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How is Book Review - The Secrets of Medical Decision Making By Oleg I Reznik, MC
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How to Avoid Becoming a Victim of the Health Care Machine
Oleg I. Reznik, M.D.
Loving Healing Press (2006)
1932690174
Everyone needs to read this book. Everyone at some point in his or her life is going to be involved with what Reznik calls the "Health Care Machine." This book should be read before you visit your doctor, have any procedures done, or make any medical decisions.
"The Secrets of Medical Decision Making" is not completely about secrets, but rather expresses the concerns the medical community now has about treating patients, and how those concerns have become less about the patient, and more about fear of being sued by patients, as well as dictated to by pharmaceutical and insurance companies. Patients are often subjected to many unnecessary tests and procedures because doctors feel they must cover all the bases just in case they are sued. Reznik gives several examples from his own experiences as a doctor where he and his colleagues have had to perform tests or procedures that were unnecessary and in some cases, gave patients unneeded extra stress or discomfort all in the quest to be thorough to protect the hospital and the medical profession.
Much of "The Secrets of Medical Decision Making" is just about common sense. Patients have a responsibility to use common sense and to keep their own best interests in mind when being treated by a doctor. In an age where surgeries are often outpatient and we are bombarded with information about new miracle pills that will resolve problems, patients are given false expectations that medicine can resolve nearly every health issue; consequently, patients are ready to sue when something goes wrong, when truthfully, they do not ask the appropriate questions about risks involved with procedures, and doctors do not provide their personal opinions unless asked because of restrictions imposed upon them by the medical and insurance systems.
What I found most interesting about "The Secrets of Medical Decision Making" was Reznik's elaboration on the many unnecessary procedures and tests given, including colon and breast cancer screening. He takes a hard look at the statistics medicine uses to suggest that pre-screening can prevent cancer or increase lifespan. Reznik states patients must be more pro-active in asking their doctors about the necessity of many tests and how likely it is they will actually have the disease for which the screening is being performed. Patients also need to trust their own decisions because they know their own bodies better than their doctors, and they know what will make them most comfortable.
While at times, I found Reznik's discussion a bit repetitious, I appreciated the summary he placed at the end of the book, breaking each of his main points into a paragraph with a subtitle so a person can quickly refer to it and remember which questions to ask before a visit with a physician.
"The Secrets of Medical Decision Making" is a book everyone will benefit from. Patients need to realize that modern medicine does not have the cure for everything-in fact, it can cure very little, and therefore, the patient must be largely responsible for his medical care and decisions. This book will help the patient have more control over his treatment and give him useful questions to ask his doctor. I intend to tell everyone I know in the medical professions, as well as everyone I know with health issues, about this book. Patients will save themselves many hours of wasted time, money and discomfort simply by spending a few hours reading "The Secrets of Medical Decision Making."
- Tyler R. Tichelaar, Ph.D., author of The Marquette Trilogy
There are many pros and cons to converting to electronic health records; depending on the point of view, it may have more pros or more cons.
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How is Electronic Medical Records (EMR) Incentive Reimbursement - Who Qualifies?
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The American Recovery and Reinvestment Act is planning to give billion to physicians as an incentive to encourage physicians to use electronic medical records. This money will be given to physicians and practices over the duration of five years to invest in electronic medical records. Unfortunately, this incentive is not going to be given to just any practice that purchases the system. A practice must qualify in order to receive the reimbursement. The hard truth is that not everyone who applies for an incentive reimbursement is going to get it.
Who Qualifies for EMR Reimbursement?
In order to qualify for an incentive reimbursement, practices must pass a few things on the list. The incentive money is meant to use the electronic system in a meaningful way. This can mean several things. The electronic medical records system must be able to communicate with other systems from different vendors and have advanced features, such as the clinical decision support feature. In addition, you must be a meaningful user, meaning you prescribe electronically, exchange data with different providers, and generate reports on how well you do compared to the unspecified clinical quality measures. These measures may resemble what you would find in the Quality Reporting Initiative.
The qualification list does not stop there. In addition to the qualifications listed above, electronic medical records must also be certified. The American Recovery and Reimbursement Act has yet to specify who can certify electronic health records; however, the federal government will most likely choose the Certification Commission on Healthcare Information Technology (CCHIT). In order to receive the full disbursement of ,000 over the course of five years, physicians must also qualify as a meaningful electronic health record user beginning by 2011 or 2012. The later physicians choose to wait to qualify, the less they will receive in incentive payments.
There is another catch as well. Many physicians are eligible to receive incentive reimbursements, but not all physicians. Dentists, physicians, nurse practitioners, nurse midwives, and some physician assistants are included. Physicians who are not eligible are hospital-based professionals, such as radiologists, emergency physicians, pathologists, and anesthesiologists. Practices that choose not to use electronic health records will be penalized a 1% reduction in 2015 in their Medicare fee schedule and it can continue up to 5% as the years pass. Many physicians disagree with the federal government's plan to give incentive reimbursements. Many feel it is just one way the government can control how healthcare is administered, and as a way to push national healthcare coverage.
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Sometimes a provider is reimbursed too much money for the services provided which results in an overpayment. Sometimes the overpayment is made by the insurance carrier and sometimes it is made by the patient. In whether case, it is prominent that the overpayment be returned to the appropriate person or carrier.
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How is Dealing With Overpayments When Billing medical Claims
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If a inpatient pays more than they are required to the inpatient must be notified as soon as the overpayment is discovered. The overpayment can be applied to a future visit if the inpatient will be returning but only if the inpatient agrees to that. The provider can not just indefinitely hold onto the money.
An example would be if a inpatient came in for an office visit and paid a co-pay. The provider ends up removing a mole which is determined surgery and doesn't need a co-pay resulting in an overpayment. Once the office realizes the co-pay should not have been collected they can do one of two things.
1. Notify the inpatient of the overpayment. If the inpatient will be returning the office can recommend that they apply it as a prestige toward the next visit. If the inpatient doesn't want to apply it toward a future visit, the overpayment must be returned.
2. Send the inpatient a check for the overpaid whole with a note explaining the overpayment.
In any case a provider cannot just keep the overpayment. That is illegal.
If an insurance carrier makes an over cost it is prominent to first decree if it is truly an over payment. Call the carrier that made the overpayment and ask them to justify how they determined their cost whole and if they processed the claim correctly. If they confirm that they did make an overpayment they should reprocess the claim to show literal, cost and send a invite for the provider to return the overpayment.
Sometimes they will just ask the provider over the phone to return the overpayment. Personally I all the time ask them to invite the money back with a written explanation. When you receive the written invite for the overpayment attach a check for the overpayment to the invite and send it to the address indicated on the request. If they don't furnish an address send it to the claims address but indicate "Attn: Overpayments".
If you receive a cost from an insurance carrier and the entire cost is wrong or not rightfully due to the provider write "void" on the check and return it to the insurance carrier with an explanation of why the cost was not due. For example if the cost is for a inpatient that was not seen by the provider, write "void" on the check and attach a note saying "This inpatient was not seen in our office."
If they state during the call that they processed the claim correctly and that there was no overpayment then you need to decree if there truly was an overpayment. Sometimes a inpatient has two insurance plans. The original allows a inevitable whole and then makes cost Then the secondary processes the claim and allows a higher whole than the original insurance carrier which results in a prestige balance.
This is not truly an overpayment. The whole contractually adjusted off from the original insurance carrier was more than needed to be adjusted off based on the secondary insurance carrier's payment. Therefore there is not a true overpayment and no money needs to be returned. The patient's balance just needs to be adjusted to offset the credit.
Sometimes a patient's secondary insurance carrier is a confidentially purchased insurance. They do not all the time consequent the same guidelines as other insurance carriers. Many times they ignore the whole paid by the original and make cost as if no other insurance is complicated resulting in an overpayment. In this case the overpayment whole belongs to the inpatient since they purchased the other insurance plan. The provider cannot just keep the money. The provider cannot get more than he or she billed out for their services.
It is prominent that overpayments are not ignored. First decree if it is a true overpayment. If it is, decree who the overpayment needs to be returned to and then do what is needful to return it. Remember only prestige it to a future visit with the patient's permission
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Cincinnati Address - Four Differences in the middle of the Cincinnati Enquirer and the Nky Post.
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There are two local newspapers, the Cincinnati Enquirer and Nyk Post, that serve Greater Cincinnati and Nky that are both owned and operated by the same company. While much of the article addresses the same data there are many differences for the readers in both of these geographic regions. Other than inherent advertisements for Northern Kentucky photo rehabilitation or Northern Kentucky photo transfer, there are many other major differences in the middle of the two papers. Some of these differences occur in the news stories, the event listings, the sports section and the classifies.
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How is Four Differences in the middle of the Cincinnati Enquirer and the Nky Post
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The news stories in both of the papers information the happenings of the day both locally and nationally. While the Cincinnati paper addresses crime and news in the neighborhoods in southwestern Ohio, the Nky paper focuses on all the foremost issues happening in its geographic area. Both papers will talk about the city government that effects them and all the issues that their taxpayers face. The primary dissimilarity is while these papers cover the same types of information, they make note of dissimilar habitancy development the news and the varied locations where it is happening. They both make the news stories relevant to the exact neighborhoods they serve.
The event listings of all papers are exact to the areas their readers inhabit. Even though Cincinnati and Nky are just a small bridge apart, the event listings in the Enquirer may not consist of things taking place in Newport or Covington. This is the same for the Post. An event at a church in Burlington may get a lot of press in the pages of the Post and won't even get a mention in the Enquirer. A reader of these papers who is finding for local events would whether have to buy both papers or revert to their websites where all the exact events are listed regardless of where they are happening. These event listing differences apply to fundraisers, festivals, art exhibits, concerts and other house activities.
One of the most popular sections of the paper is the quantum that reports on Sports. The Enquire and the Post both have a Sports section that serves their readers very well. The primary dissimilarity in the middle of these two papers in this area is what sporting events they pick to cover. Typically in the fall the Saturday paper will have a large estimate of press dedicated to the high school football games from the Friday night before. The Enquirer will cover all the news and scores of the Elder, St. X and Moeller games, while the Post covers schools in Nky. The readers of each paper want to be educated on the teams and exact players that have meaning and live in proximity to their home.
Lastly, the classified sections of the Enquirer and Post will have listings that are relevant to their exact neighborhoods. For instance, the Post will highlight homes for sale, garage sales and habitancy gift services in the Nky area. It may have some listings for Cincinnati, but it is petite and has less priority than those serving Nky. All data and advertisements in this section of the paper need to be of interest to the bulk of the readers. This means the data has to focus on what is geographically relevant to the reader.
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Queen City Physicians - Book Review - The Secrets of Medical Decision Making By Oleg I Reznik, MC
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Do you know about - Book Review - The Secrets of Medical Decision Making By Oleg I Reznik, MC
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The Secrets of Medical Decision Making:
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How is Book Review - The Secrets of Medical Decision Making By Oleg I Reznik, MC
We had a good read. For the benefit of yourself. Be sure to read to the end. I want you to get good knowledge from Queen City Physicians.
How to Avoid Becoming a Victim of the Health Care Machine
Oleg I. Reznik, M.D.
Loving Healing Press (2006)
1932690174
Everyone needs to read this book. Everyone at some point in his or her life is going to be involved with what Reznik calls the "Health Care Machine." This book should be read before you visit your doctor, have any procedures done, or make any medical decisions.
"The Secrets of Medical Decision Making" is not completely about secrets, but rather expresses the concerns the medical community now has about treating patients, and how those concerns have become less about the patient, and more about fear of being sued by patients, as well as dictated to by pharmaceutical and insurance companies. Patients are often subjected to many unnecessary tests and procedures because doctors feel they must cover all the bases just in case they are sued. Reznik gives several examples from his own experiences as a doctor where he and his colleagues have had to perform tests or procedures that were unnecessary and in some cases, gave patients unneeded extra stress or discomfort all in the quest to be thorough to protect the hospital and the medical profession.
Much of "The Secrets of Medical Decision Making" is just about common sense. Patients have a responsibility to use common sense and to keep their own best interests in mind when being treated by a doctor. In an age where surgeries are often outpatient and we are bombarded with information about new miracle pills that will resolve problems, patients are given false expectations that medicine can resolve nearly every health issue; consequently, patients are ready to sue when something goes wrong, when truthfully, they do not ask the appropriate questions about risks involved with procedures, and doctors do not provide their personal opinions unless asked because of restrictions imposed upon them by the medical and insurance systems.
What I found most interesting about "The Secrets of Medical Decision Making" was Reznik's elaboration on the many unnecessary procedures and tests given, including colon and breast cancer screening. He takes a hard look at the statistics medicine uses to suggest that pre-screening can prevent cancer or increase lifespan. Reznik states patients must be more pro-active in asking their doctors about the necessity of many tests and how likely it is they will actually have the disease for which the screening is being performed. Patients also need to trust their own decisions because they know their own bodies better than their doctors, and they know what will make them most comfortable.
While at times, I found Reznik's discussion a bit repetitious, I appreciated the summary he placed at the end of the book, breaking each of his main points into a paragraph with a subtitle so a person can quickly refer to it and remember which questions to ask before a visit with a physician.
"The Secrets of Medical Decision Making" is a book everyone will benefit from. Patients need to realize that modern medicine does not have the cure for everything-in fact, it can cure very little, and therefore, the patient must be largely responsible for his medical care and decisions. This book will help the patient have more control over his treatment and give him useful questions to ask his doctor. I intend to tell everyone I know in the medical professions, as well as everyone I know with health issues, about this book. Patients will save themselves many hours of wasted time, money and discomfort simply by spending a few hours reading "The Secrets of Medical Decision Making."
- Tyler R. Tichelaar, Ph.D., author of The Marquette Trilogy
March 24, 2008
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Pediatric Physicians - Medical Sales Positions in Pediatrics
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Do you know about - Medical Sales Positions in Pediatrics
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One of the more interesting specialties in medical sales is pediatrics involving doctors who treat children. The pediatrics medical specialty involves a fair number of over the counter (OTC) non-prescription products in addition to the usual prescription drugs. Some pharmaceutical firms deal only with OTC products in this specialty including those with baby formulas. This may be a feasible entry route for newcomers to medical sales since the pediatrics field is so OTC intensive.
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How is Medical Sales Positions in Pediatrics
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The OTC business is generally very sample intensive so medical sales representatives working in this particular area will be expected to deal with huge supplies of free samples for the medical clinics on a daily basis. One thing to be forewarned especially for pediatrics is that because of the nature of the baby formula samples in canned formats, there could be some moderate lifting required. Medical sales representatives routinely carry cases of canned baby formulas around for the pediatric clinics.
Cough and cold syrups as well as skin creams are also common products in pediatrics. Since many kids can't swallow tablets, pharmaceutical companies develop many pediatric drugs in syrup formats. This often results in free samples in small bottle formats which of course will be heavier to carry around for the medical rep than samples in pill forms.
The field itself is a good one to work in because I have found in my experience working with pediatricians, they are generally a nice group of physicians to deal with. They are usually more relaxed than other certain types of doctors. Perhaps this is because pediatricians have to deal with kids all day so a certain playful personality is probably required for this specialty. This works well with medical sales representatives who call on this group of doctors.
Like other medical specialty sales territories, pediatric territories will likely be larger than the average family medicine territory in terms of geography since there are fewer pediatricians per community compared to family doctors. Family physicians seeing a lot of kids will probably also be included in the target group. Because of larger geographic territories, medical sales reps working in pediatrics will likely have to travel more compared to the average drug rep working only with family physicians.
Overall, pediatrics is a good specialty to work in for many medical sales representatives. It is also a possible entry point for those who are hoping to get a medical sales position for the first time.
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Primary Care Doctors - Eye Doctors Explanation of Why Freckles and Spots in Your Eyes Need Monitoring With vision Exams
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Do you know about - Eye Doctors Explanation of Why Freckles and Spots in Your Eyes Need Monitoring With vision Exams
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So you have been told by your eye doctor there is a freckle in your eye. Should you be worried? It could be a estimate of things but the most likely are choroid nevus or benign choroid melanoma congenital hypertrophy of the retinal pigmented epithelium. Both conditions are normally benign and not a serious problem. They both need to be monitored to make sure they are not malignant melanomas.
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How is Eye Doctors Explanation of Why Freckles and Spots in Your Eyes Need Monitoring With vision Exams
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Congenital hypertrophy of the retinal pigmented epithelium (also known as halo nevus) is a pigmented, well demarcated dark spot inside the back of your eye on your retina. Though size varies, it is favorable to think of it as about equivalent to the top of an eraser on a pencil. It is an accumulation of increases in pigment in the cells of the retinal pigment epithelium cell layer. This is hypertrophy, or an increase in the size but not the estimate of cells. The blood vessels underneath it atrophy also which results in a small blind spot which you are not capable of perceiving. While there are often changes over time; it is mostly a stable, inconsequential change and congenital hypertrophy of the retinal pigmented epithelium can be notion of like a freckle on your skin. The distinction is you can't search for it for any changes like you can a spot on your hand, so serious conditions can strengthen past the treatable stages. On rare occasions a halo nevus can change from a normally flat surface and create elevated nodules. The formation of these tumors are very rare but something eye doctors do check for on an annual basis. normally no supplementary tests are required other than eye exams with your eyes dilated in 3-6 months after first observation, then annually there after.
Congenital hypertrophy of the retinal pigmented epithelium also occurs in a form called "Bear Tracks." Bear tracks are multiple dark spots in the back of the eye that look like tiny bear footprints. They oftentimes occur in conjunction with a condition called familial polyps and wish supplementary testing for colon and rectal cancer. This can be due to a dominant gene that is often seen to run in families as an predisposition to colon cancer. Bear Tracks may be seen years before the cancer occurs so they may be a considerable deterrent sign to your optometrist. Bear tracks may wish a referral to another specialist for supplementary evaluation. Not every sick person with Bear Tracks will get colon cancer, but it is more likely if they are large, present in both eyes, and there are more than 3 or 4 spots in each eye. Isolated single congenital hypertrophy of the retinal pigmented epithelium spots are not connected with Familial polyps or an increased risk of colon cancer.
Trauma to the retina whether from injury or infections in the eye can cause dark spots similar to congenital hypertrophy of the retinal pigmented epithelium but they are irregular in shape. They are due to an actual increase in the estimate of retinal pigment epithelial cells. The primary concern in this case is to monitor the condition that caused it. If it is an infection in one of the layers of the eye it could recur at a later date.
A choroid nevus is assuredly like a nevus (freckle) but it is occurring in the choroid, the level below the retina which supplies circulation to the retinal tissue. These appear as round, gray, normally flat spots and are very tasteless occurring in up to 30% of the population. They are also referred to as benign choroid melanomas, though they are not true melanomas. They are due to an increase of pigment cells in the choroid. These types of cells are found in our skin and in parts of the eye. The retina does not have the same type of pigment cells, it has pigmented epithelium cells instead. A choroid nevus is normally flat, but does appear more similar to melanomas in the choroid due to being settled at the same level below the retina. They wish closer consideration and sometimes supplementary testing to make sure they are benign spots. Any nevus can undergo transformation to a melanoma but it is very rare.
Testing to diagnose any new spot observed can consist of ongoing observation, optic coherence tomography techniques of imaging the layers of the retina, digital imaging pictures, and dye imaging of the retina. A dilated exam of the inside of your eye annually is the only technique that allows eye doctors to adequately detect most of theses spots. Although this can be mildly uncomfortable causing light sensitivity and mild dry eyes, it should be done by you optometrist. oftentimes patients have not had their eyes routinely dilated in the past so when your optometrist finds a new spot or freckle in your eye it may have been there unchanged for years. You can be reassured in knowing that the large majority of the time it is fully innocuous and only needs to be rechecked once every year for any changes. In areas with large amounts of Uv exposure like Northern Colorado, sun wear with Uv protection can help cut the risk of melanomas. There is some controversy over Uv exposure and cancer, and some suggestions that vitamin D may cut certain type of tumors and the colon cancer seen connected with bear tracks. In the future, sun wear and moderate exposure to Uv could become the recommendation.
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Primary Care Providers - medical Billing Terms and medical Coding Terminology
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Do you know about - medical Billing Terms and medical Coding Terminology
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Those in healing billing and coding careers have a terminology of unique terms and abbreviations. Below are some of the more frequently used healing Billing terms and acronyms. Also included is some healing coding terminology.
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Aging - Refers to the unpaid insurance claims or patient balances that are due past 30 days. Most healing billing software's have the ability to originate a isolate description for insurance aging and patient aging. These reports typically list balances by 30, 60, 90, and 120 day increments.
Appeal - When an insurance plan does not pay for treatment, an appeal (either by the victualer or patient) is the process of formally objecting this judgment. The insurer may require added documentation.
Applied to Deductible - Typically seen on the patient statement. This is the amount of the charges, considered by the patients insurance plan, the patient owes the provider. Many plans have a maximum annual deductible that once met is then covered by the insurance provider.
Assignment of Benefits - insurance payments that are paid to the physician or hospital for a patients treatment.
Beneficiary - person or persons covered by the condition insurance plan.
Clearinghouse - This is a aid that transmits claims to insurance carriers. Prior to submitting claims the clearinghouse scrubs claims and checks for errors. This minimizes the amount of rejected claims as most errors can be for real corrected. Clearinghouses electronically transmit claim facts that is compliant with the literal, Hippa standards (this is one of the healing billing terms we see a lot more of lately).
Cms - Centers for Medicaid and Medicare Services. Federal branch which administers Medicare, Medicaid, Hippa, and other condition programs. Formerly known as the Hcfa (Health Care Financing Administration). You'll consideration that Cms it the source of a lot of healing billing terms.
Cms 1500 - healing claim form established by Cms to submit paper claims to Medicare and Medicaid. Most market insurance carriers also require paper claims be submitted on Cms-1500's. The form is suited by it's red ink.
Coding -Medical Billing Coding involves taking the doctors notes from a patient visit and translating them into the permissible Icd-9 code for prognosis and Cpt codes for treatment.
Co-Insurance - ration or amount defined in the insurance plan for which the patient is responsible. Most plans have a ratio of 90/10 or 80/20, 70/30, etc. For example the insurance carrier pays 80% and the patient pays 20%.
Co-Pay - amount paid by patient at each visit as defined by the insured plan.
Cpt Code - Current Procedural Terminology. This is a 5 digit code assigned for reporting a course performed by the physician. The Cpt has a corresponding Icd-9 prognosis code. Established by the American healing Association. This is one of the healing billing terms we use a lot.
Date of aid (Dos) - Date that condition care services were provided.
Day Sheet - overview of daily patient treatments, charges, and payments received.
Deductible - amount patient must pay before insurance coverage begins. For example, a patient could have a 00 deductible per year before their condition insurance will begin paying. This could take several doctor's visits or prescriptions to reach the deductible.
Demographics - corporal characteristics of a patient such as age, sex, address, etc. Vital for filing a claim.
Dme - Durable healing tool - healing supplies such as wheelchairs, oxygen, catheter, glucose monitors, crutches, walkers, etc.
Dob - Abbreviation for Date of Birth
Dx - Abbreviation for prognosis code (Icd-9-Cm).
Electronic Claim - Claim facts is sent electronically from the billing software to the clearinghouse or directly to the insurance carrier. The claim file must be in a appropriate electronic format as defined by the receiver.
E/M - estimation and supervision section of the Cpt codes. These are the Cpt codes 99201 thru 99499 most used by physicians to entrance (or evaluate) a patients medicine needs.
Emr - Electronic healing Records. healing records in digital format of a patients hospital or victualer treatment.
Eob - Explanation of Benefits. One of the healing billing terms for the statement that comes with the insurance enterprise cost to the victualer explaining cost details, covered charges, write offs, and patient responsibilities and deductibles.
Era - Electronic Remittance Advice. This is an electronic version of an insurance Eob that provides details of insurance claim payments. These are formatted in agreeing to the Hipaa X12N 835 standard.
Fee schedule - Cost linked with each medicine Cpt healing billing codes.
Fraud - When a victualer receives cost or a patient obtains services by deliberate, dishonest, or misleading means.
Guarantor - A responsible party and/or insured party who is not a patient.
Hcpcs - condition Care Financing supervision base course Coding System. (pronounced "hick-picks"). This is a three level principles of codes. Cpt is Level I. A standardized healing coding principles used to narrate exact items or services provided when delivering condition services. May also be referred to as a course code in the healing billing glossary.
The three Hcpcs levels are:
Level I - American healing Associations Current Procedural Terminology (Cpt) codes.
Level Ii - The alphanumeric codes which contain mostly non-physician items or services such as healing supplies, ambulatory services, prosthesis, etc. These are items and services not covered by Cpt (Level I) procedures.
Level Iii - Local codes used by state Medicaid organizations, Medicare contractors, and hidden insurers for exact areas or programs.
Hipaa - condition insurance Portability and accountability Act. several federal regulations intended to improve the efficiency and effectiveness of condition care. Hipaa has introduced a lot of new healing billing terms into our vocabulary lately.
Hmo - condition Maintenance Organization. A type of condition care plan that places restrictions on treatments.
Icd-9 Code - Also know as Icd-9-Cm. International Classification of Diseases classification principles used to assign codes to patient diagnosis. This is a 3 to 5 digit number.
Icd 10 Code - 10th improvement of the International Classification of Diseases. Uses 3 to 7 digit. Includes added digits to allow more ready codes. The U.S. branch of condition and Human Services has set an implementation deadline of October, 2013 for Icd-10.
Inpatient - Hospital stay longer than one day (24 hours).
Maximum Out of Pocket - The maximum amount the insured is responsible for paying for eligible condition plan expenses. When this maximum limit is reached, the insurance typically then pays 100% of eligible expenses.
Medical Assistant - Performs administrative and clinical duties to sustain a condition care victualer such as a physician, physicians assistant, nurse, or nurse practitioner.
Medical Coder - Analyzes patient charts and assigns the literal, Icd-9 prognosis codes (soon to be Icd-10) and corresponding Cpt medicine codes and any linked Cpt modifiers.
Medical Billing expert - The person who processes insurance claims and patient payments of services performed by a physician or other condition care victualer and vital to the financial operation of a practice. Makes sure healing billing codes and insurance facts are entered correctly and submitted to insurance payer. Enters insurance cost facts and processes patient statements and payments.
Medical Necessity - healing aid or course performed for medicine of an illness or injury not considered investigational, cosmetic, or experimental.
Medical Transcription - The conversion of voice recorded or hand written healing facts dictated by condition care professionals (such as physicians) into text format records. These records can be whether electronic or paper.
Medicare - insurance provided by federal government for citizen over 65 or citizen under 65 with inevitable restrictions. Medicare has 2 parts; Medicare Part A for hospital coverage and Part B for doctors office or patient care.
Medicare Donut Hole - The gap or contrast in the middle of the initial limits of insurance and the catastrophic Medicare Part D coverage limits for prescription drugs.
Medicaid - insurance coverage for low revenue patients. Funded by Federal and state government and administered by states.
Modifier - Modifier to a Cpt medicine code that furnish added facts to insurance payers for procedures or services that have been altered or "modified" in some way. Modifiers are foremost to expound added procedures and accumulate repayment for them.
Network victualer - condition care victualer who is contracted with an insurance victualer to furnish care at a negotiated cost.
Npi amount - National victualer Identifier. A unique 10 digit identification amount required by Hipaa and assigned through the National Plan and victualer Enumeration principles (Nppes).
Out-of Network (or Non-Participating) - A victualer that does not have a contract with the insurance carrier. Patients regularly responsible for a greater measure of the charges or may have to pay all the charges for using an out-of network provider.
Out-Of-Pocket Maximum - The maximum amount the patient is responsible to pay under their insurance. Charges above this limit are the insurance clubs obligation. These Out-of-pocket maximums can apply to all coverage or to a exact advantage kind such as prescriptions.
Outpatient - Typically medicine in a physicians office, clinic, or day surgery facility continuing less than one day.
Patient accountability - The amount a patient is responsible for paying that is not covered by the insurance plan.
Pcp - traditional Care physician - regularly the physician who provides initial care and coordinates added care if necessary.
Ppo - beloved victualer Organization. insurance plan that allows the patient to pick a physician or hospital within the network. Similar to an Hmo.
Practice supervision Software - software used for the daily operations of a providers office. Typically includes appointment scheduling and billing functions.
Preauthorization - Requirement of insurance plan for traditional care physician to inform the patient insurance carrier of inevitable healing procedures (such as patient surgery) for those procedures to be considered a covered expense.
Premium - The amount the insured or their owner pays (usually monthly) to the condition insurance enterprise for coverage.
Provider - physician or healing care facility (hospital) that provides condition care services.
Referral - When a victualer (typically the traditional Care Physician) refers a patient to an additional one victualer (usually a specialist).
Self Pay - cost made at the time of aid by the patient.
Secondary insurance Claim - insurance claim for coverage paid after traditional insurance makes payment. Typically intended to cover gaps in insurance coverage.
Sof - Signature on File.
Superbill - One of the healing billing terms for the form the victualer uses to document the medicine and prognosis for a patient visit. Typically includes several commonly used Icd-9 prognosis and Cpt procedural codes. One of the most frequently used healing billing terms.
Supplemental insurance - added insurance course that covers claims fro deductibles and coinsurance. frequently used to cover these expenses not covered by Medicare.
Taxonomy Code - Code for the victualer specialty sometimes required to process a claim.
Tertiary insurance - insurance paid in increasing to traditional and secondary insurance. Tertiary insurance covers costs the traditional and secondary insurance may not cover.
Tin - Tax Identification Number. Also known as owner Identification amount (Ein).
Tos - Type of Service. description of the kind of aid performed.
Ub04 - Claim form for hospitals, clinics, or any victualer billing for facility fees similar to Cms 1500. Replaces the Ub92 form.
Unbundling - Submitting more than one Cpt medicine code when only one is appropriate.
Upin - Unique physician Identification Number. 6 digit physician identification amount created by Cms. Discontinued in 2007 and replaced by Npi number.
Write-off (W/O) - The contrast in the middle of what the victualer charges for a course or medicine and what the insurance plan allows. The patient is not responsible for the write off amount. May also be referred to as "not covered" in some glossary of billing terms.
medical Billing Terms and medical Coding Terminology (with Health & Product)
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