Archive for the ‘Information’ Category

List of AAPC Credentials

March 12, 2014

The American Academy of Professional Coders has medical coding certifications for several types of credentials. Each organization offers several types of credentials, some parallel each other like the CPC and CCS, while other credentials may be unique to the organization. Credentials that you can obtain are as follows:

CPC-A: Certified Professional Coder, Apprentice

CPC: Certified Professional Coder

CPC-P: Certified Professional Coder – Payer

CPC-H: Certified Professional Coder – Hospital

CPC-I: Certified Professional Coder – Instructor

Specialty Medical Coding Credentials are as follows:

List of HCPCS Categories

December 11, 2013

The letters at the beginning of HCPCS Level II codes have the following meanings:

  • A-codes (example: A0021): Transportation, Medical & Surgical Supplies, Miscellaneous & Experimental
  • B-codes (example: B4034): Enteral and Parenteral Therapy
  • C-codes (example: C1300): Temporary Hospital Outpatient Prospective Payment System
  • D-codes: Dental Procedures
  • E-codes (example: E0100): Durable Medical Equipment
  • G-codes (example: G0008): Temporary Procedures & Professional Services
  • H-codes (example: H0001): Rehabilitative Services
  • J-codes (example: J0120): Drugs Administered Other Than Oral Method, Chemotherapy Drugs
  • K-codes (example: K0001): Temporary Codes for Durable Medical Equipment Regional Carriers
  • L-codes (example: L0112): Orthotic/Prosthetic Procedures
  • M-codes (example: M0064): Medical Services
  • P-codes (example: P2028): Pathology and Laboratory
  • Q-codes (example: Q0035): Temporary Codes
  • R-codes (example: R0070): Diagnostic Radiology Services
  • S-codes (example: S0012): Private Payer Codes
  • T-codes (example: T1000): State Medicaid Agency Codes
  • V-codes (example: V2020): Vision/Hearing Services

Medical & Business Industry Leaders to follow

November 14, 2013

We get asked frequently on who is a good resource for a Medical Practice.  We have comprised a list [specific in some areas to the State of Texas as that is where our business originates from].  Below is a list that will help you get started if you are working or interested in the Medical Field.

Stay informed on the changes in the industry to improve your viability and health of your practice.  Take classes, attend seminars, and share what you lead with your team.  Together you can be excellent in your industry as a Physician, Medical Practice Administrator, Medical Biller, Medical Coder and Nurse!

How to control your Facebook News Feed

September 26, 2013

If you are like me, you have lots of Facebook Friends and you support the companies you do business with, your strategic business partners, and ones that relate to your industry or hobbies.  However, sometimes it seems like what you are seeing in your News Feed isn’t encouraging, helpful, or interesting.  What do you do?

Well, my recommendation is to filter your settings so that you get what you want to see on a daily basis!  Also, are you aware that if you Share, Like or Comment on posts more regularly in your news feed that Facebook will detect you want more and create your News Feed accordingly?  Yup!  Tis true.

So how do you control your News Feed?

  1. Hover over the “Like” button on your friends wall or company page that you have liked and make sure “Show In News Feed” is selected.
  2. Once that is set, if you select “Settings”, you can choose from All, Most, or Only Important updates to display to change what will post into your News Feed.  The settings are automatically set to Most Updates, which I kinda think is crazy, but that is how it is!
  3. If you REALLY don’t want to miss a post, select “Get Notifications” from that same drop-down menu.  This will ensure you get every single post!
  4. Additionally, you can use Facebook’s new “Interest Lists”.
What other tips do you have to control and create a News Feed that inspires, encourages and benefits you?  Share with us!

Dilemmas with Friends on Social Media

September 24, 2013

Social Media is a great tool!  You can connect with people all over the world.  However, as with all tools, you have to ensure that you are using them to your best advantage.

I get asked frequently how to handle “Friend Requests” on Facebook.  The friend terminology is sort of a loose term.  Friend on what level?

In order to answer that, you need to understand why you have a platform on Social Media.  Specifically in today’s blog post we will discuss Facebook and the relationship with requests to be connected.  Once you have determined what your platform is and why you have it, you can move on to answer other questions, but without knowing this, you are going to be limited at knowing how to effectively address them.

Here are some questions to help you figure out that dilemma of adding someone to your network.

  • Is the request you received from someone you know?
  • If so, do you want to interact with them?  Do you want to know what is going on in their lives?  Do you want them to know what is going on in your life?
  • If not, do you have mutual friends?
  • If not, are they someone who may have connections to others that you wish to interact with?
  • If not, are they a competitor?
  • Is the request SPAM or solicitation that you don’t want?
  • Do they work for a company that you want to be connected to?
  • Are they well known in the community as someone who serves and is giving and you would like to know?
  • Do they have a profile picture or are they hiding and not being honest about who they are?
  • Do you share mutual interests?
  • Were you referred to them?

Some of these things are hard to answer before you have accepted the friend request.  However, you can always check out LinkedIn and even Google them to see what comes up.  You can learn a lot about someone online.

Additionally, I don’t think you should be afraid to reach out and say “Hey, Thanks for the connection. I apologize, but I don’t recognize your name or picture.  Can you tell me where we met?  Or how you know me?  If you don’t mind me asking, what is your reason for connecting?”

How someone responds or doesn’t respond tells you a lot about their request too!  Make sure that the friends you connect with support your platform and reason for using Social Media, particularly Facebook and you will ensure your interactions are fun, supportive and beneficial.

Do you have other questions you think are good ones to ask yourself when reviewing accepting a “Friend Request”?

Learning to do what You Love

September 20, 2013

This week, we posted a picture to encourage you in your Entrepreneurship Journey…it read:

Do What You Love

Love What You Do

Today we ask you to consider:

  1. Are you doing what you love?
  2. Do you love what you do?

Are those the same things?

For some people they are.  For some people, they aren’t.

How can you align them?  First you have to figure out what you love.

What are you drawn to?

What makes you excited?

What do you think is a great thing to be involved in?

What makes you absolutely passionate about it?

What can you do even when utterly exhausted, you find more energy to pursue that?

What gives you energy?

What makes you want to make a difference?

Make a list of these questions.  Add more question to it.  Look inside.  Find the answer deep within you.  This is what you Love.  You LOVE!

Go do that.  You will find you will be happy.  You will be encouraged.  You will be blessed.  You will thrive.  You will bring life.

Social Media Questions

August 16, 2013

Facebook is a main form of Social Media interaction today.  Everyone uses it for a different platform.  Some people are out to vent about their day.  Some people check in at every spot they go.  Some people never post, never like, never comment, never share, never seem alive.  Some people even have a generic profile picture because they want to look like they are hiding.  No matter your reasons, your method, your choice of which Social Media you use, we all must address these questions:

  • What do I want to get out of Social Media?
  • Who do I want to interact with?
  • Why do I want to be on Social Media?
  • Who are my “friends”?
  • What happens if someone disagrees with my post?
  • What happens if I hurt someone’s feelings?
  • What message do I want my Social Media to say about me?
  • How often do I wish to engage on Social Media?
  • Who am I trying to target with my Social Media?
  • What are the benefits of Social Media?

These are a few questions that you must answer in order to create and have the online Social Media presence you want.  Once these are answered, you can move forward with implementing the purpose and vision you have for Social Media.

As you reflect on the answer to these questions above, are there others you feel need to be asked?  If so, share them with the readers below!

We look forward to hearing from you and you sharing the what, why, and who of Social Media with us!

5 Keys to Establish You Know What You are Talking About

August 1, 2013

In order to create a rapport with your team, you need to establish a relationship with them that you know what you are talking about. Nobody wants to be taught from someone who “thinks” they know the right thing. It is pertinent that you have your data and facts in order and spend time understanding them to be able to explain it in detail to someone who doesn’t. This means that you must develop a technical command over your subject matter. If you don’t possess subject matter expertise, few people will give you the time of day. You will be passed off as a “wanna be” and someone who “thinks they know it all”. People have little interest in listening to those individuals who cannot add value to a situation or topic, but force themselves into a conversation just to hear themselves speak. You must bring value to the table to be heard.

1. Spend time learning your subject matter.
2. Create articles to support what you know.
3. Be willing to have discussions around the topic to answer the why’s and how’s people have about it.
4. Find like minded people who have an interest in what you do so that you can learn to share your ideas and knowledge with others.
5. Perform speaking engagements to perfect your skill.

8 Simple Ways to Improve Quality of Sleep

July 3, 2013

1. Exercise, but not after the early evening.
2. Don’t drink caffeine after 2 p.m.
3. Avoid late night eating or alcohol (but don’t go to bed hungry either!).
4. Don’t use electronic devices before sleeping. They stimulate the brain and the screen light acts like sunlight in the morning.
5. Don’t study, etc. in your bed. Reserve it for the other three S’s: Sleep, Sex, Sickness.
6. Maintain a regular schedule. If you have off days, try not to sleep in too much.
7. Avoid naps, especially after 2 p.m. and not longer than 20 minutes.
8. Try to go to sleep at the same time every night. You can set an alarm at night to remind you of bedtime. This will help you develop a healthy sleeping pattern and hopefully, feel better in the morning.

ICD‐9 AND ICD‐10 Diagnosis Code Format and Differences

June 26, 2013

ICD‐9‐CM diagnosis codes vs ICD‐10‐CM diagnosis codes

  • 3‐5 characters in length vs 3‐7 characters in length
  • Approximately 14,000 codes vs Approximately 69,000 available codes
  • First digit may be alpha (E or V) or numeric & Digits 2‐5 are numeric vs Digit one is alpha & Digits two and three are numeric & Digits 4‐7 are alpha or numeric
  • Limited space for adding new codes vs Flexible for adding new codes
  • Lacks detail vs Very specific
  • Lacks laterality vs Has laterality
  • Difficult to analyze data due to nonspecific codes vs Specificity improves coding accuracy and richness of data for analysis
  • Codes are non‐specific and do not adequately define diagnosis needed for medical research vs Detail improves the accuracy of data used for medical research
  • Does not support interoperability because it is not used by other countries vs Supports interoperability and the exchange of health data between other countries and the United States

Why do we need ICD-10?

June 19, 2013

ICD‐9‐CM is outdated, over 30 years old, and cannot adequately accommodate the dramatic advances in
medicine and medical terminology. Many categories are full and not descriptive enough. Originally utilized for indexing purposes in the hospital inpatient setting, it was never intended to be part of the reimbursement process.

An effective coding system needs to be:

  • Flexible enough to quickly incorporate emerging diagnoses
  • Specific enough to precisely identify diagnoses and procedures resulting in
    • a reduction in claims denials due to increased granularity
    • improved coding accuracy
  • Able to support health IT and data exchange initiatives facilitating
    • data exchange between the U.S. and other countries
    • public health surveillance
    • improved quality of care measures and disease management

The ICD-10-CM Foundation and Background

June 12, 2013

Definition of Terms

In order to be able to discuss the transition from ICD‐9‐CM to ICD10‐CM, you first need to understand
the “language” in which the new coding process communicates. Following are terms you need to know.

Important Terms for ICD-10

Covered Entity: Providers, payers and clearinghouses who conduct specific administrative transactions electronically.

EDI: Electronic Data Interchange. Usually used in conjunction with the transmission of health data between providers and clearinghouses/insurance payers.

EHR: Electronic Health Record. This acronym is interchangeable with EMR (Electronic Medical Record). Generally means software that digitally stores patient charts and automates patient care functions such as computerized order entry and ePrescribing.

GEMs: “General Equivalence Mapping” is an approximate conversion and reference
mapping system that attempts to include all valid relationships between the codes in ICD‐9‐CM and ICD‐10‐CM. The relationships can be “one to many,” “many to one,” and in some cases, “one to one.” GEMs is an excellent tool to be used for ICD‐10‐CM staff training and chart auditing.

HIPAA: Health Insurance Portability and Accountability Act of 1996 established not just new rules for ensuring the privacy of health records but also set standards for the electronic transaction of interchanged health data.

HHS: The U.S. Department of Health and Human Services.

ICD‐9‐CM: The Diagnosis Coding lexicon currently in use. It is outdated, inflexible and many categories are full. ICD‐9‐CM contains approximately 13,000 diagnosis codes using a 5 numeric character structure and is electronically communicated using the traditional v.4010 data format.

ICD‐10‐CM: The Diagnosis Coding lexicon mandated for use on Oct. 1, 2014. Developed by World Health Organization (WHO), and used in most industrialized nations, this code structure requires a new data format (v.5010) because it contains up to 7 alphanumeric characters unlike the 5 numeric characters used in ICD‐9‐CM. Comprised of approximately 68,000 codes, it requires providers to code and document to much greater “specificity”.

ICD‐10‐PCS: For use in Inpatient Hospital procedure coding only. Physician outpatient settings will continue to use CPT‐4 to report procedures and services.

O.N.C.: Stands for the Office of the National Coordinator for Health Information
Technology and is a division of the U.S. Department of Health and Human Services (HHS). Under ONC, there are three bodies that can certify Electronic Medical Record technology for “Meaningful Use”.

Placeholder: When a seven character ICD‐10‐CM code requires a seventh character but the sixth position character has no function (e.g. no category, etiology or location), a “placeholder” consisting of the letter “X” is inserted in the sixth character position in order to hold that place in the code so that a seventh character can be used.

PM Software: “Front End” practice management software that schedules, tracks and codes patient encounters. (As opposed to the automated charting functions of EMR).

R.A.C. Audit: Recovery Audit Contractor ‐ The RAC Program’s purpose is to reduce improper Medicare payments and implement actions to prevent future improper payments. The demonstration program in 3 states started in 2005. 3 more states were added and by 2008, $1.03 billion were recovered from improper payments.

Role Based: Used to describe a type of training strategy that focuses the amount and type of training on job classification rather than general training for an entire group. In this context for example, you should consider a different level of training for your physicians (documentation training) than for your coding staff (full ICD‐10‐CM training).

Sequela: An aftereffect of a disease, condition or injury. Also called a “late effect.”

Specificity: In this context, “specificity” is a term used to describe choosing the diagnosis code that is the most descriptive possible given the available provider documentation.

V.5010: An electronic data reporting format scheduled replacing V.4010 on Jan. 1, 2012. Electronic testing of transactions using V.5010 commenced on Jan. 1, 2011. This new data format is required because the new ICD‐10‐CM codes are comprised of up to 7 alpha numeric characters and the old data format currently in use (v.4010) is unable to accommodate ICD‐10‐CM. (On Nov 17, 2011 CMS announced a 90‐Day period of enforcement discretion.)

W.E.D.I.: Comprised of a cross section of the health care industry, the Workgroup for Electronic Data Interchange (WEDI) is the leading authority on the use of Health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency and to reduce costs of the American healthcare system. Formed in 1991 by the Secretary of Health and Human Services (HHS), WEDI was named in the 1996 HIPAA legislation as an advisor to HHS and continues to fulfill that role today.

WHO: World Health Organization is made up of representatives from numerous
countries that create policy and develop health programs to be adopted on a
world‐wide basis. The WHO developed ICD‐10.

2012 Personal Tax due date is Monday!

April 12, 2013

Don’t forget…Monday is the due date to file your Personal Taxes for 2012! If you can’t meet the deadline, you must file an extension to extend this deadline. Don’t wait until the last minute!

 

Reminder to Immunize your Children

August 30, 2012

According to the American Medical Association, vaccinations are available for 20 infectious diseases. Vaccines against 10 deadly diseases are recommended for all U.S. children to protect the child and the community where they live.

Read the full article here.

How To Write an Effective Appeal Letter

April 30, 2012

The following is a list of steps to preparing an appeal:

  1. Address the appeal letter to the Insurance Company who paid/rejected the claim.
  2. If this is your 2nd Level Appeal or 3rd Level Appeal, notate that on the header also.  If it is your first there is no need to be specific.
  3. Put the Date that you are preparing the appeal on the appeal letter.
  4. Address the appeal to:  To Whom It May Concern.
  5. Include the Patient Name, DOB, ID#, DOS and Billed Amount of the claim originally submitted.
  6. Point out the reason for claim denial.  Example: This claim was denied for timely filing however according to our records this is incorrect.
  7. Provide an explanation as to why this is incorrect based off of:  Contract, Fee Schedule, Timely Filling Submission Dates, Coding Guidelines, State Rules & Regulations (resources for Texas: TID, TMB, TMA, TCMS), Federal Rules & Regulations (CMS, AMA, HIPAA, OIG, HHS, FDCPA, PHI, Prompt Pay Act), Payor Guidelines, Provider Information or Credentials that rendered the services, Medical Necessity, Patient Benefits, Authorization on file, Any other applicable reason for an invalid denial
  8. Close with expectations:  Please reprocess for payment according to our contract, Please reprocess according to our fee schedule, Please see attached proof of submission for timely filing, Please reprocess per coding guidelines (list the exact coding guideline), Please reprocess according to rules & regulations (list the exact rule or regulation that they violated), Please correct the CPT Code/ICD9 Code, Please reprocess with attached information regarding medical necessity, Please make additional payment within 14 business days
  9. Attach any applicable documents:  Contract (if necessary), Fee Schedule (if necessary), Proof of Timely Filing, Documentation on Coding Guidelines, Documentation on any State and/or Federal Rules & Regulations, CPT, HCPCS or ICD9 Code information, Copy of Provider information (Provider License, Provider Credentials, Practice Information, etc), Medical Records, Copy of Patient Benefits, Copy of Authorization, Or any other further documentation to support the denial

Utilize these 9 steps and you will have the foundation for an effective Appeal Letter to win the fight against the insurance carrier!  We wish you great success!  If we can assist you further, please to not hesitate to contact us at 817.239.6595

[The steps are written for Providers in the State of Texas…some of the resources listed may not apply to your state.]

Classics to a Business Woman’s Wardrobe

April 18, 2012

As a Business Woman, I want to look professional.  I want to be distinguished and classy, but not over the top.  I want to not be so elaborate in my clothing and jewelry that you are distracted and don’t see the fact that I am a servant, there to work for you.  I am not here to look like a model but I still want to have an image that conveys business.  That does not mean what I wear is not cute or can’t be flattering.

There are many articles out there on what to wear and not wear.  This post is not going to be about that.  It is going to be  me sharing some information as to why I dress the way I do.

  • I wear a skirt or dress.  I don’t wear pants, never have.  Doesn’t meant there are not situations for them, but I am a lady, want to be seen as a lady, and want to act like one.  I don’t care what your views are on woman in pants, a woman in a skirt or dress brings automatic respect, especially when dealing with business men.
  • I wear lots of black.  Black is classic.  Black goes with nearly 100% of all other colors (navy and brown are the only two colors I know of that it doesn’t look good with).  Black is slimming.  Black is considered business dress.  You can never go wrong in black.
  • I introduce more white into my wardrobe from April – October here in Texas, depending on the weather.  White is a crisp, clean and fresh look that is classy, just like black.  It is not quite as businesslike, but it still is professional.  I don’t remove black completely, just don’t use it exclusively.
  • I do not want to have a suit or outfit for every day of the week.  Everything I have can be mixed and matched with at least one or two more outfits, if not with everything.  This cuts down on the number of items I have to have in my closet and things I have to take care of (from washing, mending, ironing, maintaining, storage, etc).
  • I have 5 classic pieces of jewelry that are always my standbys and coordinate with nearly all outfits.  A thin silver jewel necklace.  A cream large pearl bead necklace with black ribbon.  A fancy vintage diamond like necklace.  Silver beads.  A long silver necklace with a round piece of silver metal.  All of these pieces match with nearly all outfits, this means I don’t have to have a wardrobe full of stuff to accent an outfit.  I simply won’t purchase items that can’t accessorize any outfit.
  • I either wear a watch on my left hand or a bracelet.  I have very few big or bulky bracelets and only wear those if my outfit needs for boldness because it is too plain.  I have three watches, a plain grey faced/silver one, a red faced/silver one and a vintage one.  I wear a bracelet when it fits the outfit more and a watch when it doesn’t.  I also wear a watch if I am going to need to know the time and won’t have my cell phone with me (and may not be in a room with access to a clock).
  • I buy leather shoes and ones that are versatile with everything.  A pair of shoes that can’t be worn with various styles is a waste of money and means that I must pack more when going on a trip, let alone have more in the closet, and more to clean and care for.
  • I need my outfits to be versatile to be ready quickly and without a bunch of fuss.  Life is too short to be spending hours getting prepared for your client appointments, networking events, business meetings, and/or business trips.  I take the time ahead of time so that there is no last minute rush on trying to figure out what to wear, what matches with what, it all will coordinate or it won’t work for me!  That means very few items that are dry clean only.  Most of my blazers have to be dry cleaned, but the shirts and skirts I avoid that as much as possible.

What tips do you have for creating a Classic Business Woman’s Wardrobe?  What colors do you wear?  I would love it if you would share something that will help each of us to have a better wardrobe and maximize it.

Quit While You Still Can!

April 16, 2012

I am continually amazed at the number of people in the Healthcare Industry that smoke.  I am allergic, severely allergic, to it.  I choke up, start itching, and have breathing issues when I am around cigarette smoke.  It never ceases to amaze me that when you go into a healthcare facility, you will find healthcare workers right outside the entrance puffing away like it is their only lifeline.  They, above others, know the hard core reasons not to smoke and what smoking does to your body and the issues it causes to your health.

I know a doctor who doesn’t like it that he/she smokes and wants to stop, but is doing nothing to do so.  This physician puts this up in his/her office to help be a reminder as to what smoking does to you.  Do you think this will work?  What if when you sit in your office your back is to it?  Would you still smoke after seeing this?

Quit While You Still Can…is a great message…if you are listening.  But if you don’t read the fine print and your back is to it, it probably won’t do you much good.

Texas Clean Claim Requirements

April 2, 2012

Each states has its own guidelines and regulations set forth in various forms of the Healthcare Industry.  The Texas Department of Insurance has guidelines on specific requirements that are needed on a HCFA1500 in order for it to be considered as a Clean Claim.  You can review those documents here on the Texas Secretary of State website.

Do you wonder if the Texas Clean Claim Requirements apply to you?  You can read and find that information here.

A clean claim must be submitted in order for the Prompt Pay Guidelines to apply.  We will review those with you soon!

How to create a dedicated link for Business Facebook Pages

March 26, 2012

Did you know you can get rid of the numbers at the end of your FB Page if you have over 25 followers? So many times, I see Business Facebook pages that do not have a dedicated link.  What do I mean by that?  A link without a code or other letters that do not support your business name.  So instead of http://www.facebook/yourbusines/130498703278427 it can be just www.facebook.com/yourbusines.  Much easier for telling people your FB page!  It is easy to get one and I want to share for my Entrepreneur friends who have business pages how:

  • Step 1: Go to your business page and on the top right side hit EDIT PAGE
  • Step 2: Click on resources
  • Step 3: Click on Select Username
  • Step 4: Follow directions and enter a name (your business name is what I recommend).  BEWARE:  This can’t be changed once done as it is permanent. Whatever you enter here, only what shows up after the facebook.com/—-.

Go brand yourself!  What other Facebook Tips do you have for your Entrepreneur friends?

Managers vs Leaders

March 26, 2012

Leading vs. Managing 

Are you a manager or a leader? Although you may hear these two terms thrown out interchangeably, they are in fact two very different animals complete with different personalities and world views. By learning whether you are more of a leader or more of a manager, you will gain the insight and self-confidence that comes with knowing more about yourself. The result is greater impact and effectiveness when dealing with others and running your business.

We are going to take a look at the different personality styles of managers versus leaders, the attitudes each have toward goals, their basic conceptions of what work entails, their relationships with others, and their sense of self (or self-identity) and how it develops. Last of all, we will examine leadership development and discover what criteria is necessary for leaders to reach their full potential.

First of all, let’s take a look at the difference in personality styles between a manager and a leader.

Managers – emphasize rationality and control, are problem-solvers (focusing on goals, resources, organization structures, or people), often ask question, “What problems have to be solved, and what are the best ways to achieve results so that people will continue to contribute to this organization?”, are persistent, tough-minded, hard-working, intelligent, analytical, tolerant, and have goodwill toward others.

Leaders – are perceived as brilliant, but sometimes lonely, achieve control of themselves before they try to control others, can visualize a purpose and generate value in work, and are imaginative, passionate, non-conforming risk-takers.

Managers and leaders have very different attitudes toward goals.

Managers – adopt impersonal, almost passive, attitudes toward goals, decide upon goals based on necessity instead of desire and are therefore deeply tied to their organization’s culture, and tend to be reactive since they focus on current information.

Leaders – tend to be active since they envision and promote their ideas instead of reacting to current situations, shape ideas instead of responding to them, have a personal orientation toward goals, and provide a vision that alters the way people think about what is desirable, possible, and necessary.

Now let’s look at managers’ and leaders’ conceptions of work.

Managers – view work as an enabling process, establish strategies and makes decisions by combining people and ideas, continually coordinate and balance opposing views, are good at reaching compromises and mediating conflicts between opposing values and perspectives, act to limit choice, and tolerate practical, mundane work because of a strong survival instinct which makes them risk-averse.

Leaders – develop new approaches to long-standing problems and open issues to new options, first use their vision to excite people and only then develop choices which give those images substance, focus people on shared ideals and raise their expectations, and work from high-risk positions because of strong dislike of mundane work.

Managers and leaders have very different relations with others.

Managers – prefer working with others, report that solitary activity makes them anxious, are collaborative, maintain a low level of emotional involvement in relationships, attempt to reconcile differences, seek compromises, and establish a balance of power, relate to people according to the role they play in a sequence of events or in a decision-making process, focus on how things get done, maintain controlled, rational, and equitable structures, and may be viewed by others as inscrutable, detached, and manipulative.

Leaders – maintain inner perceptiveness that they can use in their relationships with others, relate to people in intuitive, empathetic way, focus on what events and decisions mean to participants, attract strong feelings of identity and difference or of love and hate, and create systems where human relations may be turbulent, intense, and at times even disorganized.

The Self-Identity of managers versus leaders is strongly influenced by their past.

Managers – report that their adjustments to life have been straightforward and that their lives have been more or less peaceful since birth, have a sense of self as a guide to conduct and attitude which is derived from a feeling of being at home and in harmony with their environment, see themselves as conservators and regulators of an existing order of affairs with which they personally identify and from which they gain rewards, report that their role harmonizes with their ideals of responsibility and duty, perpetuate and strengthen existing institutions, and display a life development process which focuses on socialization. This socialization process prepares them to guide institutions and maintain the existing balance of social relations.

Leaders – reportedly have not had an easy time of it, their lives are marked by a continual struggle to find some sense of order, do not take things for granted and are not satisfied with the status quo, report that their sense of self is derived from a feeling of profound separateness, may work in organizations, but they never belong to them, report that their sense of self is independent of work roles, memberships, or other social indicators of social identity, seek opportunities for change (i.e. technological, political, or ideological), support change, find their purpose is to profoundly alter human,

economic, and political relationships, and display a life development process which focuses on personal mastery. This process compels them to struggle for psychological and social change.

Development of Leadership

As you can see, managers and leaders are very different animals. It is important to remember that there are definite strengths and weaknesses in both types of individuals. Managers are very good at maintaining the status quo and adding stability and order to our culture. However, they may not be as good at instigating change and envisioning the future. On the other hand, leaders are very good at stirring people’s emotions, raising their expectations, and taking them in new directions (both good and bad). However, like artists and other gifted people, leaders often suffer from neuroses and have a tendency toward self-absorption and preoccupation.

If you are planning on owning your own business, you must develop management skills, whether they come naturally or not. However, what do you do if you believe you are, in fact, a leader – a diamond in the rough? What can you do to develop as a leader? Throughout history, it has been shown again and again that leaders have needed strong one-on-one relationships with teachers whose strengths lie in cultivating talent in order to reach their full potential. If you think you are a leader at heart, find a teacher that you admire – someone who you can connect with and who can help you develop your natural talents and interests. Whether you reach glory status or not, you will grow in ways you never even imagined. Isn’t that what life is about anyway?

HIPAA Security Tool Kit from NIST

March 19, 2012

The National Institute of Standards and Technology (NIST) has made available a security toolkit in an effort to help organizations better adhere to HIPAA compliance mandates.

“The NIST HIPAA Security Toolkit Application is intended to help organizations better understand the requirements of the HIPAA Security Rule, implement those requirements, and assess those implementations in their operational environment,” the NIST states.

The toolkit is designed to provide guidance for not only covered entities, but their business associates and any other entity impacted by federal HIPAA compliance requirements.

“Target users include, but are not limited to, HIPAA covered entities, business associates, and other organizations such as those providing HIPAA Security Rule implementation, assessment, and compliance services. Target user organizations can range in size from large nationwide health plans with vast information technology (IT) resources to small health care providers with limited access to IT expertise,” NIST continued.

You can download the tool kit here.

Clinical Documentation and Compliance

March 12, 2012

Documentation apart of the medical record has many aspects involved.  Whether one has an intrinsic interest in medical records or not, everyone wants to get paid and, for most physicians, that still involves a bill, usually to an insurance carrier. Unfortunately, there are documentation requirements to get paid. Merely submitting a billing code is not sufficient.

The University of North Texas has summarized the minimum required documentation pretty well here in their Clinical Documentation and Compliance Manual, however we will outline a few of the important aspects of them below.

Every Patient Encounter should include:

  • reason for the encounter and relevant history;
  • physical examination findings and prior diagnostic test results;
  • assessment, clinical impression, or diagnosis;
  • plan for care; and
  • date and legible identity of the observer.
If not documented, the rationale for ordering diagnostic and other ancillary services should be easily inferred.
Appropriate health risk factors should be identified.

The patient’s progress, response to and changes in treatment, and revision of diagnosis should be documented.

The CPT and ICD9 codes reported on the health insurance claim form or billing statement should be supported by the documentation in the medical record.

These are just a few of the very important things that must be included to maintain documentation and compliance.

Podcast: Get More Done in Less Time

February 28, 2012

Absorb what is useful, discard what is not, add what is uniquely your own.  – Bruce Lee

Do you feel you have so much to do and so little time to do it?  Your energy is your most asset.  Our productivity and our happiness suffers when we don’t take care of it.  We have to be intentional in when to use it and when to save it.  We all have the same amount of time.  Focus your energy…

A great article and podcast by one of my friends, Pam Weatherford, owner of D3Seminars.  She has a very popular class called Cut the CRAP: Get More Done in Less Time.  This is a short review of the article and podcast, but you can read it and/or listen to it here.  [My comments are entered in these brackets…and yes, I am one of the chics that join her regularly for a Yogurt Brainstorming Session!]

What gets in our way?  Entrepreneurs think they need to do everything themselves.  You have to learn to delegate.

C – Complete It

R – Refuse It

A – Assign It

P – Pitch it

Complete, say No to, Delegate or Throw Away?  [Wow is it really that simple?]  It is not always about doing more.  Don’t get bogged down with everything that comes your way.  Set boundaries.  Being an Entrepreneur is hard work.  We don’t always know how to say no.  Where can I put 20% of my time & effort to get 80% of results so that you are more efficient and effective. Prioritize and focus on taking one bite at a time.  You have to answer what is the highest and best use of my time and do those things.  It helps to have a Mentor or a Coach when you get stuck in the weeds.  You have to stay on track and not get overwhelmed.

Are you running to stand still?  Or are you running on the treadmill?  Take a moment to breathe.  Relax.  Refocus.

Sometimes we are just scarred to say no.  We have to practice this.  If it doesn’t resonate, you need to say: “I am sorry, that doesn’t fit in with where I am going.” [I forget, it is my life, not yours and God is the One I am following on this Journey.  I need to learn that No is a word and a complete sentence.]

Highly productive people stay focused.  Stay away from the bright shiny objects syndrome.  Have a niche.  Do what you are great at and passionate about.  [What a loaded reminder…focused on what is important, not what is not important. Glitter gets you nowhere, everytime. ]

Eat the frog.

It is an every day process.  Think about your focus, remember it is not about working harder.  Don’t fight it if you are not feeling it.

You have to take care of yourself to be your best.

[I have wanted to take this class several times she has offered it; however every time that it has been offered it has been a conflict of interest with other business and client events…so this was a teaser that wet my appetite to review cutting the stuff out of my life!]

What is the NUCC?

February 27, 2012

The NUCC was created to develop a standardized data set for use by the professional health care community to transmit claim and encounter information to and from all third-party payers. It is chaired by the American Medical Association (AMA), with the Centers for Medicare & Medicaid Services (CMS) as a critical partner. The NUCC is a diverse group of health care industry stakeholders representing providers, payers, designated standards maintenance organizations, public health organizations, and vendors.

The NUCC was formally named in the administrative simplification section of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Public Law 104-191 (P.L. 104-191) as one of the organizations to be consulted by the American National Standards Institute’s accredited Standards Developing Organizations (SDOs) and the Secretary of Health and Human Services (HHS) as they develop, adopt, or modify national standards for health care transactions. The NUCC was also named as one of the HIPAA Designated Standards Maintenance Organizations (DSMO) to maintain the HIPAA transaction standards. A DSMO Web site has been established to submit requests for changes to the HIPAA
implementation guides. For more information regarding the DSMO groups and the process for submitting change requests go to www.hipaa-dsmo.org. Therefore, the NUCC is intended to have an authoritative voice regarding
national standard content and data definitions for professional health care claims in the United States. The NUCC’s recommendations in this area are explicitly designed to complement and expedite the work of the ASC
X12N in complying with the provisions of P.L. 104-191. The NUCC is comprised of the key parties affected by health care electronic data interchange (EDI) – those at either end of a health care transaction, generally payers and providers. Criteria for membership include a national scope and representation of a unique constituency affected by health care EDI, with an emphasis on maintaining or enhancing the provider/payer balance in the original NUCC composition. Each NUCC member is intended to represent the perspective of the sponsoring organization and the applicable constituency. Representatives are responsible for communicating information between the NUCC and the group(s) they represent.
The following organizations serve on the NUCC as voting members:

  • American Medical Association – provider
  • American Academy of Physician Assistants (Non-Physician Provider) – provider
  • American Association of Homecare – provider
  • Medical Group Management Association – provider
  • State Medical Association – provider
  • Veterans Health Administration – provider
  • Alliance for Managed Care – payer
  • America’s Health Insurance Plans – payer
  • Blue Cross Blue Shield Association – payer
  • Centers for Medicare and Medicaid Services – Medicaid – payer
  • Centers for Medicare and Medicaid Services – Medicare – payer
  • National Association of State Medicaid Directors – payer
  • ANSI ASC X12 Insurance Subcommittee – designated standards maintenance organization
  • Dental Content Committee – designated standards maintenance organization
  • Health Level Seven – designated standards maintenance organization
  • National Council for Prescription Drug Programs – designated standards maintenance organization
  • National Uniform Billing Committee – designated standards maintenance organization
  • Public Health/Public Health Services Research – state perspective
  • Public Health/Public Health Services Research – federal perspective
  • Health Information Management Systems Society Association for Electronic Health Care Transactions – vendor

CMS Important Update regarding 5010

February 20, 2012

With the implementation of Accredited Standards Committee (ASC) X12 Version 5010, several concerns have been identified that may impact certain activities surrounding the transition.  Medicare has published a Guidance and Clarification for Version 5010 Implementations here.

HSA Data for 2012

February 17, 2012

Do you have an HSA?  If you do, you will be interested in knowing the information on the update on your contributions for the calendar year of 2012…

For 2012, an individual can contribute up to $3,100 to their HSA, and a family can contribute up to $6,250. Minimum high deductible health plan deductible requirements remain the same, at $1,200 for an individual and $2,400 for a family. Maximum out-of-pocket for HSA plans in the 2012 calendar year is $6,050 for an individual and $12,100 for a family.

Do you have an HSA?  Do you utilize it as one?  If you don’t know if it is a good thing for you and your tax plan, consider talking to both your Insurance Agent and your CPA.  They will advise you in your circumstances on what would be best.

Meaningful Use Deadline…

February 14, 2012

Physicians who met the reporting requirements for Medicare’s meaningful use program for electronic health records (EHR) in 2011 have until February 29, 2012 to register and attest to meeting meaningful use requirements to receive payments for 2011 through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System.

February 29, 2012 also is the deadline to submit any pending Medicare Part B claims from 2011, as the Centers for Medicare & Medicaid Services (CMS) allows 60 days after December 31, 2011, for all pending claims to be processed.