Maximum Diagnosis Codes Submission on Claim Forms

January 23, 2018

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…

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Cybersecurity and Your Risk

November 10, 2017

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),…

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Understanding Important Facts Around the ACA and Potential Replacement or Revisions

February 28, 2017

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…

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Cultural Competency Series: Transgendered Patients

February 23, 2017

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:…

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HMO, PPO, EPO, Oh My!

December 2, 2016

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…

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World AIDS Day

December 1, 2016

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…

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World Diabetes Day is November 14th

November 14, 2016

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….

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Understanding Sepsis, Severe Sepsis, & Septic Shock

October 24, 2016

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…

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Coding Epilepsy

October 11, 2016

Epilepsy is a neurological disorder where patients suffer from seizures. These seizures are a result of excessive and abnormal cortical nerve cell activity in the brain. The cause of epilepsy in many patients may be unknown, but it can develop from brain injury, stroke, brain cancer, and drug or alcohol abuse. Seizures present differently based on the person’s age and the part of the brain involved. The most common seizures…

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Importance of Flu Vaccination (from the CDC)

September 29, 2016

Flu Vaccination Why should people get vaccinated against the flu? Influenza is a serious disease that can lead to hospitalization and sometimes even death. Every flu season is different, and influenza infection can affect people differently. Even healthy people can get very sick from the flu and spread it to others. Over a period of 31 seasons between 1976 and 2007, estimates of flu-associated deaths in the United States range from…

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