Most of us are familiar with President George Bush’s transformation of the federal government’s role in education, phrased as “…No Child Left Behind.” With a goal to focus on what works by spending federal dollars on effective, research based programs and practices, funds are targeted to improve schools and enhance teacher quality.
What happens to disabled children who will mature into adulthood and still require assistance with managing life? In Virginia, there are good things happening to secure a happy medium for disabled children and their families.
One program, Blue Ridge Services, provides financial resources to family members who are currently maintaining ongoing care for their disabled children who are age 18 and over. Extensive 3-4 day training is provided for the parents, with annual recertification provided by Blue Ridge Services. Generally, if a disabled person qualifies under the MR/DD waiver; their sponsor (often a parent) can leave the workforce to completely care for their child who may otherwise have to be placed in a facility.
For families who need help placing their disabled adult child into housing other than a nursing facility or group home, Junction Center for Independent Living, serves as an agent for the Virginia Housing Development Authority. They offer services to persons with disabilities, their families, and their community. Junction Center's Section 8 Housing Choice Voucher Program has specialized programs that assist persons with disabilities with safe, sanitary and affordable housing.
For disabled children in Virginia, the list of resources is inspiring for their families. As the presidential candidates race toward the upcoming election, Virginians can hope that our new president supports federal and state funding that leaves no disabled child behind.
Thursday, January 31, 2008
Tuesday, January 29, 2008
An Ounce of Prevention: Coding and Billing Challenges for Physicians
As the saying goes, "An ounce of prevention is worth a pound of cure". When it comes to circumventing medical coding and billing errors, getting claims paid quickly, and putting an end to the waiting game, a truer word was never spoken. As stated in an article in Medical News Today, navigating the complicated maze of rules, regulations, and correct coding initiatives present special challenges for physicians. According to MSNBC, medical billing errors are becoming more common, due to clerical errors and items being billed separately instead of as part of the surgical package, for example. Coding and billing errors are not limited to physicians and hospitals, however. Anyone can make errors at any stage of the process, and human nature being what it is, they can happen in the most efficiently run offices and can be caused by any number of factors, as outlined in For The Record Magazine. As detailed in the Physician News Digest, almost anything can happen: Two numbers in an ICD9 code become transposed accidentally; an E/M service, done with a separate procedure, does not include the necessary
-25 modifier; a service level is inadvertently upcoded without supporting documentation, or intentionally downcoded to avoid raising eyebrows.
Or maybe there's a simpler explanation: Maybe the doctor's handwriting is illegible, resulting in inaccurate interpretation and coding.
This is why it is important for everyone to take responsibility at each stage of the process: physicians, coders, office managers, billers, auditors, and medical transcriptionists. We all play a role in avoiding common coding mistakes. We are "passing the baton" to each person in the next stage of the coding process, so education on correct coding, compliance, and reimbursement is crucial, and is a neverending process. Taking this step on the front end maximizes reimbursement potential, while minimizing prospective claim denials. Remember CCI Edits are your friend, and Medicare makes them available on the web. It is also a good idea to perform random and routine self-audits. A self-audit ensures charts are accurate, legible, and complete, with all of the necessary supporting documentation to avoid claim denials. Just like an ounce of prevention is worth a pound of cure, "a stitch in time, saves nine". So being proactive and taking the right steps to minimize potential claim denials by avoiding some common pitfalls, can reduce a lot of headaches later.
Since we are all "in this together" as the saying goes, what are some of the challenges that you face as a coder, biller, or office manager, when trying to get claims paid accurately and quickly? Name some areas where you think physicians might benefit from additional education on coding and reimbursement? How do you spot "hot spots", i.e., potential billing and coding problems that aren't a problem now, but might be a problem tomorrow or next week? What have you learned through experience? What would you tell a new coder or biller to "be on the lookout for" when it comes to coding, billing and maximizing reimbursement?
-25 modifier; a service level is inadvertently upcoded without supporting documentation, or intentionally downcoded to avoid raising eyebrows.
Or maybe there's a simpler explanation: Maybe the doctor's handwriting is illegible, resulting in inaccurate interpretation and coding.
This is why it is important for everyone to take responsibility at each stage of the process: physicians, coders, office managers, billers, auditors, and medical transcriptionists. We all play a role in avoiding common coding mistakes. We are "passing the baton" to each person in the next stage of the coding process, so education on correct coding, compliance, and reimbursement is crucial, and is a neverending process. Taking this step on the front end maximizes reimbursement potential, while minimizing prospective claim denials. Remember CCI Edits are your friend, and Medicare makes them available on the web. It is also a good idea to perform random and routine self-audits. A self-audit ensures charts are accurate, legible, and complete, with all of the necessary supporting documentation to avoid claim denials. Just like an ounce of prevention is worth a pound of cure, "a stitch in time, saves nine". So being proactive and taking the right steps to minimize potential claim denials by avoiding some common pitfalls, can reduce a lot of headaches later.
Since we are all "in this together" as the saying goes, what are some of the challenges that you face as a coder, biller, or office manager, when trying to get claims paid accurately and quickly? Name some areas where you think physicians might benefit from additional education on coding and reimbursement? How do you spot "hot spots", i.e., potential billing and coding problems that aren't a problem now, but might be a problem tomorrow or next week? What have you learned through experience? What would you tell a new coder or biller to "be on the lookout for" when it comes to coding, billing and maximizing reimbursement?
Pay the Piper AND the Doctor
Does the quality of your physician’s care depend on the quality of your insurance’s medical billing and coding? When we’re ready to “face the music” or “pay the piper” by visiting the doctor we expect to give the co-pay and leave the major financial responsibility to insurance providers, including Medicare. That means, as patients, we expect a lengthy visit by a doctor who has been well-paid for such treatment.
The unfortunate situation for most physicians is that unless a patient will pay the billed expenses out of pocket, it is unlikely that the physician will receive comparable pay for services provided.
Physician’s fees cover increasing practice expenses, costly medical malpractice insurance, and personal expenses. Many insurance companies compensate physicians 10-20% less than Medicare, although Medicare reimbursement rates were never meant to be used as a guide for private insurance companies. Perhaps physicians suffer as much as patients when it comes to medical insurance.
Pennsylvania Medical Society suggests that several ways for physicians to maximize revenue are to collect co-payments and balances due when the patient is in the office and to use automatic payment posting wherever possible which is not only efficient, but it's typically more accurate than manual posting.
Although MSNBC has reported that doctors caring for the elderly and the disabled will see a 5 percent cut in reimbursement rates when they treat Medicare patients in 2008, the government will pay physicians more to counsel patients on ways to improve their health.
The unfortunate situation for most physicians is that unless a patient will pay the billed expenses out of pocket, it is unlikely that the physician will receive comparable pay for services provided.
Physician’s fees cover increasing practice expenses, costly medical malpractice insurance, and personal expenses. Many insurance companies compensate physicians 10-20% less than Medicare, although Medicare reimbursement rates were never meant to be used as a guide for private insurance companies. Perhaps physicians suffer as much as patients when it comes to medical insurance.
Pennsylvania Medical Society suggests that several ways for physicians to maximize revenue are to collect co-payments and balances due when the patient is in the office and to use automatic payment posting wherever possible which is not only efficient, but it's typically more accurate than manual posting.
Although MSNBC has reported that doctors caring for the elderly and the disabled will see a 5 percent cut in reimbursement rates when they treat Medicare patients in 2008, the government will pay physicians more to counsel patients on ways to improve their health.
Sunday, January 27, 2008
America’s Great Depression
A recent conversation on a popular subject sparked a question that get us all down-depression. Is it an American phenomenon? Is the world depressed? Is there a co-pay? The latter was a trick question, the former are still perplexing, and in a way, depressing. Considering the risk factors for depression encompass most aspects of life, obtaining happiness without medication seems to be impossible.
Cymbalta provides a gamut of risk factors for depression; some are usually considered milestones, whereas others are more obvious triggers. Family history of depression, death, and stressful conflicts are listed among getting married, graduating from college, and becoming a new parent. Whatever the circumstances, depression is caused by an imbalance of certain chemicals in the brain, concludes Lexapro.
A new book, Black Pain: It Just Looks Like We're Not Hurting, by Terrie Williams focuses on depression among the African-American community and offers statistics regarding depression in blacks and whites. Regardless of the race, Talk Therapy is the current label for Psychotherapy or the visit to the “Shrink.” In today’s healthcare market, most health insurance plans cover diagnosis and treatment.
Now that depression is known to encompass all aspects of life and that it is treatable, the co-pay for treatment still depends on an individual health plan.
Cymbalta provides a gamut of risk factors for depression; some are usually considered milestones, whereas others are more obvious triggers. Family history of depression, death, and stressful conflicts are listed among getting married, graduating from college, and becoming a new parent. Whatever the circumstances, depression is caused by an imbalance of certain chemicals in the brain, concludes Lexapro.
A new book, Black Pain: It Just Looks Like We're Not Hurting, by Terrie Williams focuses on depression among the African-American community and offers statistics regarding depression in blacks and whites. Regardless of the race, Talk Therapy is the current label for Psychotherapy or the visit to the “Shrink.” In today’s healthcare market, most health insurance plans cover diagnosis and treatment.
Now that depression is known to encompass all aspects of life and that it is treatable, the co-pay for treatment still depends on an individual health plan.
Thursday, January 24, 2008
Pork-the Other Cloned White Meat
Americans have adjusted their diets to make better use of the food pyramid for a better body image, but more importantly, for a healthier body. The probability of a better looking body has increased due to a nationwide quest for improved food sources. One such choice has been pork, popularly dubbed “the other white meat.”
Although Americans are scrutinizing their caloric intake and pork options, the origins of certain foods may soon be questioned. According to a January 16, 2008 press conference, the FDA has concluded that meat and milk from clones of cattle, swine and goats and the offspring of clones from any species traditionally consumed as food are as safe to eat as food from conventionally bred animals.
Cloned food has not reportedly uncovered any subtle hazards that might indicate food consumption risks, says Yahoo. Other reports have piqued an appetite for more information as the Washington Post announced that hundreds of cloned pigs, cows and other animals are already living on farms around the country. With the cloned community being a reality, consumers may possibly be able to identify changes since MSNBC declared “…Officials said they don’t think special labels are needed, although a decision on labeling is pending.”
Although Americans are scrutinizing their caloric intake and pork options, the origins of certain foods may soon be questioned. According to a January 16, 2008 press conference, the FDA has concluded that meat and milk from clones of cattle, swine and goats and the offspring of clones from any species traditionally consumed as food are as safe to eat as food from conventionally bred animals.
Cloned food has not reportedly uncovered any subtle hazards that might indicate food consumption risks, says Yahoo. Other reports have piqued an appetite for more information as the Washington Post announced that hundreds of cloned pigs, cows and other animals are already living on farms around the country. With the cloned community being a reality, consumers may possibly be able to identify changes since MSNBC declared “…Officials said they don’t think special labels are needed, although a decision on labeling is pending.”
Wednesday, January 23, 2008
Nursing Shortages in Healthcare Shortchanges Patients
Across the country, nursing colleges and universities are experiencing difficulty in their efforts to expand enrollment levels to meet the rising demand for nursing care. Several issues that magnify the problem include a shortage of nursing school faculty which restricts nursing program enrollments. Reports from 2006-2007 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing say that U.S. nursing schools turned away 42,866 qualified applicants from baccalaureate and graduate nursing programs in 2006 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints.
The certainty of the slow rate of registered nurses entering the profession increases the demands of currently employed nurses. In the March-April 2005 issue of Nursing Economic$, Dr. Peter Buerhaus and colleagues found that more than 75% of RNs believe the nursing shortage presents a major problem for the quality of their work life, the quality of patient care, and the amount of time nurses can spend with patients.
Eventually, this type of problem leads to job burnout, job dissatisfaction, emotional exhaustion and high turnover rates. A study in the October 2002 Journal of the American Medical Association supports these findings. With fledgling nursing care, patients and families suffer as well as medical facilities in their quest to provide adequate service.
Surely, with a well-defined problem, there are resolutions underway on various levels. Methods for combating the nursing shortages are found in a July 2007 report from PricewaterhouseCoopers’ Health Research Institute titled What Works: Healing the Healthcare Staffing Shortage. The information involves developing more public-private partnerships, creating healthy work environments, using technology as a training tool and designing more flexible roles for advanced practice nurses given their increased us as primary care providers.
The certainty of the slow rate of registered nurses entering the profession increases the demands of currently employed nurses. In the March-April 2005 issue of Nursing Economic$, Dr. Peter Buerhaus and colleagues found that more than 75% of RNs believe the nursing shortage presents a major problem for the quality of their work life, the quality of patient care, and the amount of time nurses can spend with patients.
Eventually, this type of problem leads to job burnout, job dissatisfaction, emotional exhaustion and high turnover rates. A study in the October 2002 Journal of the American Medical Association supports these findings. With fledgling nursing care, patients and families suffer as well as medical facilities in their quest to provide adequate service.
Surely, with a well-defined problem, there are resolutions underway on various levels. Methods for combating the nursing shortages are found in a July 2007 report from PricewaterhouseCoopers’ Health Research Institute titled What Works: Healing the Healthcare Staffing Shortage. The information involves developing more public-private partnerships, creating healthy work environments, using technology as a training tool and designing more flexible roles for advanced practice nurses given their increased us as primary care providers.
Friday, January 18, 2008
The Big Payback in Healthcare
At the height of music legend James Brown’s career, the song, "The Big Payback," was a chart topping hit. In 2008, with a vast knowledge of CPT and ICD-9 Codes that gets back-logged claims submitted fast, innovative billing companies have made the James Brown classic a song that healthcare providers can sing all the way to the bank.
Reported in 2006 by the Blue Cross Blue Shield Association(BCBSA), The House [of Representatives] is considering health information technology legislation (H.R. 4157) that would require providers and payers to switch from the ICD-9 billing code set to a very different ICD-10-CM/PCS (ICD-10) code set by October 1, 2009. The BCBSA is advocating for the extension of the deadline to 2012 because much has to be done before a switch to ICD-10 can be started…The efficiency of today’s company to quickly obtain information and correctly submit claims to Blue Cross Blue Shield as well as Florida Medicaid has proven to be an achievable task by New Jersey Healthcare Solutions.
Finances and proper procedures are a heavyweight with all healthcare providers. Sentara, which offers Optima as a health plan, gives the harsh reality of improper billing and coding in their 2008 Guide to Compliance and Ethics. The company and employees can be prosecuted for filing inaccurate claims for reimbursement, which carries extremely large civil fines or criminal penalties or both.
In the 1990’s, Hip-Hop artist L. L. Cool J. used "The Big Payback" as a musical backdrop for his hit single, "Booming System." Healthcare providers’ reimbursement systems can “boom” with a billing company knowledgeable to State regulations pertaining to varying types of insurances and third party payers.
Reported in 2006 by the Blue Cross Blue Shield Association(BCBSA), The House [of Representatives] is considering health information technology legislation (H.R. 4157) that would require providers and payers to switch from the ICD-9 billing code set to a very different ICD-10-CM/PCS (ICD-10) code set by October 1, 2009. The BCBSA is advocating for the extension of the deadline to 2012 because much has to be done before a switch to ICD-10 can be started…The efficiency of today’s company to quickly obtain information and correctly submit claims to Blue Cross Blue Shield as well as Florida Medicaid has proven to be an achievable task by New Jersey Healthcare Solutions.
Finances and proper procedures are a heavyweight with all healthcare providers. Sentara, which offers Optima as a health plan, gives the harsh reality of improper billing and coding in their 2008 Guide to Compliance and Ethics. The company and employees can be prosecuted for filing inaccurate claims for reimbursement, which carries extremely large civil fines or criminal penalties or both.
In the 1990’s, Hip-Hop artist L. L. Cool J. used "The Big Payback" as a musical backdrop for his hit single, "Booming System." Healthcare providers’ reimbursement systems can “boom” with a billing company knowledgeable to State regulations pertaining to varying types of insurances and third party payers.
Subscribe to:
Posts (Atom)