Ango Mark, Author at Medical Billing Services | Medical Billing Company Checklist

Infographics: Physicians Going ‘Tabletized’ to Access EHRs

October 1, 2013 by Ango Mark Leave a Comment

The E-gadget Backdrop

The mobile gadget revolution in the healthcare arena is at the cusp of ‘tabletization’, according to a string of new reports. Clinicians are increasingly using their mobile devices, especially tablets at practices for the rapid, secure and amicable electronic health records’ (EHRs’) usage, storage and exchange.

Insights into the Penchant for Tablets

It’s a trendy ‘spectator sport’ among new practices and the mobile purveyors to fathom why physicians are utilizing their tablets. Two recent reports, “Mobile Usage in the Medical Space 2013″ and “Tablet Usage by Physicians 2013″ from American EHR Partners based on the survey of about 1,400 physicians, underscored that tablets are more useful than smartphones for doctors using EHRs.

The doctors use their tablets in the clinical settings for performing the following activities :

1. Sending and receiving e-mails (52.4 percent);
2. Accessing electronic health records (EHRs) (50.6 percent);
3. Retrieving diagnostic information (41.7 percent);
4. Research data about drugs (33.3 percent);
5. Keeping abreast with medical field through journals and articles (29.8 percent).

Snapshots on Tablet Usage in Healthcare Space

1. Physicians use Epocrates^®, Medscape^®, Up To Date^®, MedCalc^®, and Skyscape^® as the top five tablet apps in their medical practices.
2. Smaller enterprises, with three doctors or less, are expected to carry out an extensive range of bustles on their tablet, such as banking, patients’ correspondence, or taking snaps for medical research, etc.
3. One-third of EHR users and one-quarter of non-EHR users prefer a tablet gadget in their clinical practice.
4. The users of EHR are hanging about 25 hours per week on their tablet device, with a better portion of time used up on business (59 percent) than for personal points (41%).
5. With an increased clinical and healthcare research funding, the research about medications is escalating. About 33 percent of EHR users employ a tablet to research medications every day.
6. About 70 percent of the physicians are tablet users who access EHR through password.
7. More than 32 percent have installed device tracker apps on their tablets, so as to remotely clear all data on their tablet – if misplaced or stolen.

Tablet- Benefits Overwhelm !

A. Though smartphones and tablets are competitively used by physicians, most physicians are feeling convenient with the EHR access on a portable, wider screen as in tablets.
B. Making video calls to interact with patients for research, feedback and patient services is much easier and pleasing with this device.
C. During business meetings and even during special patient encounters, this is a great instrument to scribble upon.

Contact MedicalBillingStar to know about the recent healthcare trends in gadget landscape !

Rest Assured – Coding Howlers in Oncology Practice are Removable

September 23, 2013 by Ango Mark Leave a Comment

Oncology is a clinically-focused specialty that is undergoing frequent technological and process updates. It requires a high degree of physician’s skill, experience and the urge to learn to stay tuned with the revisions related to documentation, coding, billing, and revenue cycle management (RCM).

Common Oncology-Specific Coding Errors :

Errors abound. Some of the many are:

1. Coders are not up-to-date with on-going changes in codes and related modifiers.
2. Failure to capture correct levels of CPT (Common Procedural Terminology) codes.
3. Under-coding and over-coding errors.
4. Misusing modifiers, using of wrong modifier and mixing up of modifiers.
5. Coders are not conversant with coding for specialist oncology services such as bone marrow procedures, transplantations, and blood transfusions.
6. Coders round off drug administration times instead of noting the exact time.

What the Experts Have to Say :

According to oncologists, correct coding is the main ingredient for successful practice. The complexity and regular updating of coding system contribute to unintended coding errors. According to the American Society of Clinical Oncology (ASCO), failure to complete the code capture at the time when oncology procedures are provided is common.

Continued usage of codes that have been eliminated by Medicare continues to be the bane of the US oncologists. A survey conducted by two nationally recognized experts in oncology practice management-Roberta Buell from OnPoint Oncology LLC and Patrica Falconer from Health Options, on behalf of the Association of Northern California Oncologists (ANCO), revealed that only 1 out of the 14 surveyed practices had updated their oncologists about the elimination of consultation codes by Medicare.

According to Cynthia Stewart, coding education coordinator president of AAPC, problems arise for coders when physicians fail to document the steps they went through to arrive at a diagnosis. Enos further clarifies that coders need to understand the depth or extent of medical decision making. Medical decision depends on complete documentation to make a “medical necessity linkage” between the procedure performed and the diagnosis code.

Tips to Ensure Correct Coding :

There are umpteen of them – to name a few :

1. Be aware of on-going changes in codes and modifiers.
2. Continually train oncologists and coders on coding mistakes and consequences, along with how to avoid the mistakes.
3. Do not neglect equipment or instrument used : Be conversant with recent codes related to the equipment or instrument (e.g. for radiation oncology) used to provide oncology services.
4. Beware of the tendency to code according to the complexity of the diagnosis, rather than the extent of decision making involved.
5. Be aware of new or established (existing) office visit codes and in-patient visit codes established by Centres for Medicare and Medicaid Services (CMS).
6. Make sure you understand the billing rules and regulations for Medicare and private payers. In fact, with the high cost of new cancer therapies, many oncology practices are now verifying insurance information before every treatment.
7. The American Medical Association’s (AMA) multi-specialty Relative-Value Update Committee (RUC) frequently reviews and updates oncology codes. Keep in sync with these changes.
8. Oncology clinics and hospitals will find the guidebook on billing and coding for oncology-related services offered by American Society of Clinical Oncology (ACCO) very useful.

Escapade from the Oncology Coding Malaise :

Perplexed and unsettled due to plethora of oncological coding errors! Don’t panic. Be assured by adopting a prudent approach by outsourcing or rather “Right Sourcing” your coding worries to MedicalBillingStar,as we :

A. Are an established, experienced, and knowledgeable one-shop outsourcing vendor for oncology coding in the US.
B. Are conversant with intricacies of oncology coding practices and comply with medical coding systems such as International Classification of Diseases (ICD), Current Procedure Technology (CPT), and Healthcare Common Procedure Coding System (HCPCS).
C.Understand your EMR and work with any platform, with security features and options. You are free to select EMR/EHR of your choice and we will cover the involved expenses.

Here’s our presentation on 8 Oncology Coding Tips !

Revenue Cycle Management – The Road to Maximized Profit

September 19, 2013 by Ango Mark Leave a Comment

Effective and efficient Revenue Cycle Management (RCM) is bread-and-butter for survival and prosperity of any medical practice business. RCM is not limited to medical billing and collecting reimbursement claims. It involves tightly integrating all the clinical workflow steps, commencing with patient’s registration at the front desk, diagnosis, treatment, discharge, recovery of dues from the patient and the insurance company, and follow up on denied claims.

For ensuring financial viability of the business and before initiating implementation process of RCM, it would be prudent to carry out an in-depth assessment of the current position of the practice.

In-depth Self-examination :

There is a need to evaluate the present standing of the practice with the following posers :

1. Does it take unduly a long time to collect reimbursement claims and patient payment?
2. Is the denial rate for the first submission of reimbursement rate more than 4%? (For best practice standard the rate should be less than 4%)

3. Are write-offs and adjustments of pending reimbursement money very frequent and high?
4. Is percentage of accounts receivable, which are more than 120 days old, higher than 10%? (For best practice it should be less than 10%).

If answer to any one of these posers is in the affirmative, then the financial viability of the practice is jeopardized.

Critical Post-evaluation Measures :

Patient Reporting-in :

On receipt of a phone call for an appointment from the patient, the front desk should ascertain medical problem and insurance coverage of the patient, and then guide the patient to provide information for registration by going online on the hospital’s/clinic’s website. Any incomplete information should be followed up before the appointment, so that the insurance coverage of the patient can be verified. An alternative process involves a kiosk for patient check-in at the clinic or hospital for collection of patient’s demographic data and automatic verification of insurance coverage.

Charge Entry and Capture in the Superbill :

As a basic requirement, physicians should ensure that the correct code with appropriate modifier is recorded in the clinical document of the patient, to ensure correct billing and preparation of claims. The billing should be timely and close to the date the patient has been provided with the medical services to avoid delay and piling up of pending claims.

Bill Clearing House :

Bill clearing house checks whether all the required data are included in the bills transmitted to the clearing house by the clinic/hospital.

Follow-up with Insurance Company :

Once the claims are transmitted to the insurance agency, follow-up is a must to ascertain the progress on submitted claims. When the claims are passed, in full or partial, the insurance company remits the payment automatically to the practice account.

Patient’s Portion of Payment :

Ascertain and recover patient’s payment contribution for diagnosis and treatment through aggressive AR callers.

Denied Claims and Follow up :

Correct and resubmit denied claims to the insurance company and follow up till receipt of payment.

Complete End-to-end RCM :

RCM encompasses all the workflow of the clinic or hospital, with each step linked to the next step as under :

The Hallmark Solutions To Frequent Medical Coding Gaffes

September 11, 2013 by Ango Mark Leave a Comment

Most healthcare providers are on the horns of dilemma due to the medical coding mistakes and the ensuing claim denials. The Best Medical Coding Practice paves the Greenway to recoup your dollars for the exact service rendered by you, whilst improper coding takes away your dollars. This article underscores the common coding mistakes and the conduit to resolve them.

Ensure Medical Necessity :

The healthcare insurance payers are progressively more apprehensive about the medical necessity. The payment for the physician services is based on the CPT codes, whereas the claim approval and reimbursement by the payer is based on the diagnostic codes. Thus, elucidating the harmony between CPT and diagnostic codes is a key step in the coding process. If the payer deems that the service is medically necessary, you will be paid or else your repayment will be hampered and/ or even you will be monetarily penalized.

Ethically Exploit the Modifiers :

A Modifier is the Nucleus of Multi-procedure Coding-based medical claim. Modifiers can be the benchmark for full reimbursement – abridged reimbursement – complete denial – or partial denial. Forgetting, abusing or confusing modifiers in requisite circumstances may lead to negative impacts on reimbursements.

Examples :

1. Failure to tag on Modifier 25 to the E&M service or erroneously appending it to the surgical procedure will cause claim denial.
2. A CPT code linked with Modifier 51 notifies the payer that two or more procedures are being done on the same day and to employ the multiple procedure payment formula. Modifier 59 tells that the procedures/services those are not usually reported collectively, but are apt under a specific circumstance.
3. CPT advocates using Modifier 24 with an “unrelated E&M service by the same physician during a postoperative period.”
4. Modifier 53 is tagged on, when the physician opts for ceasing a surgical or diagnostic procedure because of extenuating events or a hazard to the patient’s health.

Shun Missed Charges :

Most biggies among healthcare providers, can simply fail to spot charge captures for the multiple services delivered. Imaging, laboratory and other subsidiary services often miss the unwritten/ verbal orders of the clinic or lab staff. Better avoid or document the ‘verbally communicated orders’ so as to rule out this problem.

Take Cognizance of the Code Revisions :

Many providers use out-of-date encounter forms thinking that updating is an onerous and mind-numbing task. But, it is inevitable to update the Superbills with the revised codes so as to recoup your payment for the rendered service. Every year, procure new CPT, HCPCS and ICD-9 books and educate the pertinent staff members to get accustomed with the revised codes.

Eschew ‘Over-coding’ and ‘Under-coding’ :

Over-coding is sometimes deliberately done to acquire a higher reimbursements, but it may lead to claim denial and often resubmission or appeal processing/ penalty cost more than that of the anticipated payment.
Example: If, the code 413.9 (unspecified angina pectoris) is used along with 414.01 (Coronary atherosclerosis of native coronary artery), instead of 414.01 alone, it is ‘over-coding’ and would be considered as a fraudulent activity by the corresponding statutory authorities.

Under-coding is usually a result of ‘fear for denials’. The best solution is to do ethical coding using coding and quality control veterans. Besides, perform NCCI (National Correct Coding Initiative) or other appropriate edits to ensure correct coding and to control the inappropriate assignment of codes that result in improper reimbursement or penalty.
Example: Some physicians consider 99213 as the default code as they believe much documentation will be desired for coding anything higher and they deem 99213 is the safe and sound option. But, in point of fact, this is an under-coding and culminates in diminished reimbursement.

The Soul of Medical Coding Remedies :

In a nutshell, our think tanks say that the following tips can augment accurate coding, and sequentially, medical practice revenue vanished to denials:

1. Keep your staff abreast of the revised codes.
2. Educate your staff to hone their coding skills.
3. Create a channelized workflow between coders and physicians.
4. Follow ethical coding practice.
5. Resubmit denials earlier and rigorously track the denied claims.

Click here to have a word with MedicalBillingStar and crash the coding menace effortlessly !

Infographics: EMR Implementation At Cross-Roads

September 3, 2013 by Ango Mark Leave a Comment

EMR, a Marriage that has to succeed :

Healthcare providers in the US have opted for EMR as mandated by the federal government, for superior patient care and efficiency,with reduction in costs and enhancement of patient experience. However, the biggest hurdle, namely getting it to work efficiently, is not yet crossed.

Thorny path where benefits galore :

Implementation of an EMR system involves treading on a thorny transition path from paper-based to computer-based on-line live medical practice. However, once successfully implemented, improved efficiency, speed and accuracy of performing clinical tasks render the EMR systems an invaluable investment. It also promises to reduce clinician workload and medical errors.

The EMR Carrot :

Incentive payments of up to $27 billion for EMR implementation, or as much as $44,000 (through Medicare) or $63,750 (through Medicaid) per eligible health care professional, are offered by Centres for Medicare and Medicaid Services (CMS). As of July 2013, more than 316,000 health care providers received incentive payment, according to CMS. According to the Robert Wood Johnson Foundation, the number of hospitals with EMR increased to 44 % in 2012, up by 17 % from 2011.

On the flip side,survey results depicta gloomy picture with yet to be realised EMR promises.

1. Based upon American EMR data collected from 2010 to 2012, user satisfaction levels with EMRs are dropping. These findings were presented at Healthcare Information and Management Systems Society (HIMSS) conference on March 5, 2013.
2. Overall EMR user satisfaction surveys revealed a 12% drop in satisfied users from 2010 to 2012 and a corresponding increase in very dissatisfied users of 10% for the same period.
3. Dissatisfaction with EMR implementation is increasing regardless of practice type or EMR system, asserts Michael Barr, MD, ofAmerican College of Physicians’ (ACP’s) .
4. 50% of EMR implementations failed according to the National Coordinator for Health IT
5. Ohio-based StreamlineMDasserts that only 27% of EMRs are successful.
6. Yes and No! A recent survey of 17,000 EMR users revealed that nephrology (88%), urology (85%) and ophthalmology (80%) practices expressed the highest rates of discontent with their EMRs, while internal medicine (89%), family practice (85%), general practice (82%) and paediatrics (80%) specialists experienced highest rates of satisfaction with their EMRs.

Reasons for the impasse: Lack of effective end user physician training in EMR is the bane across the US healthcare industry. Importance of training has been overlooked and under-estimated by physicians.Richard Stokes, director of sales for Network 1 Consulting, warns that continued inadequate training of physicians will slow down the EMR system implementation.

Way out of the doldrums: Need of the hour is effective EMR training that involves 8 important issues :

1. Tailoring the EMR training sessions specific to the hospital/clinic.
2. Using experienced and certified EMR trainers
3. One-on-one training: Every physician has a different learning curve. Hence, having one-on-one training is a must. For smaller practices that may not have advanced IT background, physicians should be made to initially work side-by-side with experienced trainers.
4. EMR training for everyday workflow: Training needs to bescheduled around normal physician practice workflow. The physicians should be made to use EMR consistently in the manner they’ll need towork after going-live.
5. Basic skills and practice procedures: Many physicians are not even familiar with intricacies of computer usage. They have to be familiarised with basic computer skills.
6. Train, retrain and retrain: Training never ends and is a true ally.Training patiently, retraining, and on-going training hold the key for success, adds Susan Miller, administrator at Family Practice Associates of Kentucky. Leann DiDomenico, administrative director of Performance Paediatrics, uses EMR training videos and makes the physicians repeatedly carry out their tasks on the EMR, until they are confident of performing on their own.
7. Avoiding rushed training sessions.
8. Continuous evaluation of on-going training.

Helping hand from MedicalBillingStar :

Hospitals and clinics in the US can bank on MedicalBillingStar as their EHR trusted partner to help train physicians in nuances of EMR implementation and functioning.Tailor-made EMR training modules are available to cater to the specifics of any clinic/hospital. Training options include formal training during office hours or in special sessions outside of normal business hours, offsite training, and online training.MedicalBillingStar has the resources to help in training doctors, so that they can catalyse successful EMR adoption.

7 Salubrious Coding Tactics to Thwart Claim Denials

August 28, 2013 by Ango Mark Leave a Comment

Evolving code sets in varied coding systems (ICD-10-CM/PCS, CPT-4, HCPCS Level II, etc.) are creating an intricate, but beneficial platform for the patient care, clinical documentation, data transfer, research, practice analysis and also repayment. Despite this pragmatism, quite a lot of physicians don’t recognize the significance of coding in clinical practice and its impact on reimbursement.

The Tactics to Beat Around the Bush :

Beyond a shadow of a doubt, coding is the backbone of the practice business. Improper medical coding cause claim denialsand culminate ultimately in revenue loss. Thus, it is imperative to address the hardships in medical coding with a fresh pair of eyes.

1. Update to Upsurge : Once the new codes are released, every practice must update their encounter forms, super bills, user guidelines and EHR/PMS systems with the fresh codes to create clean claims and to zero down the denials.

2. Revise to Revive : During every ‘updated codes’ release, revise the corresponding fee schedule up-to-date, so as to improve your bottom line and to achieve compliance.

3. Educate to Excel : Apart from updating the tools and systems, it is indispensable to educate the physician and the coders with the fresh and revised codes and the records desirable to make the codes evident.

4. Check to Cheer: Although, the claim scrubbers effectively validate claims – by recognizing billing errors and creating edits to scrutinize denial issues – a manual check could ensure submission of clean claims. For example, the scrubbers may fail to validate the modifiers even though the software flags the claim as “modifier inappropriate”.

5. Review to Revamp : It is essential to review the new payment policies and coding guidelines constantly, to get acquainted with the payer’s regulations.

A. CPT^®: The American Medical Association’s (AMA’s) revised CPT^® codes can be effortlessly recognized. The green text in the CPT^® code book highlights the modifications that are new to the revised book. Sometimes, the guidelines will modify or add supplementary information for proper codes although the codes remain unchanged.

B. NCD/LCD : Medicare’s National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) can be reviewed through the Centers for Medicare and Medicaid Services’ (CMS’) website. More to the point, the revised payment policies of private insurance companies can be reviewed through the payer’s website. Reviewing the policies in this fashion aids the coders to – elucidate code use – spot the diagnoses that call for medical necessity – offer documentation requirements.

C. NCCI : The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services can be reviewed to understand the bundling of codes. Supplementations and revisions to the policy manual have been italicized in red font in the electronic copy.

6. Designate to Delight : It is unfair that most physicians don’t designate the primary diagnosis among an array of multiple diagnoses performed on the same patient. Furthermore, the physicians must number the diagnoses in the order of their significance so as to evade the denials based on ‘medical necessity’.

7. Invent to Infer : Following the aforesaid steps will assist you thwart claim denials associated with code revisions but will not eradicate them utterly, making “denial resolution” obligatory. All the perfectly created codes would not get you the repayment. For instance, one of the new complex chronic care coordination (CCCC) code – 99488 is not reimbursed by Medicare as per its policy guidelines and thus it will be denied. But, on another edge, a secondary or other insurance payer may reimburse for this code. Thus, you need to invent a procedure so as to deduce the non-covered codes for every payer in your network.

To know more about the coding tactics or to clinch a deal !

Contact MedicalBillingStar @ 1-877-272-1572

Infographics: Wriggling Out Of Problematic Emergency Medicine Coding Nightmares

August 20, 2013 by Ango Mark Leave a Comment

In today’s healthcare scenario,Emergency medicine (EM) practice have assumed enormous importance due to ever-increasing natural as well as man-made disasters, not to speak of acute health problems created by changing lifestyle and fast-spaced competitive environment. Few people appreciate the importance of emergency medical services until they are the ones having an emergency.

The EM Practice Fact Box :

1. Heavy Patient influx !EM services have emerged as the gateway for hospitals, and account for more than 50% of hospital admissions in the US.
2. According to the US Health Directorate, there was a spike in the number of patients who were seen in first 10 minutes (wait time) in 2012 (23.5%)as compared against 2009 (18.62%).
3. Thought-provoking !Every year, around 300,000 persons in the US experience an out-of-hospital cardiac arrest (OHCA), and approximately 92% of these die, according to Centres for Disease Control and Prevention (CDC).
4. Food for Thought !The majority of persons who experience an OHCA event do not receive cardiopulmonary resuscitation (CPR) or other timely interventions.
5. Revenue Potential !According to OIG (Office of Inspector General, US Department of Health & Social Services) between 2001 and 2010, Medicare payments for EM services increased by 48%, from more than $22 billion to more than $33 billion.
6. A surprise ! In a survey of Emergency Medical Services (EMS) leaders in the 200 largest American cities, the Journal of Emergency Medical Services found that 44 % of the areas surveyed had made budget cuts to emergency response services in 2012.

Against this back drop, it is not surprising that overworked EM physicians are unable to keep abreast of the constantly evolving and changing clinical codes and related modifiers. This situation is further aggravated due to impeding implementation of ICD-10 and the spate of on-going EM inventions and enhancements. The ever-shrinking reimbursement pool in EM forces every emergency clinic to focus on revenue cycle maximization strategies or face extinction.

Are you perplexed and in a dilemma how to keep in touch with frequent changes codes and related modifiers ?

Do not worry.OutSource or RightSource your EM specific coding worries to MedicalBillingStar.

We, at MedicalBillingStar :

1. Are well versed in the intricacies of EM specific coding services, with many satisfied EM customers across the US.
2. Can extricate you from this problematic scenario.
3. Are fully conversant with the on-going changes in the EM domain.
4. Ideally positioned to offer guidance and a safe passage for the EM fraternity through the thorn-ridden pathway.
5. In addition as freebies we offer free EMR consultation.We also provide pay for subscription involved in any EMR platform of your choice.We provide free EMR consultation services.

‘Furious Patient’ Encounters: The Mysterious Art of Care – Uncovered !

August 6, 2013 by Ango Mark Leave a Comment

A sullen patient may wreck your whole day !

The majority physician encounters with patients are constructive. Conversely, just as any venture has intricate and challenging customers; doctors also come across their share of exigent patient encounters. However, the kind of encounters faced by the healthcare providers is completely exclusive. Though, the art of communicating with ‘difficult’ patients is quite primitive, in the hectic practice environment, the communication hand-offs between patient and physician can easily be fumbled. Even a single encounter with a sullen patient can spoil your whole day and may even affect your prospective agenda.

A couple of approaches that will make the encounter “worse”

A physician must have comprehensive information of the patients and their problems. With a scanty clinical, personal and social knowledge pertaining to the patient, if a physician approaches an upset patient, it may exacerbate the patient’s mood leading a pointless plight. Usually, if you face a sullen person you may be doing one of the two things:
1. Guard yourself or the person who upset them.
2. Try to “crack their trouble”
These are natural human intuitions and they NEVER WORK and instead aggravate the scene.

Miscommunication – A social faux pas

Though there is a dispute about patient safety and physician liability, in the social and legal milieu, the saddle for “triumphant” physician-patient communication lies ultimately with the physicians. Dr. Dike Drummond has designed a simple, structured communication protocol named “The Universal Upset Person Protocol (UUPP)”, to deal with an upset person rapidly, elegantly, effortlessly and empathetically.
UUPP states that, at any instance of the upset patient – physician tête-à-tête, the patient must express their “feelings first”. They are yearning to be listened and understood, for someone to heed their situation. Thus, you must:
1. Realize – as they are upset.

2. Provide an opportunity for them to elucidate their problem.

3. Empathize their trouble.

4. Plan accordingly to resolve the issue.

UUPP – The coherent communication protocol :

The application of UUPP in your clinical practice will be get you a great surprise to see how swiftly the person pacifies, making you hassle-free for cracking the trouble.

1. Face the upset person before you converse :

The upset person needn’t be a patient as the UUPP works for even colleagues, your life-partner, children and even complete strangers. Take a deep-breath! Follow the script below and experience how it right away defuses the ‘difficult’ encounters.

Despite what/who they are upset with… the distress generally comes in one of two flavors.

1. The person is candidly and verbally revealing the distress.
2. The person is upset and NOT VERBALLY EXPRESSIVE. The person is “seething”. You can spot it out clearly by their non-verbal signals, the body language.

2. Say… “You sound/look really upset.”

3. The upset person will say one of two things :

“You bet I am”

Or “No I’m not … I am ANGRY/DEPRESSED/FRUSTRATED/HURT/SAD/OUTRAGED.”

They may name a different emotion. There is a part of you that will believe you have “made a gaffe” here. You didn’t name the correct emotion! Just let that go.

The simple act of you commenting on their upset … caused them to think and elucidate accurately what they were feeling. That elucidation is the key for venting and moving forward in your discussion.

4. “Tell me about it.” or “Tell me what happened.”

The upset person does not usually vacillate given your invitation. They will take right off into an emotion filled description of what happened. Your job here is simple … LISTEN. Really listen.

Look to understand their perspective here. Muster up as much empathy as you can. lend your hands for them

“Get it all out of their system”.

5. When their description is over… look them in the eyes and say,

“I am so sorry that happened to you” or “I am so sorry you feel this way”.

6. Ask, “What would you like me to do to help you?”,

In general, the upset person will have a particular demand. Observe their emotions and listen warily as they make it and observe whether or not you are ready to do what they want you to. This is your opportunity to observe your boundaries for the next pace.

Sometimes, the upset person will wind up here. They just wanted to be heard and are done now. Thank them for trusting you with their feelings – see step 8 below. You can move ahead to your clinical issues at this point with a clean slate.

7. Tell them what you suggest be done now.

Analyze deeply and make a decision about your willingness to make a specific stroke.

If the upset person has asked you to take a specific action – and you are willing to do it – tell them so.
If the upset person’s request is NOT something you are willing to do – set your borders and communicate them obviously. Tell them you are NOT willing to do what they request and do not stop there. Think about what you are willing to do that will address their upset and tell them what you ARE willing instead. Ask if your proposal works for them. It usually only takes a minute or two to come to a concord here.

8. Thank the upset person for being open with you,

“Thank you for telling me how you really feel… it is imperative to me that we understood each other obviously”.

9. Move ahead…

You have now efficiently “emptied the air” with this patient and you can move on to the clinical reasons for their visit today.

Note:

1.Even though the full UUPP above has 9 steps, the whole protocol conversation may take only 2-4 minutes

2. IF YOU DON’T FOLLOW THE UUPP – and either try to defend or fix the problem up front — you are in for a 20 minute kerfuffle every time … because people really don’t care how much you know until they know how much you care.

YOUR NEXT PACE :

1. PRACTICE – PRACTICE – PRACTICE.
2. Print out this document.
3. Learn it.
4. Perform a “role play” with your friend – Let him play the part of upset person.
5. PRACTICE until you are comfortable with the steps and phrases.
6. USE THE ‘UUPP’ WITH YOUR NEXT UPSET PERSON.

GRAB YOUR BENEFITS :

1. Alleviate your stress levels.

2. Thwart burnouts.

3. Turn into a more influential leader.

Stay chilled and enjoy rest of your day !

Why Inadequacies In Clinical Documentation For Anesthesia ?

July 31, 2013 by Ango Mark Leave a Comment

Bogged Down with Clinical Documentation for Anesthesia using Complex, Tough, and Ever-Evolving Coding Systems ?

Are you unable to accurately and thoroughly document the surgical and anaesthesia processes and use the right combination of billing codes and modifiers for timely and proper submission of medical insurance reimbursement claims ?

Are you experiencing nightmares due to lack of awareness of multiple ranges of anaesthetic reimbursement guidelines adopted by different insurance companies ?

The era of inconsistent, inaccurate and incomplete Anaesthetic Documentation: According to a survey conducted by Academic Health Sciences Centre, Montreal, Quebecmany of the preoperative and intraoperative variables which are important for documentation of anaesthesia are recorded inconsistently and incompletely.

Why the need for Precise and Thorough Clinical Anaesthetic Documentation ?

a• A thorough and precise clinical anaesthetic documentation helps in capturing the right combination of the diagnostic/treatment code coupled to the appropriate modifier to depict the actual surgical scenario under which operations are performed.
b• Such an optimal combination of codes and modifiers, along with justified need for the treatment and approved care, helps in sending the correct medical reimbursement claims to insurance companies for speedy receipt of claims, without denial of claims and need to resubmit and follow up the claims.
c.• The cumulative process results in maximizing revenue and profits.
To survive and prosper, you need to enhance documentation, boost coding accuracy, decrease denials, and safeguard payments.

Why the urgency and criticality ? There are more than half-a-dozen issues :

a• Improvement in anaesthesia documentation is critical, since documentation can make or break up the business of anaesthesia providers.
b• In this economic scenario, anaesthetics have to cope-up ever-increasing patient rush, federal and state health regulatory stipulations, and quality care at affordable costs.
c• On and after October 1, 2014, entities covered under the Health Insurance Portability and Accountability Act (HIPAA) are required to use the ICD-10 code sets in standard transactions adopted under HIPAA. The HIPAA standard health care claim transactions are among those for which ICD-10 codes must be used for dates of service on and after October 1, 2014. This implies that the in-house billing and coding staffs are aware of these changes.
d• ICD-10 diagnosis codes have different rules regarding specificity and providers/suppliers are required to submit the most specific diagnosis codes based upon the information that is available at the time.
e• In addition, ICD-10 Procedure Codes (PCs) will only be utilized by inpatient hospital claims as is currently the case with ICD-9 procedure codes.
f• For instance, many carriers have special policies regarding reimbursement for anaesthesia, which are surgical/treatment-specific such as during endoscopy. This needs familiarity with respective insurance companies to ensure that the documentation supports what the insurer requires.
g• There is a need to be up to date with the latest coding guideline, and the ability to pinpoint small differences when the descriptors to some of the most common codes change.

3 Examples of intricacies of accurate, exhaustive clinical documentation :

a• Every detail supporting moderate sedation is crucial, considering how closely insurance companies audit the medical necessity and authorization.
b• Correct calculation of time for which anaesthetic services, including time for which the surgeon is present, and so on, are provided.
c• Assigning the correct add-on code when the anaesthetic service lasts longer than 30 minutes (each additional 15 minutes intra-service time), taking care to match the add-on code with the appropriate base code.

The way out of this impasse :

Relax….and Rest Assured and get rid of your nightmares by outsourcing your documentation, coding and billing worries to MedicalBillingStar, an established, experienced one-shop outsourcing vendor.

Why MedicalBillingStar ?

Anesthesia billing is completely unique compared to other specialties and MedicalBillingStar with a commitment to excellence has been billing for anesthesia practices has been billing for anesthesia practices. We streamline documentation, resulting in more efficient billing, and most importantly, better patient care and engagement which ensures that the necessary data is accurate. We offer a sophisticated customized EHR platform for anaesthesiologists and our solutions facilitate secure distribution of information and shortening the reimbursement cycle for anaesthesiologists by ensuring that all required data is present and complete, thus eliminating claim rejections.

The AMA Suggests That Physicians Should Focus On Billing. Are You?

July 10, 2013 by Ango Mark Leave a Comment

Are you losing out on billable dollars ?

This is not the best time to be a healthcare provider! Financial constraints and regulatory pressures are giving physicians, sleepless nights. Doomsayers have crawled out of the wood works to proclaim that medical practices are going to fold up and die.

It is certainly not like healthcare is circling the drain hole. But it is essential that medical practices up their game to stay afloat.

Still stuck with a payment contract that is five years old ?

The major mistake that healthcare practices make is to get paid much lower than the services they provide. Nobody likes getting on the phone and haggling with insurers. But what has to be done has to be done! Frequently negotiating reimbursement contracts will go a long way in increasing revenue.

Thorough claim analysis and evaluation of top paying CPT codes every three months can prevent and clot the bleeding.

It is okay to discuss money with patients !

Do you feel delicate when discussing about money with patients? Instead of dillydallying be forthright with your patients about treatment costs and payment options. Give them a lowdown on what and how much the insurer will cover.

A lot of patients promptly sue their doctor the minute they receive a bill. Discussing about payment prior to a medical procedure will prevent heartaches and heated arguments.

Don’t rely on straight- out of a- can solutions…

Most EMR/EHR systems come with coding and billing features. But no matter how loaded your system is, don’t lean on it completely. There are certain factors such as duration of treatment or the extent of injury that play a crucial role in increasing reimbursement. Middle of the road coding isn’t going to cut it anymore.

Why work just eight hours ?

As pressures mount and operational costs skyrocket, outsourcing has become a viable option. It makes a lot of sense to work with a billing company that works 24 hours. You not only process claims faster you can clear revenue backlogs.

Furthermore it is a nice feeling to walk in to your practice the next day knowing fully well that your biller has transmitted your claims to the insurer. And that now, finally, the accent will once more be on patient care.

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Lisa Maciejewski-WestCMC, CMOM, CMIS, MCS-P