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Learn/Think

October 11, 2011 in QUOTES

Con­fu­cius

He who learns but does not think, is lost! He who thinks but does not learn is in great danger.

Actions

October 11, 2011 in QUOTES

Ralph Waldo Emerson

What you do speaks so loudly that I can­not hear what you say.

Ralph Waldo Emerson

Strive To Realize Your Full Potential

October 5, 2011 in QUOTES

US Pres­i­dent


We need to steer clear of this poverty of ambi­tion, where peo­ple want to drive fancy cars and wear nice clothes and live in nice apart­ments but don’t want to work hard to accom­plish these things. Every­one should try to real­ize their full potential.

BARACK OBAMA,

There Is Not Effort Without Error

October 5, 2011 in QUOTES

Pres­i­dent T. Roosevelt

It is not the critic who counts; not the man who points out how the strong man stum­bles, or where the doer of deeds could have done them bet­ter. The credit belongs to the man who is actu­ally in the arena, whose face is marred by dust and sweat and blood, who strives valiantly; who errs and comes short again and again; because there is not effort with­out error and short­com­ings; but who does actu­ally strive to do the deed; who knows the great enthu­si­asm, the great devo­tion, who spends him­self in a wor­thy cause, who at the best knows in the end the tri­umph of high achieve­ment and who at the worst, if he fails, at least he fails while dar­ing greatly. So that his place shall never be with those cold and timid souls who know nei­ther vic­tory nor defeat.”
– Theodore Roosevelt

Wanting More

October 5, 2011 in QUOTES

Dr. Phil

If you want more, you have to require more from your­self.”
– Dr Phil

The promise of ICD-10-CM

October 5, 2011 in Medical Billing/Coding

The health­care indus­try is mak­ing sig­nif­i­cant strides toward the adop­tion of elec­tronic health records (EHRs). How­ever, increased deploy­ment of EHR tech­nol­ogy only par­tially addresses the cru­cial need for bet­ter health infor­ma­tion in the U.S. The full ben­e­fits of an EHR can only be real­ized if we improve the qual­ity of data that EHRs are designed to manage.

The cur­rent clas­si­fi­ca­tion cod­ing sys­tem used in the U.S., ICD-9-CM, is a 30-year old sys­tem and can no longer accu­rately describe today’s prac­tice of med­i­cine. Con­tin­u­ing to use this sys­tem jeop­ar­dizes the abil­ity to effec­tively col­lect and use accu­rate, detailed health­care data and infor­ma­tion for the bet­ter­ment of domes­tic and global health­care. By fail­ing to upgrade, we could find our­selves build­ing an infra­struc­ture that does not pro­vide the infor­ma­tion nec­es­sary to meet the health­care demands of the 21st century.

Despite annual updates, ICD-9-CM does not meet our health­care needs. Ter­mi­nol­ogy and clas­si­fi­ca­tion of numer­ous con­di­tions and pro­ce­dures are out­dated and incon­sis­tent with cur­rent med­ical knowl­edge and appli­ca­tion. ICD-9-CM also can­not address the increas­ing pres­sure for more spe­cific codes, espe­cially codes that rep­re­sent new tech­nol­ogy. Out­dated codes pro­vide inac­cu­rate or lim­ited data and insuf­fi­cient detail related to health diag­noses, pro­ce­dures and technologies.

Med­ical care has changed dras­ti­cally since ICD-9-CM was imple­mented. Many new health­care diag­noses and ser­vices can no longer be described accu­rately using ICD-9-CM. For exam­ple, the ter­mi­nol­ogy used to clas­sify asthma in ICD-9-CM is out­dated, result­ing in an inabil­ity to assess the effi­cacy of treat­ment pro­to­cols that are based on the cur­rent clin­i­cal clas­si­fi­ca­tion of asthma types.

Spe­cific Gains

Upgrad­ing ICD-9-CM to ICD-10-CM, a U.S. ver­sion of ICD-10 devel­oped by the World Health Orga­ni­za­tion, and ICD-10-PCS, a pro­ce­dural cod­ing sys­tem designed by the Cen­ters for Medicare and Med­ic­aid to replace the cur­rent inpa­tient pro­ce­dural cod­ing sys­tem included in ICD-9-CM, will pro­vide supe­rior infor­ma­tion for mea­sur­ing health­care ser­vice qual­ity, safety and the effi­cacy of care. This data impacts qual­ity reports and report cards, out­comes and per­for­mance mea­sure­ment, clin­i­cal research, case man­age­ment and pay-for-performance programs.

So why is the U.S. health­care sys­tem the only devel­oped coun­try that has not adopted ICD-10? Per­ceived cost is a huge fac­tor. How­ever, delay­ing its imple­men­ta­tion will actu­ally increase future imple­men­ta­tion costs as imple­ment­ing a new cod­ing sys­tem will require sys­tems and appli­ca­tion upgrades. This can be avoided if imple­men­ta­tion is planned with other sys­tem changes to max­i­mize impact and reduce complexity.

Not only does ICD-10 lever­age our invest­ment in EHR and mod­ern tech­nolo­gies, but it also will give the U.S. health­care system:

* Bet­ter data for patient safety, qual­ity of care analy­sis and reimbursement;

* Increased capac­ity to iden­tify and respond to pub­lic health or bio­log­i­cal threats;

* The abil­ity to achieve full ben­e­fit from the use of SNOMED-CT as the clin­i­cal lan­guage of medicine.

Although reim­burse­ment con­sid­er­a­tions should not drive code set revi­sions, accu­rate and spe­cific coded data should be used to sup­port appro­pri­ate reim­burse­ment. The level of speci­ficity in ICD-10-PCS will pro­vide pay­ers, pol­icy mak­ers and providers with more detailed infor­ma­tion for estab­lish­ing appro­pri­ate reim­burse­ment rates, eval­u­at­ing and improv­ing the qual­ity of patient care, improv­ing effi­cien­cies in health­care deliv­ery, reduc­ing health­care costs, and effec­tively mon­i­tor­ing resource and ser­vice utilization.

For exam­ple, reduced health­care costs will result if a more spe­cific cod­ing sys­tem is employed, facil­i­tat­ing pre­ven­tion and iden­ti­fi­ca­tion of fraud and abuse or the speci­ficity needed to con­duct good qual­ity improve­ment and error reduc­tion pro­grams. The exchange of addi­tional data beyond the basic claim, and the time it takes to gather and process such detail, will sig­nif­i­cantly be reduced due to the more spe­cific detail con­tained in the ICD-10-CM and ICD-10-PCS codes.

An Invest­ment That Pays

By being the only coun­try with a mod­ern health­care sys­tem that has not adopted ICD-10 (more than 100 coun­tries already have), we are also mak­ing it more dif­fi­cult to share dis­ease and mor­tal­ity data at a time when such global shar­ing is crit­i­cal for pub­lic health. With recent pub­lic health and bioter­ror­ism events, our abil­ity to track and respond to inter­na­tional threats in real time is lim­ited by our reliance on ICD-9-CM.

For exam­ple, ICD-10-CM would have bet­ter doc­u­mented the West Nile Virus and SARS com­plexes for ear­lier detec­tion and bet­ter track­ing. Our national data sys­tems are being ren­dered use­less. The U.S. must be part of the world health data com­mu­nity. Many coun­tries rely on U.S. ana­lyt­i­cal tools based on codes and groupers. This mar­ket edge is being lost by the inex­plic­a­ble delay in com­ing inline with con­tem­po­rary code sets.

The adop­tion of SNOMED-CT as the Con­sol­i­dated Health Infor­mat­ics ini­tia­tive and license agree­ment between the National Library of Med­i­cine and SNOMED Inter­na­tional posi­tion it as the clin­i­cal lan­guage of med­i­cine in the U.S. Even­tual use of SNOMED-CT will not elim­i­nate the need for clas­si­fi­ca­tion sys­tems. Even with fully deployed ter­mi­nol­ogy sys­tems, most health infor­mat­ics pro­fes­sion­als point to the ongo­ing need for clas­si­fi­ca­tions to per­mit aggre­ga­tion of clin­i­cal data for admin­is­tra­tive pur­poses includ­ing reim­burse­ment, sta­tis­ti­cal and epi­demi­o­log­i­cal analy­ses, and health pol­icy decisions.

Con­tin­ued use of the out­dated ver­sion of ICD dimin­ishes the U.S. invest­ment in SNOMED-CT. The antic­i­pated ben­e­fits of an EHR will not be fully achieved if the ref­er­ence ter­mi­nol­ogy employed, such as SNOMED-CT, is aggre­gated into a 30-year old clas­si­fi­ca­tion sys­tem for admin­is­tra­tive use and index­ing. Valid maps are urgently needed to link from a highly spe­cific ter­mi­nol­ogy to a clas­si­fi­ca­tion sys­tem so that infor­ma­tion cap­tured in the ref­er­ence ter­mi­nol­ogy can uti­lize the power of sum­mary required for health­care report­ing and index­ing offered by the clas­si­fi­ca­tion sys­tems. The ICD-10 med­ical cod­ing sys­tem facil­i­tates more robust map­ping from SNOMED-CT in the EHR due to its gran­u­lar­ity and use of cur­rent clin­i­cal terminology.

In 2003, the National Com­mit­tee for Vital and Health Sta­tis­tics (NCVHS) rec­om­mended that the Depart­ment of Health and Human Ser­vices ini­ti­ate the rule­mak­ing process for adop­tion of ICD-10-CM and ICD-10-PCS. NCVHS spent two years care­fully lis­ten­ing to argu­ments and weigh­ing the evi­dence before pro­ceed­ing with their pos­i­tive rec­om­men­da­tion to the full committee.

ICD-10-CM and ICD-10-PCS needs to be imple­mented by Octo­ber 2008. That means imme­di­ate adop­tion through the HIPAA rule mak­ing process in 2005 is crit­i­cal to per­mit the health­care indus­try to man­age this tran­si­tion and ensure con­ti­nu­ity in its health­care data reporting.

Linda Kloss, R.H.I.A., C.A.E., is the CEO of the Amer­i­can Health Infor­ma­tion Man­age­ment Asso­ci­a­tion, head­quar­tered in Chicago.

 

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by ronick

Medical Billing Clearinghouse

October 2, 2011 in Medical Billing/Coding

What is a Med­ical Billing Clearinghouse?

An elec­tronic med­ical billing clear­ing­house acts as a mid­dle­man that takes elec­tronic med­ical claims infor­ma­tion and then sub­mits it elec­tron­i­cally to insur­ance com­pa­nies the med­ical billing clear­ing­house con­tracts with.

Why Should a Med­ical Billing Busi­ness Con­sider Using a Clearinghouse?

Look at it this way: If you don’t use a med­ical billing clear­ing­house, your client sends you a med­ical claim in super­bill for­mat, you input that infor­ma­tion into your med­ical billing soft­ware, you print out that infor­ma­tion on to a CMS1500 form, you mail that form out to the appro­pri­ate insur­ance car­rier. The insur­ance com­pany checks the claim for any errors, if every­thing is cor­rect (called a “clean claim”) the insurer sub­mits pay­ment to the physi­cian for the ser­vices ren­dered and then you bill/invoice the physi­cian for the ser­vices that you pro­vided them. Now, how long do you think that process will take and what would be your expense? Well if you were to do this for each and every claim, for each and every client that you have, then I can assure you that it would only take about a month and a few weeks before you’d be out of business.

A med­ical billing clear­ing­house cuts down on the amount of time it takes for med­ical claims to be accepted and processed by insur­ance com­pa­nies. Today, the elec­tronic med­ical billing clear­ing­house also saves the envi­ron­ment because less paper is being used to com­plete the reim­burse­ment process.

Why Is An Elec­tronic Med­ical Billing Clear­ing­house A Must?

There are sev­eral rea­sons but these impact both your busi­ness and your profits:

  • Med­ical billing clear­ing­house soft­ware catches errors that you may have made dur­ing the data entry process.
  • Once a clear­ing­house catches those errors they let you know in real time where the mis­takes were made for each and every med­ical claim so you can cor­rect them, thus reduc­ing the chances of receiv­ing rejected claims.
  • You sub­mit your claims to a clear­ing­house elec­tron­i­cally so the clear­ing­house that you pick should also trans­mit your claims to the insur­ance car­ri­ers elec­tron­i­cally, which will dra­mat­i­cally reduce your reim­burse­ment time to less than ten days. I guar­an­tee you that your clients will love you to death and pay on time each and every month.
  • Using an elec­tronic med­ical billing clear­ing­house elim­i­nates the need for you to re-key data over and over for each payer, which saves you hun­dreds of hours in data entry. Plus, because they already have the insur­ance car­ri­ers’ infor­ma­tion in their sys­tem, you can worry less about human errors being made when trans­mit­ting claim information.
  • A med­ical billing clear­ing­house allows you to sub­mit all your claims at the same time, rather than sub­mit­ting them sep­a­rately for each indi­vid­ual insurer. Again, the faster and more cleanly your claims are sub­mit­ted to the car­ri­ers, the faster pay­ments are received by your med­ical billing client.
  • A med­ical billing clear­ing­house gives you a sec­ondary loca­tion from which to man­age all your elec­tronic claims — in addi­tion to the back ups that you cre­ate of your work on a daily basis, such as those on your com­puter, on CD/DVD, tape dri­ves, etc.
  • A med­ical billing clear­ing­house saves you from spend­ing valu­able hours of your time wait­ing on hold fol­low­ing up on claim errors or rejec­tions with sev­eral dif­fer­ent insur­ance carriers.
  • Elec­tronic med­ical billing clear­ing­houses dras­ti­cally reduce or elim­i­nate the need for you to print paper forms, envelopes and spend money on postage.

Sim­ply put, when you use a good med­ical billing clear­ing­house, your clients get paid faster so you can con­tinue to ser­vice your clients needs, which, in turn, will make your clients refer more busi­ness to you with­out your hav­ing to ask. As a result, your ROI (return on invest­ment) and prof­its will sky­rocket. In short, a med­ical billing clear­ing­house, espe­cially today’s elec­tronic med­ical billing clear­ing­house, can give your med­ical billing busi­ness a com­pet­i­tive advan­tage over your com­peti­tors who do not use them.

The Med­ical Billing Clear­ing­house You Choose Should:

  • Pro­vide you with a huge payer list from which you can choose.
  • Be nation­wide, NOT regional.
  • Pro­vide sync sup­port for the type of med­ical billing soft­ware you are using to cre­ate, batch and sub­mit claims.
  • Have an easy-to-get-out-of contract.
  • Pro­vide excel­lent cus­tomer ser­vice and support.
  • Give you online access to update, track and man­age the claims you have submitted.
  • Not charge exces­sive monthly fees that are beyond the indus­try norm.

The med­ical billing clear­ing­house you select should also pro­vide you with the abil­ity to process the fol­low­ing (Note: Some of these ser­vices can be offered to your clients at an addi­tional charge thus increas­ing your prof­its per client):

    • Eli­gi­bil­ity verification
    • Sent file status
    • Claim sta­tus reports

Rejec­tion analy­sis Drop and mail paper claims if needed Sec­ondary claims processing

  • Elec­tronic Remit­tance Advice (ERA)
  • Patient state­ment services
  • Pay­ment pro­cess­ing reporting
  • Trans­ac­tion sum­maries and reports of all your clear­ing­house activity

A home-based med­ical billing and cod­ing busi­ness is one that pro­vides physi­cians with sev­eral lev­els of ser­vices and a med­ical billing clear­ing­house does the same for the med­ical billing busi­ness owner. Be absolutely cer­tain that you shop around for med­ical billing clear­ing­houses that best fit your needs and bud­get — but DO NOT choose one strictly based on cost.

Elec­tronic med­ical billing clear­ing­houses must pro­vide at least the ser­vices I’ve men­tioned ear­lier. If you have to wait due to cus­tomer ser­vice issues at your clear­ing­house you will lose money, your per­sonal and busi­ness cred­i­bil­ity, and finally your valu­able clients.

Last, pay spe­cial atten­tion to the med­ical billing clearinghouse’s startup and enroll­ment fees that you may have to pay for each prac­ti­tioner or prac­tice you will be sub­mit­ting claims for. Those charges can eat into your prof­its. There are med­ical billing clear­ing­houses in the mar­ket­place that charge flat fees regard­less of how many physi­cians you bill for now or in the future, so proper research is the best way to keep your clear­ing­house expenses to a bare minimum.

Writ­ten BY: P.G. Hackett

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by ronick

Opportunity

October 2, 2011 in QUOTES

MIssed Oppor­tu­nity

Even when oppor­tu­nity knocks, a man still has to get up off his seat and open the door.

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by ronick

Success

October 2, 2011 in QUOTES

The man who makes a suc­cess of an impor­tant ven­ture never wails for the crowd. He strikes out for him­self. It takes nerve, it takes a great lot of grit; but the man that suc­ceeds has both. Any­one can fail. The pub­lic admires the man who has enough con­fi­dence in him­self to take a chance. These chances are the main things after all. The man who tries to suc­ceed must expect to be crit­i­cized. Noth­ing impor­tant was ever done but the greater num­ber con­sulted pre­vi­ously doubted the pos­si­bil­ity. Suc­cess is the accom­plish­ment of that which most peo­ple think can’t be done.
C. V. White

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