Background We are all living in unprecedented and unpredictable times. While there has been a lot of coverage on the importance of wearing masks when indoors or enclosed spaces, many have continued to challenge this health directive and many have compared this virus to the flu. It’s understandable because media coverage has continued to weigh these comparisons as well as governmental leadership when discussing protocols, guessing possible outcomes, and more….
Final 2019 & Proposed 2021 CMS Physician Fee Schedule Changes
Many have heard the conversations and read articles surrounding efforts to simplify E/M billing, coding, and documentation. Most of the larger proposed changes were officially postponed to 2021 which will give stakeholders time to influence the final policy. This announcement on November 1, 2018 coincided with the release of the 2019 Physician Fee Schedule (PFS) and Quality Payment Program (QPP) final rule. Providers (and coders alike) have long complained about…
Maximum Diagnosis Codes Submission on Claim Forms
We are frequently asked by clients and others in the industry about the number of diagnosis codes allowed on the electronic format as well as the paper forms when billing for services. This is especially true in risk adjustment where all current diagnoses are collected for financial forecasting purposes. Some try to use claim editing to capture these but ultimately a medical record review by an experience risk adjustment coding…
Cybersecurity and Your Risk
October was cybersecurity awareness month. While increased focus has been on this topic, many organizations are still left exposed and at serious risk. HIPAA laws do not apply overseas, thus there are zero protections for covered entities who choose to offshore services. It’s somewhat baffling that we can be concerned with the high cost of delivering healthcare, yet cannot allow a global marketplace for medications (one of the highest expenses),…
Understanding Important Facts Around the ACA and Potential Replacement or Revisions
The Patient Protection and Affordable Care Act (PPACA), commonly shortened to the Affordable Care Act (ACA) and nicknamed Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Why Did We Need the ACA (Obamacare)? In 1980, 25 million Americans were uninsured, and by 2009, it increased to 51 million (Bodenheimer/Grumbach, 2012). While many…
Cultural Competency Series: Transgendered Patients
In light of much media coverage and an obvious lack of knowledge demonstrated on social media sites, our first post for cultural competency is on Transgendered patients. Our hope is to educate others on this important topic so that they can better understand the patients under our care and the laws implicated or suggested in our country. Important Definitions It first is important to understand some important vocabulary differences: Gender Identity:…
HMO, PPO, EPO, Oh My!
Many people, including healthcare professionals, get various insurance coverage types confused. Choosing the right health insurance coverage can be difficult and individual needs vary around cost, options, coverage, deductibles, and convenience of care. HMO = Health Maintenance Organization HMOs usually have lower premiums, but come with a restricted network of doctors and hospitals. Patients choose a PCP (Primary Care Physician) who coordinates, manages, or oversees patient care. These plans usually…
World AIDS Day
WHAT IS WORLD AIDS DAY? World AIDS Day is held on the 1st December each year and is an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV and to commemorate people who have died. World AIDS Day was the first ever global health day, held for the first time in 1988. WHY IS WORLD AIDS DAY IMPORTANT? More than…
World Diabetes Day is November 14th
In observation of World Diabetes Day. -Click to read more about this event! Diabetes Diabetes is a number of diseases that involve problems with the hormone insulin. Normally, the pancreas (an organ behind the stomach) releases insulin to help your body store and use the sugar and fat from the food you eat. Diabetes is a condition where there is too much sugar in the body for long periods of time….
Understanding Sepsis, Severe Sepsis, & Septic Shock
Definitions Infection = A host response to the presence of microorganisms or tissue invasion by microorganisms. Bacteremia = The presence of viable bacteria in circulating blood. SIRS (Systemic Inflammatory Response Syndrome) = The systemic inflammatory response to a wide variety of severe clinical insults, manifested by two or more of the following conditions: Temperature above 101 F (38.3 C) or below 96.8 F (36 C) Heart rate higher than 90 beats…