Facility Environment or Provider Environment…Which One Is Right For You?

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As a person views the medical profession they see registration staff, medical assistant staff, nursing staff, transcriptionists, billers/coders, insurance staff and collection staff. Seems pretty straight forward until you look closer at what is really available within the profession. Focusing on the billing and coding side of things, have you ever really thought about what the options are for this specialty? As a new comer to the profession, many people have no true idea of what all is in store for billers and coders. Those of us that have been around for some time understand the avenues we have that open up to us as billers and coders and respect what choices we have in this field.
When you look at the billing and coding staff in the profession, you have to look closer because what you may think is more than likely just a scratch on the surface. Billers and coders work as registration specialists, referral specialists, schedulers, health information specialists, customer service representatives, data entry specialists, insurance processors, reimbursement specialists, claims adjudicators, collection specialists and that is just to list a handful of positions a biller/coder can hold in this field. The opportunities once you have been trained within the billing and coding field really becomes endless depending on your desire, need and passion for the career.
There is then even another avenue that you need to consider when looking at this profession and that would be working in an acute care facility, rehabilitation facility, surgery center, skilled nursing facilities, insurance companies, or provider offices. There are differences on how each environment works to complete their daily tasks of billing and coding care and treatment. What is the difference between facility and provider? Let’s take a look at these differences.
Facility coding involves coding with ICD-9 and DRG codes for inpatient care and using CPT codes for outpatient care. Generally facility coding allows a coder and biller to become a specialist in a specific insurance. This can entail abstracting information from just a few pages of information to volumes of medical information depending on how long the patients stay was in the facilities. The coding cycles could be as they occur, once a month or at the end of their admission depending on what type of facility you are working in. Arrangements are determined by each type of facility as to their preference. Generally the expected work load would be coding for a said insurance, billing for that specific insurance, posting revenue for that said insurance and then refilling claims when needed for that said insurance. The facility environment has a biller/coder responsible for the entire process for a said insurance company so they become very proficient with that entity. This helps to streamline the overall tracking process of services/procedures performed and ensures that things do not fall between the cracks with as many patients a facility may see in a months’ time.
Provider coding involves coding for office services as well as facility services that are performed by your provider. Hospital consultations, rounding visits, reading of diagnostic studies, surgical procedures, and discharge summaries. From the provider side of things, a biller and coder can be the same and they can also be separate positions in a provider’s office. This will depend on the arrangement of the working environment that the provider has established. It is not uncommon to have distinct coders separated from the billers. It can also be that the coding and billing positions are combined. The opportunities to cross train in a provider’s office are often easier than in a facility due to the structure of the working environments.
Coding from a providers stand point is component coding using the ICD-9 for diagnoses only and CPT for procedures and services performed by the provider. This is one of the biggest differences between facility coding and provider coding. Understanding how these both work becomes beneficial to the coder/biller to allow them opportunities in both types of locations. Understanding your strengths and weaknesses will also help you in deciding, facility or provider?
When deciding which is best for you? You are really the only person that can make that decision. Everyone will have an opinion on which one is better than the other but only you can decide what will work for you. You may want to try both types of working locations to determine which one fits you best. You may want to ask if you can shadow for a day in each style of environment to make the best educated decision. There are pro’s and con’s to both as there is with everything in life. You just need to see which one excites you the most and that will keep you engaged for the career you are looking to have.

ICD-9-CM vs. CPT-4

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ICD-9-CM versus CPT-4

Do you know what the header of this article means?  If you do, you more than likely have some experience in the medical billing and coding profession.  The next question would be; do you know the answer to this question?  What are these things? Are they important and how are they different?  Are they for facility coding/billing or are they for physician based coding/billing.  What are your thoughts?

If you have spent any time in this profession, you should know the difference in these items and how they affect your working environment.  When do you use ICD-9-CM and when do you use CPT-4? Can you explain the process?

Here is the insight to the above questions:  ICD-9-CM stands for the International Classification of Diseases, 9th Revision, Clinical Modifications and the CPT-4 is the Current Procedural Terminology, 4th edition. ICD-9-CM is used for facility coding and CPT is used for physician based coding.  What is so interesting is that ICD-9 is diagnoses and procedures where CPT-4 is only procedures and services.  Many people question why we need to still learn ICD-9-CM when ICD-10 is getting ready to be implemented?  Well, here is the reason why…even if ICD-10 were to be put into effect next October1, 2013 every biller and coder will still be working with ICD-9-CM for one calendar year following the implementation date.  So, ICD-9-CM may seem obsolete but this resource is not going away quickly and it may be around longer than some would hope.  If it has been determined that the profession is not prepared for the implementation of ICD-10, the profession will wait until ICD-11 will be released as it is being worked on at this time.

So if you ever find yourself questioning why you need to learn the ICD-9-CM, there is a good reason for this and you should embrace this process. Just imagine that eventually CPT-5 will be on the horizon and we will be answering these questions all over again only this time for CPT rather than ICD.  If you are looking to grow your prospects in this profession, there really is no better time than the present to take the reins and learn the process.  What are you waiting for?  Your future is waiting…….

The OpenNotes Project – Shared Medical Records Online

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You may have signed a release to review or obtain copies of the documents in your medical record.  Your primary care physician may have faxed or mailed copies of your notes to a specialist you were referred to.  You may have even found it necessary to make a formal request to have an error fixed in your health record.  Your PCP has given you a laundry list of instructions to follow before your next visit in a few months, but darned if you can remember all them.

What about if you had online access to your electronic health record to see what your doctor is writing about you, have copies for yourself at home to refer to, share with others as you like, and request corrections to that information?

OpenNotes, a recent year-long study, has explored this idea on a fairly large scale.  Three medical facilities in different areas of the country participated in the study:  Beth Israel Deaconess Medical Center in Boston, Massachusetts; Geisinger Health System of Danville, Pennsylvania; and Harborview Medical Center in Seattle, Washington.  Approximately 100 physicians and 20,000 patients participated in the study.

Many physicians were optimistic about the impact patient online access would have, such as improved patient-doctor communication as well as increased patient cooperation and engagement in their healthcare.  Still, others were concerned about confusing or worrying their patients, increased demands on their time when answering questions about what was written in their notes, and perhaps feeling they should be less candid and more careful about what they write in patients’ reports.

The majority of patients were enthusiastic about the opportunity to view their records online, feeling that it would lead to better understanding of their treatment plans and improved accuracy of their records.

You may read more about the OpenNotes project here http://www.myopennotes.org/.  Through this link, you may also connect to the perspective and baseline findings articles that were published in the December 20, 2011, issue of the Annals of Internal Medicine.

What are your thoughts on online access to your medical records?

When Does Meaningful Use Become Meaningless or Worse?

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Many individuals believe that electronic medical records (EMRs) are a major component driving the digital transformation of the healthcare industry. The value of EMRs have been well published and include the following benefits:

  • Remote access to patient information.
  • Immediate access to the information.
  • The elimination of chart chasing.
  • The elimination of duplicate entry of the same information on multiple forms.
  • The information is continuously updated.
  • Concurrently available to many users simultaneously.
  • Automated medical alerts.
  • Automated reminders.
  • Built-in intelligence which can recognize abnormal test results or potentially life threatening drug interactions.
  • Provide a link to the clinician to protocols, care plans, critical paths, literature databases, pharmaceutical information and other databases of healthcare knowledge, etc.
  • Provide information to improve risk management and assessment outcomes.
  • Better population management.
  • Reduction of medical errors.
  • Decrease charting time and charting errors, therefore increasing the productivity of healthcare workers and decreasing medical errors due to illegible notes.
  • Provide more accurate billing information.
  • Will allow the providers of care to submit their claims electronically, therefore receiving payment quicker.

But are we fooling ourselves?  Has anyone ever stopped to consider the impact EMRs will have on our healthcare delivery system if the information placed in them is not accurate?

For the fun of it, let’s take the same list of benefits and assume the worst…I wonder what our healthcare system might look like under this scenario?

  • Remote access to inaccurate patient information.
  • Immediate access to inaccurate information.
  • Inaccurate information is concurrently available to many users simultaneously.
  • Inaccurate automated medical alerts.
  • Inaccurate automated reminders.
  • Built-in intelligence which can inaccurately recognize abnormal test results or potentially life threatening drug interactions.
  • Provide a link to the clinician to inaccurate protocols, inaccurate care plans, inaccurate critical paths, inaccurate literature databases, inaccurate pharmaceutical information and other databases of healthcare knowledge, etc.
  • Provide inaccurate information to improve risk management and assessment outcomes.
  • Ineffective population management.
  • Increase in medical errors.
  • Increased charting time and charting errors, therefore decreasing the productivity of healthcare workers and increasing medical errors due to  inaccurate notes.
  • Less accurate billing information.
  • The ability for providers of care to submit inaccurate claims electronically, therefore delaying payment or worse, driving up the cost of healthcare due to billing confusion and the ordering unneeded tests.

Wow! That’s quite a frightening picture.

An interesting point to consider this particular week…National Medical Transcriptionist Week.  A week first set aside in 1985 by President Ronald Reagan. At the time, President Reagan recognized the important jobs these highly trained professionals do when he proclaimed, “Record-keeping is a vital function in our society, and one of the most important records for every American is the medical record. That record, including reports prepared and edited by a medical transcriptionist from physician dictation, is the permanent history of a patient’s medical care. It is appropriate for our Nation to recognize the contributions of medical transcriptionists.”

Since 1985 technology has changed every aspect of our lives.  But even with the passage of time, President Reagan’s words are more accurate today with the proliferation of electronic medical records.  The EMR places today’s Medical Transcriptionist in the role as “gatekeeper” responsible for ensuring the information going into each and every person’s medical record is complete, accurate and available to all caregivers.  We need these folks as a vital check and balance to make sure “meaningful use” doesn’t become “meaningless” or worse, is allow to negatively impact patient care.

I urge all Americans to carefully consider the important role these well trained and highly qualified individuals bring to our healthcare delivery system…in the future our lives or the lives of our loved ones WILL depend on it.

Please feel free to share your thoughts on this subject with your own personal comment. Click the comment link below.

Get a Jump Start on a New Career!

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By simply receiving a medical coding certificate, you will become prepared to work inside the one of the fastest-growing fields. With the major changes in health care, Medical Coding is quickly becoming on of the fastest growing professions in the United States.  

What is Medical Coding?

Medical coding professionals provide a key step in the medical billing process. Every time a patient receives care, the provider must document the services. This is where the Medical Coder is important. The Medical Coder must create a claim and assign CPT codes, ICD-9 codes and HCPCS codes for the claim so the provider can be paid.

At AHDPGTM, we offer Medical Coding Programs which are all online for your convenience. We also have created a “Jump” Start Coding Program for practicing medical transcriptionists or other allied health professionals who are looking to make a career change. The AHDPGTM Medical Billing and Coding Program is an approved education provider and nationally recognized by AAPC – The American Academy of Professional Coders.

According to The US Bureau of Labor Statistics, the Employment of medical records and health information technicians is expected to increase by 21 percent from 2010 to 2020, faster than the average for all occupations.

Medical Coders play a vital role in the delivery of the healthcare system. Consider training in this exciting and fast growing field. Online distance learning education can open the door to new opportunities, are you ready?

Doctors or Data Entry Clerks?

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Upon visiting this year’s American Health Information Management Association (AHIMA) conference in Salt Lake City, Utah I am bewildered at the path our country is taking in the name of “improving” healthcare.

Do we really want/need our physicians entering data in a computer? Is this what we believe “quality” healthcare is?

If so, let me get this straight…what we are saying is after four years of undergraduate schooling and four years of medical school, with three to eight years of internships and residency (depending on the area of specialty); so in total, after spending between 11 and 16 years of training, what we want our highly trained (and highly compensated) physicians doing is spending 40 to 60% of their time entering data in a computer.

Are we nuts?

Where is the American Medical Association? Where are the physicians themselves? Where is the leadership of our healthcare system? Don’t they understand that paying physicians hundreds of thousands of dollars to be data entry clerks is not sustainable?

I am astonished, with the number of smart people we have in this country, that this has gotten this far.

What is even more astonishing is the business case some technology companies are using (and some healthcare leaders are buying) that says, “you can justify spending millions of dollars on their technology by transferring the data entry responsibility from today’s medical language specialists, medical billers, medical coders, medical scribes and other allied health professionals and place this responsibility on the shoulders of the physicians, nurses and other care providers.”

This makes all the sense in the world…let’s get a physician earning $150 per hour to do the job that one of these other allied health professionals can do for $20 – $40 per hour – all the while there is a well known shortage of doctors and nurses and our population is aging and requiring more and more services.

Someone please help me understand how this is improving the efficiency of our healthcare system?  Even at a 7.5:1 ratio ($150/$20) asking a physician to spend as little as 36 minutes per day entering data is a money losing and thereby inefficient proposition.

Like most other highly trained and highly compensated individuals, physicians should have access to quality data/information to assist them in delivering their services – we should not require them to be entering the data. In fact, we should be mandating that they don’t!

This would be the same as asking the CEO of Macy’s or Walmart to spend 40-60% of his or her time behind the cash register or asking the CEO of Exxon/Mobil to spend 40-60% of his or her time pumping gas or asking Tom Brady to work the concession stand at half-time of the New England Patriots game. Ridiculous!

More than 50% of physicians move to EMR

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Physician use of Electronic Medical Records (EMR) is gaining critical mass. According to a survey recently conducted by the Centers for Disease Control, physician adoption rates have topped 50% for the first time in history. The accelerating rate of adoption is attributed to several factors, including peer pressure and financial incentives available through the American Recovery and Reinvestment Act.  Bob Cook of amednews.com offers more detail on this exciting development in his article Physician EMR use passes 50% as incentives outweigh resistance.

This is good news for employment prospects in the healthcare documentation field, which will require the services of medical transcriptionists, medical scribes, speech recognition editors, and other documentation professionals. The U.S. Department of Labor estimates a 26% increase in the need for this profession in the next several years. If your 2011 resolutions include developing a new career path, healthcare may be the way to go!