Archive for March, 2011

Introduction to Medical Coding

Monday, March 28th, 2011

Medical coding is the process of assigning standardized numerical codes to patient health care charts. This coded information is used to ensure that insurance companies, government organizations, such as Medicare, and patients alike all receive accurate billing statements for health services performed. Medical coders perform the work of converting diagnostic and procedural information into simplified numerical codes that can be electronically processed for payment by third party payers – Insurance companies and Medicare, for example.

The process of medical coding requires an attention to detail to ensure accuracy of billing records. Because of the large dollar amounts involved, coding is a highly regulated and tightly supervised activity. Coding is also subject to frequent and rigorous audits to ensure accuracy in the billing process as there are literally billions of dollars at stake. In many ways, medical coding is a much more scrutinized activity than, say the transcription of patient records.

Medical Coding work is typically performed in hospitals or clinics, although we are beginning to see some of these coding and billing jobs migrate to work at home positions. Medical coders generally begin with a transcribed patient health record and transform procedures and diagnoses etc. into numerical codes. This takes a great deal of expertise in medical terminology and a fluency with relevant codes. Of course this requires formal training. Billing specialists takes the coded output produced by the coder and submit it for reimbursement to insurance companies, Medicare, or directly to the patient. Many times a single person will perform both the coding and the billing functions. This is particularly true in smaller clinical settings. In large, high volume health care operations, coding and billing are often organized into separate functional areas. Of the two, coding specialists generally enjoy a higher income and require more specialized training.

Medical coders are in high demand and the opportunities in the career field of health records documentation are outstanding. Coders work in hospitals and clinics and for other health care providers across the country. They play a vital role in the health information management cycle.

Increasingly, the health information management industry is taking advantage of the rapid advances in online coding technology. More and more, the work is performed online over the internet. As online coding catches on as a concept, we will likely see many of the positions that have traditionally been offered exclusively in hospitals and other health care settings begin to migrate to home based jobs. The work at home employee model has worked very well for the transcription industry and will also likely begin to gain traction in the coding industry as online coding becomes more prevalent.

The Rocky Road to ICD-10 Medical Code Implementation

Sunday, March 27th, 2011

The US healthcare industry has been grappling for too many years now with the implementation of ICD-10 medical codes. The new ICD-10 code set promises to improve the classification of the massive and growing reservoir of health information and to bring the United States up to the international standard for healthcare documentation.

There is no question that the US is lagging significantly in this vital health information area. Most other developed countries have long since adopted and implemented the new standards. The need for an upgrade to the current system was identified formally in the early 1990’s when the National Committee on Vital and Health Statisics affirmed that the current code structure was “broken”. The numerous delays in implementation since that time can be traced to a handful of short-sighted economic and political considerations. Regardless of the cause, the US healthcare system can ill afford additional delays. The quality and integrity of health data in the US has been declining for several decades now.

The deterioration of health data can be blamed in large measure on the fact that the US has simply outgrown the ICD-9 medical coding system. While ICD-9 served the industry adequately for a number of years, the growth in medical procedures, treatments, diagnoses and technology have surpassed its limited adaptive capability. The universe of available ICD-9 codes is rapidly dwindling and certain code sets are becoming oversubscribed. This is resulting in tremendous inefficiency and is calling into question the integrity and completeness of the data delivered through the system. As the risk of compromised patient care increases, the need for change is becoming more obvious.

Advantages of the ICD-10 Medical Code Classification System

Implementation of the ICD-10 medical code set will confer a number of significant advantages on the industry. These include:

  1. Greater specificity and accuracy in healthcare documentation
  2. Reduction in manual intervention arising from the limited descriptive capability of the existing code set
  3. Increased level of detail in the final health record
  4. Improvement in care decisions with elevated data quality
  5. Reduction in errors and quality assurance activities
  6. Reduction in reimbursement holdups due to inadequate information or clarity
  7. Increased productivity of coding practitioners as automation becomes more applicable throughout the entire process
  8. Increased compatibility with other global health information systems
  9. Improved patient outcomes

Conclusion

While there are certainly some compelling economic costs associated with full adoption and implementation of the ICD-10 code set, the costs of non-adoption are growing every day and threaten to dwarf real implementation costs. Additionally, the negative impact on patient care will increase exponentially as the existing data model becomes less stable. The evidence for successful implementation is readily available. Virtually every other major developed country in the world has successfully adopted ICD-10. The time for discussion and analysis is past. The time for bold action and implementation is here.

The Future of Medical Transcription and Medical Transcription Jobs

Tuesday, March 22nd, 2011

There has been a lot of talk lately about the future of medical transcription. As the trends of off-shoring and voice recognition pick up steam and threaten to displace traditional jobs in the US, what is to become of the profession? It is a logical question. The reality is that MT jobs continue to enjoy high demand in the marketplace. In fact, they are a critical component of the most stable and rapidly growing segment of our economy. Healthcare! As the global economic recession deepens, healthcare may prove to be one of the only resilient segments of the US economy over the next 4 or 5 years.

Every day it seems that there are new announcements of bankruptcies and layoffs affecting tens of thousands of people. When was the last time you heard about mass layoffs in the healthcare industry? You don’t and you never will – at least not for the next several decades as the baby boom population blossoms into full retirement and demands an extraordinary volume of healthcare services. The interesting thing to note – and a fact not readily discussed by many in the medical transcription industry is that the average age of active practicing transcriptionists is somewhere in the mid 40’s. That is the average. This means that a very large portion of the active MT population is poised to retire and exit the industry in the next 5 – 10 years.

Guess what? Those jobs don’t just go away. All of those positions will need to be replaced. What is more, these seasoned practitioners are among the most productive asset the industry has. They produce an output of medical reports that is sometimes 2 to 4 times the average production for new graduates who are just entering the career field. This means that the industry will need not ONE, but possibly two or three new recent graduates to fill EACH of these positions.This spells job opportunity for prospective new students considering entering this fast growing medical transcription career field.

Unfortunately, it could also spell disaster for the healthcare industry if it doesn’t begin to take steps now to attract new talent into the industry. Some of this problem has already begun to materialize and regardless of what your opinion is on offshoring, the offshore production of some of the domestic US transcription workload has saved the industry and bought some precious time to find a more permanent solution to the acute personnel deficit. However, it will not continue to mitigate the deficit in the US market indefinitely. Vacant jobs will have to be filled as older MT’s retire and exit the industry.

Voice recognition has also played a role in mitigating the MT personnel deficit. And while voice recognition technology is finding a place in the industry, it’s role thus far has been to augment the transcription process by giving transcriptionists a new and more favorable starting point for production. It has in no way delivered the silver bullet MT replacement that some have been hailing for decades now. What we are seeing and what we will continue to see as the adoption of the technology accelerates, is that the role of a growing subset of the MT community will be transformed. The work of transcripionists in the future will increasingly be that of medical language editor; beginning with a document that has been processed through a speech recognition software engine.

But in the end, the anticipated surge of baby boom retirees will simply be too large to ignore. It is a problem that requires a serious and relatively immediate solution. What is more, the aging population consumes an exponentially large portion of available care services and resources. Which means, that as the aging population swells over the next decade, every facet of the healthcare industry will be strained. Medical records jobs will increase in both volume and importance over the next decade. Individuals who are adaptable and capable of stepping into new roles as the industry continues to morph will benefit substantially by training now for entry into this fast growing and rapidly changing industry.

Medical Billing Clearinghouses – A Key to Processing Efficiency

Monday, March 21st, 2011

Medical Billing Clearinghouses are rapidly becoming a larger and larger part of the healthcare reimbursement landscape. Basically, billing clearinghouses are organizations dedicated to electronic healthcare claims processing and reimbursement. Most independent billing companies and specialists rely on an established clearinghouse to process their healthcare reimbursement claims.

As a general rule, clearinghouses depend on economies of scale to operate efficiently. In other words, by processing millions of claims each day or week, a clearinghouse is able to drive its average cost per claim down to a very low level. It would be extremely cost prohibitive for an independent billing organization to deploy the necessary resources to accomplish all of the detailed quality assurance activities that are required to meet minimum reimbursement standards. Most billing companies and practitioners find this to be an invaluable service. It turns out that being out of compliance in the healthcare reimbursement arena can lead to steep fines or even criminal penalties, particularly when dealing with a government reimbursement organization such as Medicare or Medicaid. For this reason, most independent billing specialists choose to transfer a portion of the workload as well as a portion of the liability for their claims processing activities to large medical billing clearinghouses. This is wise, providing the right clearinghouse is selected.

In addition to quality control functions, the clearinghouses specialize in converting claims submitted by an independent billing company or specialist into a format that is recognized by the various healthcare reimbursement organizations: government agencies and a multitude of different insurance companies.

Most billing clearinghouses charge some kind of setup fee to add an independent billing specialist as a new client. Also, they normally charge a small fee for each claim that they process. Some clearinghouses only charge for certain claims processing services. Often they will charge more for a Medicare claim, as the claim processing requirements are more stringent when government dollars are involved. While medical billing companies and practitioners can benefit substantially from the services of a medical billing clearinghouse, it is wise to carefully evaluate all of your options if you get to a point where you feel you could benefit from the services of a medical billing clearinghouse.

Turning Healthcare Over to Computers: The Risks of Rapid Adoption of EMR and Speech Rec Technology

Friday, March 18th, 2011

Healthcare documentation has come a long way. A continuous stream of technological advancement and automation has generated significant gains in efficiency while increasing the quality of care through improved access to vital patient information. The future looks bright indeed, as incremental improvements in technology promise to confer additional benefits. Many health care providers are embracing new versions of technology as quickly as they are rolled out in the hope of delivering heightened levels of patient care at a lower cost.

Nowhere are the advances in technology felt more keenly than in the healthcare documentation arena. For many years, medical records departments have been viewed as cost centers and subordinated to other seemingly more important areas of the healthcare organization. As a consequence, healthcare documentation has historically received neither the glamour nor the funding that other front office and patient care activities have enjoyed. Over the past few decades, however, the balance of power has begun to shift. Healthcare documentation is now rightly seen as one of the keys to profitability and a catalyst for industry growth.

New talent and resources are beginning to flow into this area breathing new life and vitality into what was once an afterthought in most healthcare organizations. Leading the charge is a new breed of profit minded executives set on transforming the healthcare model. As the industry ushers in a new era of efficiency and profitability, decision making executives would do well to remain aware of some of the significant risks of an overly ambitious technology adoption timeline. For instance:

Underdocumentation

The risk of underdocumentation has the potential of increasing dramatically with new electronic medical record (EMR) protocols. That EMR technology promises to exponentially increase efficiency in some aspects of care – primarily by decreasing administrative workload and increasing the speed of information flow – is not in dispute.

However, it should be recognized that the rapid adoption of this technology in its current form has the potential to create down- stream issues with patient care as a result of improper or inadequate documentation. EMR threatens to increase costs as inadequately documented assessments and activities are reworked. Patient care may also be compromised as diagnoses are delayed due to lack of complete information flow.

Underexamination

EMR’s may steer physicians to point and click their way through a few standard procedures, potentially ignoring less obvious, non-charted options.

Undervaluing the traditional role of the physician

As technology asserts itself with fits and starts into the patient care process, there is a real risk that the transition from physician directed outcomes to technology driven outcomes will be too abrupt, again compromising patient care. Additionally, recent studies suggest that the physicians spend about 9 times longer entering an equivalent amount of information via EMR and EHR than with traditional dictation based narratives. Time is money, and physician resources are far too costly to be assigning tasks better handled by non-physician professionals.

Chronic under reporting

Pushing physicians in a direction of drastically less documentation when the trend has been toward greater documentation of patient care for the past several decades is at best imprudent and at worst reckless. While some efficiency in healthcare documentation may be good and necessary, it is simply unrealistic to expect a physician to render what has historically been a multi-page detailed medical record document with a few clicks of a mouse.

Undervaluing the role of the medical transcriptionist and medical record technician in the records process

Speech recognition has made some significant strides in recent years and now plays an increasingly prominent role in the healthcare documentation process. However, it has still not proven to be as effective as a seasoned transcriptionist in rendering a dependable output – particularly when it comes to some of the more complex documentation tasks. There are simply too many variables that require human intervention to achieve consistently accurate and completely automated documentation with today’s technology. While it seems clear that the role of the traditional medical transcriptionist will be forever transformed by new advances in technology, there will likely always be a role, and I trust, an increasingly important role, for the professional medical records technician.

Conclusion

As technology continues its steady march, there is no doubt that it will continue to encroach on traditional methodologies and bring a new and important measure of efficiency and profitability to the healthcare industry – benefiting patients and practitioners alike. Those organizations that are careful and thoughtful in their implementation strategies will tend to have smoother transitions and will likely manage their risk more successfully than their more zealous counterparts.

After 20 Years MTIA Opts for Name Change

Thursday, March 17th, 2011

Following the lead of the organization formerly known as the AAMT – American Association for Medical Transcription – (now the Association for Healthcare Documentation Integrity – AHDI), the Medical Transcription Industry Association ( MTIA) quietly but officially changed it’s name in 2010. The newly branded organization will now be known as the Clinical Documentation Industry Association (CDIA).  According to a spokesperson, the new name more accurately reflects the organizations expanded scope and role and positions the organization to add value to its members as the healthcare documentation industry morphs from a traditional medical transcription industry to a healthcare documentation production and management industry.

The newly named and repurposed organization will continue to be a strong proponent of the traditional clinical narrative.  However, it also intends to position itself to respond to the recent trends in healthcare documentation such as the electronic health record (EHR) and other health information documentation and delivery tools.  The integration of these new documentation options with the traditional narrative will likely be a primary focus for the organization and the industry for many years to come.

Tax Court Decision Yields Important Victory for Medical Transcription Industry in Battle to Define Independent Contractors

Wednesday, March 16th, 2011

After a lengthy and expensive legal battle, an IRS tax case was recently settled in favor of a medical transcription service organization (MTSO). In a rare defeat, the IRS conceded that the MTSO was in the right.

The IRS had demanded an amount exceeding $500,000 in overdue taxes and penalties for what it characterized as improper reporting and payment of payroll taxes. At the center of the legal controversy was the MTSO’s treatment of its medical transcriptionists as independent contractors instead of employees. The IRS argued that the medical transcriptionists providing services to the MTSO should have properly been designated as employees and that the company should have been withholding and submitting payroll taxes to the US Treasury on behalf of these employees on a quarterly basis. Mr. Brager, on behalf of his client, argued that the transcriptionists in fact met the IRS definition of independent contractor and that no taxes were due.

At the conclusion of a multi-year legal battle the tax courts ruled in favor of Mr. Brager and his medical transcription service client – and the IRS conceded that the evidence supported the claims of the MTSO. The courts also ordered the IRS to pay attorney fees to the MTSO in light of the unreasonable legal burdens which had been placed upon the MTSO in defending its position.

The case represents a significant victory for MTSO’s and other small businesses who make an honest concerted effort to comply with published standards as they distinguish between employees and contract workers. For more information on IRS employee vs independent contractor standards consult the IRS website.

Boomer Retirement Impact on Medical Transcription and the Health Care Industry

Wednesday, March 16th, 2011

Medical transcription has been under siege by off-shoring and technology advances for the last several decades. However, there is a perfect storm brewing — and it is just now beginning to arrive at our shores. Just when the pundits were ready to give up on the medical transcription industry, the tidal wave of baby boom retirees is officially upon us. The baby boom generation has typically been defined as individuals born in the United States between 1946 and 1964. In the years following World War II, the United States experienced a sharp increase in births. This high birth rate trend continued relatively unabated for almost two decades. After 1964, there was a precipitous drop off in the birth rate.  The following 20 years brought about a baby bust with relatively few babies born by comparison.  This sharp generational contrast in birth rates has much to do with the hype surrounding the baby boom generation.  There are a lot of reasons that the baby boom generation matters. Demographically, boomers make up a significant and influential portion of the population. Perhaps most importantly, the earliest baby boomers are now reaching retirement age.  In 2011, those born in 1946 will turn 65 and begin to usher in a new era of social and economic upheaval that will sweep over the country like a tsunami.

No where will the impact of the retiring boomer generation be felt more acutely than in the health care arena.  Health care and medicare resources, currently operating at full capacity, will feel the additional strain and burden of increasingly large waves of elderly retirees over the next two decades.  Shortages of trained nurses, physicians, allied health professionals, medical transcriptionists and medical coders, will create both problems and opportunities.  Problems will arise as the population competes for increasingly scarce health care resources.  Opportunities will present themselves for individuals willing to get the training needed to enter the exploding health care field.  Both the problems and the opportunities will be magnified by the fact that many individuals who are currently practicing in the health professions are themselves part of the boomer retiring generation!  As these seasoned health practitioners exit the health care industry en masse, wages will rise and the expenses of caring for the aging population will increase exponentially.  Get ready!