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Sunday, December 9, 2012

Why Work in Medical Billing and Coding?

If the field of medical coding and billing sounds interesting to you then check out these reasons as to why one should work in this area? The reasons are:

• One of the reasons why the field of medical coding and billing is so lucrative is the fact that anyone can learn it within a year or so. Depending upon the course and school you choose you can pass with a diploma in medical billing and coding in a year or even have a certification in 2 years.

• This career path allows you to work from home. You can either start your own medical coding and billing company or can work for some other company. In both the cases the rewards are very high. Clinics and hospitals do not handle the medical insurance documents on their own and normally require the services of medical coding and billing companies. Working from home is a great option for freelancers who enjoy working from home or for housewives who have the zeal to work but were not able to do so because of other responsibilities.

• The job of medical billers and coders is just the starting point for these medical billing and coding professionals. With experience and expertise in the medical field you can diversify your career and go in for various other job designations.

• Once you have gained some experience working as a professional medical biller and coder you can opt to quit your job and start your own company. Starting a company is a big step and this decision should not be taken lightly.

• Due to the everlasting increase in the demand for health care facilities one can be sure that going in for a medical billing and coding course will give you the much needed job security.

How to Choose the Best Medical Billing Service CMS Announces "Meaningful Use" Rules Medical Billing And Coding Service - Reasons To Pick As Your Career Option Important Difference in UK Vs US Health Insurance Models How Under-Coding Affects the Financial Well-Being of Your Medical Practice

The Politics of Preventive Medicine

"The most costly of all follies is to believe passionately in the palpably not true."

HL Menken

A recurring theme of mine is the maddening, confounding and fascinating complexity of human health and disease. Common sense, unifying principles, and single-explanation theories cannot encompass the diversity of the human organism. Easily understandable, common sense approaches to health care can often be ineffective or counterproductive. Lay people and their political representatives rarely grasp these intricacies, which leads to poor individual choices and public policy.

Obamacare panders to these tendencies by stressing "preventive care" as a core principle. What could be more sensible and cost-effective than preventing disease by finding it early? Two papers published last week seriously question these underlying assumptions and raise fundamental issues about the integrity of the medical foundations of Obamacare.

The first paper is about prostate screening. The conclusion is that finding tumors early has no impact on the life or health of the people screened. This counter-intuitive outcome is based upon the unusual behavior of some of the prostate cancers found. It appears than many cancers never progress far enough to cause any actual problems. Screening finds these harmless tumors, and treating them results in no benefit, and greatly increased cost. Waiting to treat those cancers which actually do cause problems is just as effective. Needless to say, this kind of result is difficult for many people, even some physicians, to accept.

The second paper is about mammography (disclosure: I derive income from billing for radiologists performing mammography). This detailed study questions the role of mammography in the reduction of breast cancer mortality. Although there has been a substantial reduction in breast cancer mortality since mammography has become widespread, there has also been dramatic improvement in various therapies. The study questions the portion of survival benefit attributable to mammography, which may be smaller than either simple reasoning or prior studies suggest. Again, this finding is strongly counter-intuitive. Common sense would dictate finding a cancer earlier would be of great benefit, but common sense might be wrong.

Other "preventive" measures, mandated by Obamacare, including weight loss and smoking cessation counseling, are also essentially worthless. A strong anti-smoking lobby and weight loss industry has influenced Congress to include expensive counseling and education programs in the mandated insurance coverage, which have been proven by many studies to be ineffective. Demanding insurance companies pay for such services will be costly and of little benefit to all but those selling the services.

From a health care policy viewpoint, the money, time, and effort spent on these "preventive" measures will be wasted. Compelling insurance companies to cover such services, cost free under Obamacare, is not supported by "evidence based" medicine. Obamacare's backers hypocritically reject overwhelming evidence if it does not support their political agenda. However, they are quick to accept borderline data in order to malign therapies not so politically popular. Removing Tonsils and Adenoids was singled out by President Obama as a wasteful and expensive therapy. In actuality, the evidence about this surgery is not conclusive, and many children (including my own) demonstrate great benefit. It seems the political connections of the supporters of a therapy are more important than the medical evidence.

These ill-conceived policies represent the triumph of politics and lobbying over medical science. Obamacare is not about health, but reflects the economic and political power of the constituencies trying to manipulate the dollars behind it. The process has also further eroded what little trust Congress held for the American people. Costly, useless, fanciful, and doomed to fail, not a good prognosis for Obamacare, or the health of America.

Eva von Schaper, "Prostate Screening Fails to Cut Cancer Deaths, Study Says. Bloomberg news, September 14, 2010 Anthony B. Miller, MB, FRCP; Teresa To, PhD; Cornelia J. Baines, MD; and Claus Wall, MSc, "The Canadian National Breast Screening Study-1: Breast Cancer Mortality after 11 to 16 Years of Follow-up - A Randomized Screening Trial of Mammography in Women Age 40 to 49 Years," September 3, 2002, Annals of Internal Medicine, Volume 137, Number 5 (Part 1) E-315 How to Choose the Best Medical Billing Service CMS Announces "Meaningful Use" Rules Medical Billing And Coding Service - Reasons To Pick As Your Career Option How Under-Coding Affects the Financial Well-Being of Your Medical Practice TV Medical Leads

Need a Medical Coding Update? Audio Conferences Can Help You

In today's complex regulatory environment, what with healthcare resources stretched to the limit, you need to optimize your coding and compliance efforts. A good way to do so is by signing up for audio conferences. When you sign up for one, you will get a medical coding update, inside scoop on how to tackle the coding issues that are costing you money and putting you at risk for a bad audit, and lots more.

When you get onboard such a conference, you will get an idea where you are losing money, get the lowdown on the most common missed reimbursement opportunities, it'll help you get the latest update on regulatory issues, ways to analyze your billing performance and tips and tricks to make every appeal a success!

When you sign up for one, you will be able to save on your travel costs as you can listen to them from the comforts of your own office or meeting room. Such a conference provides multiple formats to fit your training needs. And the best part is such conferences can be had in CDs or PDF transcript.

One more advantage of audio conferences is that you can even gather around a speaker phone or computer and train your team at a small price. Post the conference, you can take active part in the Q&A session. And after every conference, the presentation materials are yours for keeps.

But the best part of such audio conference is that you can earn CEUs from them. So go sign up for one today!

How to Choose the Best Medical Billing Service CMS Announces "Meaningful Use" Rules Medical Billing And Coding Service - Reasons To Pick As Your Career Option How Under-Coding Affects the Financial Well-Being of Your Medical Practice TV Medical Leads Important Difference in UK Vs US Health Insurance Models

7 Steps to Getting Experimental Surgery Authorized

Do you need experimental surgery or this is what your insurance company called it. Is it really experimental surgery? How many times has it been performed? Who performed it? Before you hear from your medical insurance the procedure your doctor wants to perform is considered experimental, too expensive, the statistics are low for the surgery to be beneficial. Think again.

Your medical insurance said they will not pay for the surgery what is your next step?

Calm down think logically. You need to appeal!! You need this surgery to save your life or limb.

These are the questions you need to ask yourself?

1. Is this the surgical procedure I really need?

2. Is there another surgery which is better?

3. Is the surgeon that really can perform this particular surgery on your medical plan or is the surgeon out of network?

4. What will be the entire cost of the surgery?

5. HOW DO I GET MY MEDICAL INSURANCE TO PAY FOR THE SURGICAL PROCEDURE?

BREAK DOWN OF CHARGES:

a. Charge of operating room?

b. Charge for surgeon?

c. Charge for assistant surgeon?

d. Charge for anesthesiologist?

e. Charge for Laboratory?

f. Charge for X-rays?

g. Charge for unknown?

1. You can get this information simply by calling your doctor's office. There will be somebody whose job it is to get this information to you.

With this information in hand you will now have a substantial plan in hand.

2. Another vital part of your appeal is getting the names of people who have had this experimental procedure performed and your insurance company has paid for it. You will need a list of their names, date of surgery, the name of surgeon, the surgical procedure performed.

You can get this information by requesting it online at any of the popular websites. Make sure you include in your request why you need this information. Include your contact information (name and email address)

This is the time to think outside of the box to get all the information you need, what phone calls to make, and what websites can get you the information you need.

3. If the surgeon you want actually performs this particular surgical procedure, is on another medical plan, you must get this same estimate from that physician's office.

You can then do a cost comparison.

In an appeal letter in which the surgical procedure you need has been denied, ask the insurance company what form of MEDICAL NECESSITY information they need.

4. What is in your contract about this type of appeal procedure?

You can get some of this information off the internet in your medical insurance company's website. If you can't get everything you need call and ask them to mail it. Make sure whatever you receive you send back to them in the appeal package.

5. Always send medical records with your appeal. You can request them in writing from your physicians, hospital, x-ray, lab, ambulance, etc.

6.. Fax your appeal letter and all your documents the more documents the better make it at least 20 plus pages.

Get to the top person in your medical insurance company.

Do your homework.

Use your computer or start calling and asking for the CEO's phone number, fax number and email #.

The president, vice presidents any body in power.

Then fax all this information marked Urgent Expedite Immediately and I would add Personal and Confidential.

Fax this at midnight on Sunday night.

Fax it to everybody you can get their fax #s.

Make sure you change the Fax information sheet.

The name of the person being faxed, title, your name, Appeal Letter for Specific Surgery

CPT and ICD numbers. CPT numbers is the reason for the visit Example: Doctors Visit, ICD is the medical diagnosis Example: Ear infection.

How many pages and your contact information which includes not only your name, phone number, email address, your insurance identification number.

I would also Email it all at the same time to each person. Do not forget anybody.

This is a life or death situation and you can put this appeal letter together with the guide lines above.

Remember money talks and if you can prove the surgeon you want (not the one the insurance company will give you) will be paid at the same rate, you have a great chance of getting your appeal paid.

Everything is negotiable in medical insurance. If this surgeon or hospital or both are out of net-work the payment can be negotiated by the insurance companies.

Experimental Surgery Authorized What About the Doctor

The experimental surgical procedure has been approved. Yeah!

Now is your battle really over? If this is experimental surgery there are not many doctor's which will do this very new surgical procedure.

Now is the time for you to do your homework. What is the name of the doctor who does this particular surgical procedure? How do I get this doctor to do the procedure for me and get my insurance company to pay for it, even if it is out- of-network.

Now you need to write another appeal letter.

You do a cost comparison between the doctor your insurance company picked and the doctor you want to perform your surgical procedure. See above.

You can get statements in writing (if possible) from physicians who are picked to perform this experimental procedure to say they do not do this kind of procedure they work in another part of the body. They make charge you.

The important thing is get your surgical procedure authorized, get the right physician and have a great life. Thank you for reading my article. Please feel free to read any of my various articles on numerous subjects. Linda E. Meckler copyright

Malpractice - It Is Personal

It's been a year since my trial, and five years since the elderly man came into the ED in shock. The trial came much later, of course, after years of depositions, most of which I insisted on attending. The trial itself is best described as life-changing: six days of humiliation and accusations, all the while being told that it was nothing personal.

It felt very personal when they questioned my honesty, morals, and intelligence. It felt personal when they didn't miss a chance to accuse me of recklessness, stupidity, arrogance, and laziness. It felt very personal when they asked for an award far more than my policy limits, and I, as the sole defendant, had to imagine the possibility of losing my house, retirement savings, and kids' college fund. Through a stroke of luck, the jury returned a decision for the defense. No one will convince me that on another day, a different group of 12 people could not have found me guilty, and awarded my future to the plaintiff.

Dr. George Hossfeld, Assistant Professor Emergency Medicine, University of Illinois-Chicago

One of my recurring topics is the gap of understanding between physicians and those attempting to reform medical care. No greater disconnect exists than between doctors and outsiders than their attitude toward medical malpractice. As illustrated in the above quote and as mentioned previous blogs, this visceral issue may be the most important factor undermining social contract between physicians and society. Congress does not understand the non-economic, "black swan" impact of medical malpractice on the physician, which may doom all attempts to cut medical costs.

For doctors, malpractice is personal, but for Congress it is all about business, often their own. Trial attorneys are one of the largest political contributors and are substantial backers of Obama and Biden. Senator John Edwards made his fortune suing doctors. Malpractice attorneys point to the statistic that only 2% of medical costs are directly related to malpractice, and many patients are severely injured or killed by medical incompetence. This is a complex issue, with good arguments on both sides, however it is clear that most money spent on malpractice litigation goes to lawyers not patients, and the legal profession's motivation is not the health of the American people.

The most important impact our malpractice system may have is on doctor behavior. Being involved in such a lawsuit, or even hearing about one, changes behavior forever. Avoiding the pain or litigation never leaves consciousness, and often becomes the overriding consideration for how doctors perform their duties. This worry about malpractice will prevent the transition for "exception based" medicine to the "evidence based" medicine touted by Dr. Berwick and other Obamacare advocates.

As long as the specter of malpractice looms doctors will continue to do expensive tests for low probability diseases. The tiny risk of malpractice litigation overwhelms all learning, evidence and reason. "I was sued once" spoken by a colleague becomes the final arbiter of medical decision making. One missed case of coronary disease in a young patient justifies thousands of negative blood tests, no matter what the "evidence".

Estimates are that 20-30% of medical costs are related to malpractice avoidance. These numbers may understate the problem, as malpractice concern permeates the entire medical enterprise. The "reformers" point to these statistics as a potential source for huge savings by avoiding these unnecessary studies. However, without simultaneous dramatic change in the malpractice process, doctors will not change their behavior. The reforms required will require more than monetary limits. The entire process needs to be changed. More later.

http://journals.lww.com/em-news/pages/articleviewer.aspx?year=2009&issue=01000&article=00003&type=fulltext

http://www.insurance-reform.org/issues/MedMalSystemCostsFactSheet2009F.html

A Medical Billing and Coding Salary Can Be Yours For the Taking

Your medical billing and coding salary, should you decide to enter this sector of the healthcare industry, will vary somewhat depending on a number of factors. The first is your geographical location. Your medical billing and coding salary is likely to be better if you work in a big city like Boston, Chicago, Houston, or New York, as salaries reflect the higher cost of living. Also there are more, larger organisations like nursing homes and hospitals that are able to afford better rates, than a typical small town doctor's office. Remember though, that responsibilities and work load may be higher working for a larger organisation.

Having a certificate or degree is not essential to command a good medical billing and coding salary, but it certainly helps, and those with qualifications will be likely to achieve better rates of remuneration.

The American Academy of Professional Codes (AAPC), has quoted salary figures in the region of $30,000 per year for a non-certified coder, and up to $38,000 for a certified one. These are only averages but it seems well worth going the extra mile to take the certification exam.

Medical coding and medical billing are separate specialities, yet they are closely associated and overlap somewhat, so that a person who is accomplished in both areas of expertise is more valuable to an employer than just a coder or billing specialist. If you are able, it is well worth taking a course that covers both aspects of healthcare payment administration.

Another important factor in respect of a medical billing and coding salary is experience. Somebody who is experienced is likely to be able to work faster, and with greater confidence than an inexperienced person, as they will be familiar with lots of codes without necessarily having to look them up all the time. Thus experience leads to increased productivity, and a person who is really good at the job can command a salary as high as $50,000 per year. An experienced person also knows about all the rules and regulations governing the job, and will have developed a workable modus operandi.

Instead of working for a fixed salary in an organisation, it is possible to operate as an independent contractor from home. This enables you to have flexible hours and take on as much work as you have the time to do, provided, of course, that you have sufficient clients. You would then be paid by the hour, at a rate of perhaps, $10-12 per hour, depending on your certification and level of experience. This way of working is not likely to be as remunerative as full-time employment on a fixed salary, but may suit someone with other responsibilities, or who is unable, or, does not wish to travel.

One needs, though, to be aware of scams and bogus job offers that are rife these days, especially in the work-at-home area, and offered on the internet with heavily persuasive copy.

There is, however, little doubt that someone conscientious and accomplished can earn a very fair medical billing and coding salary.