Health

Category Archives: Health

DIAGNOSIS RELATED GROUPS

A key issue for an additional fast move towards universal health coverage is that the economical use of resources, in addition to exaggerated resource mobilization and improved pooling. Substantial potency gains might be created by reforming hospital payment mechanisms, particularly since expenditure on hospital services contains one of the biggest shares of total health-care payment … Continue reading DIAGNOSIS RELATED GROUPS

RISK ADJUSTMENT DATA VALIDATION (RADV)

CMS has started conducting its Risk Adjustment Data Validation (RADV) Audit which will continue till august of this year. So this is the high time you should know in and out of Risk Adjustment Data Validation Audits so to prevent payment of high penalties. Federal laws need Medicare Advantage organizations, their providers, and practitioners to submit medical records for … Continue reading RISK ADJUSTMENT DATA VALIDATION (RADV)

ROADBLOCKS AND CHANGES TO SPINE SURGERY REIMBURSEMENT

Coding and Billing for Spine Surgery; a complicated and troublesome task for most of the healthcare practitioners, isn’t it?? Well, yes it is! While coding for spine surgery medical practitioners or professionals face several huge obstacles in achieving proper and accurate reimbursement for their spine procedures. Many of the claims even get denied by the … Continue reading ROADBLOCKS AND CHANGES TO SPINE SURGERY REIMBURSEMENT

INCIDENT-TO & SHARED SERVICES BY NON-PHYSICIAN PRACTITIONERS

Non-Physician Practitioners or Mid Level Providers are eligible to provide all types of visits that a physician provides. Although rules for coding are same for both, but payment is 85 percent of the payment for physicians from Medicare. Non-physician practitioners include Nurse Practitioners, Physician’s Assistants, and Clinical Nurse Specialists. By involving NPPs in daily practice, … Continue reading INCIDENT-TO & SHARED SERVICES BY NON-PHYSICIAN PRACTITIONERS

TELEMEDICINE SERVICES & IT’S REIMBURSEMENT

Earlier, Telemedicine services were used to deliver healthcare services in remote areas. But in today’s healthcare system, patient needs more convenient and accessible healthcare, therefore telemedicine services are now also used to evaluate, diagnose and treat people using common technology without the need of in-person visit. But similar to other services, physicians are concerned about … Continue reading TELEMEDICINE SERVICES & IT’S REIMBURSEMENT

STRATEGIES TO PREVENT COMPASSION FATIGUE AND BURNOUT IN MEDICAL FIELD

Being a physician or other healthcare provider is not at all easy! It includes lots and lots of paper work, long shifts, physical and emotional exhaustion and so much more. All of these things causes stress or we can say ‘Compassion Fatigue’ in healthcare service providers. And it is very obvious. You can’t be the … Continue reading STRATEGIES TO PREVENT COMPASSION FATIGUE AND BURNOUT IN MEDICAL FIELD

THE FEDERAL FALSE CLAIMS ACT : AN EFFECTIVE TOOL TO REDUCE FRAUDS AGAINST THE GOVERNMENT AND PROTECTION GIVEN TO QUI TAM PLAINTIFF BY THE LAW

The Federal False Claims Act is a law that imposes liability on a person or a company who intentionally makes a false claim regarding any health care program or tries to defraud the federal government. As a health care executive, physician or other health care provider, you should be very concerned about the potential for the … Continue reading THE FEDERAL FALSE CLAIMS ACT : AN EFFECTIVE TOOL TO REDUCE FRAUDS AGAINST THE GOVERNMENT AND PROTECTION GIVEN TO QUI TAM PLAINTIFF BY THE LAW

STRATEGIES FOR CORRECT E/M CODING

Despite of having proper guidelines, coding for Evaluation and Management (E/M) services is still a challenge for healthcare service providers. CMS reported that more than 15% of E/M services were improperly paid due to over or under coding of these services. Due to higher rates of errors, Reimbursement for providers has declined over the years. … Continue reading STRATEGIES FOR CORRECT E/M CODING

ROLE OF HEALTHCARE INFORMATION TECHNOLOGIES IN IMPROVING CARE COORDINATION

In this new emerging healthcare environment, it is very important to design a care process which should be focused on prevention, chronic illness management, quality improvement and cost savings. Care coordination is one of the key roles of healthcare organizations which not only affects the length of stay but also helps in reducing healthcare cost. … Continue reading ROLE OF HEALTHCARE INFORMATION TECHNOLOGIES IN IMPROVING CARE COORDINATION

BUNDLED PAYMENTS AND CASE MANAGEMENT IN HOSPITALS

Earlier, healthcare providers were reimbursed by insurance companies and governmental agencies for different procedures used in the service provided. This was under fee-for-service healthcare system. Many agree that fee for service has not only increased healthcare costs but has also affect quality care. In Fee-for-value healthcare system third-party payers reimburse healthcare providers to deliver the … Continue reading BUNDLED PAYMENTS AND CASE MANAGEMENT IN HOSPITALS

ENSURE PROPER REIMBURSEMENT BY THE CORRECT USE OF MODIFIERS

Earlier when procedure codes were not introduced, the health practitioners used to write the description of the service provided and the insurance carriers had to code the same and then pay the claim. To reduce the workload of insurance carriers, Medicare made it compulsory for the healthcare service providers to provide a medical code on … Continue reading ENSURE PROPER REIMBURSEMENT BY THE CORRECT USE OF MODIFIERS

REDUCE AUDIT RISK SCRUTINY BY PROPER DOCUMENTATION

Mistakes in medical coding and billing, results in monetary loss to the healthcare practitioners. Year on Year OIG (Office of Inspector General) and CMS (Centers for Medicare & Medicaid Services) rules and regulations are proving to be difficult to comply with, so non compliance to these rules can prove to be fatal, thus it has … Continue reading REDUCE AUDIT RISK SCRUTINY BY PROPER DOCUMENTATION

INTERDISCIPLINARY CARE ROUNDS: STRATEGIES FOR STARTING AND MANAGING WALKING ROUNDS

Traditionally, there was one to one relationship between patient and the physician. But now in this emerging and developing era of healthcare there is a need of continuous interaction between the patient and the healthcare delivery system which can be achieved through interdisciplinary care rounds. Interdisciplinary round model of care is considered to be the … Continue reading INTERDISCIPLINARY CARE ROUNDS: STRATEGIES FOR STARTING AND MANAGING WALKING ROUNDS

GUIDE ON THE HIPAA RULES AND THE BUSINESS ASSOCIATES

Business associates are simply entities or even individuals willing to perform functions regarding the use of some protected data or personal information of the individuals or entities being covered. Some of these covered entities includes health care entities, health plans and health care providers among other entities. Relationship between HIPAA and the business associates: The … Continue reading GUIDE ON THE HIPAA RULES AND THE BUSINESS ASSOCIATES

2019 HEALTHCARE TRENDS

With emerging technologies, there are a lot of developments happening in the healthcare sector. Much of these developments are taking place on the artificial intelligence and blockchain technology fronts. AI is being used for a wide range of healthcare and research purposes, which includes detection of disease, delivery of health services, management of chronic conditions, … Continue reading 2019 HEALTHCARE TRENDS

THE DISRUPTIVE PRACTITIONER: A DANGER TO THE HOSPITAL’S OPERATION

The basic definition of disruptive practice is any behavior that is disrespectful or harmful to another person. In our healthcare facilities, this type of behavior can be dangerous and lead to harmful or deadly mistakes. Facilities treating patients have been mandated to have policies in place to prevent these disruptive behaviors from affecting the prime … Continue reading THE DISRUPTIVE PRACTITIONER: A DANGER TO THE HOSPITAL’S OPERATION

MPFS 2019: HEALTHCARE TO SERVE YOU & YOUR CARETAKERS

Have you ever wondered why everyone is inquiring about health and medical benefits when they’re applying for a job in a certain company? The usual questions that rise when interviewers ask their applicant after the interview are, “Do you have a health card for employees?”, “How much is the reimbursable amount for outpatient medical expenses?”, … Continue reading MPFS 2019: HEALTHCARE TO SERVE YOU & YOUR CARETAKERS

WHAT ARE THE CONDITIONS OF PARTICIPATION IN DISCHARGE PLANNING RULE?

As a doctor, do you observe that your patient will need transitioning care once discharged from the hospital? Or as a nurse, do you foresee increased involvement for yourself post, discharge of your patient from the hospital? Discussions are continuously taking place on the final upcoming hospital discharge planning rules and the relevant conditions of … Continue reading WHAT ARE THE CONDITIONS OF PARTICIPATION IN DISCHARGE PLANNING RULE?

HYPNOSIS or HYPNOTHERAPY

Hypnosis uses guided relaxation, intense concentration, and focused attention to achieve a heightened state of awareness, that is sometimes called a trance. During this state, the person’s attention is so focused that anything going on around the person is temporarily blocked out or ignored. A trained therapist helps a person to focus his or her … Continue reading HYPNOSIS or HYPNOTHERAPY