Since the 2014 federal mandate for providers to adopt electronic health records (EHRs), almost all healthcare organizations have made the switch over from paper medical records. With good intentions of better healthcare data capture and easier record sharing and portability, the EHR transition unfortunately opened a new list of problems. The good news is EHR technology […]
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Tag Archives: Their
OIG Report Reminds Providers to Review their Billing Practices
Recently, a reort issued by the U.S. Department of HHS, Office of Inspector General, estimates that over 60% of claims submitted to Medicare for outpatient PT fails to comply with the correct requirements. The OIG report serves as a reminder about the importance of accurate billing and compliance with Medicare requirements.
The post OIG Report Reminds Providers to Review their Billing Practices appeared first on The Coding Network.
Patients Take Control of Their Health Data with Blue Button 2.0
The Centers for Medicare & Medicaid Services (CMS) announced a new government-wide initiative, MyHealthEData, that provides patients with control of their health data. MyHealthEData is a response to the Executive Order to Promote Healthcare Choice and Competition Across the United States, issued by President Trump last year. The initiative’s aim is to: Empower patients, so every American […]
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Biotechnological Plants and their Incredible contributions in the Medical World
Biotechnology is an emerging branch which has already proved its proficiency. But it is still thriving. Biotechnological plants incorporate the ideas of biotechnology and have blessed this world by providing medicines for the deadly and life taking diseases. Genetic Engineering and Genomics are the two expanding technologies which has given new heights to biotechnological plants. Several research processes are still going on to develop efficient medicines for future diseases and improving the existing ones.
The key objective of biotechnological plants is to create alternatives for the chemical compounds used in the manufacturing process as these can be very lethal. Slowly and gradually, genetically engineered and pharmacy plants are substituting these harmful chemicals. These pharmacy plants are harmless and eco-friendly. These plants can be utilized to develop salutary proteins by adopting the gene expression methods. These plants can be food crops e.g. soya and maize as well as non-food crops e.g. tobacco. These plants have enabled the pharmaceutical industries to produce medicines without any side effects and allergies.
Using the genetically engineered plants, more effective medicines can be developed which has high resistance against numerous deadly diseases. The biotechnological industries are still hungry to produce more transgenic plants which can challenge all the threats produced by diseases to the mankind. Efforts are also being made to increase the crop yield by using various genetic tools and techniques. Pharmaceutical plants are trying hard to meet the growing requirements of the medicines. Numerous training programs are also running to handle the major technological and social challenges. Biotechnological experts are consistently trying to adopt the latest techniques to enhance their information on genetic design of several capable resources that can be used for pharmaceutical production.
Different political and social units are attempting to enhance the alertness and awareness on biotechnology and associated techniques. Numerous seminars and workshops are also carried out to increase the knowledge of these new technologies to the society. Several career opportunities are also provided by industries to young and innovative talents to become a part of them.
For more information on Pharmaceutical engineering and the benefits of Pharmaceutical manufacturing and Biotechnological Plants please visit the mentioned website
Medical importance of specific tapeworms and their threats to man
Such tape worms in question are: the dwarf tapeworm, the dog tapeworm and Echinococcus multilocularis. Such names sound so scary huh? What are their effects?
Hymenolepis nana (dwarf tapeworm)
Hymenolepis nana is found worldwide, commonly in the tropics. Multilocular Hydratid disease occurs primarily in hunters and is endemic in northern Europe, siberia, and the western provinces of Canada. Unilocular Hydratid Cyst Disease is found primarily in shepherds living in the Mediterranean region, the Middle East and Australia.
It is only 2-3cm in length. Scolex has round form and contains suckers and hooks. Its neck is very long and thick. Strobila has 200 proglottides. the uterus has an excretory ostium. Eggs are released from it into the feces. Transmission is through the fecal-oral (by the ingestion of eggs from contaminated food or water) route.
H.nana is different from other tapeworms, because its eggs are directly infectious for humans; i.e ingested eggs can develop into adult worms without an intermediate host. Within the duodenum, the eggs hatch and differentiate into cysticercoid larvae and then into adult worms. Gravid proglottids detach, disintegrate, and release fetilized eggs. The eggs either pass in the stool or can reinfect the small intestine (autoinfection). In contrast to infection by other tapeworms, where only one adult worm is present, many H.nana worms (sometimes hundreds) are found.
It is asymptomatic, but diarrhea and abdominal cramps may be present. Diagnosis can be proven by observing eggs in stool. The characteristic feature of H.nana eggs is the 8-10 polar filaments lying between the membrane of the 6-hooked larva and the outer shell. There are so many suggestions to the treatment therapy of Hymenolepsis nana. One suggestions recommends Acranil drug in tablets taken orally (depending on doctor’s prescription) while others recommend three drugs which are: Praziquantel, niclosamide and paromomycin. Nitrazoxamide has been recently discovered as another treatment option. Prevention consists of good personal hygiene and avoidance of fecal contamination of food and water.
Echinococcus granulosus (dog tapeworm)
It is found primarily in shepherds living in the Mediterranean region, the Middle East, Australia and USA (western states). The worm is up to 3-5mm. Scolex has suckers and hooks. Its neck is short, strobila has 3-5 proglottids. Posterior segment (mature) is the largest and contains uterus with the haustrums, genital pore situated in the back of the proglottid. Transmission is through the fecal oral route by the ingestion of eggs from contaminated food or water.
Dogs are the most important definitive hosts. The intermediate hosts are usually sheep. Humans are almost always dead-end intermediate hosts. Worms in the dog’s intestine liberate thousands of eggs, which are ingested by sheep (or humans). The oncosphere embryos emerge in the small intestine and migrate primarily to the liver but also to the lungs, bones, and brain. The embryos develop into large fluid-filled hydatid cysts, the inner germinal layer of which generates many protoscoleces within “brood capsules”. The outer layer of the cyst is thick, fibrous tissue produce by the host. The life cycle is completed when the entrails (for example liver containing hydatid cysts) of slaughtered sheep are eaten by dogs.
Many individuals with hydatic cysts are asymptomatic, but liver may cause hepatic dysfunction. Cysts in the lungs can erode into a bronchus, causing bloody sputum, and cerebral cysts can cause headache and focal neurologic stings. If the cysts ruptures spontaneously or during trauma or surgical removal, life-threatening anaphylaxis can occur (the cyst fluid contains parasite antigens, which can sensitize the host). Diagnosis may be done by X-ray, observation of eosinophilia and serologic tests. Prevention of human disease involves not feeding the entrails of slaughtered sheep to dogs.
Echinococcus multilocularis
It is found in northern Europe, siberia, Canada (western provinces), the USA (North and South Dakota, Minnesota, and Alaska). Many of the features of this organism are the same as those of E.granulosus, but the definitive hosts are mainly foxes and the intermediate hosts are various rodents. Humans are infected by accidental ingestion of food contaminated with fox feces. The disease occurs primarily in hunters and trappers. Within the human liver, the larvae form multiloculated cysts with few protoscoleces. No outer fibrous capsule forms, so the cysts continue to proliferate, producing a honeycomb effect of hundreds of small vesicles (without fluid). The clinical picture usually involves jaundice and weight loss. The prognosis is poor and hence surgical removal may be feasible.
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When a Patient Requests Access to their Medical Record
Establish policy to handle patient medical record access scenarios, legally. Patients have a right to “request to view” their medical record. This right is conferred by the Standards for Privacy of Individually Identifiable Health Information, known as the HIPAA Privacy Rule of 2001 [45 C.F.R. § 164.524]. Let’s review legal details, so you can best […]
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Accident Victims to Need to Guide Their Medical Care
Most car accident lawyers will tell you that people who suffer a car accident often suffer from confusion as to where to turn for help. Some legal practitioners, in trying to help their clients, often advise them on where to seek medical treatment. Regrettably, this type of “counsel” occurs with increasing frequency, driven by the numerous car accidents that occur in La Habra, California.
Tragic Car Accidents in La Habra
A brief summary of La Habra’s car accident statistics can be enlightening. In 2006, the California Highway Patrol’s Statewide Integrated Traffic Records System (SWITRS) reported that three people were killed and 266 were injured in La Habra car crashes. One pedestrian was killed and 20 were injured in car collisions. Bicyclist vs. car collisions injured 19. And motorcyclist accidents killed one and injured 13. DUI crashes caused two fatalities and 29 injuries. In 2007, there were three car accidents that resulted in five fatalities. the following year, one car accident caused one fatality.
Let Your Medical Practitioner Direct Your Medical Treatment
Experienced La Habra car accident lawyers know that it’s dangerous to mix specialties. Lawyers protect your legal rights, doctors safeguard your health. If you get the feeling that your lawyer is trying to steer you to a certain medical practitioner, chiropractor, clinic, or a specific treatment option, question his authority, for he or she may have a conflict of interest. Keep in mind that a conflict of interest like this can exist even if nothing improper is actually going on (no kickbacks or incentives given to the lawyer). It’s the appearance of impropriety that can cause all sorts of problems. For one thing, defense lawyers love to dig out this kind of information, and they will use it raise doubts with any jury about any doctor’s opinions whose payments hinge on the successful outcome of a trial. Or if dozens of patients were referred to one particular medical practitioner by the same lawyer. Both can cause your treatments to fall into the “suspect” category.
Since 1978, Bisnar | Chase lawyers have represented over six thousand people in car, motorcycle, truck, pedestrian and other personal injury cases. The law firm has an “AV” rating, the highest level of professional excellence, by Martindale-Hubble. John Bisnar, who is the author of this article, and his partner Brian Chase each have a “10” Avvo rating, the highest possible. John was named a “Community Hero” by the United Way, while Brian was named a “Trial Lawyer of the Year” in 2004 and one of the 2007 Top 100 Trial Lawyers. You should settle for nothing less than the finest legal representation available. For more information on a La Habra car accident lawyer, get “The Seven Fatal Mistakes That Can Wreck Your California Personal Injury Claim” at http://www.BestAttorneyBooks.com or call 1-800-561-4887.
How coders can build a successful relationship with their physicians
How coders can build a successful relationship with their physicians
by Sue Egan, CPC, CCD
All coders know that working with physicians is not always a positive experience.
It can be tough providing them education or getting responses from queries. Conversely, providers are busy and typically do not like anything to do with coding. When they hear coding they often take that to mean more work on their part.I have been working with providers for many years and the one thing coders always ask me is, ‘What is your secret for getting along so well with doctors and engaging them to change behavior?’
Building a relationship with your providers can make both of your lives easier. Outlined are a number of ideas that can facilitate building a strong relationship with your physicians.
- Documentation clarification inquiries for the hospital are likely to support physician billing. Communicate to the physicians that if the hospital is asking for documentation it will better support their billed services as well. Complete and accurate documentation will hold up to increased scrutiny by payers.
- Demonstrate why. When you ask a physician to change the way he or she documents in the medical record, show them why it matters. Show how accurate and complete documentation enables appropriate risk adjustments for the patients a physician treats. Remind physicians that good documentation can prove that the patients he or she treats really are sicker than others. This approach is more effective than stating the hospital will get a higher paid DRG.
- Knowing when to step away will help you keep a positive relationship with a provider.
- Regardless of how important the material is you want to educate the provider on, if he or she has a patient that has just passed away, now is not the time to share?they won’t remember what you tell them. Let the provider know you recognize the situation and will reschedule.
- If you know a physician is overwhelmed or is having a really bad day, then recognize that now may not be a good time and offer to reschedule.
- Be available. When approaching a physician for one-on-one education, be flexible in your availability. This could mean coming in early to meet with a doctor before his or her first case. If the physician can meet at lunch, do it. Recognizing the physician’s workload demands and being flexible will yield many benefits to the relationship.
- Be prepared. Physicians will ask you a question once, maybe twice, where you can say, ‘I don’t know,’ but chances are they won’t ask a third time. Be creative in your response. Instead, try saying, ‘You know, I just read something about that, let me go back and make sure I am giving you the most updated information,’ or ‘I just saw something on this, I am not sure if it was CMS or carrier directed. Let me find it and get back with you.’ Once you lose a physician’s trust, it is very difficult to regain it.
- Don’t waste their time. One of the biggest complaints I have heard from doctors is related to queries they deem as a waste of time. Make sure the query or question you are asking is
- Addressed to the right physician/provider
- Relevant to the patient care being provided
- The information you are basing your query on is accurate
- Walk in their shoes for a day. Offer to round with them, where you can provide live audit and education to the provider. See how their days really are. In most cases, you will be amazed at how much they get done.
- Be a better listener. Some coding and documentation guidelines are not clinical in nature and providers can get frustrated by being asked to document things that aren’t clinically significant (e.g., family history for the 85-year-old patient). Sometimes your provider may just need to vent this frustration and while you may not have a resolution to offer, listening and understanding can go a long way in building rapport.
- Ask questions. Ask your provider how they translate a patient visit into medical record documentation. Questions that might solicit opportunities for improved documentation may include:
- What questions are they asking when interviewing the patient?
- What concerns do they have?
- What is the patient experiencing? You can utilize this information to point out how the documented note can better demonstrate the patient’s current condition and treatment plan.
- Share the good as well as the bad. When a physician is doing a really great job documenting timely, accurately, and completely, give them a shout out. Or, when they answer queries timely, let them know. A quick note with a smiley face or even a gold star will be very much appreciated. Positive recognition given to one physician and not another often results in the physician inquiring how he or she can get recognition.
- Sports and (other interests). While engaging physicians in discussions such as sports is completely unrelated to coding and documentation, it can pay off significantly. Many providers are very loyal to their alma mater’s college football and basketball teams. Relationship building can be accelerated when you engage physicians in areas of personal interest. Gaining an understanding of a physician’s college coach, conference, and team standing, and discussing this information with a physician can go a long way to building a relationship. But sports isn’t the be-all, end-all. If you know a doctor has a particular interest (cooking, piano, horror movies, or painting) learning a little about that interest can go a long way. Expanding your knowledge is a good thing and building your relationship with that provider is a great thing.
- Empathy. It is important to remember that physicians are busy with competing priorities. Providers often get interrupted while they are dictating and/or documenting their notes, and when they leave something out of their notes, it is not intentional.
Recognizing that one of our major responsibilities as coders and documentation specialists is to make the physician’s job easier and their data as accurate as it can be is essential.
Avoid approaches that make them feel like they have done something wrong. Let providers know your job is ‘to make you look as good as you are.’
Editor’s note
Egan is an associate director with Navigant Consulting and has been working with providers, of all specialties, for more than 25 years. She works with providers to improve documentation as well as provide education and training related to CPT coding. Sue has lived in Charlotte, North Carolina, for the last 23 years, enjoys traveling with friends, and relaxing at home with a good book and her cats. Opinions expressed are that of the author and do not represent HCPro or ACDIS.
When a Patient Requests to Amend their Medical Record
How to fulfill their legal right, legally. Patients have a federal right to “request to amend” their medical record. This right is conferred by the Standards for Privacy of Individually Identifiable Health Information, otherwise known as the HIPAA Privacy Rule of 2001 (45 C.F.R. § 164.526). Let’s review legal details so you can best formulate […]
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Survey respondents share their thoughts on HIM roles and compensation
2016 HIM director and manager salary survey
More HIM professionals needed to manage an increasing workload, responsibilities
When compared to data from past surveys, HCPro’s 2016 HIM director and manager salary survey revealed a harsh truth that many HIM professionals already know: There has been little movement in HIM manager and director salaries over the years.
This year, the highest percentage of respondents indicated earning between $ 60,000 and $ 89,999 annually, an amount that has not budged much since 2013 (see the figure on p. 3). The percentage of respondents earning less than $ 40,000 decreased from 7% in 2013 to 4% in 2016, and the percentage of those earning $ 150,000 or more increased from just 3% in 2013 to 6% in 2016?but this is happening during a time when the HIM department is often tasked with doing more work with fewer resources.
"As budgets get tighter, we get more responsibility with the increase in pay," one respondent said.
Another respondent echoed those sentiments: "It is not so much the pay as the ever-increasing workload. We need more bodies throughout HIM, not necessarily more money."
Despite the fact that average salaries have remained fairly consistent since this survey was first conducted, 78% of 2016 respondents received a raise in the past year. One-third of respondents (33%) received a 3% raise, and approximately one-quarter (26%) received a 2% raise.
While 56% of respondents feel they are fairly compensated for the work they do, 62% do not believe HIM directors and managers overall are sufficiently compensated for their work.
Statistics
More than half (53%) of this year’s respondents work as HIM directors, and 29% work as HIM managers. The majority (93%) of respondents are female. One respondent noted the ties between gender and salary in the workplace.
"There is still gender disparity?females are not paid the same as male counterparts for same/similar work," the respondent said. "There are other healthcare professionals with less responsibility/scope earning more. HIM professionals tend to have a wider scope of responsibility with multiple specialized functions."
Half of the respondents work at acute care hospitals, and 15% work in critical access hospitals. The plurality of those working in a hospital setting are in hospitals with fewer than 199 beds (42%), whereas more than one-quarter (26%) work at hospitals with 200?599 beds and 18% work at 600+ bed hospitals. The remainder of respondents do not work in hospital settings.
Experience, education, and certification
The percentage of respondents whose highest level of education is a bachelor’s degree remained steady at 42% from 2015 to 2016, which is an increase from the 30% of respondents with a bachelor’s degree in 2014. Similarly, the percentage of respondents whose highest level of education is an associate’s degree decreased from 22% in 2015 to 20% in 2015, indicating that a baccalaureate-level education is becoming the standard in the HIM profession. Although 21% reported earning a master’s degree, none had a doctoral-level education.
More than half of those whose highest level of education is an associate’s degree earn $ 50,000?$ 69,999 annually (54%), whereas most respondents with a bachelor’s degree earn $ 60,000?$ 89,999 annually (44%). (See p. 4 for more information.)
The majority of respondents are aged 40?59. The plurality of respondents (20%) have 21?29 years of HIM experience, a figure that has remained relatively steady since the 2015 survey. Just 13% have 3?5 years’ experience, and just 7% have 6?10 years, while 16% have been in the profession 30?39 years, indicating that HIM may need some fresh faces as directors and managers near retirement age.
The plurality of respondents with 16?20 years’ experience earn $ 70,000?$ 89,000 annually, whereas the plurality of those in the profession 21?29 years earn $ 80,000?$ 89,000 annually (23%). However, 30% of those with 30?39 years’ experience earn $ 150,000 or more.
Nearly half of this year’s respondents (43%) are certified as registered health information administrators (RHIA), compared to 53% in 2015. The percentage of respondents certified as registered health information technicians (RHIT) increased from 28% last year to 31% this year. The percentage of respondents who are certified coding specialists (CCS) increased from 16% in 2015 to 25% in 2016.
The percentage of respondents with an RHIT certification whose highest level of education is an associate’s degree continues to climb?78% in 2015 compared to 82% in 2016. These respondents appear motivated to earn certifications, with 32% holding a CCS certification this year compared to 19% in 2015.
In general, HIM directors and managers are obtaining CCS certifications. Among respondents whose highest level of education is a bachelor’s degree, one-quarter are CCS certified this year compared to 12% in 2015. However, the percentage of respondents with this level of education who are RHIA certified dropped from 68% in 2015 to 56% in 2016, while the percentage of those with an RHIT certification increased from 17% in 2015 to 22% this year.
RHIA certification also declined among respondents whose highest level of education is a master’s degree?84% in 2015 to 70% in 2016. The percentage of respondents in this group who are RHIT certified increased at a rate similar to respondents in other educational categories, more than doubling from 6% in 2015 to 13% in 2016.
Benefits and overtime
The percentage of respondents who work 42?50 hours weekly continues to increase, with 55% in 2014 compared to 58% in 2015 and 60% in 2016. However, 76% of 2016 respondents indicated that they are not compensated for overtime. Those who are compensated receive one and a half times their regular pay (9%) or time off in lieu of additional pay (2%).
Despite an increasing workload and a growth in the number of hours many respondents work, few have seen an increase in their benefits, including health coverage, retirement plan matching, pension plans, travel budget, vacation and holiday time, tuition reimbursement, continuing education budget, and the ability to accrue time off.
One respondent indicated that he or she does not receive any bonuses or perks, yet is still expected to take on more work. "I was given clinical documentation improvement [CDI] responsibilities in the last year with no salary increase. I am the inpatient coder and I do CDI by myself. I am also over privacy. When my salary is determined, privacy, CDI, and coding are not taken into consideration in the calculation?only the salaries of HIM department managers in the immediate area are considered."
Respondents were split on whether overall HIM salary, benefits, bonuses, and job perks keep up with the cost of living, with 56% stating these benefits have not kept pace throughout the industry. "It is similar to most industries?more work is added and cost of living rises and companies are able to keep up with rising costs," one respondent said.
Similarly, respondents were asked if their personal salary, benefits, bonuses, and perks keep up with the cost of living; more than half (51%) said no.
HIM responsibilities
In years past, respondents listed release of information as their top responsibility, with 76% responsible for this function in 2014. This figure remained steady, at 72% in both 2015 and 2016.
However, in the wake of ICD-10 implementation, the percentage of respondents working on coding increased from 70% in 2014 to 72% in 2015 and 77% in 2016. Other responsibilities appeared to dip slightly as coding took center stage, although the percentage of HIM directors and managers responsible for CDI increased from 45% in 2015 to 56% in 2016, which is not surprising as this function often goes hand-in-hand with coding.
Other responsibilities include the following:
- Document imaging, including preparation, scanning, indexing, and verification (65% in 2016, 2015, and 2014)
- Transcription, including report processing, interface failures, corrections, and distribution (53% in 2016, 57% in 2015, and 55% in 2014)
- Privacy (43% in 2016, 52% in 2015, and 51% in 2014)
- Recovery Audit program (33% in 2016, 30% in 2015, and 37% in 2014, which may be attributed to the temporary hold on these audits)
- Compliance (30% in 2016, 27% in 2015, and 32% in 2014)
- Birth certificates (33% in 2016, 31% in 2015, and 26% in 2014)
- Tumor registry (21% in 2016, 24% in 2015, and 20% in 2014)
- Security (15% in 2016 and 2015, 18% in 2014)
- Utilization review (5% in 2016, 6% in 2015, and 12% in 2014, which may indicate that this function is moving to other departments such as nursing or case management)
- Case management (2% in 2016 and 2015, 4% in 2014)
Survey respondents share their thoughts on HIM roles and compensation
HCPro’s HIM Briefings asked 2016 HIM director and manager salary survey respondents about their satisfaction with their roles, compensation, and benefits. They said:
"I think that the revenue the HIM departments generate and are required to ensure/validate compliance the salaries are way off in comparison to job requirements!"
"I suspect that people don’t realize the location has a lot to do with salary/compensation. Salaries for these positions in smaller communities is generally less."
"Some of my colleagues have not kept current with trends in the EMR, permitting IT staff to take control. I think this has lessened HIM’s role in some institutions. We have fought to get to the discussion table and have shown how our experience has a great value in implementing systems."
"Sometimes, we are branded one of the ‘non-revenue producing’ departments so we are an afterthought."
"The amount of work and knowledge needed in the role is comparable to information systems roles and the salaries are not comparable."
"HIM work is not understood nor appreciated. We are a critical member of the team."