated a kink in the catheter as it entered
the internal jugular vein. We were unable to resolve the kink and for this
reason the catheter had to be removed and the procedure restarted after re-
prepping and draping of the area.

Using sterile technique under real-time ultrasonic guidance a 21 gauge needle
was placed in the right internal jugular vein. An introducer sheath was
advanced into the vein.

A 6 French dual-lumen central venous catheter was then advanced through the
subcutaneous tunnel and into the internal jugular vein until its tip reached
the central portion of the patent superior vena cava. This time no kinks
were identified along the course of the catheter.

Both ports were capped and heparinized and the catheter was then secured to
the skin with 2-0 nylon sutures. The incision at the base of the neck was
closed with tissue glue and SteriStrips.

There were no complications.

CAN ANYBODY SUGGEST CORRECT CODING FOR THIS?

Medical Billing and Coding Forum – Interventional Radiology

Need Help with Modifiers

Could someone please help me out with placement of modifiers.

Claim was submitted as below. Line 2, 4, 5 and 6 denied. Invalid modifier, included in another procedure.

Line 1 99213 25 M76.52 Patellar tendinitis left knee, M25.362 Other instability left knee, M25.361 Other instability right knee
Line 2 20611 M76.52 Patellar tendinitis left knee
Line 3 20611 50 M76.51 Patellar tendinitis Right Knee
Line 4 29530 59 M76.52 Patellar tendinitis left knee
Line 5 29530 50 59 M76.51 Patellar tendinitis Right
Line 6 J2000 M76.52 Patellar tendinitis left knee

Thank you

Medical Billing and Coding Forum – Family Practice

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

$750,000 HIPAA SETTLEMENT CAUSES OCR TO UNDERSCORE NEED FOR ORGANIZATION WIDE RISK ANALYSIS

In a $ 750,000 HIPAA Settlement, the University of Washington Medicine (UWM) has agreed to settle charges that it potentially violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule by failing to implement policies and procedures to prevent, detect, contain, and correct security violations.  UWM is an affiliated covered entity, which includes designated health care components and other entities under the control of the University of Washington, including University of Washington Medical Center, the primary teaching hospital of the University of Washington School of Medicine.  Affiliated covered entities must have in place appropriate policies and processes to assure HIPAA compliance with respect to each of the entities that are part of the affiliated group.  The settlement includes a monetary payment of $ 750,000, a corrective action plan, and annual reports on the organization’s compliance efforts.

You can review the complete notice on the HHS.gov website.

The post $ 750,000 HIPAA SETTLEMENT CAUSES OCR TO UNDERSCORE NEED FOR ORGANIZATION WIDE RISK ANALYSIS appeared first on The Coding Network.

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Medical Coding ? All An Individual Need To Apprehend Regarding Medical Coding

If you’re looking to start a service based business from home, are smart, eager to learn and can invest a bit of time in training, a medical coding business may be an option for you. Medical coders operate with hospitals, doctor’s offices and a lot more to code documents for insurance filing functions.

The reimbursement process itself is a tiny extra concerned than many individuals may realize. It includes descriptions of procedures and services the physician provides. The descriptions used by the physician can be quite long and detailed – to not mention, confusing. That is why a coding process is used. This can be a code of numbers with each representing a procedure and/or service possible to be supplied by a physician. There also codes used to symbolize each disease, condition or injury.

You are no doubt reading this because you want to perform from home and are in search of a few business startup ideas. You may want to escape prairie-dog-town, home-school your youngsters, or finally do one thing on your unique. Whatever your reason, you can start and expand your medical coder or transcription business by leveraging your past perform expertise and excessive level of motivation, and professionalism. There are plenty of people who can empower and enable you.

With the median salary for a medical coder [http://www.bls.gov/oco/ocos103.htm#earnings] getting $ 25,590 in 2004 (with the top rated 10 % of medical coding specialists earning $ 41,760) and the chances of doing work from home, it’s no wonder that many females and men seeking to operate at home are exploring this career selection. By owning the medical coding business yourself, you can anticipate to earn higher profits with a successful business you then could as an worker of a medical coding agency or hospital setting.

The 2nd area of your program includes: anatomy and physiology. You’ll acquire an in-depth expertise of anatomy, physiology, pathophysiology, and laboratory medicine. Learn tips on how to identify, pronounce, spell, locate, and understand anatomical terminology so that you can describe the framework and perform of the entire body, the organ systems, and the relations of 1 part to another.

The last area of instruction includes: medical coding. Learn the coding rules for that ICD-9-CM, ICD-10-CM, CPT, and Stage II (HCPCS) systems and the way to apply these rules when coding patient records. Discover how to use the 2010 coding manuals by means of hands-on exercises and case research. Additionally, learn a basic overview of the ICD-10 coding technique and pending conversion in 2013.

A medical coding certification program is made to train coders so that they make the best use of their skills although also teaching them critical analysis methodologies which are a lot in demand by employers.

Medical coding is a great career to think about. You can get started right away by investigating college options and completing the online application type. Medical coding could possibly be the chance you have been searching for a rewarding, challenging, very well revered and great paying career.

In spite of the claims of many individuals that the need of a right medical coding certification program will not be essential; it really is worth mentioning the fact that to be able to become a professional medical coder and progress by leaps and bounds it is critically important to totally realize the really worth of a correct certification program. Additionally, owing on the increasing percentage of white collar crimes and far more sophisticated crimes rising on the realm of net; a majority of employers choose for licensed medical coders. This insures that the medical coder is trained and apt enough to deal with complex troubles and also saves them from falling prey to deliberate deceptions.

Medical Coding Factoring – An alternative financing arrangement, through which a factor purchases the accounts receivables of a company, advances a distinct percentage of the invoice immediately and then collects on those invoices.

If you desire further suggestions regarding medical coding certification and medical coding salary, check out our site that covers a great deal of medical coding certification, medical coding certification & medical coding and billing.

Do You Need Medical Billing And Coding Schools For A Career In Medical Coding?

Choosing\Selecting medical coding\Billing\billing and coding as a career\profession can be\could be\may be\might be ideal\perfect\excellent\splendid\ideally suited for a lot of people\lots of people because it is a\it’s a lucrative\well-paid way to\method to\solution to\option to make\earn a living that does not\that doesn’t come bundled\strapped with the usual\the standard\the same old stresses of a regular\an everyday 9-5\nine to five job. In fact\Actually\In reality\The truth is\In truth, on the contrary\quite the opposite, choosing\selecting a medical coding\billing\billing and coding career\profession is choosing\is selecting to make\earn a living\income with flexible time and work from home\work at home benefits. The question remains\is though\however: is continuing education needed\required\considered necessary for a career\profession in medical coding\billing\billing and coding?

The simple\The straightforward\The easy answer\reply to this is\that is yes. In order to\To be able to\In an effort to\With a purpose to\As a way to\With the intention to better\improve your employment\job opportunities, it would\it might\it could be beneficial\useful\helpful for you to acquire\purchase the necessary\the needed training\teaching required\necessary to familiarize yourself\your self with the different\totally different\completely different ins and outs of medical coding\billing\billing and coding.

One needs\wants to be able to\to have the ability to understand\perceive and learn\study\be taught all there is\there’s\there may be to learn about\study\find out about medical coding. This is because\It’s because\It is because a medical encoder is in charge of\in command of\in control of\answerable for\accountable for assigning specific\particular codes to different\totally different\completely different medical services\providers\companies and procedures to enable\allow healthcare providers\suppliers to be able to\to have the ability to bill\invoice for services\providers\companies rendered. This is\That is the reason\the rationale\the explanation why medical coders are in demand in the\within the industry.

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You will find\You can see\You will discover\You’ll discover\You will see\You’ll find that going the extra\the additional mile and investing time and resources\assets into continuing education\schooling\training for a medical coding\billing\billing and coding career\profession will take you far\a long way. After all\In any case\In spite of everything, medical coders\billers are needed\wanted by several\a number of institutions\establishments like hospitals, medical clinics and offices. If you have\When you have the proper\the right\the correct accreditation and certification for this job\profession then more opportunities\offers present themselves\are presented to you.

The American Academy of Professional Coders offers\provides\gives\affords different types of\several types of\various kinds of certifications after individuals\people have been able to pass\capable of passing their examinations\tests. Each\Every certification is nationally recognized\acknowledged and while you\whilst you can still get a medical coding\billing\billing and coding job without\with out these certifications, your options\choices for employment are limited\restricted. If you are\If you’re serious about a career\profession in medical coding\billing\billing and coding, it is\it’s better to take the examinations\tests and acquire\get these certifications.

Most specialized\specialised trainings that medical schools\faculties\colleges offer\provide for individuals\for people who choose\select a career\profession in medical coding\billing\billing and coding are prepared\ready to take the examinations\tests provided\offered\supplied by the American Academy of Professional Coders. For this purpose\objective\function\goal alone\on it’s own, it is\it’s beneficial\useful\helpful to acquire\to get additional\further education\training.

The American Academy of Professional Coders offers\provides\gives Procedural Coder Certification to those who\those that pass\are able to pass a particular\a specific\a selected examination\test\exam for this. After passing the exam\examination and being a Certified Procedural Coder, the individual\the person can then be considered for various\numerous prestigious\impressive opportunities\positions as medical encoder\coder in different\in numerous professional\skilled healthcare facilities\locations, offices\workplaces and clinics.

That type\kind of certification is basic\fundamental and if one wishes\needs, they can\they may also\additionally take the other\other types of\kinds of\forms of\sorts of examinations\tests offered\provided\supplied by the American Academy of Professional Coders. They offer\They provide Specialty Credentials that will\that may\that can enable\allow an individual\a person to prove\show their expertise\experience within\inside their present\current focus or they can\they will\they’ll even use this to jump start their medical coding\billing\billing and coding career\profession into a different\a unique type\kind of specialization\specialty altogether\completely.

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For more information on medical billng schools/a> or to find out the answer to”waht is medical billing and coding?” click on these links.