Medical Practice Management in the New Millennium

We are witnessing the approach of a new era!

Actually, healthcare computing, IT solutions in disease management, and medical informatics is nothing new, however, because the United States of America's health care system is still largely based on paper and ink, President Bush, many politicians, and health care providers have decided to follow other country's examples, such as the United Kingdom, Canada, Denmark, and Australia, and are collaborating on plans where within the next ten years all people under the care of a physician in the USA will have an electronic patient record!

Inevitably, this means that physicians, clinicians, nurse practitioners, physician assistants, nurses, medical office, health system, and benefit managers, HIPAA, and claims processing professionals, which includes the medical coders, and billers, as well as clinical and administrative medical assistants, and many other professionals working in the various settings of the health care delivering industry will have to prepare and adjust for changes to come!

Learn more about the unique challenges that implementation and maintenance of electronic medical records brings to the medical office. And if you have any comments, please post them here!

© 2005 Advanced Medical Assistant Custom Web Design, LLC. All rights reserved.

How I Turned a Snickers Bar Label into a Medical Coding Lesson

Since I am the creator, author, maintainer, and webmaster of a number of medical assisting, medical coding, billing, and phlebotomy web sites I recently enrolled in the IWA "Web Content Writing and Editing" class to enhance and refine my writing skills. I am just starting the second week, but so far it has truly been interesting, and fun, and I have already learned quite a bit. There are new lessons for each week, and for each lesson there is an assignment.

For example, week two-instructions were to read something--anything--that happens to be close at hand and write an article about it that fits into our web site. This exercise was meant to show us that when it comes to creative writing, anything can be an inspiration.
For your enjoyment, here is a copy of my assignment response:

Week 2 - Assignment 2:
I am writing an article for my Medical Coding and Billing web site. Since the instructions given for this assignment are to read anything that is nearby I will look no further than my cluttered computer desk. The first thing I spot is a plastic container of Pledge Furniture Cleaning/Polishing wipes way in the back, then to my left, on a stack of papers, an unopened Snickers bar. On the label I read: Hungry? Grab a Snickers. Net Wt. 2.07 oz. That caught my attention!

I guess I could probably work with it. I just would have to be a bit more creative than if I chose the medical terminology and medical coding books stacked on the right-hand side on my computer desk. The Snickers bar seems "doable". To accomplish this writing challenge, a good place to start might be to go over the list of ingredients, define, and analyze them with focus on nutrition and health related issues, then identify adverse reactions, or diseases that could be caused, or perpetuated by certain ingredients, such as sugar, cocoa butter, chocolate, lactose, skim milk, milk fat, soy, lecithin, peanuts, corn syrup, egg whites, and then list associated interventions and treatments.

In the next paragraph I could then show my readers how to turn the diagnoses, and associated treatments into combinations of codes that medical coders use when they submit a claim to tell the health insurance company what was wrong with a patient and the services that were provided. The article would turn out to be a coding lesson based on the ingredients of a Snickers bar. LOL

However, if I wanted to save myself this headache, then I should probably better go with the medical coding books stacked in the back of my desk. I would then simply whip up an article about the basics of medical coding, what it is, and what it is used for, what a medical coder does, and does, where they work, and what they earn; then go into details of their vocational training requirements, and how they can advance in their chosen career, and leave it at that! Simple.

But then again, given the two choices, rather than having to read those darn medical coding books all over again, and winding up with yet another dry article about medical coding, I'd prefer, at this time, to go with the Snickers bar!!! Plus, there is another temping advantage: I can take off the wrapper, analize the label, write my article, and then eat this peanutty, chocolaty, delicioius treat.


I continued to add the following resources to support my point of unhealthy ingredients in a Snickers bar, that may lead to certain conditions, or diseases, that then can be diagnosed, and coded by medical coders, so that the healthcare provider can be reimbursed for his/her services:

1. To provide basic information on ingredients and their nutritional values: Nutrition Facts and Food Composition Analysis for Candies, M&M MARS, SNICKERS Bar

2. To provide additional information how certain ingredients in a Snickers bar migh have a negative effect on health: Carbs and Fiber in Snickers Bar

3. To provide more specific information on long-term health effects of eating high-GI foods: Health Effects of High Glycemic Value Carbs

4. And last but not least, now the medical coding part: CIGNA Medicare Part B - ID LMRP 97-011 - Blood Glucose Testing




What would you have chosen to write a creative medical coding and billing article? The coding books, the Snickers bar, or may be the Pledge Furniture Cleaning Wipes way back on my desk, or something else? Please feel free to comment!

© 2005 Advanced Medical Assistant Custom Web Design, LLC. All rights reserved.


OIG Saves American Taxpayer's Money by Cracking down on Fraud

The Office of Inspector General (OIG) of the Department of Health and Human Services continually strives to eliminate fraud, waste, and abuse in HHS programs on every front and follows up on all matters involving fraud, waste and mismanagement in any Health and Human Services programs. In the fiscal year 2004, OIG reported savings to the American taxpayer of almost $30 billion! Fraud and abuse cases OIG investigated and resolved involved the following HHS programs:

Ø Medicare Part-A
Ø Medicare Part-B
Ø Child Support Enforcement
Ø National Institute Of Health
Ø Indian Health Service
Ø Food and Drug Administration
Ø Center for Disease Control
Ø Substance Abuse and Mental Health Services Administration
Ø Health Resources and Services Administration
Ø Aid to Children and Families
Ø All Other HHS agencies or related programs

OIG maintains a hotline which offers a confidential means for reporting fraud and publishes summaries of resolved fraud and abuse cases on their web site throughout the year. The following are a few exples of the types of complaints that OIG investigated and persued:
In Maine, a registered nurse was sentenced to 18 months in jail with all but 45 days suspended for theft of drugs. While working at a hospital emergency room, the woman stole morphine on at least three occasions.
In New York, a billing clerk was ordered to pay $2,100 in restitution for health care fraud. The billing clerk systematically upcoded claims. These claims had already been upcoded by nurses who routinely treated patients without any physician involvement, but coded the services as though a physician had rendered them.
In New York, a physician and his nurse were sentenced for their involvement in a scheme to defraud the Government. The physician was sentenced to three years and 10 months incarceration and ordered to pay $227,000 in restitution. The physician was previously convicted during a jury trial for health care fraud, conspiracy to distribute and dispense controlled substances, illegal distribution and dispensation of controlled substances, and aiding and abetting. The nurse was sentenced to 6 months home confinement for health care fraud and conspiracy to illegally distribute Schedule II controlled substances. The physician submitted claims to Medicare indicating he had treated the patients and performed the service directly, when actually, a nurse treated the patients. To facilitate this scheme, the physician provided presigned prescription pads for her and other nurses to prescribe narcotic drugs to patients.
In New York, three subjects were sentenced for their roles in a scheme to defraud the Government and private insurers. A podiatrist was sentenced for submitting claims for services that were either upcoded, not rendered, or were medically unnecessary. Also sentenced were two billing clerks who at the direction of the office manager, submitted claims that they knew were fraudulent.
In New York, after entering a guilty plea, a psychiatrist was sentenced to a conditional discharge for his submission of false filings. The man agreed to repay $502,000 in restitution to Medicare and Medicaid for billing for office consultations and medication dispensing when no consultations actually took place.
In Indiana a doctor was sentenced to 7 years incarceration, with 3 years suspended, for his scheme involving intimidating Medicaid beneficiaries. The doctor, who was previously found guilty during a 4-day jury trial, intimidated Medicaid recipients by telling them they would lose their benefits if they did not make cash payments.
In Michigan a dentist was sentenced to 1 year and 1 day incarceration and ordered to pay $743,000 in restitution and fines for mail fraud. The man billed insurers for services not performed and for upcoded dental services.
In Illinois a doctor and her employee were sentenced for their role in submitting false claims. The doctor was sentenced to 5 months incarceration and ordered to pay $70,000 in restitution; the employee was ordered to pay $7,500 in restitution. Claims submitted were for psychiatric services provided when the doctor was absent from the office and/or were actually provided by the employee, who has never been licensed to practice medicine.
In Virginia a physician was sentenced to 18 months incarceration and ordered to pay a $10,000 fine and $191,000 in restitution for health care fraud. From approximately January 2000 through October 2003, the physician submitted upcoded claims to Medicare and to a private insurer. In addition, claims submitted reflected comprehensive office visits that did not occur at all, or were for dates of service when the patient was only provided a prescription refill. The investigation began in July 2003 when the private insurer found that the physician’s billings were much higher than the average medical provider in the area. Shortly after the investigation began, a fire occurred at the physician’s medical office, which was determined to be a case of arson. Although a grand jury returned an indictment charging the physician with arson in connection with the fire, the Government dismissed the charge in exchange for his guilty plea to health care fraud.
In California, a doctor was sentenced for health care fraud and was required to surrender his medical license for billing Medicare and private insurers for diagnostic studies that never occurred. The doctor may not reapply for a 5-year period.

Read more about OIC Criminal Actions!

Coding from Home?

Coders with a number of years of experience may want to set up their own business from the comfort of their home. Thorough understanding of the medical coding and billing industry, as well as technical skills, high self-motivation and organizational ability, and experience will be the foundation upon which this can be achieved.

Also determination, the drive to be independent, and well respected credentials are powerful resources for success. Also, people who are practical, logical, perceptive, observant, methodical, good planners, tennacious, sound decision makers, natural team leaders, good with facts and figures, and have a reputation for firmness and a no-nonsense attitude to life can do well running their own business as an independent contractor or consultant in medical coding and billing.

If this sounds like you, read more!

© 2005 Advanced Medical Assistant Custom Web Design, LLC. All rights reserved.

Free Host | new york lasik surgery | cpa website design