Managed Healthcare

2007-07-04T17:42:00.000-07:00

Marketing To Healthcare Industry: Selling Pharma Products To Doctor
By Alexander Gordon

Marketing healthcare products to physicians requires tact and skill. Trust is very important, since physicians are always on the lookout for reliable sources of information on healthcare products. Marketing healthcare products also needs some basic knowledge of clinical evidence, as well as a good sales pitch.

Since many representatives of the pharmacy industry to endorse products approach doctors, you need to be able to convince them about the efficacy of your products. If the sales pitch is overdone, doctors may get annoyed and refuse to listen to you.

Effective Tips for Marketing Healthcare Products:
Here are some ways to convince doctors about the efficacy of your healthcare products.
1) Tone down the sales pitch and provide authentic information. Give as much scientific data and information on clinical trials as you can.
2) Apart from face to face interaction, offer information through the Internet, email, mobile phones, print media and television and radio broadcasts.
3) E-detailing is another method of selling healthcare products to physicians. It involves electronic communication between physicians and sales representatives.
4) Offering online information is another way to market to the healthcare industry. Many doctors use online resources to keep track of the latest developments in the field.
5) Some healthcare companies also organize “fairs” that let physicians meet patients. This is a good chance for the pharma industry to market itself.
6) The Epocrates mobile service provides doctors instant answers to their healthcare related queries. Alerts are sent to physicians when a response to the query is available.
How to Market Healthcare Industry Online:

Online marketing is the latest in the marketing strategies of the healthcare products related industry. Your website must provide the latest, authentic information when marketing to healthcare professionals. Here are some points to keep in mind when selling to physicians online.
1) Combine the sales pitch with facts when presenting your products online.
2) Team with vendors who are trusted by doctors.
3) Market your products on websites that are trusted by doctors.
4) The website should be well maintained and offer the latest information on clinical trials and anything else of interest to doctors.
Physicians are always on the lookout for credible information on the latest healthcare products. You should do your research well when presenting your products to doctors, since they are critical about overt sales pitch and little information. In order to market your products, you need to convince doctors about the quality of the products. Use the latest marketing tools like Internet, mobile devices and telephonic marketing in order to sell healthcare products to physicians. You can approach a business consultant for advice if you need to know more about marketing healthcare products to doctors, as well as to the public.
Alexander Gordon is a writer for [http://www.smallbusinessconsulting.com/]http://www.smallbusinessconsulting.com - The [http://www.smallbusinessconsulting.com]Small Business Consulting Community. Sign-up for the [http://www.smallbusinessconsulting.com/public/department30.cfm]free success steps newsletter and get our booklet valued at $24.95 for free as a special bonus. The newsletter provides daily strategies on starting and significantly growing a business.
Business Owners all across the country are joining "The Community of Small Business Owners” to receive and provide strategies, insight, tips, support and more on starting, managing, growing, and selling their businesses. As a member, you will have access to true Millionaire Business Owners who will provide strategies and tips from their real-life experiences.

Article Source: http://EzineArticles.com/?expert=Alexander_Gordon http://EzineArticles.com/?Marketing-To-Healthcare-Industry:-Selling-Pharma-Products-To-Doctor&id=394130

2007-07-04T17:33:00.000-07:00

How to Improve Care Management Decision Making
By Skip Freedman

Companies and individuals who are concerned about making sure that their members and patients get the proper healthcare are increasingly looking to independent review organizations to help them make crucial decisions about the allocation of healthcare resources according to the highest level of need.

Independent review organizations can help this process by providing for a systematic review of all complex and costly medical claims to determine whether or not the treatments that have been prescribed are medically necessary, are appropriate, and are aligned with the accepted standards of care. Independent review organizations are playing an increasingly important role in containing escalating healthcare costs by assuring that health care resources are only allocated to those patients and members who actually deserve them. Independent review organizations provide a key balancing force between payers and patients to assure that patients get the healthcare that they are supposed to every time. At the same time, an IRO assures that no unnecessary treatments are authorized are burdening and adding costs to the health care system in general. An independent review organization provides a critical look at the nexus of the health care decision-making chain in order to improve the delivery of healthcare to all members and patients in a health plan.
About AllMed Healthcare Management Founded in 1995, AllMed is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base for its [http://www.allmedmd.com]independent medical review and hospital peer review services includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers. Read the AllMed [http://www.allmedmd.com/blog/index.htm]Medical News Blog and the [http://www.allmedmd.com/skipblog/]Independent Review Organization Blog.

Article Source: http://EzineArticles.com/?expert=Skip_Freedman http://EzineArticles.com/?How-to-Improve-Care-Management-Decision-Making&id=233254

2007-04-07T06:29:00.000-07:00

Cigna Replaces Blue Cross Blue Shield At The Top Of Chiropractic Billing Precision Index In March
By Yuval Lirov

Billing Performance Index (BPI) in March 2007 underperformed its February value by another 1.3%, dropping the index from 17.6 down to 18.9, while replacing three of BPI participants in February on the list of top ten performers. Chiropractic Billing Performance Index guides chiropractic office managers and helps the development of both chiropractic billing software and billing performance standards. This article describes the 10-th iteration of a rule-based chiropractic billing index, including its coverage definition, update cycle, volume weighting, and provided information.

BPI = 18.9 means that the average of ten top performing payers working with Billing Precision clients have 18.9% of Accounts Receivable beyond 120 days. BPI is a key billing performance characteristic, as it is a proxy of the claims that are never paid. Obviously, the lower is the index the better is billing performance. The table below also lists the top ten performing payers and their relative index as recorded in the Billing Precision's system.

Billing Precision Index 18.9
Cigna 12.9 (down from 12.4 in February)
Blue Cross Blue Shield Illinois 15.1 (down from 11.2 in February)
Blue Cross Blue Shield Texas 15.2 (down from 14.3 in February)
Blue Cross Blue Shield Pennsylvania 17.7
Medicare New Jersey 20.5 (down from 17.6 in February)
Aetna 20.9 (down from 17 in February)
Blue Cross Blue Shield Alabama 21.3
Medicare Pennsylvania 23.1
United Healthcare 23.2 (down from 19.7 in February)
Blue Cross Blue Shield New Jersey 24.3 (down from 20.5 in February)

March BPI dropped three participants since February:

Blue Cross Blue Shield South Carolina
Medicare Illinois
Medicare Wisconsin

Improved index since February: None.

Seven participants lowered their indexes with respect to February BPI:

Cigna 12.9 (down from 12.4 in February)
Blue Cross Blue Shield Illinois 15.1 (down from 11.2 in February)
Blue Cross Blue Shield Texas 15.2 (down from 14.3 in February)
Medicare New Jersey 20.5 (down from 17.6 in February)
Aetna 20.9 (down from 17 in February)
United Healthcare 23.2 (down from 19.7 in February)
Blue Cross Blue Shield New Jersey 24.3 (down from 20.5 in February)

March BPI added three new participants since February:

Blue Cross Blue Shield Pennsylvania 17.7
Blue Cross Blue Shield Alabama 21.3
Medicare Pennsylvania 23.1

Coverage

BPI is rule-based, i.e., payer participation in the index is defined by dynamically rules at the time of computation and not by a static listing of specific payers. Therefore, any specific payer may start or discontinue participation in the index, dependent on satisfaction of rule's conditions.

Current selection of payers for participation in the BPI is based on fifty top-volume providers across all United States that have received Billing Precision services for more than six months and have more than two hundred claims in their current Accounts Receivable.

Update Cycle

BillingPrecision.com updates BPI on a monthly basis.

Volume Weighting

BPI is volume weighted, which is important to accommodate future growth of provided information, index combinations, and sensitivity across multiple indices.

Information Provided

BPI computes the percent of Accounts Receivable beyond 120 days. Note that national average across all medical specialties of percent of accounts receivable beyond 120 days is 17.7%.

Summary

Chiropractic Billing Performance Index helps the development of both chiropractic billing software and billing performance standards. Chiropractic office managers can use the index to benchmark their billing performance and guide its improvement over time. Rule-based index definition allows for automated inclusion and exclusion of payers in the index based on payer attributes, such as numbers of processed claims, accounts receivable distribution, certain mix of CPT codes, or patient demographics.

Yuval Lirov, PhD, author of "Mission Critical Systems Management" (Prentice Hall) , patent inventor in Artificial intelligence and Computer Security, and CEO of Vericle.net Billing Technologies and Services. Vericle® unites hundreds of billing systems across the nation. By consolidating operations, Vericle® tracks payer performance from a single point of control, shares compliance rules globally, and creates massive economies of scale. Yuval invites you to share your knowledge of medical billing and compliance at BillingWiki.com and register to the next webinar on audit risk at BillingPrecision.com.

Article Source: http://EzineArticles.com/?expert=Yuval_Lirov
http://EzineArticles.com/?Cigna-Replaces-Blue-Cross-Blue-Shield-At-The-Top-Of-Chiropractic-Billing-Precision-Index-In-March&id=511020

2007-04-07T06:26:00.000-07:00

Natural Alternatives for Reducing Pain
By Dr. Bruce Forciea

I see many people who deal with daily pain in my practice. Many resign themselves to taking pain medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve). Others with more serious pain end up getting prescriptions for narcotics or having procedures such as epidural injections or even surgery.

Fortunately I am in a position to recommend a number of non-medical alternatives for controlling pain. Many of these are available at the local health food store. Others require a visit to a healthcare practitioner. If you are suffering from pain here are a few things you can do.

First of all you need to determine whether you are experiencing acute or chronic pain. Acute pain feels sharper in quality than chronic or what we sometimes call subacute pain. Many times acute pain is associated with inflammation. The tissues may feel slightly swollen and can be very tender to the touch. With subacute pain the tissues feel tighter and can restrict movement.

If the pain is moderate to severe and feels sharper in quality, (acute pain) then icing the painful area will help. Most people use the gel type ice packs. These are nice because they only last for about 20 minutes which is all you need. A good protocol to follow is to ice for 20 minutes then remove the ice for 40 minutes. One of the best times to use ice is before bedtime as the tissues tend to become inflamed over night. This will cause more intense pain in the morning.

Sometimes the inflammation comes and goes over a period of weeks. This is due to the damage in the soft tissues such as in your neck and back. When you go about your day the tissues absorb a certain amount of force. If the force exceeds what the damaged tissues can handle the tissue becomes inflamed. Many of my patients prematurely used heat in this case. If you heat up tissues that are inflamed you will prolong the inflammation. Using ice is a safer bet.

Another thing you can do for pain is to begin a regimen of natural anti-inflammatory substances. Many people do not know about these. There are a number of natural substances that have an anti-inflammatory effect. You can get these at your local health food store.

The natural anti-inflammatory substances include:

Bioflavinoids -- these come from fruits and vegetables. There are

many bioflavinoid compounds and many natural

anti-inflammatory products contain them.

Tumeric and Ginger are commonly used spices and are sold in

capsule form in health food stores.

Boswellia Serrata is an Indian herb with anti-inflammatory properties.

Trypsin and Chymotrypsin are digestive enzymes usually taken for

digestive problems but also exhibit an anti-inflammatory effect.

The dose will depend on the product. You can consult with the store or a natural physician to determine the dose. Nutritional substances are much safer to take than even over the counter medications so side effects are at a minimum.

Lastly, some healthcare practitioners use electrical modalities such as TENS to help control pain. TENS stands for transcutaneous electrical nerve stimulation. Basically TENS bombards the spinal cord with electrical signals that interfere with pain. The research on TENS is mixed with regard to acute pain. In my experience with TENS I have seen both good and poor results. A lot has to do with setting up the unit properly. After using it awhile the body can adapt to the stimulus so the unit has to be adjusted regularly.

Other electrical modalities used for pain include interferential current and microcurrent. These are administered by practitioners such as chiropractors or physical therapists. Both help the tissues heal by either reducing inflammation or by stimulating the production of proteins in the cells.

One of the newer therapies used to decrease pain and stimulate healing is low level laser light therapy. The actual mechanism of healing is not known but clinical research shows that it can be effective in reducing pain and accelerating healing.

Acupuncture can also be effective in reducing muscle pain. Acupuncture is done by inserting needles or using mild electrical stimulation at specific points on the body. The points are located along meridians which are channels through which the life force flows. No one knows exactly how acupuncture works but many studies have been done that support its pain reducing effects.

There are a number of mind-body techniques that can help reduce or even eliminate pain. Meditation and guided imagery are two popular techniques that are used to reduce pain. In guided imagery you get into a relaxed state and then create an image of your pain or illness. You then imagine the image dissolving and yourself in a healthy pain-free state. Guided imagery may take a bit of practice but the results are well worth the effort.

There are many ways to treat pain aside from the familiar pills and injections that carry with them a significant risk of side effects. I always recommend trying the safer alternative methods first. In most cases the pain can be successfully treated without the dangers of medications.

Dr. Bruce Forciea is a chiropractor and author of Unlocking the Healing Code which is due for release in December 2007 by Llwellyn Worldwide. He also teaches college courses in anatomy and physiology.

For more information visit Dr. Forciea's site at: http://www.informationalhealing.com

Article Source: http://EzineArticles.com/?expert=Dr._Bruce_Forciea
http://EzineArticles.com/?Natural-Alternatives-for-Reducing-Pain&id=506310

2007-04-07T06:24:00.000-07:00

How the Advanced HealthCare Directive Makes Life-Saving Decisions
By Rocco Beatrice

An Advanced Medical Directive deals with life's real issues and combats the problems that arise where most boilerplate healthcare powers of attorney, healthcare proxies, living wills and others fall short. The Terri Schiavo case is a prime example of such a problem where the power to control one's medical condition becomes a gray realm and ends up in a myriad of appeals, numerous motions, petitions and hearings for many years in litigious battle. The result is much heartache, financial strain and most often unrealized unwanted outcomes.

WHAT IS AN ADVANCED MEDICAL DIRECTIVE? TOP TEN FACTORS FOR YOUR MEDICAL CARE

An Advanced Medical Directive is a legal written instrument signed by you and the individual you identify as your Agent to control your medical care with both signatures supervised before a notary public. Herein are the top ten reasons how an Advanced Healthcare Directive can make legal, life-saving decisions for you when you cannot. Your written instrument should contain:

1. Legal identity of yourself, mailing address, social security number.

2. Legal appointment and identity of your Agent’s mailing address and social security number.

3. Legal identity of an alternative Agent, in case where your primary Agent is unavailable, or unable to make decisions, or unwilling to make decisions.

4. An articulated written authorization for your Agent:

a. To consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a physical or mental condition, including approval or disapproval of diagnostic tests, medical or surgical procedures.

b. To request, receive, examine, copy, and consent to the disclosure of medical information or any other healthcare information.

c. To make decisions regarding orders not to resuscitate as well as decisions to provide, withhold, or withdraw artificial nutrition and hydration, and all other forms of healthcare to keep you alive.

d. To select and discharge health care providers, organizations, institutions and programs and to make and change healthcare choices and options relating to plans, services, and benefits.

e. To apply for public or private healthcare programs, to include Medicare, Medicaid, and any benefits without your Agent incurring any personal financial liability.

f. To direct that your healthcare providers and others involved in your care provide, withhold, or withdraw treatment in accordance with the limits of generally accepted healthcare standards.

g. To decide not to prolong your life if you have an incurable and irreversible condition that will result in your death within a relatively short time, or you become unconscious and, to a reasonable degree of medical certainty, you will not regain consciousness, or the likely risks and burdens of treatment would outweigh the expected benefits.

h. To direct treatment or withhold treatment to alleviate pain or discomfort even if it hastens your death.

i. To the extent that your wishes are unknown to your Agent, your Agent may make all healthcare decisions in accordance with your best interest considering your personal values and other factors known by your Agent.

5. An appointment of your Agent to become your Guardian if there’s a reason for a legal appointment of such a Guardian, together with power for the Alternative Agent to become the Guardian in cases where the primary Agent is unavailable, or unwilling to serve.

6. A very important paragraph to negate your consent to committing you or to place you in a mental health treatment facility, or to convulsive treatment, or to psychosurgery, sterilization, or abortion.

7. Participation or non-participation to the donation of your organs and body parts for purposes of transplant, therapy, research, or for other educational purposes.

8. A severability clause not to void the agreement or any provisions of the agreement considered non-essential to the primary purpose and essential to the principal objective.

9. A modification clause allowing the agreement to me modified or revoked at any time.

10. A provision for the final disposition of your body and any funeral arrangements.

In conclusion, a Medical Directive is a morbid action to take, nobody wants to think about dying, but in this case, it could save your life.

Author bio - Rocco Beatrice, CPA, MST, MBA

Award-winning estate planning & trust expert

MS - Taxation, Master of Science Taxation

MBA - Management / Taxation

BSBA - Management / Accounting

CPA - Certified Public Accountant

-----

Irrevocable Trust Asset Protection, Medicaid Asset Protection

Advanced Medical Directive with Terminal Patients-Terri Schiavo

71 Commercial Street #150, Boston, MA 02109

tel: +1.508.429.0011 fax: +1.508.429.3034

Article Source: http://EzineArticles.com/?expert=Rocco_Beatrice
http://EzineArticles.com/?How-the-Advanced-HealthCare-Directive-Makes-Life-Saving-Decisions&id=493157

Looking for PA or NP to work in Dallas, Texas

2007-01-29T06:00:00.000-08:00

Please send resume to 469.574.5069 if interested.

2006-12-28T03:49:00.000-08:00

Medical Billing - Many Players, Many Problems
By Michael Russell

Getting sick is no fun. What's even less fun is when you go to the doctor, he hands you that bill and it takes your insurance company forever to pay the claim. Medical billing may seem like a total nightmare sometimes and the truth is, it is. But few people understand the reasons. Hopefully, reading this will give you a basic idea of what all the problems are.

There are many players involved in the medical billing world and you have to understand their role in this society and where they are coming from.

For starters, we have the doctors. You have to understand that education costs today are insane. Just going to college to become a social worker can cost you $35,000 a year. Do you have any idea what it costs to become a doctor? It's insanity. So these people are in such debt to begin with that they have no choice to charge high fees for their services. A doctor's visit that once upon a time cost $15, now costs $75 or more. So medical billing starts off behind the 8 ball because doctors fees are so high. This includes all doctors and not just general practitioners.

Then you have the drug companies. The cost of research today is off the charts. Many people argue that the pill the drug company makes only costs 10 cents to make. What they fail to realize is that the cost of coming up with that miracle cure cost millions of dollars. Lab techs and chemists don't work cheaply. So medicine today is sold for prices that years ago would have been unthinkable. So, add the cost of medication to the cost of doctor fees and your medical billing costs have just gone up a little more.

Then you have the technology. Today, we have the ability to find things through MRI, CAT scans and a number of other things that we didn't have years ago. These technological wonders come with a heavy price tag. We don't simply take an x-ray anymore. Things have gotten a lot more sophisticated. So this also adds to the cost of your medical bill.

Then you have the medical billing industry itself. These people don't work for free. With the rise in skills, the people in these positions, especially those who are involved in the computer end of it, demand high salaries. Add to that the cost of software, forms and various other items and you come away with a very high price tag just for sending out the bill, which is already high to begin with.

And finally, fighting on the other end of the scale, you have the insurance carriers, whether it be Medicare, Medicaid or a private insurance company. These carriers have one thing in mind and that is to save money. So they'll pay out as little as possible on these claims. That's why there is so much red tape when it comes to medical billing.

Add all of this together and you have an industry that is in need of reform and serious help. But in order for that to happen, somebody has to give a little. And that is not likely to happen any time soon.

Michael Russell

Your Independent guide to Medical Billing

Article Source: http://EzineArticles.com/?expert=Michael_Russell

2006-12-28T03:48:00.000-08:00

Medical Billing - Getting Clients
By Michael Russell

Well, you've set up your medical billing company and you're all set to do business. Except there's one problem. You don't have any clients. So the question is, how do you go about getting them? Since nobody knows you even exist yet, they're not likely to come knocking on your door. Well, hopefully, after you've read this article, you'll have several good ideas for how to build up your medical billing client base.

Typically, what this is all going to come down to is advertising, obviously. But how? Years ago, you didn't have nearly the number of advertising methods that you have today. The Internet has opened up a new world to businesses from all over.

So let's start with the Internet. The first thing you're probably going to want to do is put up a web site. Even though you are dealing with the offline world, most businesses today do have an Internet presence. It is therefore important that you establish your own Internet presence.

To do this, the first thing you need to do is get a domain for your site. That should be easy enough. You have a company name, so use it as your domain name. If by some chance your domain name is taken, see if you can purchase it from the owner. If they're not willing to sell, then pick a name that is close enough as long as it contains the name of your company within the domain name itself.

After you have your domain, you need to put up your site. If you don't have your own web design team, then hire somebody from an outside company to do the design for you. It doesn't have to be fancy but it should be professional looking. Make sure the site has all the information about your company, what it does and how you can handle the medical billing needs of anyone.

After the site is up, you're going to want to begin promoting it. There are a number of methods to promote web sites on the Internet these days. These methods range from paid to free ads. Do your homework on this. Ask around for what the experts feel are your best options. We're not going to endorse any particular form of Internet advertising in this article.

Over time, you will begin to see your client base build. But the Internet shouldn't be your main focus. The traditional forms of advertising still apply, even in this highly technical world that we live in. This means don't forget to register with all the medical agencies in the United States. There are a number of them to choose from. If anybody needs a medical biller, each agency will recommend them to the closest company in their area. You'll get more than your share of work. Also, don't neglect newspapers, radio and television.

Getting clients, if you're a medical billing agency, doesn't have to be like pulling teeth at a dentist's office. If you take advantage of all the mediums available, there is no reason why you can't run a more than profitable medical billing business.

Michael Russell

Your Independent guide to Medical Billing

Article Source: http://EzineArticles.com/?expert=Michael_Russell

1305 Texas Certified Work Comp Networks

2006-10-31T06:06:00.000-08:00

CONCENTRA HCN

CORVEL HEALTHCARE CORPORATION/CORCARE

FIRST HEALTH/AIGCS TX HCN

FIRST HEALTH TX HCN

FIRST HEALTH/TRAVELERS HCN

FORTE INC./COMPKEY/FIRST HEALTH

GENEX SERVICES INC./GENEX HEALTH CARE NETWORK

THE HARTFORD WORKERS' COMPENSATION HEALTH CARE NETWORK- FH

IMO MED-SELECT NETWORK/INJURY MANAGEMENT ORGANIZATION, INC.

INTERNATIONAL REHABILITATION ASSOCIATES, INC./INTRACORP

LIBERTY MUTUAL MANAGED CARE, INC./LIBERTY HEALTH CARE NETWORK

MEMORIAL HERMANN HEALTH NETWORK PROVIDERS, INC./WORKLINK

PHYSICIANS COOPERATIVE OF TEXAS

SHA, LLC/FIRSTCARE NETWORK

SPECIALTY RISK SERVICES TEXAS WORKERS' COMPENSATION HEALTH CARE NETWORK (FIRST HEALTH)

TEXAS STAR NETWORK/CONCENTRA

ZURICH SERVICES CORPORATION HEALTHCARE NETWORK

As of today, there are 17 certified Worker's Comp networks, with 19 additionally known, in process for certification.

If your practice treats worker's comp patients in Texas, this is important information for you.

If you are not participating in these plans and your patient's employer is a member of these plans, you cannot get paid for services rendered to the patient. There are NO out of network benefits available in these networks.

If you would like to be a participating provider in the new certified networks, please contact Professional Healthcare Management. We have been contracting providers since June 2005 to be a part of these networks.

Professional Healthcare Management
Carrollton, TX 75006
972.245.1315

www.phmnetwork.com

credentialing@phmnetwork.com

2006-08-18T05:33:00.000-07:00

Greetings DCs!

I normally leave the articles to other doctors, but this month it was so important to get this word out to you all. We have heard this from so many directions, that it was time to get this word out. If you are not in the know on this subject, call a veteran doctor friend, or your state association. Buy a book, DVD, attend a documentation seminar, DO SOMETHING!
Failure to be in the know could cost you dearly.

Alex Niswander- Midwest Software

This months article talks about MEDICARE audits, so please read this one DCs. Especially younger doctors who do not have past experience with Medicare!!

This month's Featured Article: Are you ready for MEDICARE AUDITS!

ChiroChart EMR: What is ChiroChart and how can it help your practice?

Feature Article:

Medicare Audits! Ready or not, here they come!

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Medicare Audits! Ready or not, here they come!
Are you ready, if not we have some tips....and some things you should already be doing.

By Alex Niswander (President of Midwest Software)

As a chiropractor, you probably already realize that Medicare audits are on the rise and that insurance audits are not too far behind in the audit game.

A Medicare audit or investigation is often one of the most traumatic experiences that a Chiropractor will ever have. In addition, the financial consequences of an audit or investigation may be devastating. Large overpayment demands, suspensions and even exclusion from the Medicare program have become increasingly more common in recent years as government authorities step up their fraud and abuse enforcement activities.

Is Chiropractic a target for Medicare's fraud and abuse enforcement efforts? The answer is a definite "yes". We recently read an article in a top chiropractic magazine that said Medicare has joined forces with the FBI to specifically target Chiropractic clinics. We have also heard of some states where Medicare is planning on doing major audits on as many DCs as possible.

After a long Medicare investigation, government actions ranged from simple random requests for medical records to criminal grand jury subpoenas. The outcome? Millions of dollars in forced refunds to Medicare, placed on suspension or prepayment review, civil monetary penalties, exclusion from Medicare and, in some situations, criminal convictions.

Medicare has a powerful array of tools with which to track the coding and billing practices. First, Medicare has sophisticated software programs that "flag" doctors who use certain codes more frequently than their peers (higher billed codes especially). Medicare uses "provider profiling" to identify such doctors for audits or investigations.

Second, Medicare has enlisted the assistance of senior citizens to report Medicare fraud and abuse by turning in their own doctors. Medicare promotes seniors efforts by offering fraud hotlines, "bounties," and other incentives. Third, Medicare receives and investigates numerous complaints from disgruntled former employees, ex-spouses, competitors and even practice partners all accusing doctors of Medicare fraud and abuse. Medicare uses these informants and their tips to launch investigations.

What can you do, before its too late?

First, make darn sure that your patients really need the care plan you are recommending. Are your patients in pain? (sure they are, or they wouldn't be in your office). Are you tracking the ADLs for these patients (the activities of daily living)? You should be asking what kinds of things your patients are unable to do because of this pain.

You are also required to keep track of which of these items are getting better (EACH VISIT you should ask this) along with care. What is the pain scale today? Did the last visit help you with housework, or driving, etc?

If you patients are not notable getting better, then you better make note of it and change your treatment plan to indicate no change and that you are working hard to get them back to 100% (or as close to it as possible for their age). You should also do a full re-exam if they are not better in a very reasonable amount of time.

Another item that is also missed are the GOALs for your patient. You should have short-term goals and long-term goal for every patient you are seeing. Some short-term goals are decreasing pain, improving range of motion, decreasing muscle pain and stiffness. Some long-term goals are how much of a percentage will you have them cured in a specific amount of time.... such as 60% improved within 6 weeks.

These are just a couple of the items we help DCs with everyday and we would like to help you too. We also handle all daily SOAP notes along with the Medicare notes.

For Aug and Sept we are offering a free- chart review. What this means is that you can send us some sample forms and some sample charts and we will review them for you and give you are thoughts on what you are missing.

For information on our EMR program, please visit www.chiro-chart.com and read the short paragraph below.

Alex Niswander

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What is ChiroChart,

And how can it help your practice?

Visit the Chiro-Chart Website

Many doctors have been pushed into a tight spot regarding what to do about patient documentation. Fears of audits are on the rise and a "TravelCard" method is just not going to make the grade in a full treatment audit.

With that being said there are ways to better your notes on your own, but the trade off becomes your time. I guarantee that any doctor can have better notes, but how much time can you free up to put more into your notes?

ChiroChart was created to help you have better notes and spend much less time to get them. This is a fully-customized system that is fast, portable, user-friendly, and affordable. It is tough to find a system that matches this criteria, as well as giving the user (you) the power to modify anything in the program.

The system comes loaded with exams, findings, codes, patient handouts, referral letter templates, patient letters and much,much more.

To learn more about ChiroChart, please visit
www.Chiro-Chart.com

To contact us, send an email to Midwest Software Team

2006-07-31T19:49:00.000-07:00

How Does an Independent Review Organization (IRO) Define "Peer Review"?
By Skip Freedman

Peer review is used in many industry sectors to delineate the use of people who are peers within an industry or an organization who review and judge a person’s performance, work product or other behavior. Peer review has been used for years as a part of academia to review professor’s qualifications and credentials. Peer reviews have also been used in other circles such as accounting and finance. But in the area of health care, peer reviews commonly refers to physicians who look at medical cases in order to make an objective third party decision.

Peer review is also a substitute for the phrase “independent medical review,” where physicians are looking at cases to provide claims decisions for health insurance payers, workers compensation insurance payers, disability insurance payers, etc. Peer review also defines the review of sentinel events in a hospital environment for quality management purposes, such as looking at bad outcomes and determining whether there was any misdiagnosis, mistreatment or any systemic problems involved which lead to that event.

Peer review, independent medical review, hospital peer review, medical peer review, all of those terms are really interchangeable today. Unfortunately in the healthcare environment everybody uses their own vocabulary to talk about the same thing. Today “Peer Review” at AllMed Healthcare Management is really a substitute for the words that we prefer to use, either “independent medical review” or “hospital peer review”. In either case, the core peer review function is to take physicians who are not a party to a particular treatment but who are board certified and in active practice in that same area of treatment, and have them examine certain cases in order to provide objective, unbiased determinations on what the root cause of the treatment was—whether or not there is medical necessity, if there was a sentinel event, what was the reason for it, etc.

I hope this clarifies the use of those different terms.

About AllMed Healthcare Management Founded in 1995, AllMed is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base for its independent medical review and hospital peer review services includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers. Read the AllMed Medical News Blog and the Independent Review Organization Blog.

Article Source: http://EzineArticles.com/?expert=Skip_Freedman

2006-07-31T19:42:00.000-07:00

Improving Internal Medical Peer Review
By Skip Freedman

We still run across healthcare organizations wanting to build and maintain their own panel of physicians to perform medical peer reviews. This may have been a good practice in the distant past; however, current industry best practices suggest considering a more efficient approach.

Outsourcing has become a popular practice in the United States. This trend is based on solid benefits— reduced cost, resource flexibility and core expertise. In the past, many healthcare organizations sought to “own“ all the resources required to deliver their services and manage their business. Today, forward-thinking organizations are more likely to shed non-strategic, non-core pieces of their business, outsourcing them to specialty providers.

Let´s explore the wisdom behind outsourcing internal medical peer reviews to an independent review organization (IRO). This is an especially important topic for organizations that have already invested in building a panel of physicians to assist with internal reviews.

First, there is the high cost of building and maintaining a panel of specialists who are independent, credentialed, licensed, in active practice and board certified. In some hospitals, there is only a single specialist on staff for a specific narrow practice area. Clearly this physician cannot serve on his or her own peer review committee. The process of building and maintaining a panel that can serve specialty practice areas is very costly especially if there is a small volume of cases to amortize the cost.

Second, the changing standards of care, along with new experimental and investigational treatments, impact patient care decision-making. With the rapid advancement in medical treatments and technology, it is very difficult for an in-house panel of physician specialists to keep up with the latest advancements in all areas of medicine. The best IRO´s are constantly recruiting and credentialing specialists who have cutting-edge knowledge that can be applied to improve the overall quality of medical reviews.

Third, there is the need to assure that medical reviews are completely independent and impartial. It is difficult to make this claim when the experts are all members of the organization´s own panel. Using an outside provider assures an arms-length evaluation based on the case´s facts without a hint of contamination from existing business, personal and professional relationships that might exist among members of the panel.

Finally, by using an IRO, healthcare organizations can easily expand or contract to meet the volume of peer reviews actually required. When reviews are done in-house, there are only two choices: plan for maximum capacity which is very expensive, or let the cases queue longer when demand is higher. The latter strategy becomes problematic if the organization is subject to specific state or federal deadlines.

When all of these elements are considered, it´s clear that many healthcare organizations are better served by outsourcing their medical reviews to an IRO. What about your organization? What does your process look like? Is it time to re-invent the way you conduct medical reviews?

About AllMed Healthcare Management

Founded in 1995, AllMed is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base for its independent medical review and hospital peer review services includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers. Read the AllMed Medical News Blog and the Independent Review Organization Blog.

Article Source: http://EzineArticles.com/?expert=Skip_Freedman

2006-07-26T04:41:00.000-07:00

Osteopathy Is Different To Chiropractic Healing
By Eric Cho

Osteopathy is a system of healthcare based on the belief that disease is the direct result of the relationship between physiological function and anatomical structure. In osteopathy, function and structure are interdependent. A healthy musculoskeletal system plays a pivotal role in recovery and disease prevention. ‘Structure governs function’ – this is the tenet of osteopathy. By structure, this means muscles, ligaments, bones, organs and fascia.

The credit for initiating this system of healing is given to Andrew Taylor Still, who started this treatment at the end of the American Civil War. According to Still, disease happens when the bones are out of place thus disrupting the flow of the blood or hampering the flow of nervous impulses. He therefore concluded that diseases can be cured by manipulating the bones, which in turn, helps to restore the flow.

This system has much in common with Chiropractic techniques where the correct alignment of bones is given the utmost emphasis. Originally Osteopathy used strictly manipulative techniques for correcting abnormalities. However, over the past years, Osteopathy has embraced all aspects of modern medicine including drugs and corrective surgery.

Doctors who practice Osteopathy know how important it is to have a proper and correct understanding of the exact position and correct function of each of the structure in the body. Those who practice Osteopathy look for abnormalities in the working relationship within and between the various structures. According to these physicians, the physical integrity of the entire musculoskeletal system is one of the most important factors that contribute to good health.

Osteopathy has a lot in common with orthodox medicine as well. However, Osteopathic doctors are not merely bone-specialists. Instead, they are grandmasters in the ‘biomechanics of the human machine’. The way in which they approach disease and carry out treatment is therefore completely different from orthodox medicine.

The holistic approach to healing aims to take advantage of the body’s ability to heal itself. Osteopaths believe that health, not disease, is the natural heritage of every living thing. They focus all their attention on tracing any changes in function that have taken place within the structures. Within certain limits, the human body, like every other organism, has the ability to repair and correct itself. If given enough ‘support’, it can create its own remedies. The ‘support’ to be given includes:

- A balanced diet

- Good circulation

- Positive attitude

- A pollution free environment.

This self-healing is the backbone and sustaining principle behind all the applications of Osteopathy. According to these doctors, disease basically originates from within the individual himself. So, their main focus is the patient and not the micro-organism that invades his body. If the disease has reached a stage where the micro-organism has changed the structure beyond the point of no-return, Osteopathy tries to help the person function as best as he can.

Osteopathy differs to chiropractors in that the therapist uses massage during a treatment session to help the muscles retain the memory of the manipulation done to the bones and hence restore the flow of nerve impulses through the body to promote healing.

Osteopathy relies on various techniques that are combined with postural, dietary and occupational advice. Counseling patients who are recovering from illness and injury and those who are under excruciating pain is also a very useful part of this healing technique. Osteopathy also allows the use of invasive therapies when all else fails.

Alternative Holistic Medicine

Article Source: http://EzineArticles.com/?expert=Eric_Cho

2006-07-26T04:40:00.000-07:00

Medical Billing, HIPAA Compliance, and Role Based Access Control
By Yuval Lirov

HIPAA compliance requires special focus and effort as failure to comply carries significant risk of damage and penalties. A practice with multiple separate systems for patient scheduling, electronic medical records, and billing, requires multiple separate HIPAA management efforts. This article presents an integrated approach to HIPAA compliance and outlines key HIPAA terminology, principles, and requirements to help the practice owner to ensure HIPAA compliance by medical billing service and software vendors.

The last decade of the previous century witnessed accelerating proliferation of digital technology in health care, which, along with reduced costs and greater service quality, introduced new and greater risks for accidental disclosure of personal health information.

The Health insurance Portability and Accountability Act (HIPAA) was passed in 1996 by Congress to establish national standards for privacy and security of personal health data. The Privacy Rule, written by the US Department of Health and Human Services took effect on April 14, 2003.

Failure to comply with HIPAA risks accreditation and reputation damage, lawsuits by federal government, financial penalties, ranging from $100 to $250,000, and imprisonment, ranging from one year to ten years.

Protected Health Information (PHI)

The key term of HIPAA is Protected Health Information (PHI), which includes anything that can be used to identify an individual and any information shared with other health care providers or clearinghouses in any media (digital, verbal, recorded voice, faxed, printed, or written). Information that can be used to identify an individual includes:

Name
Dates (except year)
Zip code of more than 3 digits, telephone and fax numbers, email
Social security numbers
Medical record numbers
Health plan numbers
License numbers
Photographs

Information shared with other healthcare providers or clearinghouses

Nursing and physician notes
Billing and other treatment records

Principles of HIPAA

HIPAA intends to allow smooth flow of PHI for healthcare operations subject to patient's consent but prohibit any flow of unauthorized PHI for any other purposes. Healthcare operations include treatment, payment, care quality assessment, competence review training, accreditation, insurance rating, auditing, and legal procedures.

HIPAA promotes fair information practices and requires those with access to PHI to safeguard it. Fair information practices means that a subject must be allowed

Access to PHI,
Correction for errors and completeness, and
Knowledge of others who use PHI

Safeguarding of PHI means that the persons that hold PHI must

Be accountable for own use and disclosure
Have a legal recourse to combat violations

HIPAA Implementation Process

HIPAA implementation begins upon making assumptions about PHI disclosure threat model. The implementation includes both pre-emptive and retroactive controls and involves process, technology, and personnel aspects.

A threat model helps understanding the purpose of HIPAA implementation process. It includes assumptions about

Threat nature (Accidental disclosure by insiders? Access for profit? ),
Source of threat (outsider or insider?),
Means of potential threat (break in, physical intrusion, computer hack, virus?),
Specific kind of data at risk (patient identification, financials, medical?), and
Scale (how many patient records threatened?).

HIPAA process must include clearly stated policy, educational materials and events, clear enforcement means, a schedule for testing of HIPAA compliance, and means for continued transparency about HIPAA compliance. Stated policy typically includes a statement of least privilege data access to complete the job, definition of PHI and incident monitoring and reporting procedures. Educational materials may include case studies, control questions, and a schedule of review seminars for personnel.

Technology Requirements for HIPAA Compliance

Technology implementation of HIPAA proceeds in stages from logical data definition to physical data center to network.

To assure physical data center security, the manager must
Lock data center
Manage access list
Track data center access with closed circuit TV cameras to monitor both internal and external building activities
Protect access to data center with 24 x 7 onsite security
Protect backup data
Test recovery procedure

For network security, the data center must have special facilities for
Secure networking - firewall protection, encrypted data transfer only
Network access monitoring and report auditing

For data security, the manager must have
Individual authentication - individual logins and passwords
Role Based Access Control (see below)
Audit trails - all access to all data fields tracked and recorded
Data discipline - Limited ability to download data

Role Based Access Control (RBAC)

RBAC improves convenience and flexibility of systems management. Greater convenience helps reducing the errors of commission and omission in granting access privileges to users. Greater flexibility helps implement the policy of least privilege, where the users are granted only as much privileges as required for completing their job.

RBAC promotes economies of scale, because the frequency of changes of role definition for a single user is higher than the frequency of changes of role definitions across entire organization. Thus, to make a massive change of privileges for a large number of users with same set of privileges, the administrator only makes changes to the role definition.

Hierarchical RBAC further promotes economies of scale and reduces the likelihood of errors. It allows redefining roles by inheriting privileges assigned to roles in the higher hierarchical level.

RBAC is based on establishing a set of user profiles or roles according to responsibilities. Each role has a predefined set of privileges. The user acquires privileges by receiving membership in the role or assignment of a profile by the administrator.

Every time when the definition of the role changes along with the set of privileges that is required to complete the job associated with the role, the administrator needs only to redefine the privileges of the role. The privileges of all of the users that have this role get redefined automatically.

Similarly, if the role of a single user is changed, the only operation that needs to be performed is the reassignment of the user profile, which will redefine user's access privileges automatically according to the new profile.

Summary

HIPAA compliance requires special practice management attention. A practice with multiple separate systems for scheduling, electronic medical records, and billing, requires multiple separate HIPAA management efforts. An integrated system reduces the complexity of HIPAA implementation. By outsourcing technology to a HIPAA-compliant vendor of vericle-like technology solution on an ASP or SaaS basis, HIPAA management overhead can be eliminated (see companion papers on ASP and SaaS for medical billing).

Yuval Lirov, PhD, author of "Mission Critical Systems Management" (Prentice Hall, 1997), inventor of multiple patents in artificial intelligence and computer security, and CEO of Vericle.com Billing Technologies. Vericle delivers comprehensive practice workflow engine that integrates patient scheduling, electronic medical records (EMR), billing, transcription, and compliance management. It improves billing performance and reduces audit risk. Yuval invites you to post questions about and share your knowledge of medical billing and compliance at BillingWiki.com.

Article Source: http://EzineArticles.com/?expert=Yuval_Lirov

2006-07-26T04:38:00.000-07:00

Sell Structured Settlement Payments
By Eric Morris

An injury or an accident can be very devastating, considering the expenses that you will have to pay, especially if you need to rest and can’t work for a couple of months or years.

The good thing is that structured settlements now form part of personal injury claims, as well as worker’s compensation claims. Structured settlements are payments given to the injured claimant in regular installments. You can receive these annually, semiannually or quarterly, depending on the terms that you and the insurance company have agreed on.

The benefit of having these structured settlement payments over the lump sum amount is that you can actually pay your present expenses and future ones. However, because of the continuous increase in prices, you eventually need more money, especially if unexpected expenses arise such as healthcare costs and other fees. Or maybe you need money for a college education or for a new business venture. You may decide to sell your structured settlement payments.

A lot of people choose to sell their structured settlement payments for an immediate need. Even if these payments provide enough, it is long-term financial security. If you need to pay something urgently, you have to sell to get a lump sum amount. But you have to take note that it is not easy to sell these payments. You have to secure a court order first before you can start looking for brokers to give you quotes.

Talking to your attorney is the first thing that you should do if you are considering selling your structured settlement payments. Your attorney can help you determine if it is really a wise move. If there is indeed a need, then the attorney can help you go through the process of securing a court order, so you can sell the structured settlement payments.

Sell Structured Settlements provides detailed information on Sell Structured Settlements, Sell Structured Insurance Settlements, Sell Structured Settlement Payments, Sell Structured Settlement Companies and more. Sell Structured Settlements is affiliated with Structured Settlement Brokers.

Article Source: http://EzineArticles.com/?expert=Eric_Morris

2006-07-15T04:50:00.000-07:00

Medical Billing Control with Computer Aided Coding
By Yuval Lirov

The average practice submits half of its codes wrong, while some practices rarely exceed more than one code right out of every five codes. Inexact and inconsistent coding increases the risks of undercharging, overcharging, and post-payment audit. This article outlines evolution of coding from individualistic art towards disciplined and systematic process.

It is convenient to review the role of coding in the context of the entire claim processing cycle, which consists of patient appointment scheduling, preauthorization, patient encounter note creation, charge generation, claim scrubbing, claim submission to payer, and followup, which in turn includes denial or underpayment identification, payment reconciliation, and appeal management. The importance of thorough knowledge and correct application of coding rules at the charge generation stage of claim processing cycle are well known and have been frequently discussed. Less obvious but no less important is the ability to make correct interpretations of the same rules at the claim followup stage during denial or underpayment analysis and upon receiving payment and explanation of benefits.

Coding is difficult because of a four-dimensional complexity. First, the sheer volume and intricacy of coding rules make it difficult to select the right procedure code, correct modifier, and necessary diagnosis code for the given medical note. For instance, a claim will get denied if you charged for two CPT codes but provided an ICD-9 code that shows medical necessity for one CPT code only. Next, the payer-specific modifications exacerbate the complexity of coding, creating the need to code or process differently the same procedures depending on the payer. For example, some payers require medical notes attached to some CPT codes in addition to standard ICD-9 codes. Third, the codes and regulations change over time, necessitating continuous coding education and re-education. Finally, charge generation and claim followup are disconnected in space and time and often performed by different people, adding to confusion and costs of the claim processing cycle.

Only experienced coders can handle such complexity but experience too often turns into handicap as, in the absence of a reliable self-correcting process, the coder or the followup person may repeat the same mistake over and over. Hence ad hoc coding is error-prone and expensive. Paper superbill-driven coding improves upon traditional coding because it allows fewer errors and eliminates some of the costs. Computer aided coding with integrated superbill completes the transformation of coding from individualistic art towards disciplined and systematic process and is the most reliable and least expensive solution.

Traditional Coding

Since the practice owner is ultimately responsible for coding quality, it behooves the physician to manage personally the coding process. But traditionally, in the absence of systematic practice management, the physician looked for a coding approach to avoid the burden of coding. Such an approach to coding is error-prone and expensive. According to the Healthcare Financial Management Association's "Tip Sheet: Medical Claims Denial Management," the average error rate for CPT coding is 45%-55%. Some specialties (e.g., interventional radiologists) have trouble exceeding even 18% of correct coding, according to the March 2003 issue of "Healthcare Biller: The Communication Network for America's Health Care Billers," a monthly newsletter from Aspen Publishing.

Traditional coding involves the doctor, data entry personnel, and certified coder. The doctor dictates, types, or handwrites descriptions of diagnosis and procedures, without listing actual codes. The data entry personnel enter codes based on reading doctor's descriptions, and the certified coder supervises and audits the quality of coding by the data entry personnel.

Traditional coding process is error-prone because the certified coder does not audit 100% of entered codes and because such process does not have a vehicle for context maintenance between the charge creation and claim followup stages. The errors may become especially expensive upon post payment audit of the charges by the insurance company. This process is also expensive because multiple people are involved in the coding process and because the errors, if discovered at all, will be discovered only downstream, rising the costs of error correction.

Paper Superbill-driven Coding

Pre-compiled superbill-driven coding process places the doctor in control of coding, ties together claim creation and followup stages, and avoids many shortcomings of traditional coding. Such a process delivers two-fold advantage of lower cost and improved communication. First, the doctor codes at the end of patient encounter without involving data entry personnel in the middle. Second, the paper superbill serves the role of a formal vehicle for coding information communication between charge creation and claim followup stages. Additionally, a pre-compiled superbill improves coding consistency across the doctors within the same practice.

Superbill creation process has four stages:
1. List the codes used most often first. Use CPT frequency report.
2. List the diagnosis codes
3. Leave room for ancillary services
4. Include patient's information

Along with the advantages over the traditional coding process, the paper-based superbill still has four shortcomings. First, the data must be re-entered into the system from the paper superbill, introducing potential for errors. Next, the superbill must be reviewed periodically to adjust for changes in practice operations. Worse, it is difficult to keep up with changes in coding regulations, necessary modifiers, and bundling decisions that differ across various payers. Finally, the paper superbill contributes nothing to upfront coding error identification and correction, delaying potential error identification and resolution to post-submission, or worse, post-payment phases. Obviously, the later in the process the error is identified, the more expensive is its correction.

Computer Aided Coding with Integrated Superbill

Computerization and integration overcome most of the problems of paper superbills, eliminating duplicate data entry, automating code review and adjustment for frequency, practice operations, and payer idiosyncrasies, and shifting much of the error identification and correction from post-payment stage to claim pre-submission stage.

Computer aided coding with integrated superbill offers multiple advantages:
1. Dynamic - Adjusts for changes in practice operations and payer specifics. For instance, adds automated alert to satisfy unique payer demands, such as requests for paid drug invoices in addition to injection CPT code and J code for supplies.
2. Precise - Matches codes to EMR and alerts in real time about potential coding errors, such as confusing modifiers 59, 76, 77, and 91 for repeat procedure or test, or not coding the ICD-9 code to the highest level of possible digits in spite of specific diagnostic available in EMR.
3. Defensive - Allows for real-time profiling of coding patterns to alert about potential audit flag.
4. Reliable - Facilitates end-of-day juxtaposition of visits with charges, avoiding unpaid visits.
5. Inexpensive - The doctor can use it directly, eliminating extra data entry step and associated costs.

In summary, coding is a mission-critical responsibility of practice owner. Computer aided coding with integrated superbill places the doctor in control and enables dynamic, precise, reliable, consistent, defensive, and inexpensive coding process. Superbill digitization and integration overcome the four-dimensional coding complexity, tie it to EMR, patient scheduling, and billing (i.e., to the entire spectrum of practice management functions), and require powerful Vericle-like computing platforms.

Yuval Lirov, PhD, author of "Mission Critical Systems Management" (Prentice Hall, 1997), inventor of multiple patents in artificial intelligence and computer security, and CEO of http://www.vericle.com (medical billing technologies). Vericle delivers comprehensive practice workflow engine that integrates patient scheduling, electronic medical records (EMR), billing, transcription, and compliance management. It improves billing performance and reduces audit risk.

Yuval invites you to post questions about and share your knowledge of medical billing and compliance at http://www.billingwiki.com.

Article Source: http://EzineArticles.com/?expert=Yuval_Lirov

2006-07-15T04:42:00.000-07:00

It Pays to Understand About Medical Billing
By Jeffrey Meier

Medical Billing is the process of submitting claims to insurance companies to receive payment by a doctor or health care provider for the services rendered by him to a patient.

When the patient comes to the health care provider, he first examines the condition of his patient and then makes a medical record depending on the examination. The medical report will contain a summary of treatment given to the patient and demographic information related to him.

The Process:

Medical Billing will take place after an interaction between the heath care provider and the insurance company. To determine the procedure code the treatment given, the diagnosis and the duration of the treatment will be combined and then used to bill the insurance company. The provider can do this with the help of a billing specialist or a medical coder after which a billing record will be generated. This claim is then passed either directly to the insurance company or to a clearing house which plays the role of an intermediary.

After this the procedure for medical billing will begin with the insurance company first checking if the claim is valid or not. They do this by checking the patient eligibility for payment, credentials of the health care provider and medical necessity. Once this test is passed the provider will get his claim but if the claim fails the test the claim gets rejected. The provider will be notified immediately.

The good thing about medical billing is that even after getting rejected, the provider can resubmit the claim by reconciling with the original claim and making necessary corrections. Until the provider gets his claim this exchange of claims and messages may repeat multiple times. It has been recorded that the frequency of rejection is almost 50%.
Before all medical billing used to take place on paper but thanks to computers now this can be managed efficiently no matter how large the amounts of claims are. Even medical billing softwares are available in the market.

The Amount Paid:

The insurance never pays the full amount claimed by the provider. Depending on the amount negotiated by the company and the provider, the original claim gets reduced. This gets further reduced if the patient has a deductible, copay or a coinsurance. A coinsurance means the patient has to pay certain percentage of the amount. If a patient has copay then the doctor will be paid the negotiated amount minus the copay amount. If the patient has a deductible say $200 then he would have to pay this amount in installments until the deductible is met at which point the insurance would begin to cover a portion of the charge.

When choosing a billing center first find out about their reputation. Past experience always counts. It is not necessary that it should be a big billing company even small companies can offer the best service that you want. You just have to look for them and moreover they can offer your practice a more personalized service!

Jeffrey Meier of jam727 Enterprises offers more detailed Medical Billing information at http://www.jam727.com/medicalbilling.htm The website has many other interesting and enlightening articles for your informational needs.

Article Source: http://EzineArticles.com/?expert=Jeffrey_Meier

2006-07-08T06:24:00.000-07:00

Medical Professionals Indirectly Speeding Up Payments from Insurance Companies and Medicare
By Cassandra Ingraham

Many medical professionals say that managing their accounts receivable is one of the most time consuming task in their business management. Due to the long process associated with reimbursement from third party payers, the need for medical accounts receivable financing has greatly increased.

A/R Funding (Accounts/Receivable) is the selling of your account receivables for cash versus waiting 60 or 90 days to be paid by the Insurance company, Medicare or Medicaid.

A Healthcare Accounts Receivable Funding company purchases receivables of rated health insurance companies and governmental agencies. The monthly service fee (tax deductible) is a flat fee that is deducted from the remittances. The actual fee amount is based upon a number of factors including average turn around time of the remittances, average claim size and overall account size. The actual funding can take place within 3 to 5 days.

Different Lenders handle the Funding processes differently. Usually an Accounts Receivable Broker will select a company based upon location. Sometimes it helps if the Medical facility and the Accounts Receivable Funding source are in the same geographical area.

The sale of receivables creates no additional debt to the balance sheet and the monthly fees are 100% deductible.

Medical Accounts Receivable Funding sources are thoroughly familiar with the laws and limits of Medicare, Medicaid Insurance companies and third party payers.

Clients who may need Accounts Receivable Funding usually are too new to obtain bank financing
or need accounts receivable financing for payroll, expansion and/or working capital.

Regardless of the financial needs, Healthcare A/R Financing is a unique industry with unique solutions. To receive more information or to be referred to a Lender that can help your particular healthcare business, http://www.taxeswilltravel.com/Application.htm complete the short 5 question online pre-application and get your pre-qualified reply in a matter of hours.

Cassandra is a Registered Tax Professional and Instructor for Basic Tax Classes in the San Francisco Bay Area. During the balance of the year she can be found at http://www.taxeswilltravel.com locating Accounts Receivable Funding for clients and potential clients.

Article Source: http://EzineArticles.com/?expert=Cassandra_Ingraham

2006-07-08T06:22:00.000-07:00

It Will Eventually Happen to You-What to do When you Have to File an Auto Insurance Claim
By Mike Long

It's bound to happen. Sooner or later, if you drive long enough, you're likely to have some sort of automobile accident. With luck, it will be minor. But irregardless, knowing how to handle an auto insurance claim can possibly save you thousands of dollars.

If you are involved in an accident, particularly in moderate to severe accidents, the first thing you need to do is contact the police. They will arrive quickly and help you sort out what happened, who may be at fault, and contact towing companies to remove your vehicle from the scene of the accident if necessary.

The second thing you should do is contact your insurance company. They will likely want the insurance information of the other driver. Get that information from the other driver if possible, but if they are angry or uncooperative, do not push them. They must give that info to the police, and your auto insurance company can get it that way if necessary in order to process your claim. It takes longer, but it can still be done. This also saves you from escalating an already stressful situation if the other driver is extremely agitated.

An auto insurance claim is simply a process by which you are covered in the event of an accident. If you were at fault in an accident, your insurance company will conduct an investigation, and pay for damages. This will likely result in an increase in your premium, or if you have had multiple accidents over the past few years, your insurance company may drop you completely.

If another party was at fault for the accident, your insurance company will handle to process of handling the claim with the other drivers insurance company. Depending on the severity of damage to your vehicle, they will either issue you a check for the current market value of the vehicle, or they will provide you with information about where you can take your vehicle for repair.

The process of filing auto insurance claims is a very stressful one. However, one possible benefit to this unfortunate event is that you learn quite a bit about your insurance company in the process. It's very easy for companies to promise the world, until you actually need them. At this point, you have the opportunity to evaluate how they treat you as a paying customer. Are they responsive when you contact hem? Do they process your claim quickly? Do they get you back on the road with a repaired vehicle or a check in a timely manner? Do your rates go up? Do they drop you?

As difficult as it may be to go through, there is simply no better way then having to file an auto insurance claim, to find out if you are with the right company. Here's hoping you don't have to find this out for many, many years to come!

Mike Long is a successful Webmaster and publisher of http://www.AutoInsuranceSuperguide.com - a website that specializes in providing auto insurance advice including learning about Automobile Insurance Rules that you can research anywhere, anyplace, anytime. Be sure to sign up for his newsletter too!

Article Source: http://EzineArticles.com/?expert=Mike_Long

2006-07-06T03:57:00.000-07:00

Alternative Medicine Re-defined
By Michael Russell

The American Heritage Dictionary of the English Language defined healthcare as the prevention, treatment and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions. If we follow this definition of medical care, then alternative medicine would be seen as the use of other means, either as a complement or in place of conventional orthodox medical care. This nomenclature and definition have relegated natural medicine to a second class status and unfortunately, this has been accepted by almost everybody involved.

Realistically, it might be foolish to attempt to regard natural medicine as superior and of more benefit compared to orthodox medicine; however, it won't be unreasonable to opine that both means of achieving balanced physical and mental health stand on equal grounds, both with its shortcomings and merits.

Most of the prejudice about natural medicine (or alternative medicine, if you want), is grounded on the premise that the procedures and substances employed are not scientifically proved, as far as modern science is concerned. But the fact remains that, if we look deep enough, there is countless research and evidence to prove the efficacy of most natural cures. Talking about scientific proof, you and I can name a couple of orthodox drugs that were certified safe and good for consumption by all agencies involved and later recognized to be damaging to health, after countless innocent people had lost their lives or suffered debilitating disabilities as a result of these drugs.

Let's face the fact, even in the most developed countries of the world, today, millions of people are every day becoming disillusioned with orthodox drugs and their approach to health and illness. Modern science is basically concerned with managing a disease after it has occurred, how far has this got us? There are countless numbers of terminal illnesses that have defied modern medicine. Natural medicine is unarguably better in this respect. Natural medicine, for the great part, is concerned with maintaining health and preventing illness instead of managing diseases. Nature is replete with substances, herbs, just name it, that when effectively used, can guarantee that you will hardly fall sick.

Besides herbs and other natural substances, natural medicine can boast several procedures that have been shown to be very effective. Let's talk acupuncture for example. This simple procedure has been in practice for over two thousand years and has remained as effective as ever. Long before modern medicine, acupuncture practitioners realized that there are several energy pathways in the body and by interrupting or stimulating energy flow across these pathways, the body is stimulated to enhance self healing, improve body function and provide an overall boost to the body system.

Look at massaging or yoga that have even been accepted by most medical practitioners as a complement to orthodox medicine. These procedures have been proved to be effective both in improving mental and physical health as well as emotional health. There are also innumerable nutritional supplements made with natural substances that are known to promote health and prevent several disease conditions. Although modern science would want us to believe that these procedures and substances are not medically or scientifically proved to be safe for consumption, one reasonable question to ask is whether the medically or scientifically proven orthodox drugs have been really safe.

So far, one can conveniently conclude that orthodox and natural medicines are both man's attempt to ensure better health, making use of the intelligence and materials that nature has provided him; thus, one approach might not be placed above the other, both should be seen as different approaches to the same problem.

Michael Russell
Your Independent Alternative Medicine guide.

Article Source: http://EzineArticles.com/?expert=Michael_Russell

2006-07-06T03:55:00.000-07:00

California Blue Cross Health Insurance – An Overview
By Elizabeth Newberry

Blue Cross of California, one of the state’s largest and most respected
healthcare providers, has been in business for over 60 years. As times have
changed, so has the company – making sure the almost 7 million people they serve
get adequate health insurance.

The numbers are impressive – Blue Cross of California boasts more than 40,000
preferred provider physicians, 27,000 HMO physicians, and almost 4,000 vision
providers. The company has over 400 participating hospitals and medical
facilities. Blue Cross employs around 6500 employees statewide.

Not surprisingly, Blue Cross offers a wide range of plans and services ranging
from several different medical and dental plans to disability and life
insurance. Their wide range of plans, services and deductibles means a health
plan for everybody, regardless of income or situation. They also offer several
dental and vision plans as well as the workers’ compensation coverage, as
required under state law.

Blue cross also offers health insurance under its “tonik health” subsidiary,
aimed at young active people and priced with several different deductible plans
offered.

Obtaining prescription drugs is inexpensive and convenient under most Blue Cross
plans. The company administers prescription drugs and medication through its
subsidiary company called Wellpoint. The company also offers a diverse array of
specialist insurance products such as COBRA coverage, flexible spending accounts
and pharmacy benefit management.

Blue Cross of California has a strong track record of innovation, and is proud
of its ability to offer products to a diverse population – individuals,
businesses of all sizes and seniors. They also provide health insurance for
seniors and others eligible for state health insurance.

They also have a proud record of collaboration with education institutions and
local organizations in helping with various health-related research projects.
Blue Cross recently won a prestigious award from the EPA (Environmental
Protection Agency) for its work in helping asthma sufferers – it’s the only
health plan to receive such an award.

Visit our website to
find the best term life insurance company, to get
home insurance Phoenix, or to get
health insurance Dallas.

Article Source: http://EzineArticles.com/?expert=Elizabeth_Newberry

HCFA 1500 Forms w/bar code

2006-06-28T16:16:00.000-07:00

For sale: HCFA 1500 forms w/barcode, $10.83 per 500 plus shipping. Fax order to 469.574.5069 or email us at hcfaorders@phmnetwork.com.

Accepted form of payment MC/Visa or Check by Fax.

Call 972.245.1315 for more information.

2006-06-28T06:20:00.000-07:00

Cheap Insurance - Ten Tips
By Steve Gillman

Cheap insurance? Auto insurance, life insurance, health insurance, liability insurance - whatever type of insurance you need, you can buy it for less. Try the following:

1. Raise you deductible. Why have a $100 deductible if a $1000 deductible won't break you? It may hurt to pay the first thousand someday, but what if meanwhile you saved several thousand? High deductibles mean lower rates. Of course, get quotes with various deductibles, to be sure you're saving enough for the higher risk.

2. Lower your coverage. Insurance agents secretly admit that people usually get sued according to policy limits. You'll be sued for more if your limit is a million than if it's a hundred thousand. A judgement beyond the policy limits is a scary thought, but this can happen no matter what your limits are. If you don't have many assets or much money in the bank, consider lowering your coverage to save money. Get quotes first, of course, to see how much you'll save.

3. Lower the insurance company's risk. Using seatbelts, not smoking, and having alarm systems can mean cheap insurance. Ask your agent about any discounts that are available.

4. Use an independent agent. Why limit yourself to one insurance company? Independents can show you the cheapest policy regardless of which company it's from. Just check a rating service to see if the issuing company is financially solid, especially when buying life insurance.

5. Drop your insurance. The insurance companies will hate me for this one, but consider eliminating some coverages. You need liability coverage on your car, but collision coverage on a $2000 car doesn't make sense. Invest the money elsewhere, and take the $2000 loss once or twice in your life, or maybe never.

6. Buy stocks instead of insurance. If you and your wife both have good incomes, it probably makes more sense to invest your money than to buy life insurance. If loved ones have enough income or assets, life insurance premiums are usually wasted money.

7. Get rebates. Some states that allows "rebating". California law, for example, allows agents to rebate part of their commission to you. If you live in a non-rebating stae, find a California company online!

8. Get the legal minimums. If you have no assets to protect, ask for state-mandated minimums on auto liability policies. Most companies give you their higher, more expensive "company minimums" if you don't push the point.

9. Review your policies. It is common for parents to still pay for health insurance coverage on adult children long after they are working and have their own coverage. See what other unecessary coverages you may be paying for.

10. Get several quotes. For cheap insurance, compare quotes from several companies, and ask about different policy options. One more thing: take notes.

About The Author

Steve Gillman has been studying every aspect of money for thirty years. You can find more interesting and useful information on his website; http://www.EverythingAboutMoney.info.

Article Source: http://EzineArticles.com/?expert=Steve_Gillman

2006-06-28T06:19:00.000-07:00

Business Health Insurance
By Ross Bainbridge

It is crucial for every business to have some type of health insurance available for its employees. This insurance is typically called “group health insurance.” It refers to “securing” the health of a group of people who are working together for a business or corporation. The goal of group health insurance is to provide employees with health benefits to cover injuries or health problems, and save the business from any problems that may arise after such an incident.

The first thing that needs to be considered is the number of employees that work for the business. Additionally, executive management needs to decide what type of group health services they wish to provide, and how much the company will pay into the policy as opposed to the employees. Options include dental insurance, wellness programs (fitness clubs, weight loss, massage therapy, etc.), prescription drug plans, vision and accidental injury coverage. More complete business health insurance plans include coverage for severe accidents to employees within or outside their working environment. The insurance company takes responsibility taking care of the employee and covers all the economical expenses that may arise.

Insurance companies take into consideration the working conditions of the employees, the business type, as well as the personal characteristics of each employee. Personal characteristics are age, martial status, etc. The insurance company evaluates the probability of risk and then arranges the health insurance plan along with the business.

To sum up, business health insurance is aimed at providing a secure environment for both the employer and the employee. The available options vary for each insurance company, and the insurance quotes depend on different factors such as the number of employees and the type of business.

Business Insurance provides detailed information on Business Insurance, Business Health Insurance, Business Liability Insurance, Business Insurance Quotes and more. Business Insurance is affiliated with Small Business Owner Health Insurance.

Article Source: http://EzineArticles.com/?expert=Ross_Bainbridge

2006-06-22T06:54:00.000-07:00

Medicine Is The Third Leading Cause Of Death In United States
By Bryan Brodeur

The American Medical Association’s own esteemed research journal, the Journal of the AMA or JAMA has revealed a frightening statistic: In the United States alone, the third leading cause of death by any means is medically caused death.

What this means is that heart disease is our number one killer, cancer is our number two killer, and the conscientious following of medical protocols is the number three killer of people in our culture; a frightening fact for those of us who blindly accept a doctor’s advice as bible truth.

Here is how these deaths played out statistically, according to Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health:

- 12,000 patients died due to unnecessary surgery

- 7,000 patients died due to medication errors in hospitals

- 20,000 patients died due to other errors in hospitals

- 80,000 patients died due to infections in hospitals

- 106,000 patients died due to non-error, negative effects of drugs

These total to 225,000 deaths per year from iatrogenic causes!

Iatrogenic is a word that means death caused by the care of a physician. Take a long look at the 106,000 people who died from non-error: these are people who died taking the right pill at the right time, exactly as their doctor had told them to. Take a moment to consider that before you swallow your next prescription.

Now, take a moment to think about this, because it is important you understand the thrust of this concept: blindly following your doctors orders can be the most deadly decision you ever make about your health.

Your health comes from inside of you. Your body is nature’s ultimate machine. Why on earth would you ever be backed into such a corner that you would rely on medications or on surgery for your health? How were we ever convinced that opening our bodies with knives or poisoning our bodies with deadly chemicals would ever resolve our health issues?

So, if medicine is the third leading cause of death, what can we do to avoid falling into its traps? How do we know if the pill we are taking today, the same pill we have taken for years, will or will not be the pill that causes a violent, deadly reaction inside of us? Unfortunately, the answer is: we don’t know.

All we know for absolute certain is that every medication is a toxic chemical. Every surgery is an invasion of toxic chemicals and a violation of our internal order.

Your best bet is to learn more about your body and your health: to think beyond what the medical world is feeding you. In order to escape the pitfalls of the medical system, you have to know more about yourself and about the natural doctors of healthcare.You were not designed to be reliant on a pill or needing a surgery. You body is literally nature’s ultimate machine, dwarfing all of the powers of a hospital.

In every heartbeat you create and distribute the right drug at the right time for the right condition, sending it to the right spot in your own body with no side effects and with no need for outside intervention. Your body, when running at its peak, requires no outside interference. All your body needs is for you to make sure it is running at its peak. Drugs and surgeries only cause complications and get in the way of your internal natural ability to heal.

Consult with a chiropractor, a doctor who will help you remove internal interferences and imbalances. Learn to balance and strengthen your own body. Leave drugs and surgeries as your absolute last resort when making any health care decision.

Finally, and I will repeat this because it is so vitally important: get to know exactly how your body actually functions. Discover the power of a balanced, toned, and flexible body. The advantages you will gain when you focus on yourself and seriously take advantage of the incredible body you were born with will go way beyond simple health. Your personal power and your mental focus demand that you maintain your body in the shape it was designed to run in.

Your health and your life depend on how well you know your body, how to restore it to its full balance and flexibility, and how to harness the incredible powers you were born with.

About the Author:

Dr. Bryan Brodeur has a Family Chiropractic Clinic in St. Albert, Alberta, Canada, is the owner of the health web site, VitalityHouse, and the author of the fitness e-book, Vitalism.

Article Source: http://EzineArticles.com/?expert=Bryan_Brodeur

2006-06-22T06:53:00.000-07:00

Are HMO's Healthy For You?
By Nick Arrizza, M.D.

Over the last 15 years there has been a cry to curb the costs of health care and from this cry has arisen the HMO or Health Maintenance Organization. This entity which is more common in the US has in the last 5 years also begun to creep into Canada.

The philosophy behind HMO's is that efficient business practices can help curb health care costs and by doing so also improve the quality of healthcare.

Is this however actually happening?

Well let's take a closer look.

Physicians who work in HMO's are caught, in a manner of speaking, between a "rock and a hard place".

That is they are caught between maintaining costs of providing services below a certain defined threshold while providing the top quality healthcare demanded by their patients. Their ability to achieve this feat ultimately becomes a measure of their performance and is reflected in their income.

In today's litigious healthcare environment the cost of personal liability insurance has risen significantly across the profession in North America. Most of these costs are born by individual physicians.

As conventional medicine rarely attempts to uncover and treat the underlying causes of illness, rather it aims at symptom control, most patients are essentially placed "on ice" until their problem festers and re-erupts in some other more serious form. The patient then presents once again to the HMO physician who is once again faced with the task of "hiding" the problem.

Each time that "symptom management" is attempted more invasive and harmful treatments need to be employed. These treatments are also increasingly more expensive. Throughout this process the patient is under the delusion that because they are receiving such expensive treatment, supported by expensive and advanced technology, they are receiving top quality healthcare.

In fact this is far from the truth.

What is actually happening is that they are being made progressively more ill and their financial resources are being progressively being depleted.

It's interesting that many individuals are awakening to the truth of what is going on and are beginning to take greater responsibility for their own health by educating themselves about prevention.

Prevention is about proper nutrition, regular exercise, awareness and avoidance of toxic chemicals (i.e. environmental, hygiene products, drugs, alcohol, caffeine, tobacco, EMF's, etc.), regular and ongoing detoxification routines that cleanse the liver, use of therapeutic grade essential oils that boost immune system function, adequate supplementation with minerals & vitamins, regular de-stressing through approaches such as meditation, yoga, MRP, chi gong etc, and so on.

Many will say that they don't have the time or money for such preventative approaches. Well in the long run I would say that it is actually a much cheaper and healthier approach than the conventional one. The only thing that is stopping you from adopting it is fear.

Nick Arrizza M.D. is trained in medicine and psychiatry. He is an international healer and coach as well as the developer of the powerful Mind Resonance Process(TM) MRP

YL Web Site: http://www.youngliving.org/arrizza
Personal Web Site: http://www.telecoaching4u.com

Article Source: http://EzineArticles.com/?expert=Nick_Arrizza,_M.D.

2006-06-19T05:19:00.000-07:00

Medical Coding Salaries
By Kent Pinkerton

A career in the medical profession is a challenge, adventure and competition. One can belong to any of the fields of medical science. One can be a doctor, medical officer, pharmaceutical manager, administrator of a hospital, nurse, medical transcriptor, medical biller, medical coder and much more. However, medical careers are particularly related to the manufacturing, business administrative and management fields of medicine. Among all the careers, one of the most intriguing and interesting fields is that of medical coding.

Medical coding requires a great deal of analyzing and understanding. The average salary for a medical coder is not at all bad. This can be understood through the application of straight and simple economics. There is a considerable rise in the price for those products and services whose supply diminishes, or whose demand increases. In case of the profession of medical coders, the demand has considerably risen over the last few years. As more health tests are performed and there is closer scrutiny of healthcare, the role and importance of this profession is also on the rise, as is the salary.

Medical coders work in a variety of healthcare offices, 37 percent in hospitals. The average salary ranges from about twenty to twenty five thousand dollars, but this amount varies from organization to organization and from time to time.

However, the upper limit sometimes touches and even crosses over thirty-eight to forty thousand dollars, but the lower limit also falls below sixteen thousand dollars. But with the advancement of one’s career, this amount seldom dips.

Medical Coding provides detailed information on Medical Coding, Medical Coding Salaries, Medical Coding Certification, Medical Coding Specialists and more. Medical Coding is affiliated with Medical Billing Services.

Article Source: http://EzineArticles.com/?expert=Kent_Pinkerton

2006-06-19T05:17:00.000-07:00

Medical Careers
By Eric Morris

Careers in medical fields are full of responsibilities; the ability to remain knowledgeable about changing medical technology is very important. As time goes by, a career in the medical profession is more becoming of a challenge, adventure and competition.

A medical career is often the most admired career in the world. A medical career is humanitarian, noble and undoubtedly holds a very bright future for those who are after it. In terms of money, this field is one of the most promising of all. But in order to get into the medical arena, one has to have patience and be willing to give a lot of effort and time in places like medical school, hospitals, nursing homes and so on.

Throughout history, man has always been in search of various ways to cure and heal diseases and injuries. Today, it is the responsibly of medical professionals to promote hygiene, prevent and detect diseases, cure patients by providing proper medication to them and reduce their suffering. The medical world has become a hive of inventions, discoveries and knowledge based on the up to date awareness.

One can belong to any of the fields of medical science. One can be a doctor, a medical officer, a pharmaceutical manager, the administrator of the whole medical and pharmaceutical affairs, nurse, medical transcriptor, medical biller, medical coder and much more. However, medical careers are particularly related to the practice, manufacturing, administrative and management fields of medicine.

There are a number of fields in which one can specialize: Master of Healthcare Administration, RN to BS in Nursing, BS in Health Administration, Doctor of Health Administration, MS in Nursing / MBA / Health Care Management, Healthcare Management, Medical Office Billing and Coding Specialist, Patient Care Technician, Pharmacy Technician, Medical Assisting, Medical Insurance Billing/Coding. Even in the field of medicine, an MBA becomes a priority, as management nowadays plays a key role in this field.

Medical Careers provides detailed information on Medical Careers, Top Medical Careers, Medical Billing Careers, Medical Coding Careers and more. Medical Careers is affiliated with Medical Malpractice Law.

Article Source: http://EzineArticles.com/?expert=Eric_Morris

Time Management in the Medical Billing Workplace

2006-06-10T11:41:00.000-07:00

Managing your time at your job is essential to getting projects accomplished. Most people work for a paycheck, not considering how important their actual job duty may be to their employer.

Prioritizing your work is the first key to managing your time. First of all, if you have deadlines for certain tasks, you need to meet them.

Using a 1-31 file is extremely helpful for daily tasks. For example, if you are researching information, a 1-31 file can be extremely helpful. First get 31 file folders and number them 1 through 31.

Let's use checking insurance claim status as our example. Once your claims are filed, on a daily basis hopefully, print a day sheet or ledger sheet of all claims filed that day. Considering most insurance claims are paid within 2 to 3 weeks, file the "day sheet" 21 days from the date you first filed the claims. If the claims were filed on the first of the month, then "file" your day sheet in the folder marked "14". When the 14th of the month rolls around, pull the folder first thing in the morning to check on claims that should be in process if not already paid. With this method, you have a "daily" task of checking on your work everyday. Claims filed on the second of the month would have their day sheet or ledger filed in the folder marked 15 and so on.

Another way to manage your time is to give yourself time limits on certain aspects of your job duties. As an example, claims should be filed daily and should be the first thing you do in the morning, from charges generated the previous day. Two hours should be sufficient,if not overly generous, to allow yourself to enter your claims. Your next task should be posting payments received from patients and insurance carriers. Depending on the volume, this should account for 2-3 hours of work. As you are posting these payments, you should be able to define any claims that may require a letter to appeal a denial or rejection. If needed, these appeal letters should be generated almost immediately due to time constraints imposed by the insurance carriers.

Once these task are completed, you should have 2-3 hours to check your 1-31 file to call on claims status. Any claims showing not received can be added to the next days charges to refile. Therefore, the next day you use the same process again.

Some medical billing offices may be set up where one person files claims, one person posts payments, one person checks claims status and one person writes all of the appeals. If this is the case in your office, then I would suggest you set goals to accomplish a certain amount of work in a certain time period. You need to be quick but concise. Medical billing is basically an accounting position and should be treated as such.

By Michele Graham, CEO and Owner of Professional Healthcare Management, a billing and credentialing company. She has 41 years experience in the healthcare industry.

http://www.phmnetwork.com

http://phmnetwork.blogspot.com

http://www.healthcarenewsonline.com

Insurance Claims Filing - 10 Top Errors

2006-06-10T11:38:00.000-07:00

Correct insurance claims filing to insurance companies in todays world is crucial to the healthcare provider. We have listed the 10 top billing errors that can cause a claim to be rejected or delayed.

1. Duplicate Claim

If you are filing a claim for the second time, indicate in a letter that this is not a duplicate but a second request for payment.

2. Beneficiary Eligibility

Call and verify with the insurance carrier that the patient is indeed covered by the insurance company the patient presented to you.

3. Incorrect Carrier

Make sure you send the claim to the correct carrier. Some insurance companies have multiple addresses to send claims to. Make sure you have the correct address.

4. Procedure code/Modifier invalid

CPT codes and modifiers change every year. Make sure you are using a code that is still valid for the date of service you are billing for.

5. CLIA

This is a number that is required for claims filed for medical doctors. Without it, your claim can be denied or delayed.

6. Bundled Services

Some carriers bundle codes to allow less payment. If you feel the code should not be bundled with another code, use the appropriate modifier to indicate a separate procedure performed.

7. Medical Necessity

If a carrier determines the services were not medically necessary, be prepared to appeal the claim with notes and case history for the procedure performed.

8. Non-Covered Services

When verifying benefits, always ask specifically if your procedures you are about to perform are a covered item. This will save you a lot of time if you know ahead of time.

9. Medicare Secondary Payer (MSP)

All Medicare Primary has to be filed and responded to prior to filing with the Secondary Payer. The Explanation of Benefits or Payment from Medicare, must be attached to the Secondary claim for payment to be considered.

10. Provider Eligibility

In almost all cases, the Provider must be participating (In Network) with the carrier in order to receive payment. In some cases, Out of Network benefits are available, but the Provider still must be registered with the carrier in some form.

Submitting "clean" claims to the carrier will ensure prompt payment in most cases. Claims should be carefully audited before being submitted to the carrier if the provider wants a timely payment. When readily available, send notes with the claim to justify services.

By Michele Graham-CEO and Owner of Professional Healthcare Management, a billing and credentialing company.

http://www.phmnetwork.com

http://www.healthcarenewsonline.com

http://phmnetwork.blogspot.com

2006-06-04T14:16:00.000-07:00

Top 10 Medical Billing Questions Answered
By Allan Danny

1--What is Medical Billing?

Medical Billing is the process of submitting and following up on claims to insurance companies in order to receive payments for medical services rendered by a health care provider.

2--What is the Medical Billing Process?

The Medical Billing process is an interaction between the healthcare provider and the Insurance Company. After examining the patient, the doctor maintains a medical record. This Record includes the patients' symptoms, clinical findings, and diagnosis and treatment details.
Following these details a medical coder or a billing specialist provides a medical code for this record.
This billing code is then submitted to the Insurance Company. The Insurance Company then proceeds with the claim.

3-- What about the Payment?

Based on the amount negotiated by the doctor and the insurance company, the original charge is reduced.

4--What about the Billing Quality?

Billing Quality is measured in terms of timeliness and completeness of payment. The shape of the distribution curve of Accounts Receivable illustrates billing quality.
For several decades, medical billing was done almost entirely on paper. However, with the advent of computers it has become possible to efficiently manage large amounts of claims. Many software companies have arisen to provide medical billing software to this particularly lucrative segment of the market.

5—What are the Medical Billing mistakes you should avoid?

Physicians believing that their billing professional care a lot and will not be doing any mistakes is at the head of the list.Take a copy of patients Insurance card. Also a second ID.
Secure sign advanced Beneficiary notice when indicated.

6—Tell about medical billing software?

As we know the tens of troubles medical professionals face keeping files, data and reports sorted and made available whenever needed.
Medical Billing helps to organize these details and consolidate your all offices together.

7—Can I use medical Billing software from our home?

Yes. All you need is a computer with a broadband Internet connection.

8—Is billing Software easy to use?

Yes. The biggest benefit is that you don’t have to go through multiple databases.

9—What about the security features?

Medical Billing is protected through HIPPA- servers, which gives access to members that mean you and you only.

10—What about the cost?

Medical Billing Software is not very costly though. Also there is no long-term commitment for the software use.

Allan Danny is a medical Billing specialist and shares his knowledge at http://www.medical-billing-resource.com
Visit our sister sites

http://www.accounting-software-info.com

http://www.conference-calls-information.com

Article Source: http://EzineArticles.com/?expert=Allan_Danny

2006-06-04T14:13:00.000-07:00

Medical Billing and Practice Management Software: Luxury or Necessity?
By Jason Montag

Many of us remember the time when you showed up at the doctor’s office and he took care of you right away and told you to just pay when you are ready or that he would settle up with you at some later time. Those days ended when medical cost rose to the unbelievably high level they are now. It is for this reason many of us have taken to using insurance and doctors have been forced to fight for their hard earned dollar from the insurance companies. To the majority of the public the use and for that matter the need for medical practice software and medical billing software is invisible. TO the doctors that use them they are an invaluable resource which not only allows them to organize their practice from top to bottom, but allows them to keep their billing paid in a timely fashion which keeps their business afloat.

Medical software is a daunting topic to medical personnel the world over but it is one that must be recognized, discussed and implemented. It is this necessity that leads me to put this article together for those of you in the market for medical billing or practice management software.

When looking to buy medical practice management software there are a few really important details to consider. THe first is to make sure that the software going to be secure? Be certain that the individuals using the software are aware of the security measures that are in place and that they understand how to use them effectively. An added tip is that when dealing with passwords they should be memorized or kept under lock and key and not simply placed on a post-it note to the front of their computer.

The second is to make sure the software allows you to manipulate information. Learn if you are you going to be able to move the data in the software around? Find out how easy it will be to export or import information once the system is on line.

When going over a number of software choices it is easiest to evaluate them with a simple test that you can make up so that you get a real and fair comparison. Mock up a scenario that covers all of your basic office tasks and execute it on each piece of billing software.

The more you test the practice software in real life scenarios the better of an idea you will have of how it will work once you spend a lot of money and get it implemented in your practice. Medical billing and practice management software can be a complex area so stay organized and take it slow to be sure you are doing the right thing to ensure the success of your practice be it medical or otherwise.

Jason Montag

http://www.medbillingsoftware.info

Article Source: http://EzineArticles.com/?expert=Jason_Montag

2006-06-04T14:12:00.000-07:00

Effective Medical Billing: Physical Medicine & Rehabilitation (PM&R), Intervention Pain Management
By Pinky Mcbanon

This article is about how to effectively bill for Physical Medicine & Rehabilitation with Intervention Pain management services in an outpatient setting. This article is very useful for Board Certified Physician in Physical Medicine & Rehabilitation, Board Certified Physician in Pain Medicine and Intervention Pain Management practice.
If you are the medical biller:

1) First thing, make sure your provider is listed under his correct specialty with the insurances. Remember that Pain Management provider do not necessarily mean they are (PM&R) M.Ds. They can be Anesthesiologists, Chiropractors, Acupuncturists, Massage Therapists, Physical Therapists and Occupational Therapists! Many claims were denied for payments like for CPT code 64480, 64483, 64484, 27096 and all other related procedure codes (you will see on the EOB a “reason code” like this: the provider is not privileged to do the procedure)--- it is because your provider might have been only listed as a Pain Management provider and NOT as PM&R and Pain Medicine medical provider.

(2) In terms of Patients’ Benefits, remember that each patient has different Pain Management benefits non-inclusive with PM&R office visits! Some plans do not have pain management benefits!

(3) Make sure you have all the fee schedules assigned to your provider both for outpatient hospital and office procedures. Compare which one allows descent amount based on your billed amount

(4) Claims must be accompanied with medical documentation to support medical necessity (this is very important!). If the insurance requests for documentation, send it right away! So they do not delay processing your claims. If there is a referral or letter of precertification, attach them too!

(5) Procedures like CPT codes 72040, 72020, 72100, 72295, 73542, 76005 done in the hospital, you must use modifier 26 (professional component only, the medical equipments are from the facility or the hospital). Normally, this is with location code 22 (Outpatient Hospital). If the procedure is done in the office, do not use modifier 26. Instead use location code 11 without a modifier.

(6) Procedures like CPT 64483, 64484, 27096 & 20610, if done bilateral use first modifier 50 and second modifier RT (performed on the right side) or LT (performed on the left side). You will enter this procedure twice on your bill (e.g. 64483 50RT , 64483 50LT). But if this procedure is done only on one side, use ONLY modifier RT (procedure performed on the right side) or modifier LT (procedure done on the left side).

(7) If the provider performed an office procedure like CPT Code 64405, 20552, 20553 and sees the patient for office consultation on the same day, use modifier 25 for consultation CPT code.

(8) In terms with the insurance companies, which pays more? to which CPT procedure code? I think procedures done for Workers’ Compensation and “No-Fault” patients allows higher based on the billed amount compared to all other insurance companies.

(9) Take not: Workers Comp and No Fault patients ALWAYS needs precertification/preauthorization for procedures to be done either in an outpatient hospital or office.

(10) Generally, it is always a safer side to check on your patients’ benefits and eligibility before you render the service or do the procedure.

(11) And if you are a provider’s office, make sure you choose the best medical billing service that will submit your claims on a timely manner. Highly knowledgeable with HIPAA and with your specialty in terms of processing your claims both electronic and paper submission. Of course, you also have the option to purchase the best medical billing/accounting software that is cost-effective and won’t hurt your overhead expenses!

The above article is based on the author’s work experience, skill and professional knowledge as a Medical Biller. Pinky Mcbanon is a Systems Engineer and a Medical Biller/Coder.

She shares her medical billing and coding expertise with http://www.medclaimsplus.com. She specialize in billing Rehabilitation Medicine, Pain Management, Physical & Occupational Therapy including Speech Therapy. She also shares her technical support expertise with http://www.fix-exchange.com.

Article Source: http://EzineArticles.com/?expert=Pinky_Mcbanon

2006-06-04T14:11:00.000-07:00

Medical Billing - What's All The Hype About?
By Michele Redmond

We see so many ads for Medical Billing. Earn lots of money! Work from home! No experience needed! The ads say anyone can make lots of money doing medical billing, but is it really true?

Medical insurance billing has become much more complicated in recent years. If a doctor is to be paid well for his services, the insurance billing is a very large part of his practice.

There is a lot more to medical billing than just sending a claim in to an insurance company and sitting back to wait for the payment. Each company has its own rules and in order to get paid, we must know them and follow them. How do you learn these rules and where do you turn for medical billing information?

Because it has become so complicated, it has become increasingly difficult to find employees who can handle this time consuming job. A doctor’s office is a busy place and his employee may not have half an hour to wait on hold while checking on a claim, for a customer service representative to tell her that the claim is “not on file”.

Since their income, and ultimately the success of their office relies so heavily on the billing being done effectively, Doctors have found it increasingly cost-effective to outsource their medical billing to professionals who can concentrate solely on his billing. If the billing service is being paid on the basis of their results, the doctor is more likely to maximize his receivables.

The medical billing service is going to concentrate their efforts on getting every claim paid when the service is paid according to their results while a billing person in the office is more likely on a busy day to say “Forget it. This claim isn’t worth another phone call!!” Unfortunately in most offices this claim will be written off and the doctor will never know.

There is so much involved with billing that most people, including the doctors, don’t even realize. The claims have to be submitted properly, and timely, on the correct forms.

If claims are being submitted electronically, reports need to be read and acted upon. When payments are received, they need to be analyzed to make sure they were processed correctly, and then posted.

If there is a patient responsibility after payment is made, then a patient statement needs to be sent. If the claim is denied, or not paid properly, it needs to be handled, and handled quickly. If the denial or incorrect payment is not acted upon right away, you may not be able to correct it.

Some companies only allow a certain amount of time to request a reversal. Aging reports need to be run regularly to make sure nothing else is slipping thru the cracks. Most offices lose thousands of dollars a year due to claims slipping thru the cracks; either processed/denied incorrectly, or not processed at all. If you are not working your aging reports - you are losing money!

But the Medical Billing Services aren’t getting rich like the ads portray. There is no simple easy way to do medical billing that the doctor’s office doesn’t know about.

There is still plenty of work to do to file the medical claims and get them paid. Don’t expect that you can start this business without some background or education. There is much medical billing information you need to know to successfully run a billing business.

Medical billing is not a get rich quick scheme. If you are considering starting such a business, you should have a great interest in the field and a willingness to learn much more.

As with any other business you would consider starting, do your homework. Research the field, read as much medical billing information as you can and make sure you know what you are getting into. After all, it takes a lot more than a computer and a kitchen table to do a good job and run a successful business. Make sure you understand what is going to be required of you.

There is a lot of Medical Billing Information out there. Make sure the information you get is from a reliable source. With a growing field such as this, unfortunately there are also a lot of scam artists trying to sell you information that is worthless.

Michele Redmond is co-owner of Solutions Medical Billing and has been in business since 1994. She has a bachelor’s degree in Computer Information Science and is responsible for the medical billing for over 50 providers. For more information on medical billing and starting your own business visit her website at http://www.solutions-medical-billing.com

Article Source: http://EzineArticles.com/?expert=Michele_Redmond

2006-06-02T05:42:00.000-07:00

What Is A Point of Service (POS) Health Insurance Plan?
By Sharlene Raven

If you have been actively researching online for the perfect health insurance plan then chances are good that you have come across the term Point of Service or POS as it's commonly abbreviated. This health plan is similar in many ways to a Health Maintenance Organization (HMO) health care plan and a Preferred Provider Organization (PPO) health care plan. In fact it almost offers the best options and benefits of both types of plans. For instance the PPO is not as restrictive as a traditional HMO and yet the over costs are cheaper when compared to a PPO, including the deductible portion of your health insurance bill.

Normally with a Point of Service health care plan the consumer will be asked to select a primary health care provider from a lists of preferred providers within the POS program. They will then receive all medical care from the doctor or medical specialist selected. Referrals to other specialty doctors and hospitals that are also part of the POS plan will originate and be directed by the primary health care provider. Although many consumers get slightly anxious or concerned with choosing from a list of doctors provided to them, especially if they have a hometown favorite doctor that they are more comfortable receiving medical assistance form, but the lower overall costs usually ease those anxieties. For instance the deductible is usually quite small and there is a minimal charge in the form of a co-payment for doctor visits and medical prescriptions. Perhaps the only drawback would be that a majority of the time you must use the generic brands of any prescriptions that you receive.

Aside from having your primary health care provider refer you to specialists within the plan you also have the option to refer yourself to a specialist or doctor outside of the Point of Sale health care plan but keep in mind this will warrant additional costs (sometimes as much as 50% higher), which will need to be covered out of your own pocket. The one exception to this would be if you were in an emergency medical situation that required immediate medical assistance. If you're truly looking for a health care plan that allows you to see your own doctor or health care provider then an indemnity plan is what you're actually looking for instead of a POS plan.

Another minor drawback to the POS plan that can be a minor or major nuisance (depending on your tolerance level and viewpoint) to some consumers is the fact that if you are referred to another specialist that's in the approved health care network you will still have to pay an additional amount. This can be an entire up front cost or a partial payment with both types requiring some form of reimbursement form your health insurance company or provider.

Many folks like the flexibility and cost that a Point of Service health care plan offers. Whether you do or not is entirely up to you and should be based on your current medical needs. If this plan isn’t right for your health care needs don’t panic, just remember that there are several other choices for your health care insurance.

Quickly find more money saving health insurance tips and information on how to shop for health insurance online by visiting GoodHealthCoverage.com a website created by Sharlene Raven, a respected webmaster whose site specializes in providing health insurance information you can trust.

Article Source: http://EzineArticles.com/?expert=Sharlene_Raven

2006-06-02T05:41:00.000-07:00

Outsourcing For Your Medical Practice
By Michele Graham

Outsourcing your insurance billing and credentialing to contract with insurance carriers is the wave of the future. Time is money. Your staff needs to focus on treating patients. Outsourcing your billing and credentialing frees up time in your office to take care of your patients more effectively.

Medical Billing:

Insurance billing and verification of patient benefits is one of the most time consuming tasks in any medical office. There are times when verifying patient benefits, a person could be on hold up to an hour waiting to speak to a customer service representative. Outsourcing this part of your business relieves your staff of precious time needed for patients. As far as insurance billing, focus is of main importance. When entering charges and payments, there can be no interruptions. When this task is performed in the medical office setting, there is more chance for error. When you outsource this task, you have someone who is totally focusing on your practice, without the interruptions that usually occur in the medical office setting.

Credentialing:

Credentialing has a well-earned reputation as a labor-intensive, tedious process, that until recently, was primarily performed in the hospital setting. In order to comply with the current requirements of regulatory governmental agencies and insurance providers, credentialing has taken on a new dimension. The process is more complex, requiring sophisticated new software and computer programs. Credentialing is no longer a part-time assignment; it requires the full-time attention of trained credentialing specialists.

When performing the task of credentialing in the medical office, there is no time for tracking receipt of contracts by the carrier or for getting information necessary to credential and contract the provider. Again, outsourcing this task allows more time for your staff to take care of your patients.

Michele Carter-Graham, owner of Professional Healthcare Management. For more information, see http://www.phmnetwork.com.

Article Source: http://EzineArticles.com/?expert=Michele_Graham

2006-05-29T11:50:00.000-07:00

Medical Billing Services
By Michele Redmond

Medical billing services are companies that take the pain of collecting money out of the doctor’s office. A good service will maximize a doctor’s receivables, while keeping their cash flow consistent. The key is choosing the right medical billing service.

A great service will submit insurance claims timely (preferably electronically), track the payments, follow up on unpaid claims and deal with all denials. They will not let any claim go unpaid.

Representatives of the service will attend insurance company seminars, advise the doctor of changes in their field and provide them with regular financial reports. They should not only handle the billing needs, but should act as consultants for the doctor, advising of fee structure, coding practices, and other ways to improve the office.

An obvious way a doctor can save money by outsourcing his billing is in the savings he will generate thru payroll, equipment, software support, updates, postage, forms, etc.

Outsourcing medical billing produces more than cash savings. A good service can maximize what the doctor actually brings in by collecting more money than an in-house staff can. In most offices, the in-house staff does not have the time, or the knowledge to handle the problem claims and the doctor ends up not getting reimbursed anything for those services.

By outsourcing, a doctor is hiring a professional. Medical billing services have the expertise to submit claims accurately, collect on all claims, even those that have been denied by the insurance carrier. This helps the doctor’s patients by avoiding billing the patient for a claim that should have been paid by the insurance carrier.

A doctor should avoid choosing the wrong service by carefully checking references. A doctor should call several other doctors who might be using a particular medical billing service.

When a doctor interviews a potential service, what is his overall impression of the people who will be handling his income? During the interview, he should pay attention to how they answer his questions. Are they confident in their answers? Are they correct in their answers? Does what they offer make sense?

Like many other fields, there are good and bad billing services. But medical billing services can be a great resource for a doctor if they are careful to choose the right one.

Michele Redmond is co-owner of Solutions Medical Billing and has been in business since 1994. She has a bachelor’s degree in Computer Information Science and is responsible for the electronic claims submissions for over 50 providers. For more information on clearing houses and other alternatives for electronic claims submissions visit her website at http://www.solutions-medical-billing.com
Article Source: http://EzineArticles.com/?expert=Michele_Redmond

2006-05-29T11:48:00.000-07:00

Medical Billing - Solving the Problems Part II - Patient Billing
By Lori A Anderson

Medical billing in the United States is fraught with many challenges and problems. The primary goal of medical billing is to receive fair compensation for the work that was performed in a timely manner. However, this is rarely the case. This series will explain those challenges and suggest possible solutions to these problems.

Patient Billing
Most practices today find it more time consuming and more costly to attempt collection of fees from patients then insurance carriers. For those practices that do take patient collection seriously, they may underestimate the toll on resources to complete the task.

Have you ever wondered how long it takes your staff to complete the print and mail function of sending out patient statements? Some practices choose to do weekly, biweekly or monthly patient statement processing. Manually processing a patient statement mailing dramatically affects your practice operations and revenue streams. Processing times can be lengthy, and delays are quite common due to lack of time and resources at most physician’s practices.

A careful analysis of the costs reveals some surprising numbers.
$0.39 first-class stamp$0.08 envelope with window or label$0.08 return envelope$0.02 paper$0.10 printer ink or toner$0.25 labor (assuming $15/hour and 60 statements/hour)$0.92 Total
At $0.92 per statement to perform this operation in house, there may be a better solution for you.

Potential Solution
There is a solution; electronic patient statements. The process of sending patient statements can be as easy as sending electronic insurance claims. Electronic patient statements allow your staff more time to focus on your patients. When it comes time to print, fold, stuff, stamp, seal and bundle the statements, you can outsource this menial labor task. With electronic patient statements any patient that has a balance and is eligible to be billed, will automatically be sent a patient statement on time. With this automation, you will improve your accounts receivables timeline. Electronic patient statements also allow you to minimize mis-labeling errors and delays inherent with the in-house print and mailing functions which impacts your ability to bring your money in.

Your practice management software solution provider should have this valuable service available. Additionally, this service usually costs less than the postage and supplies outlined above. Usual automated patient billing service costs for electronic patient statements are $0.62-0.75 per statement.

Lori Anderson is an independent consultant with LAtech working with AntekHealthware on their DAQbilling Medical Billing Software and LabDAQ Laboratory Information System projects.
Article Source: http://EzineArticles.com/?expert=Lori_A_Anderson

2006-05-29T11:45:00.000-07:00

Submitting Medical Insurance Claims – Which Form Do I Use?
By Michele Redmond

When it comes to submitting medical insurance claims to the insurance companies, it is important to file the claims on the appropriate forms. The most common medical insurance form is the HCFA 1500.

The HCFA 1500 form is a 8 ½”by 11” white paper printed with red ink. It contains many fields that must be completed. In an effort to standardize the medical industry, HIPAA (Health Insurance Portability and Accountability Act of 1996) mandated that all medical service providers use the HCFA 1500 form when submitting insurance claims.

It is crucial that the fields on the HCFA form are filled out accurately and completely. If any information is missing or incorrect it can cause the entire claim to be denied. In some cases they will return the incomplete or inaccurate claim with an explanation as to why it is not being paid. Other times, you just don’t hear anything. Did they end up with your socks that never returned from the dryer?

There are some instances that a HCFA wouldn’t be used. If the claim is for an on the job injury, or a workers’ compensation claim, then a workers’ compensation form would be used. These forms vary from state to state, but can usually be found on the state’s workers’ compensation website.
In many states forms can be downloaded and printed or purchased in quantity by private suppliers. Some medical billing software comes with the capability of printing the workers’ compensation forms. The workers’ compensation forms are white with black print and have fields similar to the HCFA 1500 form. As with the HCFA 1500, it is important that these fields are filled out accurately and completely.

Facilities such as hospitals, outpatient clinics, and ambulatory surgery centers use a UB92 form. It is the facility version of the HCFA 1500. UB92 forms are also white with red ink, but the fields are different.

When claims are submitted electronically, no forms are needed as the claims are not ever printed to paper. The claims are actually put into the correct format and sent on to the insurance companies in a file. The claims can either be sent via the internet, or thru the phone lines.

HCFA and UB92 forms can be purchased from a variety of suppliers and they vary greatly in price. The higher the quantity purchased, the lower the price per form. Shop around to find the best buy.

Michele Redmond is co-owner of Solutions Medical Billing and has been in business since 1994. She has a bachelor’s degree in Computer Information Science and is responsible for the medical billing for over 50 providers. For more information on medical billing forms and other topics visit her website at http://www.solutions-medical-billing.com
Article Source: http://EzineArticles.com/?expert=Michele_Redmond

2006-05-29T11:43:00.000-07:00

How to Appeal When Your Medical Insurance Declines Your Claim
By Savig Oren

If you are like most people, when your medical insurance declines your claim, you are left feeling helpless and frustrated. After all, if you need health care and your insurance is saying you don’t, you have two choices – appealing your claim or paying for the treatment out of pocket.

Most claims are declined for specific reasons and causes. The most likely cause for your health plan to deny your claim is a direct consequence of missing data. Before appealing your denied claim, you can verify that by assuring any and all pre-authorization requests were filled out with accurate patient information.

For example, is your social security number correctly listed? Does the doctor have the most current copy of your health plan’s identification card? Does your doctor have the most up to date copy of diagnosis and procedure codes in order to fill out the forms correctly?

By verifying that you have submitted the good documentation to the physician and they in turn submitted good documentation the health plan, you are ready to move to the next level. When it comes to dealing with your health insurance company, think paranoid.

Document every phone call, every contact person and every piece of information you are given. It only takes one break down in communication to cause a problem; by documenting all of your communication with the insurance company, you are pre-preparing for any appeals case.

If you are facing an appeals claim for treatment coverage, be sure you’ve reviewed the appeals process in your company’s health insurance handbook. Most patients overlook reading through the handbooks their insurance company will provide. Plan requirements and appeal processes are detailed in these handbooks and you should make sure that your plan covers any treatment you are going to receive before the treatment is received, if possible.

When An Appeal Is Necessary

Since every plan should have a clear appeals process, you should follow it explicitly. You should talk to your doctor about appealing the claim so they can provide supporting documentation and expertise as needed. Remember, most insurance claims must be appealed within a limited amount of time, so if you wait six weeks after a denial and you only have 60 days to appeal; you may already be out of time.

You should always appeal internally to your insurance provider before going to an external source such as a government or state appeals process.

Most appeals have a process that goes as follows:
- Phone Complaint
- Written Complaint
- Written Appeal

This is another area where you should be very specific citing the coverage rules of your plan as well as documenting each contact you have with the insurance company. While the insurance carrier will approve the majority of valid appeals; there has been documented cases of insurance fraud and health plans that do not play by the rules. By documenting response times and any required response times; a patient can exhaust their option against the insurance carrier for a valid appeal and then take it to the next level.
Laws in many states govern an appeal to a state or federal insurance oversight process; these requirements often allow for an external, expert review of the appeal. By providing accurate documentation and detailed medical support from your physical, a board of qualified experts can then judge your case on an individual basis. If an external appeal validates the claim and overturns the denial, then your insurance company will not be able to deny the claim.

Knowledge of your health plan, your doctor’s knowledge of procedures and a detailed review of the appeals process are your best tools to getting the approval of the treatment you need. Do not overlook the details, keep accurate documentation and review your coverage plans if you have any questions. Remember, there are always options.

Utilization Review, Physician Peer Review & Medical Chart Review - Offers physician peer review, medical chart review, medical record review, medical bill review, & utilization review to Insurance Carriers, TPA's, MSO’s, HMO's, Worker Comp,etc.

Article Source: http://EzineArticles.com/?expert=Savig_Oren

2006-05-22T21:03:00.000-07:00

The Benefits of Outsourcing for Hospital Credentialing
By Tammy White

Hospital credentialing is the most intensive credentialing process for medical providers, repeated more frequently than other credentialing standards and involving more organization contacts and supporting documents. The amount of staff time and the expense of researching every medical provider can be heavy, draining resources from other administrative functions, and requiring experienced staff and access to research resources. Yet hospitals have been slower than other medical organizations to outsource the credentialing process, despite potential benefits: faster turnaround time, cost-effectiveness, and savings in staff time and training.

Hospital credentialing covers the most detailed questions of any credentialing standard, from medical school through the provider’s complete career. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) creates manuals outlining the credentialing processes for all different medical providers within an institution. The proscribed areas have to be verified in ways that meet JCAHO standards. This entails direct contact with organizations associated with the provider, as well as receiving copies of all certificates and licenses. All of these areas must be verified:DEA certificatesAll state licenses and sanctionsMalpractice insurance and claim historyTraining, internships, and residenciesBoard certificationsMedical educationAll past and current hospital privilegesWork history (verified through direct contact)Medicare sanctions or opt-outsPeer referencesBoth the contact results and supporting documentation are gathered to create a final profile report for the provider, which is given to the credentialing committee for review. Any warning signs or previous problems with the provider must specifically be brought to committee attention.

Most hospitals still do credentialing verification internally. If they have full access to information resources and available money and manhours to dedicate staff, as well as having experienced personnel to do it, then in-house credentialing can be as fast and thorough as outsourcing it. Most hospitals do not have those resources or need to assign those resources elsewhere. Moreover, hospitals bear the liability of any mistakes or oversights made during the credentialing process, and those mistakes can affect the results of future audits, resulting in reprimands or penalties.
Credentialing verification organizations (CVO) allow hospitals to outsource the credentialing process for all medical providers, such as physicians, respiratory therapists, X-ray technicians, nurses, and mental health specialists. CVOs dedicate resources and training to credentialing, meaning personnel have experience, comply with appropriate standards, and have access to verification resources. Hospitals can better utilize their staff and finances, while lowering hospital liability for mistakes. Additionally, CVOs can offer support services in addition to credentialing which can make managing audits, renewing licenses, and other processes more efficient.
There are minimum services that CVOs should offer to hospitals:Compliance with JCAHO standards.Minimum number of contact attempts to and organization.Adapting processes to incorporate hospital requests and specialized information requirements.Completed profiles with no sections left unverified.Improved turnaround time, usually within 60 days.Quick committee notification for problematic files. Fast response to questions or problems.Web access to profile reports and verification documentation, as well as hard copies.Quality CVOs offer other beneficial, resource-intensive services to hospitals:Surveillance between an initial credentialing process and the first recredentialing process for any disciplinary actions or sanctions.Routine notification for recredentialing and expirable deadlines.Assistance during internal or external audits.Training and consulting for in-house credentialing.Using a CVO for medical provider credentialing saves hospitals time in staff hours, money and resources, and also offers support services, such as audit support and surveillance of providers for sanctions or problems even after completing credentialing, that a hospital may not be able to maintain internally. Hospital credentialing standards are the tightest and most detailed of medical provider credentialing standards. CVOs can remove the burden of meeting those standards for hospitals through dedicated resources, experience, and support services.

Physician Credentialing Solutions is a leading provider of credentialing verification services for hospitals, PPOs and other health care organizations. http://www.credsolutions.com
Article Source: http://EzineArticles.com/?expert=Tammy_White

2006-05-22T21:00:00.000-07:00

HIPAA And How It Will Affect Your Office
By Michele Redmond

This information is designed to help you better understand HIPAA and to assist your office in becoming HIPAA compliant. The information was obtained from a variety of sources and is not intended to be legal advice. If you are having difficulty understanding any portion of the HIPAA regulations you should consult your legal counsel.

First, there are no HIPAA police. No one is going to come into your office to inspect you to see if you are HIPAA compliant. A complaint must be filed in order for any action to be taken.

What is HIPAA?

HIPAA stands for The Health Insurance Portability And Accountability Act. It was enacted by the federal government in 1996 as part of a healthcare reform effort. HIPAA is intended to ensure confidentiality of all patient related health care information. It also intends to simplify the administrative processes of health care, thereby reducing the costs and administrative burdens of health care.

One thing to remember is that the HIPAA Act uses the word “reasonable” several times. You and your office staff must do whatever reasonable to protect your patient’s privacy. For instance, smaller medical offices do not have to take the same privacy measures as large hospitals do. That would not be reasonable.

Also, there are no “privacy police.” No one is going to come in and inspect your office randomly. Someone must file a complaint first. The complaints will be handled by the Office of Civil Rights. If someone puts in a complaint, then it will be investigated. The fines are very high, so you will want to be sure that your office has good privacy practices and that they are followed all of the time.

Another thing to keep in mind is that the type of your practice may determine the level of privacy that you need to acquire. For example, patient’s in an optometrist’s office may not be as concerned about people knowing they are there, as opposed to patient’s in a mental health office. There are several different components of HIPAA, each one having its own implementation date.

Section 2: The Privacy Component : implementation date: April 2002
1. You must do everything within reason to protect your patient's privacy.
2. Patient's files and information should be kept in a secure section of your office, a section that is not accessible by other patients.
3. Charts should not be left lying around, open where someone can read it.
4. If you are making a phone call about a patient or to a patient, you need to do it from an area where you cannot be overheard if you will be giving out personal information. For example, if you are calling their insurance company, and you will be saying the patient's first and last name, date of birth, ID#, and/or a diagnosis, then you do not want to do it where others, perhaps in a waiting room, can hear you.
5. If patient's charts are ever removed from the office you need to have a policy in place. For example, you should have a sign out sheet which states the patient's name, date taken, by whom, and then signed back in when the chart is returned.
6. If charts are removed , they should be carried in a case that is marked “confidential - medical records.” If you were ever involved in an accident, or separated from the bag for any reason, either authorities or medical personel would secure the information for you. Or you would have at least done whatever reasonable to protect that information.
7. If computer screens are in a position that patients can view them, you may want to move them, or get a screen cover. A screen cover makes it so that the computer screen can only be read when directly in front of it. The above are just some things that you will need to consider when becoming HIPAA compliant. Each office will have it’s own areas that need to be reviewed. The above are many of the common areas.

Section 3: Administrative Simplification: compliance date: October 2002
This component requires the standardization of data transmissions, or EDI, and procedure/diagnosis codes.

As for the standardization of procedure/diagnosis codes, this just means that you must use CPT-4 codes for procedure codes and ICD-9 codes for diagnosis codes.

As for the standardization of EDI, that refers to your electronic billing. In order to submit your claims electronically, you must do so in a HIPAA compliant format.

Section 4: Security Component: no implementation date set yet
This component requires that health care professionals, Billing Services, and clearing houses take appropriate security measures to assure that health information pertaining to an individual remains secure and is not accessible by others.

Things to consider:

Where is your fax machine? Is it in a place where only office staff can access incoming faxes? Is it on 24 hours a day? When you are not in the office (after office hours) can anyone else access your fax machine? Whenever you fax personal information about a patient you should use a fax cover sheet with a confidentiality statement. The statement should explain that the following fax contains personal medical information and that if the fax is received by anyone other than the intended party, that the fax should be destroyed and they should notify you that it was received in error.

Do you hire a cleaning person/crew? Are they in the office when you are not? Do they have access to the patient’s personal information? You may want to ask them to sign a confidentiality statement.

Do you rent office space? If yes, does your landlord have access to your office? Do they ever enter your office without you being present? If they do, you may want to ask them to sign a confidentiality statement.
By asking people who have access to your office to sign a confidentiality statement, you are making a reasonable attempt to protect your patient’s privacy. It is not always reasonable to never allow anyone access to areas that contain private information. If those people sign an agreement and then breech that agreement, you would not be held responsible.
If you do any business by email, you will need to use an encryption service. This will ensure that if anyone were to intercept your emails, they would not be able to read them.

Section 5: Privacy Officer
All offices must designate a mandated “privacy officer.” This person would be responsible for making sure all staff are HIPAA trained and that privacy policies are typed up and followed. They would also be the person that staff members or patients could go to with any concerns or questions about HIPAA compliance. Even if you are a very small practice, you MUST have someone designated as the privacy officer. It may even be the Doctor themself.

Section 6: Release of Patient Information/Consent
You need to have the patient’s written consent in order to release any of their records/information.
(Exception: If request is due to immediate/urgent care of patient.)
You should review your current consent and authorization forms to make sure they are HIPAA compliant. HIPAA requires you to obtain consent for the use and disclosure of information from each of your patients. You may refuse to treat patients who will not sign the consent form.

Section 7: Unique Identifiers: No implementation date set yet
HIPAA will mandate the use of unique identifiers. More to come on this component. Most likely you will have one national provider number, instead of a different provider number for each insurance company.

Section 8: Policies and Procedures Required by HIPAA
1. Identify people on your staff who require access to protected health information.
2. Prevent access to protected health information by unauthorized persons.
3. Ensure that the “minimum necessary” amount of information is released for routine disclosures (only release information pertaining to what is requested, not the patient’s entire file.)
4. Verify the identity of the requestor of information.
5. Provide patients access to their records, the opportunity to request corrections, and access to and accounting of disclosures.
6. Every office must have written policies regarding privacy practices.
Summary
Evaluate your physical office for potential privacy and security risks. One of the best things that you can do to become “ready” for HIPAA is to walk through (better yet - have someone else walk through) your office as if you are a patient. Look around at EVERYTHING. What do you see? Do you see any personal patient information, charts in full view? Start right from the front door, and go through every room in your office, especially the rooms that patients have access to. Then continue to do periodic checks to ensure ongoing compliance.

Make sure that you have written policies regarding any privacy practices, such as removing charts from the office, faxing patient information, reviewing any complaints from patients, etc. Also, make sure you designate a “privacy officer.”

Make sure all staff members are trained regarding HIPAA policies. Remember to train any/all new employees regarding HIPAA policies. You should also review your current HIPAA policies regularly.

Michele Redmond is co-owner of Solutions Medical Billing and has been in business since 1994. She has a bachelor’s degree in Computer Information Science and is responsible for the medical billing for over 50 providers. For more information on medical billing and HIPAA visit her website at http://www.solutions-medical-billing.com
Article Source: http://EzineArticles.com/?expert=Michele_Redmond

Healthcare Coverage in America Today

2006-03-20T04:24:00.000-08:00

In America today, most of us depend on health insurance to cover the majority of our fees for health care from our specified providers. We get insurance coverage through our employers and on an individual basis.
The questions are:
How good is my coverage?
Why is my doctor not on my plan?
Why are there limits on the types of services I can receive?
Unfortunately, insurance carriers limit their provider rosters and therefore not all medical providers are “in network” on all insurance plans. It appears that the insurance carriers develop an exclusive “club” letting some join and others not. Additionally, the carrier's rosters are not always up to date and therefore perpetrate an illusion of their insurance provider participation as “full”, when in fact, some providers have retire, moved or even expired!
Our experience, that even when notified of incorrect information in Provider Directories that are posted on the internet, insurance carriers do nothing to correct the mis-information. It would make sense as one provider leaves an area that another provider replaces that provider and this does not happen.
Another thought: As new doctors graduate form medical school and open their practices, how are they going to be able to accept insurance to treat patients if they are not on these plans? And how will they get on these plans that have already turned away thousands of others?

Managed Healthcare: Managed Healthcare, Pros and Cons

2006-03-15T05:34:00.000-08:00

Managed Healthcare: Managed Healthcare, Pros and Cons

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Managed Healthcare, Pros and Cons

2006-03-14T05:01:00.000-08:00

Managed healthcare in today's world seems to be leaning in favor onf the insurance carriers, not the provider or patient. Patients are not allowed to see the doctor of their choice unless the doctor is in their network. Providers are not allowed to join those networks because the insurance carriers state their "panels" are full in the doctor's geographic area.

If you search the provider directories posted on the internet, a lot of the doctors that are listed "in network" have moved to different areas or have even expired or have retired from practicing.

Many healthcare professionals are being turned away from network participation for no viable reason. Some states have a "any willing provider" law that allows any provider to belong to any provider network if they choose. Unfortunately, there are more states than not that do not embrace this law.