Billing/Reimbursement

Successful Reimbursement
By Meditec Contributor: Dawn Moreno

Just as medical transcriptionists must be extremely accurate in their work- transcribing medical reports- medical coders must be meticulous and thorough. It is not enough to skim through a medical report and quickly apply the appropriate codes for diagnoses and procedures. A good medical coder must take time to thoroughly read and understand the patient medical record to make sure that the diagnosis selected is supported by corresponding documentation in the medical record. Additionally, any procedures performed must be backed up by a corresponding diagnosis. Whereas most working medical coders understand this fact, it is still easy to become a little complacent and sloppy particularly if charts are backed up and the work pile is pretty deep. However, with what’s a stake (with all the regulations and legal ramifications), it is really important to take steps to make sure that all is being done to ensure successful and accurate reporting and balance that need with the requirement for fair and equitable reimbursement.

Some quick tips to help ensure successful and accurate coding is as follows.

* Always file claims electronically whenever possible to cut down on lost claims and to speed up the reimbursement process.
* Remember to document the verification of patient coverage, and any appeals process during the reimbursement process.
* Keep up to date on payers policies, rules, and contract guidelines. This helps to avoid denials of claims and speeds the reimbursement process.
* Don’t let claims build up, and then feel under pressure to get through a mountain of files.
* File claims on a daily basis.
* Check claims for errors BEFORE filing with the payer.
* Check to make sure that the diagnosis is backed up by facts in the medical record. This way if the clinic is ever audited, you will not have to worry about what appears to be fraudulent claims. Even if you use great coding software such as Alpha II, still cross-check for accurate coding.

By being diligent in your medical coding and billing practice, you avoid the pitfalls of sloppy coding and accidentally up- or down-coding. Virtually every medical provider now needs business and medical staff who are well trained to insure the practice is successful and is in compliance with the increasing rules related to conducting a practice. Coding and billing are critical issues in the practice of medicine with lots of federal funding in place to do audits, particularly of Evaluation and Management Codes (the government now has lots of data on those). Meditec’s programs will increase staff awareness of the real issues and the penalties. Experts recommend that practices commence formalizing policies and procedures and develop complete compliance plans. Voluntary Compliance Program Component information may be found at: http://www.meditec.com/meditec-provider-index.html

Based on article “Top 5 Tips for Successful Reimbursement” found in BC Advantage magazine Aug/Sept Issue.
Electronic Health Records (EHRs) – Friend of Foe?
By Meditec Contributor: Dawn Moreno

Before laying out the benefit of EHRs, let me first start by allaying the fears of many medical transcriptionists. There are many different types of EHR software available. The government mandate and desire for all clinics to go EHR doesn’t necessarily mean an end to MT. Many hospitals are using EHR right now and many clinics are also using it. There is a type of Electronic Medical Record software that does use only macros that the doctor clicks to complete the medical record. However, most doctors don’t like using it. They don’t want to walk around with an electronic tablet and stylus taking time to click the correct macro to create proper sentences. With so many potential macros, imagine finding enough point and click macros to describe an extensive operative procedure? There is also EMR software where the doctor still does dictation, and the medical transcriptionist types directly into the EMR software. This is most likely the scenario in the foreseeable future for MTs. Just like voice recognition was not the downfall of MT, neither is the EHR.

The question remains why does the government want to change to EHRs? The reason is both simple and complex. Health Information Exchanges between doctors, hospitals, labs, are expensive and the risk factor is substantial (making sure a specialist has all the background information, for instance). Faxing records from one place to another is not an efficient way to transfer important patient information and records. Instead of redoing expensive tests, there will be an easy way to exchange information, which will cut down on healthcare expenses. One of the problems of widespread integration of EHRs is the compatibility of one system to another. It is probable that software vendors will have to make their programs more versatile and integrative with other vendors.

Some fear the loss of privacy. However, the system in place now is not exactly the best for ensuring patient confidentiality. Medical records are faxed from one place to another. Some are even mailed via regular mail. I once received a medical record that was not mine in the mail. That is a scary thought. Just like the sending and receiving of dictation is done via secure web servers now, the new EHRs will also be as safe and confidential as it possibly can be. Instead of having piles of paper files in a doctor’s office, it will all be automated. There may be some glitches to work out as our nation goes fully to HER technology, but in the long run, I believe it is a positive step to reducing health care costs, and I don’t feel it’s a threat or the end of the medical transcription career.
Tips to De-Stress!

Hopefully, it does seem like the economy is starting to improve, but many Americans are still feeling the stress of having lost their home, job, vehicles, etc. In other words, many feel like they are downing in problems and financial ruin. I was not alive during the great depression, but I’ve read about it. People were poor, hungry, and worried about just the basic necessities of life. However, many survived this time period in good spirits. Happiness is not always about life circumstances or what is currently going on in one’s life. Happiness is 90% choice, 10% circumstance. Yes, I believe that circumstances play “some” role in one’s happiness. However, the mark of true human spirit is learning how to find happiness even in the rough times. It’s okay to acknowledge that times are rough right now, but if only look for the negative, that is what we will continue to attract to ourselves. So, how can one learn to look on the bright side of things and learn to effectively handle stress? Below you will find some tips and creative ideas. Take what you feel would work for you and leave the rest.

-Remember those who have it much worse than you do. If your car isn’t working, think of the man who has no legs. If you are upset that you have to eat leftovers again this week, remember those that have nothing to eat. It’s all in perspective.

-Find something to be grateful for in your life and focus on your gratitude for this blessing. It could be a relationship, a pet, a job, a boss, a situation, anything that you feel especially grateful for.

-Do something that gives you joy. It doesn’t have to be something expensive. A walk in the park. Curl up with a good book. Watch a funny DVD. Visit a friend. Watch a bee flit from flower to flower. Take a magazine to an elderly person in a nursing home. Volunteer your time somewhere. Take your family on a picnic in the park.

-Fill your mind with inspiriting stories of those who’ve weathered life storms. A trip to the public library or subscribe to an inspirational magazine.

-Assess what you do have going for you. Job skills? Friends?

-Could this be a time to launch out on something new? If one door closes, another could be opening. Look for the opportunities that life sends your way. Maybe a job loss is an opportunity to start that small family business you’ve always wanted. Maybe getting out of that high-stress job opens the door to assess what you’d REALLY like to be doing with your life. Maybe the broken down car is an opportunity to take public transportation and meet new people, or to get out that old bike and get some exercise.

-Journal or engage in a creative pursuit. Sometimes writing out your feelings can assist you in letting go of negative ones, and then objectively looking at what is good in your life. It is also a way to help you process through your own thoughts. Creative hobbies help to shift the mind’s focus onto something else. Some creative ideas are knitting, scrapbooking, calligraphy, drawing, etc. If you don’t have a hobby, find one. If you are not the creative type naturally, why not take a class in painting, calligraphy, drawing, ceramics, or beading.

-If you’ve lost your job, you do have “time.” Why not volunteer a few hours a week helping someone more unfortunate than you are? Homeless shelters, domestic violence shelters, animal shelters, children’s organizations like Big Brother and Big Sister, or even project READ, all good places to start. There is joy in assisting someone else.

Choosing to see the glass half full is a skill that needs to be developed. It takes time to gain the skills necessary to catch yourself engaging in negative thinking and fear thoughts, and to have the courage to make a change to the positive. A wonderful book on positive thinking is The Power Of Positive Thinking by Dr. Norman Vincent Peale. It’s an older book, but is one of the very best on this subject. I believe this book is the definitive word on how to think better and to get the most out of life even when everything is not going the way you want it to at the moment. Happiness, it’s your choice.

And always remember, when the going gets tough, the tough get going! Medical Record Blunders
Source: http://www.geocities.com/medicaljokes/

1. Healthy-appearing decrepit sixty-nine-year-old male, mentally alert but forgetful.
2. The patient refused an autopsy.
3. The patient expired on the floor uneventfully.
4. Patient has left his white blood cells at another hospital.
5. The patient’s past medical history has been remarkably insignificant, with only a forty-pound weight gain in the past three days.
6. She slipped on the ice and apparently her legs went in separate directions in early December.

This Month’s Recipe
Pimento Cheese

- 1 16 oz block of hard extra sharp cheddar cheese
- 2 4oz jars of pimentos (do not drain)
- 2-3 tbls Mayonnaise
- 1 tbl apple cider vinegar
- 1 tbl Sugar

Shred the block of cheddar using the course side of the grader (larger shreds). Add the 2 jars of pimentos w/ juice. Mash the cheese and pimentos with a mashed potato masher or the bottom of a thick water class. Mash well. Add 2-3 tablespoons of mayonnaise, and 1 tbl apple cider vinegar, and 1 tbl of sugar. Mash contents together again. Then fluff with a fork. Can serve w/ crackers, but is great as a sandwich spread.