Health Insurance and How It Relates to the Current Economic Outlook

Health Insurance and How It Relates to the Current Economic Outlook

The multi-tiered healthcare system in the U.S. is a slow and ponderous process, but one that’s essential for the financial stability of practices and to ease the pain and suffering of patients. Nitin Chhoda explains health insurance and its relations to our current economy.

health insurance Healthcare is a complicated and convoluted process in the U.S. that involves patients, practitioners, health insurance providers and a multitude of clearinghouses established specifically for processing, verifying and paying claims.

Due to the many facets of the industry, it can leave even insured patients with insufficient health insurance coverage or none when they need it most, while clinicians are buried in a mountain of paperwork and rejected claims.

Healthcare in the 21st Century

Healthcare was a reactive system focused on treating ailments and illnesses as they appeared.  The beginning of the 21st century saw a shift in the thinking of health insurance company executives toward preventative measures and ways for clients to avoid becoming ill or developing conditions such as diabetes and heart disease.

When the Affordable Health Care Act is fully implemented, millions of previously uninsured individuals will have access to a core group of services through health insurance policies obtained through their employment or management insurance exchange.

Health Providers

Health insurance providers are beginning to change their procedures by forcing patients to shoulder more of the cost burden and setting limitations on costs and treatments.

The result is that many clients that have health insurance are no better off than those without.

health insurance coverage

Due to these insurance practices, physical therapy management must develop and implement strategic plans to contract with the best paying providers and examine client health insurance coverage closely before beginning a treatment.

Decide Carefully

To remain solvent, clinicians will be required to make hard decisions about the patients they treat, the health insurance they accept and the providers with which they contract.

The technology embodied in an electronic medical record (EMR) system is a clinician’s best friend for verifying health insurance, providing enhanced documentation and submitting reimbursement claims.

Medical Terms Talking the Talk and How to “Get” Them, Part 1

Medical Terms Talking the Talk and How to “Get” Them, Part 1

Nitin Chhoda shares how to use prefixes, suffixes and roots to determine the anatomy of medical terminology.

medical termsThanks to a diversity of TV programs, some medical terms have found their way into common usage.

Most people know the meaning of IV and stat, but medical terms are notoriously difficult to spell and decode, making it essential that a medical billing and coding specialist has a working knowledge of the terminology used within the practice.

They can accomplish that by learning the three-part combinations that comprise medical terms.

Medical Terms Are a Combination of Prefixes, Suffixes and Root Words
Medical terminology is comprised of prefixes, root words and suffixes stemming from Greek and Latin. Prefixes appear at the beginning of words. The pre means before, as in preschool, but the prefix can also be used to designate a location, number or time.

The root portion of a medical term forms the central part of the word. An example would be the word premature, as in premature aging. Mature is the root word and the “pre” suffix is used to indicate an individual is demonstrating symptoms of aging that’s at odds with the subject’s chronological age.

Suffixes are used at the end of a word to change the meaning, as in hopeless. It means the absence of hope and reverses the entire meaning. It’s often used to describe a condition, disease, disorder or procedure.

Root words, prefixes and suffixes are combined to create medical terms. Broken down into its component parts, the term myocarditis translates into muscle heart inflammation – or inflammation of the heart. An idiosyncrasy of medical terminology is that the words can be somewhat out of order from what most people are used to seeing.

Prefixes of medical terms work independently of root words and specific prefixes will always refer to one thing. For example, the prefix endo will always refer to inner. It’s essential for billing and coding specialists to be familiar with common prefixes and suffixes used in medical professions.

It’s also helpful to know something of anatomy, as many terms refer to a specific area of the body.

A Tried and Tested Technique for Learning Medical Terms
The best way students in all branches of the medical profession have devised for learning medical terminology is to learn groups of three roots, prefixes and suffixes.

medical terminologies

For those with a limited knowledge of anatomy, it helps to learn the root words of common body parts and then associating prefixes and suffixes with a specific part of the body.

Medical terminology sounds extremely complicated, but many people have heard and retained information about medical terms without even realizing it.

Some even use the terms, but without fully understanding how prefixes and suffixes reflect a diagnosis. Learning a few medical terms at a time is more effective than trying to memorize dozens all at once and suffer information overload. Those who approach the task by learning small groups will be surprised at how fluent they become in a very short time.

Physical Therapy Documentation: Web-Based Versus Server-Based EMR Systems

Physical Therapy Documentation: Web-Based Versus Server-Based EMR Systems

Nitin Chhoda shares the advantages and disadvantages of a web-based and server-based electronic medical records. These two types of physical therapy documentation can be very useful depending on the needs of the practice.

physical therapy documentation web-basedPractices who want to adopt an EMR physical therapy documentation system find out that there are more and more options to choose from.

Many offer similar features but perhaps the interface is better or worse depending on the development.

For most physical therapy documentation and practice management professionals, the decision will take some time to make and there will be a lot of factors to weigh.

One decision you can make up front so that your field of options is narrowed is to decide whether your practice will benefit from a web-based EMR or an in-house server-based EMR.

Pros of Web-Based EMRs

Web-based EMRs offer a number of benefits that help make the decision easy for some practices. First of all, investing in an EMR that has consistency and has been road-tested feels safer and more secure.

Web-based physical therapy documentation solutions will operate from the cloud, meaning that all of the information is stored in more than one place. You never have to worry about the server going down if the EMR company offers the highest quality of services.

Additionally, the cost and headache of maintaining a system is handled by the EMR company. Your physical therapy documentation software is maintained and updated, while the servers are well taken care of by the best IT professionals of the provider.

Pros of Server-Based EMRs

On the other hand, an in-house server gives you the control and comfort of knowing that your physical therapy documentation is right where you want it to be. You can get a back-up server to protect from down time and you can probably find a reasonable IT company that can maintain your server for you. In-house servers will be faster and will never rely on the Internet to be usable.

For large practices, a server-based physical therapy documentation EMR is usually a better option, because the costs of maintaining the system are much more reasonable compared to the benefit of having a slightly faster and more capable system.

Cons of Both Systemsphysical therapy documentation server-based

For a smaller office, the cost of maintaining a physical therapy documentation server in-house may seem prohibitive.

Even if you could work out a cheaper system in-house, you still have the stress and headaches of dealing with problems and ensuring that the system is secure and always working correctly.

With HIPAA and the HITECH Act, there are more and more physical therapy documentation regulations that will be enforced, which dictate exactly how secure your server must be. A small office will put in a significant investment for only minor gains with an in-house server.

But a web-based server does rely on the Internet, so there will be infrastructure choices to make. The downside of a web-based solution is that you may end up paying a monthly fee for a slightly slower service that is not as snappy.

But your physical therapy documentation staff may or may not notice the difference, and the convenience of portability cannot be undervalued. Figuring out which system is best for your practice will be the big challenge.

CPT Codes — from the Medical Coder Perspective

CPT Codes — from the Medical Coder Perspective

Nitin Chhoda explains how medical billing and coding can be simplified with an integrated electronic medical records and billing system. The importance of communicating with patients and elaborating costs and financial responsibilities is also discussed.

CPT codesCPT codes are pretty complex to use if you are unfamiliar with the process.

However, because they are so widely used, there have been many improvements in the way that medical coders and billers can access the codes they need.

Especially in an increasingly electronic age, CPT codes are only getting easier to use. Coding speed and accuracy can be increased with special physical therapy software that allows you to search for the right CPT codes quickly.

The most common reasons that insurance claims are rejected or denied have to do with incorrect coding or policy non-compliance. And every claim that has to be re-done makes the medical coding in your office slower and more costly.

With the Internet and software prices going down, these problems are being reduced for medical coding professionals and for the clinics that they work for. The high-end EMR solutions also include coding databases and can help improve efficiency and accuracy.

In order to draw more clients to use EMRs, software developers are learning to provide just what clinics and clinicians need from a complete electronic system.

Not Just CPT Codes – All Medical Coding

And of course, CPT codes are just one aspect of the job of a medical coder. CPT codes for Medicare are the same as certain HCPCS codes. Not every clinic will use all CPT codes, but only a certain sub-set. CPT codes list are only good if they are combined with the appropriate ICD codes when submitted with claims.

These kinds of important requirements keep medical coding staff very busy, which is one reason why many practices prefer to hire certified medical coders.

Communication with Patients

Another important way that CPT codes are used is in communication with patients. After a claim is filed and the insurance company responds with the amount they are covering, if there is any leftover amount it is up to the medical biller to bill the patient.

Patients usually find the medical billing paperwork to be confusing and overwhelming, especially patients who have recently undergone a medical procedure or have been diagnosed with a serious disease or condition.

CPT codesMedical billing staff have to be able to communicate why certain CPT codes are used, why the insurance company did not cover the entire cost, and what the patient is responsible for paying.

Determining Future Costs

It can also be helpful if patients get an explanation about what future costs to expect due to discrepancies between the amount the insurance company will cover and the amount the patient has to pay.

CPT codes dictate how much a patient will be charged as well as how much the insurance company will pay.

The hope is that with a reasonable agreement between the health care provider and the insurance company, the patient will not be responsible for partial payments all the time. CPT codes can be used to ensure that pricing is consistent with the expected reimbursements from insurance companies as well as programs like Medicare and Medicaid.

CPT Codes: What’s In It?

CPT Codes: What’s In It?

CPT codes and ICD codes are the terms used when discussing medical situations, and are used by the insurance and medical billing companies as guides. Nitin Chhoda describes the categories and roles of these codes as they relate to the physical therapy business.

CPT codes definitionCPT stands for Current Procedural Teminology. The CPT codes have been set and maintained by the American Medical Association and they are updated every year in October.

One of the easiest ways to understand the CPT codes is to compare them to ICD codes. While ICD-10 codes identify the diagnosis of a patient, CPT codes identify the services rendered.

CPT codes are used by clinicians, medical billing and coding professionals, and patients, as well as accreditation organizations, as a standardized communication tool for talking about medical services.

In fact, the reason that CPT codes are so useful is that everyone uses them when referencing medical services. The most prominent uses are in medical coding and billing, when a clinic needs to bill an insurance provider or government program. Medicare and Medicaid are both billed using CPT codes list along with ICD-10 codes.

Categories and Sections

CPT codes come in three categories, Category I, II, and III. Category I is split into six sections: Codes for Evaluation and Management, such as home services, hospital observation services, or emergency dept services; Codes for Anesthesia, such as obstetric, head, or neck; Codes for Surgery, such as nervous system, digestive system, or general; Codes for Radiology, such as nuclear medicine, diagnostic ultrasound, or mammography; Codes for Pathology & Laboratory, such as drug testing, immunology, or transfusion medicine; and Codes for Medicine, such as dialysis, allergy & clinical immunology, acupuncture, and ophthalmology.

Categories II and III are a little different. Category II are CPT codes that measure performance and are entirely optional. Category III are CPT codes for emerging technology use.

Not OptionalCPT codes defined

CPT codes are required by health insurance companies, as well as Medicare and Medicaid, in order for medical or physical therapy billing to be successful.

Additionally, HIPAA requires that CPT codes are used as part of a national data standardization and collection effort.

However, the copyright for CPT codes is help by the American Medical Association (AMA). That means that anyone who uses the CPT codes must pay license fees. This usually falls on the shoulders of health care services providers.

Insurance companies and government programs also use CPT codes as a reference for the amount of reimbursement that the clinician or clinic is paid for services. Insurance companies will negotiate with health care service providers in order to determine the precise amount, but once the amount for a service is set, all both parties need to know is which CPT code to use and the payment can be made in the agreed upon amount.

Updates and Improvements

But paying for access to CPT codes isn’t all bad. The AMA maintains the system and ensures that updates are made every year. The resulting system provides all users with a way to share information quickly and in a standardized way. The AMA has workshops to get informed feedback in order to make the system easier to use. The uniformity that CPT codes provide benefits everyone who works in medicine.