In what reads like a cheesy TV script, a McAllen-area, Texas physician is being charged of healthcare fraud and abuse by abusing patients and money laundering by the Department of Justice (DOJ) to the tune of $ 240 million. Jorge Zamora-Quesada faces a seven-count Grand Jury indictment alleging he and his co-conspirators “orchestrated a massive fraud scheme that jeopardized […]
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Tag Archives: Texas
Looking for a mentor regarding real world coding – Dallas Texas
Hello all,
I have been in billing for seven years and decided to study for coding and passed my CPC exam back in December of last year. My current employer is not willing to do any on the job or even allow me to shadow the few coders that are available. I am trying to find new employment as a CPC but no company is willing to train and expects two years experience minimum. Though I have assisted with coding reviews for appealing claims, I have yet to personally code any cases. If anyone can help my email is [email protected]
Thanks
CPC A Looking for Billing, Coding Position in Houston, Katy Texas.
CPC-A seeking employment in Galveston, Texas area
Hello! Just recently got my CPC-A on November 14th. Would love to work here in my hometown of Galveston, Texas, doing Medical Coding. I know this is probably an old question, but would appreciate any suggestions on how to find a position. Have checked the local hospital here and there are no coding positions posted at this time. Am considering doing the Practicode course to work toward removing the "A" from my CPC designation.
Any suggestions or leads would be greatly appreciated. Thank you!
Amarillo, Texas Medical Transcription Services
In today’s business oriented world, transcription services are in great demand, especially in the medical sector. Every medical entity, whether hospitals, clinics, individual physicians or groups, has to maintain the medical records and other health and medical details of patients in a proper and efficient manner. As medical transcription is a time consuming process, many healthcare professionals outsource their medical transcription assignments to other firms who have the required expertise or resources to undertake the transcription work at low rates.
If you are a healthcare professional in Amarillo, Texas looking for quality and accurate medical transcription services, then choose a company which can provide the right service for your practice. Nowadays, a number of medical transcription companies are in the scenario to provide you with cost-effective, reliable, and HIPAA compliant medical transcription services in Amarillo and other places in Texas.
To meet your transcription needs, all these firms maintain a team of highly skilled and talented medical transcription specialists and quality assurance staffs. These medical transcription specialists transcribe the medical records dictated by doctors and others, including history and physical notes, clinic notes, office notes, laboratory reports, pathology reports, consultation notes, discharge summaries, peer reviews, psychiatric evaluations, x-ray reports and many more. In order to check the quality, all the transcribed medical reports are cross checked by proofreaders and medical experts. Most of the firms are fully equipped with the latest technology available.
Almost all medical transcription companies support toll free number, digital recorder, and computer dictation systems for medical detailing. By availing of the medical transcription services from a standard MT firm, you can experience 99% accuracy, security and confidentiality of the medical records and other documents.
Some other benefits that you gain include:
• HIPAA compliant transcription practices
• Three levels of quality control
• Competitive medical transcription rates
• Prompt guaranteed turnaround
• Superior work product
Upon completion of the proofreading and editing process, the transcribed medical records are routed back to the concerned doctor or hospital in the required format. Most of the MT firms offer free trial offer to evaluate their service quality. So before relying on a medical transcription firm in Amarillo, Texas, it is better to take advantage of those free trial offers.
Outsource Strategies International (OSI) is a medical transcription company and a medical billing services company providing HIPAA compliant medical transcription services added with other services such as medical billing, medical coding, patient scheduling, authorizations and verifications.
Austin, Texas Medical Transcription Services
With the increase in the number of patients approaching healthcare facilities in the US for various treatments, these firms are having a tough time in efficient manipulation and recording of patient treatment details. Effective patient treatments and timely processing of insurance claims all depend on how effectively and quickly, patient medical records are being processed by healthcare firms. To cater to such needs of healthcare firms including hospitals, clinics, acute care centers, and long term care facilities in Austin, Texas, medical transcription facilities in the state are now offering cost-effective and reliable services for their clients.
Apart from hospitals, individual practitioners and doctors also benefit from these services. With medical transcription services being outsourced, doctors and physicians can concentrate more on their patients and worry less about maintaining and keeping patient records. Since high expenses are involved in hiring transcriptionists and buying dictation equipments, having these jobs outsourced to state-of-the-art transcription facilities in Austin, Texas helps medical care facilities to save time and money. A number of medical transcription service providers are now operating in Texas and their services are available in all major cities in Texas including Austin, Houston, Dallas, San Antonio and Fort Worth.
Most of these medical transcription providers offer their services in a highly competitive and dedicated manner, with services delivered on the basis of individual client requirements. The availability of skilled and experienced transcriptionists working in these firms is a factor that helps clients to have their daily patient information management jobs done faster and in a thoroughly efficient manner. With HIPAA compliant operations provided at medical transcription facilities in Texas, all transactions involving patient medical records are safe and secure. These Texas based firms are also offering excellent backup and disaster recovery services for their client healthcare centers.
To have better accuracy maintained in processed patient records, most Texas based medical transcription firms are utilizing the services of experienced proofreaders, language experts and editors. They can double check and correct files for errors and thus most processed records coming from these transcription facilities maintain a high accuracy level of up to 99 % which is required by healthcare clients.
With medical transcription services being provided 24×7 by these Austin and Texas based firms, all client jobs are done in a time-bound manner and thereby healthcare providers can strictly avoid possible backlog situations. Quality and competitive pricing are also positive factors which enable healthcare clients to have their transcription jobs outsourced to these firms. Most medical transcription facilities are also providing related services such as medical billing and medical coding to help healthcare clients further in their daily patient information management operations.
Outsource Strategies International (OSI) is a medical transcription company and a medical billing services company providing HIPAA compliant medical transcription services added with other services such as medical billing, medical coding, patient scheduling, authorizations and verifications.
Texas Disaster Relief Efforts Include Medicare
The Centers for Medicare & Medicaid Services (CMS) revised MLN Matters Number SE17020, “Hurricane Harvey and Medicare Disaster Related Texas Claims,” to include new information about Texas disaster relief efforts. On Aug. 26, following President Trump declaring a major disaster exists in Texas, Secretary Price of the U.S. Department of Health and Human Services authorized […]
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Newly Certified coder looking for work experience in Central Texas area
Hello,
My name is Hyunjee Jun and I’ve very recently passed my exam.(CPC-A)
I’ve also completed 6-month online CPC preparation course early this year.
I’m currently looking any related work experience in Killeen/Temple/Waco/Belton area in Texas.
My main goal is to find a place where I can learn and gain experience in medical field so any related position(medical billing, coding, revenue cycle, frond desk, administrative works) would be great!
Job position can be full-time/part-time/temporary/internship/remote/voluntary.
My name is Hyunjee Jun and I’ve very recently passed my exam.(CPC-A)
I’ve also completed 6-month online CPC preparation course early this year.
I’m currently looking any related work experience in Killeen/Temple/Waco/Belton area in Texas.
My main goal is to find a place where I can learn and gain experience in medical field so any related position(medical billing, coding, revenue cycle, frond desk, administrative works) would be great!
Job position can be full-time/part-time/temporary/internship/remote/voluntary.
I have Bachelor’s degree in F.A. and previous work experience as a textbook editor.
Fluent in English and Korean.
Excellent computer skills with fast typing speed (87 words per minute) with accuracy.
Please review my attached resume if you’re interested.
You can contact me at 254-317-9728 or [email protected].
Thank you.
Texas Medicare Patients
IF a patient is in the hospital and the provider office bills Medicare 95165, do we need to add a modifier to the cpt code? Medicare has denied this code stating that during this period of time the patient was in the hospital. This is the first time we are dealing with something like this.
Thanks in advance!
Erica
Texas court grants writ of mandamus for credentialing file documents
Case summary
The Court of Appeals for the Fifth District of Texas (the "Court") granted a petition for writ of mandamus, requiring the trial court to vacate its order requiring a hospital to produce documents it contended were protected from discovery by the Texas medical peer review committee and medical committee privileges.
In Gambreezzi, P.A. v. Rockwall Regional Hospital, LLC, Gambreezzi, P.A., which is owned by Joel Ciarochi, MD, sued Rockwall (Texas) Regional Hospital (the "Hospital"), a physician-owned hospital. Ciarochi had held clinical privileges to perform anesthesia services at the Hospital, in which Gambreezzi held shares. The Hospital attempted to purchase Gambreezzi’s shares after Ciarochi terminated his employment with the anesthesia practice through which he provided services to the Hospital. This was attempted pursuant to a buy-back provision in the contract between Gambreezzi and the Hospital.
In August 2014, Gambreezzi brought suit against the Hospital, asserting a number of claims, including breach of contract. Ciarochi’s fundamental problem was dissatisfaction with the Hospital’s calculation of the compensation it would pay for the shares. As part of those proceedings, Ciarochi requested to review his credentialing file at the Hospital. On December 24, 2015, the Hospital’s counsel sent Gambreezzi’s counsel a letter stating that Ciarochi would be allowed to review, but not copy, his file.
Gambreezzi then requested additional documents, including those related to the Hospital’s buy-back of shares from another physician?Dr. Timothy Bray?who had also terminated his affiliation with the Hospital. The purpose of this request was to determine whether Bray had received more favorable compensation. This request included Ciarochi’s and Bray’s peer review and credentialing files. The Hospital objected on the grounds that the files were protected by the Texas medical peer review committee and medical committee privileges.
At a hearing to determine if the Hospital had to produce the documents, Gambreezzi asserted that not all of the documents in the files were protected by the Texas privileges and identified 53 specific pages that he alleged were not protected. The trial court reviewed those pages in camera and ordered that 50 pages should be produced, one should be produced in redacted form, and two pages didn’t need to be produced.
The Hospital said it would produce four pages of documents, as ordered by the trial court, but filed a writ of mandamus against the judge contending that the Texas medical peer review committee and medical committee privileges applied and precluded discovery. Gambreezzi countered that the Hospital failed to show that the documents fell within the scope of the privileges and were in fact ordinary "business records." Additionally, Gambreezzi argued that the Hospital waived the privileges when it allowed Ciarochi to review his credentialing file and produced four pages from Bray’s credentialing file.
After reviewing the documents in camera, the Court found that they related to Ciarochi’s credentialing or recredentialing and a variance report review in Bray’s credentialing file, meaning they were protected by the medical peer review committee privilege.
With respect to Gambreezzi’s argument that the Hospital waived the privileges by allowing Ciarochi to review his credentialing file, the Court cited Texas Occupations Code, section 160.007(e), which states, "Unless disclosure is required or authorized by law, a record or determination of or a communication to a medical peer review committee is not subject to subpoena or discovery and is not admissible as evidence in any civil judicial or administrative proceeding without waiver of the privilege of confidentiality executed in writing by the committee."
Gambreezzi argued that the December 24, 2015, letter qualified as a written waiver of the privilege, but the Court stated that the occupations code requires a written waiver to be executed by the chair, vice chair, or secretary of the medical review committee. The letter did not meet this requirement.
The Court also found that the Hospital did not waive the medical peer review committee privilege when it produced the pages from Bray’s credentialing file as it was complying with the trial court’s order.
Source: In re Rockwall Reg’l Hosp., LLC, No. 05-15-01554-CV (Tex. App. Mar. 2, 2016)
What does this decision mean for you?
J. Michael Eisner, Esq., of Eisner & Lugli in New Haven, Connecticut: In this decision, the court upheld the validity and scope of the very broad Texas "medical peer review privilege." This privilege covers initial credentialing of a physician by a medical review committee, as well as the committee’s subsequent review of the physician for purposes of reappointment/recredentialing. It also protects documents "generated" by a peer review committee or "prepared by or at the direction of the committee for committee purposes." In addition, it covers the minutes and recommendations of the committee, and its inquiries to outside sources and their responses.
Note that the scope of this privilege is extremely broad, unlike the peer review privilege in most states.
The moral to this story is that if a broad peer review statute can be enacted by your state legislature, it will provide very significant protection to the activities of physicians engaged in peer review.
The secret, of course, is getting past the formidable lobbying power of the trial lawyers and convincing your state legislature that such privileges are in the interests of the patients. If physicians are protected, they will be able to do their job without fear of baseless litigation, and will be able to protect patients from physicians who could cause them harm. If they are not protected, physicians will be subject to harassment through litigation, which obviously will greatly reduce their willingness to participate in the peer review process.
As regular readers know, my view is that restrictive peer review statutes have a very chilling effect on physicians. Why engage in peer review if one can be sued and have to spend time, effort, money, and emotional capital on dealing with trial lawyers?