Dictionary - Manage My Practice
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- Access to Health Services
- A person’s or population’s ability to engage in healthcare services and coverage, which are a) geographically proximate, b) physically accessible (for people with limited mobility), c) temporally (timing) appropriate d) socioculturally consistent, and e) without financial barriers.
- 350 is the number that leading scientists say is the safe upper limit for carbon dioxide””measured in "Parts Per Million" in our atmosphere. 350 PPM””it's the number humanity needs to get back to as soon as possible to avoid runaway climate change. (Defintiion courtesy of 350.org.)
- 5 & 10 Rules
- What is the 5 and 10 staff rule?
I believe the first answer is the one that readers are asking about, but the others are interesting too.
- Customer Service: The 10-5 Rule states that when a patient moves to within 10 feet of you, you make eye contact. When a patient moves within 5 feet of you, you greet them. This applies to patients, co-workers, visitors, anyone in your practice anywhere.
- Poker: When contemplating a raise because your position is good, you have a clear call if the raise is less than 5% of your stack, and a clear fold if it is more than10%.
- Baseball: The 5/10 Rule states that players who have been with a club for 5 consecutive years and have been a major league player for 10 years cannot be traded without their consent.
- Finances: If your current annual taxable income is below the poverty line, save five percent of your income every month. Otherwise, save ten percent of your income every month.
- Book: "Avoiding Malpractice: 10 Rules, 5 Systems, 20 Cases" by Carolyn Buppert. This book offers 10 rules and 5 systems for nurse practitioners to incorporate into their practices, in order to avoid diagnostic omissions or lapses in follow-up (the two major reasons nurse practitioners and medical doctors are sued for malpractice).
- Organized Religion/Networking: The 5 -10 ”“ Link Rule encourages the church to build community, encourage regular attenders to initiate contact with people they don't know. Someone living by the rule sets this as a personal standard: "I won't initiate a conversation with anyone I know until I have attempted for 5 minutes after every meeting to reach someone I don't know. If, when talking to someone, I see an unfamiliar person within 10 feet, I will go to them or draw them in. I will not leave a newcomer without linking the person to another contact."
- Accountable Care Organization (ACO)
- An ACO is an organized group of hospitals and physicians that together assume shared risk around the care it provides to patients. For a review of the pros, cons and new twists in ACOs, read the article here.
- Accounts Receivable & Aged Accounts Receivable & Re-aging
- Accounts Receivable, abbreviated and called "A.R." and written as "A/R" is the money due to a healthcare organization for services provided. For most cash-based non-hospital practices, the A/R works as follows:
- When a service is provided to a patient, the charges are added to the A/R.
- For most charges that are added to the A/R, it is assumed that a portion will be paid by an insurance company, a portion will be paid by the patient, and a portion will be written off.
- Very few, if any healthcare organizations will actually collect the entire A/R as most provide whopping amounts of charity care, negotiated payment care, government-subsidized care and care that is never compensated and is written off to bad debt as uncollectable.
- When payments are made, the amount due is reduced and therefore, the A/R is reduced.
- An aged A/R will divide the money owed into aging buckets of Current (less than 30 days old), 30, 60, 90, 120, and 150+ days old.
- The older or more "aged" the charges in the A/R become, the harder it is to collect and the less value it has.
- I think the appropriate way to age charges is from the date of service, but some groups age their A/R from the date the insurance pays and the remaining balance is due from the patient. This is called "re-aging" the account.
- Acronyms - Texting, Email, etc.
- Acronyms are abbreviations written as the initial letter or letters of words, and pronounced based on this abbreviation. (Many acronyms below courtesy of netlingo.com)
- AFAIC - As Far As I'm Concerned
- ASAP - As Soon As Possible
- BFF - Best Friends Forever
- BHAG - Big Hairy Audacious Goal
- BRB - Be Right Back
- BTW - By The Way
- COD - Close of Day
- CLM - Career Limiting Move
- CYA - Cover Your A**
- DD - Due Diligence
- DQYDJ - Don't Quit Your Day Job
- ETA - Estimated Time of Arrival
- FAQ - Frequently Asked Questions
- FTW - For The Win!
- FUBAR - F***ed Up Beyond All Recognition (or Repair)
- FWIW - For What It's Worth
- FYI - For Your Information
- GMTA - Great Minds Think Alike
- IMO - In My Opinion
- IMHO - In My Humble Opinion
- KISS - Keep It Simple Stupid
- LMAO - Laughing My A** Off
- LOL - Laughing Out Loud
- LOPSOD - Long On Promises, Short On Delivery
- LSS - Long Story Short
- MTFBWY - May The Force Be With You
- MYOB - Mind Your Own Business
- NRN - No Reply Necessary
- OT - Off Topic
- P&C - Private & Confidential
- PDA - Public Display of Affection OR Personal Digital Assistant
- PEBCAK - Problem Exists Between Chair And Keyboard
- PITA - Pain In The A**
- POV - Point of View
- QQ - Quick Question
- RFI - Request For Information
- RFP - Request For Proposal
- SME - Subject Matter Expert
- SNAFU - Situation Normal, All F***ed Up
- SSDD - Same Sh** Different Day
- SWAG - Scientific Wild A** Guess
- TBA - To Be Advised
- TBD - To Be Determined
- TMI - Too Much Information
- TWIMC - To Whom It May Concern
- TIA - Thanks In Advance
- WIIFM - What's In It For Me
- WOMBAT - Waste Of Money, Brains And Time
- WTF - What The ****
- WTG - Way To Go
- YW - You're Welcome
- Adjudication (of claims)
- When a claim is adjudicated, the payer (or possibly the Third Party Administrator) applies a series of payment rules such as:
- the subscriber or beneficiary's eligibility to receive benefits
- whether the services provided are covered under the subscriber's plan
- the allowable charge per the contract between the care provider and the payer
- the percentage of the allowable charge paid according to the contract
- the application of the terms of the subscriber's plan insofar as deductibles, co-insurance, co-pays
- Advance Directive
- An advance directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions for yourself. Your requests may come into play if your illness is one you won't recover from or if you are premanently unconcious.
- Advanced Practice Nurses (ANCC)
- American Nurses Credentialing Center (ANCC) is the world's largest and most prestigious nurse credentialing organization, and is a subsidiary of the American Nurses Association (ANA). ANCC certification exams validate nurses’ skills, knowledge, and abilities and more than 80,000 advanced practice nurses are currently certified by ANCC. Before nurses can sit for a certification examination, they must demonstrate that they hold active RN licenses, have the appropriate education, and, for all but nurse practitioners and clinical nurse specialists, have experience in the specialty field. Those who have met the eligibility requirements can then register to take the certification examination. Each exam is designed by certified nurses in the specialty under the guidance of a professional psychometrician who ensures that all tests are psychometrically sound and legally defensible. Tests are based on the scope and standards of practice approved by the American Nurses Association Congress of Nursing Practice and Economics. The paper-and-pencil tests generally are given twice each year at many locations around the United States and at military installations abroad. Most Clinical Nurse Specialist and all Nurse Practitioner, Informatics Nursing, Cardiac/Vascular, and Gerontological examinations can be taken at the candidate's convenience because they are computer-based.
- Ambient Intelligence (AmI)
- From Wikipedia
"In computing, ambient intelligence (AmI) refers to electronic environments that are sensitive and responsive to the presence of people. Ambient intelligence is a vision on the future of consumer electronics, telecommunications and computing that was originally developed in the late 1990s for the time frame 2010”“2020. In an ambient intelligence world, devices work in concert to support people in carrying out their everyday life activities, tasks and rituals in easy, natural way using information and intelligence that is hidden in the network connecting these devices (see Internet of Things). As these devices grow smaller, more connected and more integrated into our environment, the technology disappears into our surroundings until only the user interface remains perceivable by users.
The ambient intelligence paradigm builds upon pervasive computing, ubiquitous computing, profiling practices, and human-centric computer interaction design and is characterized by systems and technologies that are (Zelkha & Epstein 1998; Aarts, Harwig & Schuurmans 2001):
- embedded: many networked devices are integrated into the environment
- context aware: these devices can recognize you and your situational context
- personalized: they can be tailored to your needs
- adaptive: they can change in response to you
- anticipatory: they can anticipate your desires without conscious mediation."
- Angry Birds
- Angry Birds is an addictive smartphone game that is the best-selling iPhone app (application) for 2010. The birds are angry in the game because pigs steal their eggs and the birds plot revenge upon the pigs. Coming soon: Angry Bird applications for gaming consoles and computers, as well as stuffed animals, a TV show and a movie. Angry Birds was developed by Rovio, a Finnish company.
- ANN (Artificial Neural Network)
- An artificial neural network (ANN), usually called "neural network" (NN), is a mathematical model or computational model that tries to simulate the structure and/or functional aspects of biological neural networks. It consists of an interconnected group of artificial neurons and processes information using a connectionist approach to computation. In most cases an ANN is an adaptive system that changes its structure based on external or internal information that flows through the network during the learning phase. Modern neural networks are non-linear statistical data modeling tools. They are usually used to model complex relationships between inputs and outputs or to find patterns in data. (definition courtesy of Wikipedia)
ANNs are now being used for medical diagnoses.
From Medical Diagnosis Through Artificial Intelligence by Ashley M. Jones on the website Medicine and Technology by Dr. Joseph Kim:
The advantages that machines with artificial intelligence, or more specifically, Artificial Neural Networks (ANN) bring to this field are many: ”¢ They bring down the costs of medical diagnoses and treatment. ”¢ They can learn from information and data that is made available on a continuous basis, and so, take logical decisions without making errors. ”¢ When doctors are tired and overworked, they tend to make mistakes that affect the lives and health of their patients. Machines are not limited or hampered by physical constraints and can work for long hours without giving in to emotions or fatigue. ”¢ They help minimize invasive procedures - a case in point is the ANN program used last year by the Mayo Clinic to help doctors accurately diagnose patients with the heart infection endocarditis without the need for an invasive procedure, thus reducing overall healthcare costs and costs to the patient as well. ”¢ The highly structured reasoning abilities of ANNs allow doctors to make “educated” decisions based on their intuitions. With ANN, intuition is backed by solid knowledge, a combination that reduces the risk of medical errors by a great percentage. ”¢ They provide doctors with all the facts needed to make accurate decisions, facts that are often ignored or forgotten in the myriad of things going on in the minds of physicians because of their professional and personal lives.
- Apps (Applications)
- App is shorthand for an application. Applications are also called programs or software. Traditionally, they’ve been designed to do broad, intensive tasks like accounting or word processing. In the online world of web browsers and smart phones, apps are usually nimbler programs focused on a single task. Web apps, in particular, run these tasks inside the web browser and often provide a rich, interactive experience. (definition courtesy of Google Chrome's "20 Things I Learned About Browsers and the Web")
- American Recovery and Reinvestment Act of 2009, also called “The Stimulus Package” or “The Stimulus Bill.” Of the $850B in the bill, $51B is pegged for the health care industry and $19B of that will be used to incent medical practices to adopt EMRs/EHRs.
- ARRA (Stimulus Plan) Acronyms
- A/I/U ”“Adopt, implement or upgrade
- CAH ”“Critical Access Hospital
- CCN ”“CMS Certification Number
- CDS ”“Clinical Decision Support
- CMS ”“Centers for Medicare & Medicaid Services
- CY ”“Calendar Year
- EHR ”“Electronic Health Record
- EP ”“Eligible Professional
- eRx ”“E-Prescribing
- FFS ”“Fee-for-service
- FY ”“Federal Fiscal Year
- HHS ”“U.S. Department of Health and Human Services
- HIT ”“Health Information Technology
- HITECH Act ”“Health Information Technology for Electronic and Clinical Health Act
- HITPC ”“Health Information Technology Policy Committee
- HIPAA ”“Health Insurance Portability and Accountability Act of 1996
- HPSA ”“Health Professional Shortage Area
- IFR ”“Interim Final Rule
- MA ”“Medicare Advantage
- MCMP ”“Medicare Care Management Performance Demonstration
- MITA-Medicaid Information Technology Architecture
- MU ”“Meaningful Use
- NPI ”“National Provider Identifier
- NPRM ”“Notice of Proposed Rulemaking
- OMB ”“Office of Management and Budget
- ONC ”“Office of the National Coordinator of Health Information Technology
- PQRI ”“Medicare Physician Quality Reporting Initiative
- Recovery Act ”“American Reinvestment & Recovery Act of 2009
- TIN ”“Taxpayer Identification Number
- Accepting assignment means that:
- you will accept as payment in full the allowed amount established by the payer (Medicare or any other payer you are contracted with) and
- the payment will be sent directly to the provider for services rendered.
- ATCB (Authorized Testing and Certification Bodies)
- The Office of the National Coordinator for Health Information Technology (ONC) is utilizing a temporary certification program to authorize organizations to test and certify Complete Electronic Health Records (EHRs) and/or EHR Modules, thereby making Certified EHR Technology available prior to the date on which health care providers seeking incentive payments available under the Medicare and Medicaid EHR Incentive Programs may begin demonstrating meaningful use of Certified EHR Technology. ATCBs are those bodies which will be tasked with "certifying" EHRs as meeting the requirements for software that can be used to achieve "meaningful use." ONC now estimates there may be as many as five ONC-ATCBs, up from the three estimated in the interim rule and that they will certify ”at most, approximately 205 Complete EHRs and/or EHR Modules under the temporary certification program.” Organizations for ATCB status may start applying July 1, 2010.ï»¿ FINAL RULE Issued: Temporary Certification Program for Health IT Published in Federal Register on June 24, 2010 AGENCY: Office of the National Coordinator for Health Information Technology, Department of Health and Human Services. 45 CFR Part 170
- Bad Debt
- Bad debt is accounts receivable (money owed) that cannot be collected from the patient and is written off as uncollectable. If you turn a patient account over to a third-party collection agency, the account is considered bad debt and is written off. If money is received on the account in the future, the amount is returned to the A/R and the payment is posted. Many practices write off the bad debt but do not turn the account over to collections. If the patient requests services from the practice in the future, the patient must pay off the bad debt balance first before being seen in the practice.
- Balance Billing
- Every health organization has a standard fee schedule that it discounts for volume health services payers such as Blue Cross or Aetna. When one agrees to accept a discounted fee schedule, it is not legal to bill the patient the difference between your standard fee schedule and the discounted fee schedule. This practice is called balance billing and is only allowable if you do not have a contract with the payer. The slight exception to this rule is Medicare, which regulates the amount above the Medicare allowable that you may bill the patient, but only if you are a non-participating provider. If you are a participating provider with Medicare, you may only bill the patient for their unmet deductible and for co-insurance which is 20% of the allowed amount. A health care organization's attempt to collect from the patient the difference between the standard charge amount and the allowed amount approved by a contracted carrier such as Medicare. Balanced billing is a contract violation and may be illegal. The practice should be avoided.
- Balance Sheet
- A Balance Sheet is a snapshot of the assets, liabilities and net worth of the business on a specific date, indicating the financial health of a company at one point in time.
- If traffic on the Internet were akin to a stream of water, the Internet’s bandwidth is equivalent to the amount of water that flows through the stream per second. So when you hear engineers talking about bandwidth, what they’re really referring to is the amount of data that can be sent over your Internet connection per second. This is an indication of how fast your connection is. Faster connections are now possible with better physical infrastructure (such as fiber optic cables that can send information close to the speed of light), as well as better ways to encode the information onto the physical medium itself, even on older medium like copper wires. (definition courtesy of Google Chrome's "20 Things I Learned About Browsers and the Web")
- Bank Deposit (How to Make One)
- Steps for making a bank deposit of any kind:
- Gather the checks and/or cash that you wish to deposit and total them.
- Prepare the deposit slip. You may have a book of deposit slips (business account) or a deposit slip found in the back of your check book (personal account) or you may get a blank deposit slip from the bank.
- Stamp the name of the bank on the back with a "For Deposit Only" statement, or if the checks are made out to you personally, you may endorse the check by signing your name on the back as it is written on the check, and handwrite "For Deposit Only". If the checks to be deposited were lost or stolen, others would not be able (theoretically) to cash your checks.
- If you are using a blank deposit slip from the bank, you must know your account number, or you must be able to get your account number from the teller, who must recognize you or will ask to see your photo identification.
- Put the day you will be depositing the money at the top of the form.
- List each check separately if you are using a business deposit slip. A personal or bank deposit slip will have room for more checks to be listed on the back of the form.
- List cash separately in the space provided.
- Business deposit slips will have a place to tally the number of checks you are depositing.
- Total the cash and checks together. Business deposit slips will have a second place to total the deposit.
- Paperclip or rubber-band the deposit slip and the checks together. If you are depositing change, you may want to place everything in an envelope.
- Take the deposit to the bank. You can mail a deposit, however, most authorities do not recommend it.
- You can make a deposit at an ATM machine.
- You can also place a deposit in the bank night deposit at any time.
- The teller will machine stamp or manually stamp the date the deposit was received and give a receipt to you for your records. if you are using a two-part deposit slip, the bank will keep one part and return the second part to you as a receipt.
- If you have not used a face-to-face method of depositing the money, you will receive a receipt in the mail.
- BARDA (Biomedical Advanced Research and Development Authority) within the Office of the Assistant Secretary for Preparedness and Response in the U.S. Department of Health and Human Services, uses a comprehensive integrated portfolio approach to the advanced research and development, stockpile acquisition, innovation, and manufacturing infrastructure building of the necessary vaccines, drugs, therapeutics, diagnostic tools, and non-pharmaceutical products for public health medical emergencies including chemical, biological, radiological, and nuclear threats, and pandemic influenza, and emerging infectious diseases. (Courtesy of hhs.gov)
- Bending the Curve
- Healthcare cost trends in the United States are two to three times greater than inflation and are therefore unsustainable. This popular phrase describes current efforts to promote health and wellbeing as well as a more effective and efficient healthcare delivery system that will thereby slow the growth in healthcare spending.
- Benefit Period (as it applies to Medicare)
- A benefit period is a defined period of time in which the services a Medicare beneficiary uses are measured. It is also called a "spell of illness". A benefit period:
- starts the day a beneficiary goes into a hospital or skilled nursing facility (SNF)
- ends when the beneficiary has not received any hospital or SNF care (skilled or unskilled) for 60 days in a row
- After a benefit period ends, another benefit period begins again when a beneficiary goes into a hospital or SNF.
- There is no cap on the number of benefit periods for a beneficiary.
- Benefit Year
- A benefit year is the 12-month period for which a patient is subscribed to a plan, and during which the payer has agreed to pay for services according to the patient's plan.
- Big Data
- The term “Big Data” means the access to, and more importantly, analysis of huge sets of data created by medical providers and devices while treating patients. The end goal is to use the huge sets of data to gain insights into patient care and the human body with statistical analysis. Companies like SAS, Oracle, Microsoft, IBM and Dell all make technologies that allow massive sets of data to be managed and analyzed for insights to improve health.
- Black Ink & Blue Ink (and Red Ink)
- It used to be that blue ink would not copy on a copier, so the rule was that all handwritten medical records must be written in and signed in black ink. Now some attorneys are counseling people to sign documents in blue ink, as it stands out from the black text and can be verified as "original." My mentor taught me to always carry a red pen with me, so when you sign an attendance list or guest log, your name will jump off the page!
- Blue Ocean Strategy
- Blue Ocean Strategy is a business strategy book authored by W. Chan Kim and Renee Mauborgne. The central theme of the book is rejecting competition in current business lines and creating new demand, services or goods, a so-called "Blue Ocean." Wikipedia describes the metaphor of the market universe as red and blue oceans like this: " Red Oceans are all the industries in existence today””the known market space. In the red oceans, industry boundaries are defined and accepted, and the competitive rules of the game are known. Here companies try to outperform their rivals to grab a greater share of product or service demand. As the market space gets crowded, prospects for profits and growth are reduced. Products become commodities or niche, and cutthroat competition turns the ocean bloody. Hence, the term red oceans. Blue oceans, in contrast, denote all the industries not in existence today””the unknown market space, untainted by competition. In blue oceans, demand is created rather than fought over. There is ample opportunity for growth that is both profitable and rapid. In blue oceans, competition is irrelevant because the rules of the game are waiting to be set. Blue ocean is an analogy to describe the wider, deeper potential of market space that is not yet explored."
- A botnet is an army of infected computers that hackers can control from a central machine.
- A browser is a software program used to view and interact with Web pages. Commonly used browsers are:
- IE - Internet Explorer (Microsoft)
- FF - Firefox (Mozilla) - free and open-source
- Chrome (Google) - free and open-source
- Safari (Apple)
- Opera (Opera)
- Bundled Payments/Episodic Payments
- A bundled payment is a single, standardized comprehensive payment that covers all services provided to a patient during an episode of care for a procedure or an acute or chronic condition.
- C. diff (courtesy of Mayo Clinic)
- Clostridium difficile, often called C. difficile or "C. diff," is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. Illness from C. difficile most commonly affects older adults in hospitals or in long term care facilities and typically occurs after use of antibiotic medications. More here.
- Cadillac Tax
- The Cadillac Tax is a 40 percent excise tax on healthcare premiums (employer + employee) that is placed on employers for premiums that exceed $10,200 for individual coverage and $27,500 for family coverage. The Cadillac Tax is part of the Patient Protection and Affordable Care Act and is slated to go into effect on January 1 in 2018.
- Capitation is a payment structure which is the opposite of traditional fee-for-service reimbursement. In fee-for-service (FFS), a practice receives a payment for every visit to the practice a covered patient makes. With capitation, the practice is paid a certain amount per member, per month (PMPM) regardless of how many times the patient is seen at the practice. If a patient is seen 10 times during a month, the practice receives the same amount as if the patient is not seen at all at the practice during the month.
- Cardiologists Explained
- Interventional cardiologists - do stents and PTCAs
Non-interventional Cardiologists - do caths, but no stents or PTCAs
Invasive Cardiologists - do caths, and may do stents or PTCAs
Non-invasive Cardiologists - does not do caths, stents or PTCAs
PCTA - Percutanueous transluminal coronary angioplasty is one of the most common procedures for opening damaged or obstructed coronary arteries (sometime referred to as the "balloon" procedure.)
A stent is a wire metal mesh tube used to prop open an artery during angioplasty. The stent is collapsed to a small diameter and put over a balloon catheter. It's then moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a scaffold. This holds the artery open. The stent stays in the artery permanently, holds it open, improves blood flow to the heart muscle and relieves symptoms (usually chest pain).
Cardiac catheterization (cath) is a medical procedure used to diagnose and treat certain heart conditions. A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. Through the catheter, doctors can do diagnostic tests and treatments on your heart. Blockages in the coronary arteries also can be seen using ultrasound during cardiac catheterization. Ultrasound uses sound waves to create detailed pictures of the heart's blood vessels.
- Care Continuum
- The care continuum describes the full range of services that a patient may encounter from prenatal care prior to birth to palliative services at end of life. This term also recognizes that care is provided across the full spectrum of healthcare delivery including outpatient, inpatient, home care, rehabilitation, nursing, virtual, and pre- and post-acute care settings.
- A carve-out is a group of services that are not covered under the primary contract, but are addressed under a separate agreement. For instance, a practice may have a contract with a payer whereby the all services will be reimbursed to the practice at a specific percentage of Medicare. There may also be a carve-out, whereby 10 procedures are paid at a contracted dollar rate, not a precentage of Medicare.
- Case Management
- Case management is a department/program wherein registered nurses and licensed social workers coordinate care for patients who require additional services with the goal of attaining the best health outcomes at the most reasonable cost.
The Case Management Society of America can be found here. The part of their mission statement that I really liked was:
Care managers are advocates who help patients understand their current health status, what they can do about it and why those treatments are important.
- Cash Flow Statement
- The Cash Flow Statement answers the question: where did the cash and any profit (positive margin) go? It reflects where the money came from and how the business spent it.
- The Certification Commission for Health Information Technology is a private organization that certifies EMRs and EHRs based on 475 criteria spanning functionality, interoperability and security. CCHIT does not evaluate ease of use of products, financial viability of the company offering the software; or the quality of customer support offered by the software vendor. Whether or not CCHIT will be THE certifying organization to approve “qualified EMRs” will be announced at the end of the year. (Can be pronounced “SEA-CHIT” or each letter can be pronounced as in “C.C.H.I.T.”)
- CDC Definition of Underinsured for Vaccines
- the patient has private insurance but there is no vaccine benefit
- the patient has private insurance but the vaccine benefit is limited to certain vaccines
- the patient has private insurance but the vaccine benefit caps at a specific dollar amount
- Center for Medicare and Medicaid Innovation (CMMI)
- The CMMI was established to test new healthcare delivery and payment models. The threefold focus of the CMMI is to help find better ways to care for individuals, better overall health and reduced costs. The initial focus will be on patient-centered medical homes, advanced primary care practice within community health centers, and comprehensive treatment practices for dual (Medicare and Medicaid) eligibles.
- CfC (Conditions for Coverage)
- UPDATE: 2/11/2010
Clarification on H&P Requirement Prior To ASC Procedure (Angela Mason-Elbert of CMS:
"Each patient that is seen in an ASC must have a comprehensive medical history and physical assessment (H&P) not more than 30 days before the date of the scheduled surgery. The H&P is to determine if the patient has any underlying conditions that would put the patient at risk for having such a procedure or to identify any new or existing co-morbid conditions that would require additional interventions. Additionally, the H&P could provide evidence that the ASC is not the appropriate setting for this particular procedure. The H&P, as long as it is comprehensive, can be completed the day prior to the procedure and even on the day of the procedure. It does not have to be completed prior to scheduling the procedure."
Medicare announced that it will allow an exception for the patient notices required in advance of the day of the procedure in certain cases. Specifically, the Centers for Medicare and Medicaid Services (CMS) said:
It is not acceptable for the ASC to provide the required notice for the first time to a patient on the day that the surgical procedure is scheduled to occur, unless:
- the referral to the ASC for surgery is made on that same date; and
- the referring physician indicates, in writing, that it is medically necessary for the patient to have the surgery on the same day, and that surgery in an ASC setting is suitable for that patient.
In such situations the ASC must provide the required notice prior to obtaining the patient's informed consent. Cases of surgery occurring on the same day it is scheduled are expected to be rare, since ASCs typically perform elective procedures. Frequent occurrence of such cases may represent noncompliance with the advance notice requirement.This information and new interpretive guidelines are available at www.ascassociation.org/coverage. As the ASC Association analyzes these guidelines more information will be available on the web site.
The OPPS/ASC (Outpatient Prospective Payment System for Ambulatory Surgery Centers) final rule modernizes Medicare’s ASC Conditions for Coverage (CfC). The rule reflects current ASC practice by focusing on the care provided to patients and th impact of that care on patient outcomes. Specifically, the new CfCs:
- Define an ASC as a distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following admission.
- Strengthen Patients’ rights regarding disclosure of physician financial interests in the ASC; advance directives; the grievance process; and confidentiality of clinical records.
- Impose stronger obligations on the governing body of an ASC to oversee its quality assessment and performance improvement (QAPI) program, while allowing ASCs flexibility to use their own information to assess and improve patient services, outcomes, and satisfaction.
- Emphasize the importance of infection control practices.
- Strengthen the requirements for assessing the patient’s condition at admission to verify that the surgery is appropriate and safe for the patient in an ASC setting, and at discharge to ensure appropriate post-surgical care for the patient.
- Require the ASC to adopt a disaster preparedness plan.
- Charge Capture
- Charge capture is the process of entering services rendered into a billing system so the services can be billed to an insurance company or payer or to an individual for payment. Charge capture can be accomplished by having the care provider:
- Mark a form (called an encounter form, superbill, fee ticket or routing slip) and having a staff member enter the charges
- Mark a bubble form and scan the charges into the system
- Enter the charges directly into the billing system
- Have an EMR/EHR product translate/abstract the service dictation or documentation into charges
- Enter the charges through a handheld charge capture system with a PDA or smartphone which then electronically post to the billing system
- Charity Care
- Charity care (no fee or sliding scale reduced fees) is determined prior to the patient receiving services and is based on an inability to pay. Some practices consider patients eligible for care at no or reduced fee if their household income is at or below 200% of the federal poverty guidelines (link for guidelines is under the library tab.)
- Chart Audit Request Management
- When a payer or health plan calls your practice and requests records or requests an on-site visit to review charts, follow this guideline:
- Be professional at all times. Audits can be nerve-wracking and can be a drain on internal resources, but there is always something to be learned from the process.
- Ask for the request in writing, to include the names of the patients whose charts will be accessed, the dates of service covered under the audit, the name of the auditor, the specific reason for the audit, what the result from the audit will entail (warnings, sanctions, grading, etc.) and if the result will be published in any form anywhere. Request that the specific information culled from the audit be shared with your practice in a usable form.
- Review your contract with the payer for any language related to the payer's rights to access information, the description of the information, and any payment due to the practice for the labor and resources used in producing the records. Check with your state insurance laws for any information regarding such requests. Note that Medicare Advantage plans do not have contracts with practices, so you do have the right to charge for the labor and resources necessary to produce records.
- When the information arrives from the payer, confirm that the patients named in the audit have records in your practice.
- If the explanation for the audit is unclear, request more in-depth information in writing.
- If you are satisfied that all requirements are being met by the payer, schedule the audit, or arrange for records to be sent. If coming on-site, arrange for a quiet place for the auditor to review records, preferably close to you so you can observe, answer questions and ask questions.
- Review records or charts requested by the payer and be sure to remove any documentation that does not specifically refer to the dates being included in the audit. Do not give the entire chart to the auditor,
- For practices with EMRs, print the appropriate documentation for the auditor if they request an on-site visit. Do not give the auditor access the system, as their permission to review records is limited.
- Analyze the feedback received to improve any areas needed and document your effort as a part of your compliance plan. Have all practice employees sign off on any compliance plan updates.
- Check 21 Act
- The Check Clearing for the 21st Century Act (or Check 21 Act) is a United States federal law, Pub.L. 108-100, enacted into law October 28, 2003 by the 108th Congress. It took effect one year later, on October 28, 2004. The law allows the recipient of the original paper check to create a digital version of the original check””called a "substitute check," thereby eliminating the need for further handling of the physical document. An implication of the law is that it is legal for anyone to use a computer scanner to capture images of checks and deposit them electronically, a process known as remote deposit. (Definition courtesy of Wikipedia)
- A clearinghouse is an organization that receives claims data from practice management systems and repackages it in electronic or paper format to send to payers in bulk. Clearinghouses started out as independent organizations, but now many are owned by vendors who require customers to use their clearinghouses if they use their practice management systems. Clearinghouses now also offer eligibility products, patient statement services, claims scrubbing products, and electronic remittance interfaces for direct posting of receipts into practice management systems.
- Clinical Decision Support
- These are computerized tools that incorporate information-gathering, as well as monitoring and delivery systems, to ensure optimal decision-making on the part of the treating clinician. They assist physicians and other providers at the point of care to follow evidence-based guidelines and improve healthcare outcomes.
- Cloud Computing
- As you sit hunched over your laptop at home watching a YouTube video or using a search engine, you’re actually plugging into the collective power of thousands of computers that serve all this information to you from far-away rooms distributed around the world. It’s almost like having a massive supercomputer at your beck and call, thanks to the Internet. This phenomenon is what we typically refer to as cloud computing. We now read the news, listen to music, shop, watch TV shows and store our files on the web. Some of us live in cities in which nearly every museum, bank, and government office has a website. The end result? We spend less time in lines or on the phone, as these websites allow us to do things like pay bills and make reservations. The movement of many of our daily tasks online enables us to live more fully in the real world. (definition courtesy of Google Chrome's "20 Things I Learned About Browsers and the Web")
- Cloud Computing (also SaaS)
- no server onsite
- no server management (techs) onsite
- no need to increase onsite storage
- transparent upgrades, patches and fixes
- You can't touch it
- You can't see what's wrong
- You are trusting others with a most precious asset - your data
- CMS 1500
- The CMS 1500 (formerly called the HCFA 1500) is the form/format (paper or electronic) used to submit Medicare Part B claims.
- Co-insurance is a percentage of the allowable charges that the patient is required to pay at the time of service. Typically, the patient's deductible must be satisfied before the payer will pay on a claim.
- COBRA (Consolidated Omnibus Budget Reconciliation Act)
- The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan. COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage (called continuation coverage) in certain instances where coverage under the plan would otherwise end. The American Recovery and Reinvestment Act (ARRA) provides a COBRA premium reduction for eligible individuals who are involuntarily terminated from employment through the end of May 2010. Due to the statutory sunset, the COBRA premium reduction under ARRA is not available for individuals who experience involuntary terminations after May 31, 2010. However, individuals who qualified on or before May 31, 2010 may continue to pay reduced premiums for up to 15 months, as long as they are not eligible for another group health plan or Medicare. The Unemployment Compensation Extension Act of 2010 signed by the President on July 22, 2010, did not extend the COBRA premium reduction.
- Collection Agency
- A collection agency collects the amount owed to a medical practice by a patient when the practice has exhausted all efforts to collect the debt. Most practices will send the patient several statements and call the patient before "turning them over" to a third-party collector. Unfortunately, some patients will only pay when threatened with the prospect of having their credit affected by the attempt to collect. Most collection agencies assess a percentage of the collected debt (anywhere from 15% to 50%) in return for their services, however, practices may recoup that amount from the patient in addition to the original debt if the patient is informed of this practice before the service is rendered and agrees to the terms. Some practices will discharge a patient from their practice upon turning them over to external collections, but some do not.
- Comparative Effectiveness
- Comparative Effectiveness Research (CER) compares treatments and strategies to improve health. For CER, HITECH provides $300M for the Agency for Healthcare Research and Quality, $400M for the National Institutes of Health, and $400M for the Office of the Secretary of Health and Human Services.
- Comparative Effectiveness Research
- Presently most research compares a treatment or intervention to a placebo or doing nothing. There are few studies that compare multiple approaches to medical concerns. Comparative Effectiveness Research addresses this problem. According to the Department of Health and Human Services, “Comparative effectiveness research is the conduct and synthesis of systematic research comparing different interventions and strategies to prevent, diagnose, treat and monitor health conditions. The purpose of comparative effectiveness research is to inform patients, providers, and decision-makers, responding to their expressed needs, about which interventions are most effective for which patients under specific circumstances.” Source: http://www.hhs.gov/recovery/
programs/cer/draftdefinition.Accessed 7/28/2010. html
- Computerized Physician Order Entry
- Computerized Physician Order Entry (CPOE) is the electronic entry of medical practitioner instructions for services, tests, and treatments of patients into a computerized system that relays the orders to the appropriate party such as a hospital pharmacists or blood-draw lab. These systems can be used for care orders, prescriptions, lab tests, and radiological orders.
- Consumerist Patient
- The consumerist patient is one who takes an active interest in the cost of his/her healthcare services. This may be a change for practices as patients of the past would not ask any questions about the cost of services, particularly if their insurance plan covered all services at 100% of allowable. As more responsibility for payment is falling to the patient, the patient is acting as a consumerist by:
- Shopping for good values in services
- Negotiating for service rates
- Looking for providers that offer cash discounts
- Looking for providers that offer acommodating payment plans
- Considering going out of state or out of the country for services (medical tourism)
- Content Curation
- I am a Content Curator. I take information from the internet and rewrite it, bullet it, augment it and publish it for the MMP readers.
- Comprehensive Outpatient Rehabilitative Facility
- Coverage Limits
- A health insurance plan has been able dictate the maximum number of dollars spent on benefits per individual/family/policy, and these restrictions come in two forms — annual and lifetime.
- Creative Commons
- Creative Commons is a non-profit that offers an alternative to full copyright. CC allows sharing of work with others through licensing rules, as described below by the nice people at My Creative Team on their blog THINKing.
Attribution ”“ You let others copy, distribute, display, and perform your copyrighted work ”” and derivative works based upon it ”” but only if they give credit the way you request. Share Alike ”“ You allow others to distribute derivative works only under a license identical to the license that governs your work. Non-Commercial ”“ You let others copy, distribute, display, and perform your work ”” and derivative works based upon it ”” but for non-commercial purposes only. No Derivative Works - You let others copy, distribute, display, and perform only verbatim copies of your work, not derivative works based upon it.
- CSS (Cascading Style Sheets)
- Web pages have also become more expressive with the introduction of CSS (Cascading Style Sheets). CSS gives programmers an easy, efficient way to define a web page’s layout and beautify the page with design elements like colors, rounded corners, gradients, and animation. (definition courtesy of Google Chrome's "20 Things I Learned About Browsers and the Web")
- Culture of Health
- This is an ideological transformation of an organization’s culture that passively accepts rising, unsustainable healthcare costs to a proactive entity that encourages the holistic wellbeing of each of its employees. Such organizations integrate the health status of their workforce into their mission and vision statements and require all of their employees to be accountable for their health.
- d/b/a (DBA)
- Doing Business As: when the ownership company name is different than the name being used as a trade name. For instance, the ownership company name might be ABC Amalgamated Healthcare and the d/b/a could be Home Town Primary Care.
- Dartmouth Atlas of Health Care (The)
- For more than 20 years the Dartmouth Atlas of Health Care has collated information on how medical resources are distributed and used in the United States. The data comes straight from Medicare claims, and can be used to review and analyze local, regional and national markets. As the Dartmouth Atlas of Health Care online site states:
These reports, used by policymakers, the media, health care analysts and others, have radically changed our understanding of the efficiency and effectiveness of our health care system. This valuable data forms the foundation for many of the ongoing efforts to improve health and health systems across America.The funding to create the Dartmouth Atlas of Health Care online was made possible by a grant from The Robert Wood Johnson Foundation, which is the nation's largest philanthropy making grants exclusively in the health care field.
- David Blumenthal, M.D., M.P.P
- Selected by President Obama as his choice for National Coordinator for Health Information Technology Dr. Blumenthal will lead the implementation of a nationwide interoperable, privacy-protected health information technology infrastructure as called for in the American Recovery and Reinvestment Act.
- Definition of a Group Practice (Stark)
- The Group Practice Definition (courtesy of HealthNoob.com)
Under Stark, a group practice is a physician practice that meets the following conditions:
Single Legal Entity.
The group practice must consist of a single legal entity operating primarily for the purpose of being a physician group practice in any organizational form recognized by the State in which the group practice achieves its legal status.
The group practice must have at least two physicians who are members of the group (whether employees, or direct or indirect owners). Stark defines a member of the group as a direct or indirect owner of a group practice (including a physician whose interest is held by his or her individual professional corporation or by another entity), a physician employee of the group practice, a locum tenens physician, or an on-call physician while the physician is providing on call services for members of the practice. An independent contractor is not a member of the group.
Range of Care.
Each physician who is a member of the group, must furnish substantially the full range of patient care services that the physician routinely furnishes, including medical care, consultation, diagnosis, and treatment, through the joint use of shared office space, facilities, equipment, and personnel.
Services Furnished by Group Practice Members.
Substantially all of the patient care services of the physicians who are members of the group (that is, at least 75% of the total patient care services of the group practice members) must be furnished through the group and billed under a billing number assigned to the group, and the amounts received must be treated as receipts of the group. Patient care services must be measured by one of the following:
- The total time each member spends on patient care services documented by any reasonable means (for example, time cards and appointment schedules.)
- Any alternative measure that is reasonable, fixed in advance of the performance of the services being measured, uniformly applied over time, verifiable, and documented.
Special Rules for Productivity Bonuses and Profit SharesThe special rules for productivity bonuses and profit shares allow a physician who is in the group practice to be paid a share of overall profits of the group or a productivity bonus based on services that he/she has personally performed (including services “incident to” those personally performed services), provided that the share or bonus is not determined in any manner that is directly related to the volume or value of referrals of DHS by the physician. CMS now takes the position that diagnostic-testing services cannot be billed as “incident to” but practices that provide physical therapy can, however, bill physical therapy services as “incident to” services (provided that all of the “incident to” requirements are met). The Stark regulations specifically set forth examples of formulas that will be deemed not to relate directly to the volume or value of referrals. For example, a group’s profits will be deemed not to relate directly to the volume or value of referrals if revenues derived from DHS are distributed based on the distribution of the group practice’s revenue attributed to services that are not DHS payable by any Federal health care program or private payer.
- Demonstration Projects
- These are federally funded efforts to test and evaluate care delivery, cost reduction, health improvement, and payment reform models. The goal of these projects is to develop new, effective methodologies for care and payment, which can be expanded to a broader, perhaps national, scope. The Affordable Care Act has several funded pilots dealing with innovations such as the bundled payment model and programs for chronically ill Medicare beneficiaries using home-based teams. Note that demonstration project opportunities have been ongoing for years and are not solely tied to recent legislation.
- Diagnosis (ICD-9 and ICD-10)
- Update: MLN (Medicare Learning Network) published this pdf on ICD-10 on June 22, 2010
The diagnosis is the identification of a patient's disease or medical condition and is currently (2010) described by a six place numeric identifier (5 digits and one decimal) called the International Classification of Diseases, Ninth Revision or the ICD-9 code. On October 1, 2013, the United States will move to ICD-10. The International version of ICD should not be confused with national Clinical Modifications of ICD that include frequently much more detail, and sometimes have separate sections for procedures, so the new US ICD-10 CM has more than 150,000 codes.
The differences are:
ICD-9 codes consist of 3-5 digits:
”¢ Chapters 1-7 are numeric
”¢ Supplemental chapters: the first digit is alpha (E or V) and the rest are numeric
ICD-10-CM codes consist of 3-7 alphanumeric characters:
”¢ Digit 1 is alpha
”¢ Digit 2 is numeric
”¢ Digits 3-7 are alpha or numeric
2009 totals, according to the U.S. Department of Health and Human Services:
Diagnosis (ICD-10-CM): 68,105
Procedure (ICD-10-PCS): 72,589
Healthcare Information Management, Inc. states:
The ICD-10-CM is divided into an index. The first is the alphabetical list of terms and their corresponding code. The second is the Tabular List, a chronological list of codes divided into chapters that represent different conditions or body systems. There are also two parts to the Index ”“ the Index to External Causes of Injury and the Index for Diseases and Injury. The Index and Tabular portions of the ICD-10-CM include the conventions and structural notes. The Tabular List contains alphanumeric categories, subcategories, and codes. When a three character category has no more subdivisions, it is considered a code. Each level of subdivision after the category is a subcategory. The ”˜code’ is considered complete once there are no more subcategories. A code indicated to have a 7th character is considered incomplete without the missing character. In order to be reportable, only a complete ”˜code’ can be used. Subcategories or diagnoses that are not complete cannot be used for reporting. When there is an unknown subcategory, the place holder X is allowable in either the 5th or 6th position. This placeholder allows for the future addition of characters, thereby accommodating expansion when needed. The notes in the Tabular List will indicate categories where a 7th character is required.ICD-9 codes are arranged thusly:
- List of ICD-9 codes 001-139: Infectious and parasitic diseases
- List of ICD-9 codes 140-239: Neoplasms
- List of ICD-9 codes 240-279: Endocrine, nutritional and metabolic diseases, and immunity disorders
- List of ICD-9 codes 280-289: Diseases of the blood and blood-forming organs
- List of ICD-9 codes 290-319: Mental disorders
- List of ICD-9 codes 320-359: Diseases of the nervous system
- List of ICD-9 codes 360-389: Diseases of the sense organs
- List of ICD-9 codes 390-459: Diseases of the circulatory system
- List of ICD-9 codes 460-519: Diseases of the respiratory system
- List of ICD-9 codes 520-579: Diseases of the digestive system
- List of ICD-9 codes 580-629: Diseases of the genitourinary system
- List of ICD-9 codes 630-676: Complications of pregnancy, childbirth, and the puerperium
- List of ICD-9 codes 680-709: Diseases of the skin and subcutaneous tissue
- List of ICD-9 codes 710-739: Diseases of the musculoskeletal system and connective tissue
- List of ICD-9 codes 740-759: Congenital anomalies
- List of ICD-9 codes 760-779: Certain conditions originating in the perinatal period
- List of ICD-9 codes 780-799: Symptoms, signs, and ill-defined conditions
- List of ICD-9 codes 800-999: Injury and poisoning
- List of ICD-9 codes E and V codes: external causes of injury and supplemental classification
Chapter Blocks Title I A00-B99 Certain infectious and parasitic diseases II C00-D48 Neoplasms III D50-D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism IV E00-E90 Endocrine, nutritional and metabolic diseases V F00-F99 Mental and behavioural disorders VI G00-G99 Diseases of the nervous system VII H00-H59 Diseases of the eye and adnexa VIII H60-H95 Diseases of the ear and mastoid process IX I00-I99 Diseases of the circulatory system X J00-J99 Diseases of the respiratory system XI K00-K93 Diseases of the digestive system XII L00-L99 Diseases of the skin and subcutaneous tissue XIII M00-M99 Diseases of the musculoskeletal system and connective tissue XIV N00-N99 Diseases of the genitourinary system XV O00-O99 Pregnancy, childbirth and the puerperium XVI P00-P96 Certain conditions originating in the perinatal period XVII Q00-Q99 Congenital malformations, deformations and chromosomal abnormalities XVIII R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified XIX S00-T98 Injury, poisoning and certain other consequences of external causes XX V01-Y98 External causes of morbidity and mortality XXI Z00-Z99 Factors influencing health status and contact with health services XXII U00-U99 Codes for special purposes
- Diagnosis-Related Groups (DRGs)
- DRGs may not be familiar to many practice administrators as they are a payment method for hospitals. Applied to all U.S. hospitals as a Medicare reimbursement method in 1983, DRGs are groups of hospital services clustered around diagnoses. The theory of DRGs is that this reimbursement system would require hospital administrators to alter the behavior of the physicians and surgeons comprising their medical staffs. (Are you thinking what I'm thinking about physician behavior?) A defining moment in healthcare reimbursement was MS-DRG Grouper version 26. It took effect October 1, 2008 with one main change: implementation of Hospital Acquired Conditions (HAC). Certain conditions are no longer considered complications if they were not present on admission (POA), which will cause reduced reimbursement from Medicare for conditions apparently caused by the hospital. MS-DRG Grouper version 27 (pdf here) took effect as of October 1, 2009 and predominant changes are relatedhanges involved are mainly related to Influenza A virus subtype H1N1.
- Digital Stealth Economy
- You know what this is. Businesses, industries and others are digitally listening to our chatter and our clicks and are mining our buying decisions, website trail and yes, health information for the purpose of improved marketing and sales.
- Disease Management
- Disease management programs address the needs of population cohorts affected by chronic illnesses to reduce their medical costs and the deleterious effects of these conditions. A successful effort involves an effective way to identify worthy patients and engage them to fully participate in evidence- based interventions that produce measurable improvements in care, reduced costs, and perceived value.
- Disenrollment is the process of rescinding insurance coverage to individuals or groups.
- Do Not Resuscitate (DNR) Order
- A Do Not Resuscitate order ia a kind of Advance Directive. A DNR is a request not to have cardiopulminary resuscitation (CPR) if your heart stops or if you stop breathing. You can use an Advance Directive to tell your doctor that you do not want to be resuscitated.
- Double Effect (as applied to terminal sedation)
- The philosophical principle or rule of double effect, attributed to the 13th century Roman Catholic philosopher Thomas Aquinas, states that even if there is a foreseeable bad outcome, like death, it is acceptable if it is unintended and outweighed by an intentional good outcome ”” the relief of unyielding suffering before death. The principle has been applied to ethical dilemmas in realms from medicine to war, and it is one of the few universal standards on how end-of-life sedation should be carried out. Reference: New York Times article December 26, 2009.
- Dual Eligibles
- Dual Eligibles is a term used to describe the 8.8 million Americans who are eligible for both Medicare and Medicaid.
- Dunbar's Number
- British anthropologist Robin Dunbar proposed in 1992 that there is a limit to the number of people with whom each of us can maintain a stable social relationship. Although there is no actual number proven, the number generally agreed upon as Dunbar's Number is 150.
- Durable Power of Attorney (DPA)
- A Durable Power of Attorney for healthcare is a kind of Advance Directive. A DPA states whom you have chosen to make health care decisions for you. It becomes active any time you are unconcious or unable to make medical decisions for yourself. A DPA is generally more useful than a Living Will, but only if you have another person who you trust to make medical decisions for you.
- According to the Centers for Medicare and Medicaid, e-prescribing is, “a prescriber’s ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care.” Studies have demonstrated that replacing handwritten prescriptions with this electronic transmission greatly reduces medication errors.
- EAP (Employee Assistance Program)
- EAP is a benefit provided by some employers to assist employees with personal problems, problems at home and problems at work. Employees may contact the EAP Providers (usually a behavioral health provider) themselves or may be referred to EAP by a supervisor or manager. The employer pays for a certain number of provider visits for each distinct episode. Some reasons why employees might use their EAP benefit are:
- mental illness
- substance abuse
- marital problems
- family issues
- domestic violence
- performance coaching
- communication issues
- grief management
- worksite violence
- cultural understanding
- anger management
- diversity sensitivity
- executive coaching
- bullying behavior
- Early Retiree Reinsurance Program
- The Early Retiree Reinsurance Program (ERRP) is a temporary $5 billion program established by the Patient Protection and Affordable Care Act. Its purpose is to help businesses and unions cover the healthcare costs of Medicare-ineligible early retirees, their spouses, and other dependents. It provides 80 percent of claims costs for benefits between $15,000 and $90,000 starting with the 2010 calendar year.
- Economic Credentialing
- Economic credentialing is the practice of denying clinical privileges because of financial rather than competency concerns. Hospitals can dismiss a practitioner for economic credentialing reasons at any time; they do not need to wait until the end of a reappointment cycle to act. Not all states allow economic credentialing; check your state laws for clarification.
- Economies of Scale
- Economies of scale is a term used by economists to refer to the situation in which the cost of producing an additional unit of output (i.e., the marginal cost) of a product (i.e., a good or service) decreases as the volume of output (i.e., the scale of production) increases. In the medical practice, economies of scale are related to the group practice model of more than two physicians working together. A single physician needs and will pay for a receptionist for the practice, but the receptionist may not have enough work to do to fill the time for a solo physician. In a practice of three physicians, however, the receptionist is kept busy and each physician needs only to pay 1/3 of the cost. Additionally, group practices are able to negotiate discounts on supplies due to volume and may also be able to negotiate better rates from payers. They may also be able to raise capital to invest in ancillaries like a specimen laboratory, imaging, or other type of testing lab. Economies of scale can also determine the optimum size for a medical practice and at what point an increase in the number of physicians actually causes "diseconomies of scale" due to complexity of the organization.
- EDI Transactions (ANSI X12)
- 270 ”” eligibility & benefit inquiry - Is the patient an insured of this payer?
- 271 ”” eligibility & benefit response (response to 270) - A yes or no response that the patient is insured
- 276 ”” claims status inquiry (follows 837 submission)
- 277 ”” claim status response (response to 276)
- 835 ”” claim payment/advice (follows 837)
- 837 - medical claim is paid, and amount of payment and the patient's financial responsibility
- 837D ”” claim submission for dental claims
- 837I ”” claim submission for institutional claims
- 837P ”” claim submission for professional claims
- The aggregate electronic record of health-related information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care (as defined by NAHIT, the National Alliance for Health Information Technology.)
- EKG or ECG (Medicare Coverage of electrocardiograms)
- How many EKGs does Medicare pay for in a year?
- There are two types of electrocardiograms (abbreviated EKG or ECG) - screening and diagnostic. Medicare covers one screening EKG in the patient's lifetime in conjunction with the Initial Preventive Physical Exam (IPPE), referred to as the "welcome-to-Medicare" exam, which the patient must have performed within 12 months of enrolling in Medicare for the first time. As of January 2009, the deductible does not apply to the IPPE or EKG. The patient will pay 20% of the Medicare-allowed amount.
- Medicare will also cover EKGs performed as a diagnostic test, which means that the patient has symptoms which leads the provider to prescribe an EKG to diagnose the patient's problem. For an EKG performed in a hospital outpatient department, Medicare Part B pays the full Medicare-approved amount, except for a patient co-payment. For an EKG in any other setting, Medicare Part B pays 80 percent of the Medicare-approved amount.
- As of January 2009, the EKG was removed from the list of mandated services that must be included in the IPPE benefit and makes the EKG an educational, counseling, and referral service to be discussed with the patient and, if necessary, ordered by the physician. This change alleviates physician frustration of having to perform a screening ECG when the patient just had a diagnostic EKG/ECG.
- Medicare will cover the screening ECG when the physician deems the screening is appropriate for the individual patient
- Codes to be used for the EKG are:
- G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment
- G0403 Electrocardiogram, routine ECG with at least 12 leads; performed as a screening test for the initial preventive examination with interpretation and report
- G0404 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive examination
- G0405 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only, performed as a screening for the initial preventive examination
- How many EKGs does Medicare pay for in a year?
- Electronic Faxing
- Electronic faxing (also called efaxing, online faxing or internet faxing) is the process of sending a document between two people/accounts via the Internet, much in the way email sends messages over the Internet between two people. eFaxing is a preferred method of sending information as opposed to traditional faxing as it is more compliant with HIPAA security regulations as it can be encrypted and password protected.
eFaxing is also preferable because:
- No dedicated telephone line is required for the efax
- No fax machines are needed (purchase, maintenance, toner)
- No paper is used - it's green!
- Multiple faxes can be sent and received simultaneously
- Long-distance and monthly phone costs are eliminated
- Any location that has Internet access can send or receive faxes
- Electronic Medical Record/Electronic Health Record
- Electronic medical records (EMRs) and electronic health records (EHRs) are computerized records maintained centrally by a medical practice or health center to keep track of patient care. EMRs are electronic versions of a patient’s paper medical chart and maintain a patient’s medical history over time, including patient demographics, clinical notes, prescriptions and registries, web applications, and connection to personal health records kept by patients. They are usually constructed so the data can be part of other systems such as clinical workflow and decision support and possess the ability to safely exchange health information between entities such as collaborating providers.
- Employer Identification Number (EIN)
- An Employer Identification Number (EIN) is also known as a Federal Tax Identification Number (TIN), and is used to identify a business entity.
- Employer Mandate/Pay or Play
- This Patient Protection and Affordable Care Act mandate requires employers to either offer minimal levels of health insurance coverage to their employees or pay a fine, which in turn will subsidize health insurance for those without access. This part of the health reform law will go into effect for plan years beginning on or after 1/1/2014 and for employers with 50 or more full-time employees who choose not to provide group coverage and have at least one employee obtaining federally subsidized coverage through a health insurance exchange.
- The electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care (as defined by NAHIT, the National Alliance for Health Information Technology.)
- Evidence-Based Medicine
- Much of the care delivered today has been simply based on expert opinion. Evidence-Based Medicine’s (EBM)’s charge is to deliver care that has strong scientific validation. Ideally this term refers to the synthesis of individual, first-hand clinical experience with evidence garnered by external systematic research to create best practices in care delivery. It involves the interested clinician or organization asking a specific care question and then proceeding to systematically review published research to find practices backed by concrete data.
- eWaste is broken, obsolete or otherwise discarded electronics equipment. With healthcare moving forward to new products and technology, a lot of ancient systems are going to require proper disposal. Who ya gonna call?
- Exam Rooms (how many?)
- How many exam rooms should you have in a practice, you ask? This number depends on several things:
- The pace at which the provider works
- The amount of time the provider spends in the exam rooms
- How mature the provider's practice is
- Services that are provided in the exam room by someone other than the provider
- The specialty - are the providers using exam rooms every day all day, or some days for parts of the day?
- Plans for the future
- Time your physicians and mid-level providers to get an average amount of minutes spent in the exam room. You may have some outliers who spend very little time in the exam room or some who spend a long time with every single patient. You may need to adjust up for the fast ones and down for the slow ones. Over all specialties most providers are in the exam room about 15 minutes for established patient visits.
- A provider with a mature practice may see more or less patients. He may be able to see patients in a shorter amount of time due to his experience (surgery) OR he may spend more time with his patients as they age up and start dealing with more chronic illness (primary care.) A provider with a new practice may take longer with patients because he has the luxury of less patients and more time.
- Are your nurses/assistants taking vitals, doing medication reconciliation, giving injections, taking blood, taking out sutures/staples, doing EKGs, scheduling future appointments, scheduling tests or procedures, teaching etc.? Don't forget to allow time in your analysis for when the room is busy, but the provider is not in it. You might want to add 5 or more minutes to your average if you're using the exam room for pre-provider processes and 5 or more minutes to your average if you're using the exam room for post-provider processes. A note here that doing everything you possibly can in the exam room is both a patient pleaser and is HIPAA-compliant.
- The ideal situation is one in which every exam room is full every day. If you cannot fill every room every day (and most can't unless they are undersized for the number of providers), you are bearing an expense on something that has the potential to pay for itself, but isn't. Many providers like their "own" exam rooms, but will pay unnecessarily for their exam rooms when they aren't using them.
- How do you find that sweet spot of being rightsized for your specialty and number of providers? Once you've timed your providers, and determined the best way to keep as many exam rooms full as possible, map out the time and entrance and exit of a typical schedule, trying it out on different numbers of rooms. For instance, with one exam room, and average of 15 minutes per patient and adding 10 minutes for vitals and history of present illness documentation and room turnaround a physician working from 8:00 a.m. to 5:00 p.m. with one hour off for lunch can see 19.4 patients a day. Here's the math:
- 8 hours x 60 minutes = 480 minutes
- 480 minutes / 25 minute per patient = 19.4 patients per day
- the provider has 10 minutes between each patient for documentation, phone calls, etc.
- Let's try it with 2 exam rooms.Now you're saving the time that the provider can't get into the exam room because the assistant is working with a patient or cleaning the room for the next patient. Now he can potentially see 32 patients per day, which is closer to daily standards for family practice, medicine and medicine subspecialties, but he has no between time for other tasks. Remember also that this does not take into account any x-rays, urine collection, etc. that the patient has to leave the exam room for.
- Traditionally, physicians have been told that 3 exam rooms are ideal. A patient is beginning a visit in one room, ending a visit in one room and actually with the physician in the third room. Don't forget, however, that a single assistant cannot be in two places at one time, so take that into consideration when planning how many rooms a provider needs. You also do not want to use more rooms than the provider can comfortably move between because patients dislike waiting in the exam room just as much as they dislike waiting in the waiting room.
- In planning for the future, it is cheaper to build an exam room than add one after the fact. An exam room can always be retrofitted for an office, but an office may not necessarily work as an exam room without modification. Many medical architects recommend having some extra rooms that can easily be repurposed to exam rooms if needed.
- When planning for exam rooms, don't forget to keep virtual visits in mind. You don't need exam rooms for these, but the provider will need time to diagnose and communicate a plan for these patients.
- Expanded Coverage
- A significant goal of the Affordable Care Act is near universal coverage. To accomplish this, a mandate requiring most U.S. citizens and legal residents to have health insurance is included. There are individual regulations that support this initiative by: • Expanding Medicaid coverage • Removing bans on coverage of individuals with pre-existing conditions • Setting required groundwork for the formation of state-based health insurance exchanges • Supplying assistance for individuals to procure insurance • Expanding coverage of dependents up to age 26
- f/k/a (FKA)
- Formerly Known As: a company's previous name
- A formulary is a listing of preferred prescription drugs (generic or brand name) chosen by a health plan/payer/insuror or Pharmacy Benefit Manager (PBM) for their cost to benefit ratio. Open Formulary = covers formulary and non-formulary drugs but charges the employer more for non-formulary drugs Tiered Formulary = covers formulary and non-formulary drugs but charges the patient more for the non-formulary drugs Closed Forumlary = only covers formulary drugs
- Geriatrics is a branch of medicine that deals with the problems and diseases of old age and aging people. The term comes from the Greek geron meaning "old man" and iatros meaning "healer". Although there is no specific age when one is a geriatric patient, age 65 is typically considered the beginning age when a patient might choose to see a geriatrician. Here is the link for the American Geriatric Society.
- Global Payments (Global Capitation)
- Global payments (global capitation) are fixed payments for which providers are given a pre-specified amount per patient (dependent on demographic data and other considerations) for a time period such as a month or a year. This payment schema places the burden of risk on the provider who will be responsible for delivering comprehensive acute, chronic, and preventive care during that time period for that all-inclusive payment. Health Information Exchange and Interoperability – A Health Information Exchange (HIE) is an initiative focused on the electronic exchange of healthcare data between healthcare stakeholders. The exchange typically includes clinical, administrative, and financial data across a medical care and coverage area. Interoperability refers to the ability to connect to two or more disparate systems, for example, a disease registry and a payer claims database, for the sharing of permissible secure information via standardized protocols and exchanges.
- "Gomer" stands for Get Out of My Emergency Room, reflecting the annoyance of the doctors. It first appeared in widespread print in the medical novel The House of God by Samuel Shem, and was used mostly in the 1980s and 1990s. It is still used today, although many medical professionals find it disrespectful and unprofessional.
- Gorilla on the Basketball Court
- A short film demonstrating the "surprising limits of perception, attention, and awareness." Viewers are instructed to count bounces or baskets made by one team, and in doing so, completely miss that a person in a gorilla suit walks among the players! Viewers are astounded when viewing the video a second time and seeing the gorilla. The video is part of a 2003 DVD Surprising Studies of Visual Awareness, Volume 1 produced by Viscog Productions, Inc.
- H & P (History & Physical) vs. HNP (Herniated Nucleus Pulposus or Spinal Disc Herniation)
- Two acronyms that confused me early on in my career were "H & P" and "HNP" because they sound exactly the same and few people enunciate clearly enough to distinguish the difference. The context will tell you the difference, but for anyone new to healthcare the context might be just as confusing.
H & P - History and Physical
An H & P may be performed upon a patient's admission to the hospital, prior to a surgery/procedure, or as part of a new patient visit. An H & P includes:
- History of Present Illness
- Past Medical History
- Family History
- Review of Systems
- Physical Examination
- Problem List
- Health ICT (Information & Communication Technology)
- mobile telephony
- mapping systems
- disease surveillance systems
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- HIPAA Law The Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes provisions related to insurance, privacy, security, transactions and code sets. The Administrative Simplification Compliance Act (ASCA) amended the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and required that all claims submitted to Medicare on October 16, 2003 and beyond be done so electronically except for certain circumstances. Patient Protection and Affordable Care Act (ACA) Administrative Simplification provisions build upon the Health Insurance Portability and Accountability Act of 1996 (HIPAA) with new and expanded provisions, including a requirement to adopt operating rules for each of the HIPAA transactions; a unique, standard Health Plan Identifier; and standards for electronic funds transfer (EFT) and electronic health care claims attachments. The Affordable Care Act requires that health plans certify their compliance with the standards and operating rules, and provides penalties for noncompliance.
- Health Reimbursement Account (HRA)
- Health Reimbursement Accounts or Health Reimbursement Arrangements (HRAs) are Internal Revenue Service (IRS)-sanctioned programs that allow an employer to set aside funds to reimburse medical expenses paid by participating employees. Using an HRA yields "tax advantages to offset health care costs" for both employees as well as an employer. (definition courtesy of Wikipedia)
- Health Savings Account (HSA)
- An HSA is a medical savings account that allows individuals and employers with high-deductible insurance policies to contribute tax free to an account to pay current or future qualified medical expenses.
- Health Story Project
Health Story is a non profit, informal industry alliance of members who share a vision and mission and who contribute through active participation and annual membership dues. The project was initiated by the Association for Healthcare Documentation Integrity (AHDI), Medical Transcription Industry Association (MTIA), American Health Information Management Association (AHIMA) and M*Modal and is being managed by Alschuler Associates, LLC and Optimal Accords, LLC. Approximately 1.2 billion clinical documents are produced in the United States each year. These documents comprise around 60% of clinical information, the majority of physician-attested information and are used as the primary source of information for reimbursement and proof of service. This tremendous source of clinical information is underutilized in current computer-based record systems. Health Story is an alliance of healthcare vendors, providers and associations that pooled resources over the previous three years in a rapid-development initiative to produce data standards for the flow of information between common types of healthcare documents and electronic health records. Our Mission: To develop and promote information standards through HL7 that support the flow of information between narrative documents and electronic medical records. The Health Story Project established the following five-year goals:From the Health Story Project website here.
- Establish awareness
- Maintain strong coalition
- Publish catalog of data standards through HL7
- Increase market demand for standards
- Earn national endorsement
- Foster widespread adoption of standards
- Declare success
- Healthcare Common Procedure Coding System (HCPCS)
- Medicare and Medicaid use HCPCS (Healthcare Common Procedure Coding System) which is based on the American Medical Association's CPT system. Codes are globally grouped into Level I and Level II:
- Level I codes include the 5-digit numeric CPT (Current Procedural Terminology) codes. These were developed by the American Medical Association (AMA) in 1966 and remain proprietary to the AMA. The codes are updated in October and become effective as of the next calendar year. They are available as a printed manual or as an electronic file.
- Level II codes are national codes developed by the Centers for Medicare and Medicaid Services (CMS) to describe medical services and supplies not covered in the CPT. They consist of alphabetic characters (A through V) and four digits.
- The HIT components of the stimulus package ”” collectively labeled HITECH are:
- Funding to the Office of the National Coordinator of HIT (ONCHIT)
- HIT adoption incentives through Medicare and Medicaid reimbursement
- Comparative effectiveness research for the Agency for Healthcare Research and Quality (AHRQ)
- Funding for the Indian Health Service
- Construction funds for the Health Resources and Services Administration (HRSA) for community health centers
- Funds for the Social Security Administration to upgrade HIT systems
- Funding for the Veterans Administration
- The Department of Agriculture will receive telemedicine funding
- Funds to the National Telecommunications Administration for broadband to enable telemedicine.
- Having employees work at home for your company.
- Hospital Value-Based Purchasing/Pay for Performance
- These programs are established to reward providers of care for better results. They require the care-providing organizations have a system of accurate measurements to gauge performance (i.e., a hospital measuring readmission rates). If the organization achieves established goals set by a program sponsor, the organization receives an incentive payment. Organizations can also receive lower remunerations for poor outcomes.
- Hospitalists are physicians who work full-time in the hospital setting. Hospitalists typically work long shifts, often 12 hours at a time and may work 5 to 10 days in a row, taking 5 to 10 days off in rotation. Hospitalists may be employed by the hospitals or by private groups, and are responsible for admitting patients, caring for them during their inpatient stay and discharging them. They may care for patients on behalf of community physicians, or may see only patients who do not have a primary care physician.
- How Can Patients Find Out What Medicare Coverage They Have?
- Call the Social Security Administration at 1.800.772.1213.
- If the patient needs help, someone else can be on the phone.
- The patient can authorize someone else to check for them by authorizing Medicare to release their information by downloading the "Appointment of Representative Form (Form CMS 1696-U4) from here or by calling 1.800.MEDICARE (663.4227)
- HSA (Health Savings Account)
- Individuals or families covered under a high-deductible health insurance plan during the year are eligible to contribute to an HSA. Here is some information on HSAs from Reed Tinsley, a Houston CPA and consultant:
- Money contributed into an HSA is tax-deductible. Either you contribute into an HSA on your own, or your employer contributes on your behalf.
- Money invested within the HSA is your money and grows tax-deferred. Unlike Flexible Spending Accounts (FSA) offered to you as part of your employee benefit package where you set aside a set amount of money to pay for your family's healthcare costs with pre-tax dollars, there is no "use it or lose it" pitfall with HSAs.
- Money can be withdrawn tax-free from your HSA at any time to pay for your family's healthcare expenses.
- Any money remaining in your HSA upon your reaching the age of 65 is available to subsidize your retirement.
- Web pages are written in HTML (HyperText Markup Language), the web programming language that tells web browsers how to structure and present content on a web page. In other words, HTML provides the basic building blocks for the web. And for a long time, those building blocks were pretty simple and static: lines of text, links and images. (definition courtesy of Google Chrome's "20 Things I Learned About Browsers and the Web")
- These questions led to the evolution of the latest version of HTML known as HTML5, a set of capabilities that gives web designers and developers the ability to create the next generation of great online applications. Take the HTML5 <video> tag, for example. Video wasn’t a major (or, really, any) part of the early web; instead, internet users installed additional software called plug-ins, in order to watch videos inside their web browsers. Soon it became apparent that easy access to video was a much-wanted feature on the web. The introduction of the <video> tag in HTML5 allows videos to be easily embedded and played in web pages without additional software. Other cool HTML5 features include offline capabilities that let users interact with web apps even when they don’t have an internet connection, as well as drag-and-drop capabilities. In Gmail, for instance, easy drag-and-drop allows users to instantly attach a file to an email message by simply dragging the file from the user’s desktop computer into the browser window. HTML5, like the web itself, is in perpetual evolution, based on users’ needs and developers’ imaginations. As an open standard, HTML5 embodies some of the best aspects of the web: it works everywhere, and on any device with a modern browser. But just as you can only watch HDTV broadcasts on an HD-compatible television, you need to use an up-to-date, HTML5-compatible browser in order to enjoy sites and apps that take advantage of HTML5’s features. Thankfully, as an Internet user, you have lots of choice when it comes to web browsers ”” and unlike TVs, web browsers can be downloaded for free. Definition courtesy of Google Chrome's "20 Things I Learned About Browsers and the Web"
- Incident To (Billing for Mid-level Providers)
- To bill "Incident To" in which the Mid-level Provider (MLP) provides the service, but the claim is filed under the physician's Medicare number:
- The services must be part of the patient’s normal course of treatment.
- The physician MUST have personally performed the initial service and remain actively involved in the course of treatment (Medicare does not define what “actively involved” means).
- The physician must provide direct supervision (must be in the office suite and immediately available to render assistance). I f there are no physicians in the office, then any services performed by the Mid-Level Provider (MLP) must be billed under the MLP’s own Medicare number.
- In a group practice, the supervising physician does not have to be the patient’s personal physician or the physician that initiated the initial service.
- If the visit qualifies as “incident to” the record must state who the supervising physician was and the service(s) must be billed under that physicians Medicare number. The documentation must clearly indicate the supervising physician’s presence in the office suite during the service.
- If a patient is being seen for a new problem, the MLP cannot bill the service as “incident to.” These visits would have to be billed under the MLP's Medicare number.
- New problems must be billed under the MLP's own Medicare number. If however, a MLP is seeing a patient in follow-up for the physician and a new problem is identified at that time, that visit can be billed “incident to.”
- In the hospital setting, “incident to” does not apply. Split/shared visits are possible as hospital E&M visits are reported according to the level of work done per day. Only one visit can be reported per DOS for any given provider, but the level of service billed may actually be comprised of the work done by a NPP and a physician from the same group practice done on separate encounters on the same DOS. This would typically be seen in the performance of a subsequent hospital visit. The visits would have to be medically necessary, performed separately, and documented separately. In the performance of an initial hospital visit, if the patient is new to the GROUP practice, the physician would be expected to perform the entire encounter.
- Unless required by state law, physicians are not mandated to read and/or co-sign a MLP's history and physical, progress note or other documentation.
- Incident-to services are reimbursed by Medicare at 100% of the 80% of the allowable, while services billed under a MLP's Medicare number are reimbursed by Medicare at 85% of the 80% of the allowable. Here's an example:
- Your charge is $150.00 for the service provided.
- The Medicare allowable for that service for your locality is $120.
- Medicare will pay 80% of the allowable, or $96.00, and the patient will pay 20% of the allowable, or $24.
- If you filed this under a physician's Medicare number as "incident-to", the practice will receive 100% of the 80% of the allowable, or $96.00.
- If you filed this under a MLP's Medicare number, the practice will receive 85% of the 80% (85% of $96.00) or $81.60 and the patient's portion would remain $24.00.
- You will write off $30 as non-allowable if billing incident-to and you will write-off $44.40 as non-allowable if billing under the MLP's Medicare number.
- Other payers allow MLPs to apply for and bill under their own provider numbers, while some only recognize the physicians and MLPs will bill under those physician numbers. Check with each payer with whom you contract.
- Income Statement
- The Income Statement reveals a profit or a loss for a specific accounting period. The statement itemizes income, cost of goods, operating expenses and other income/expense data.
- Individual Coverage Market
- For people unable to receive health coverage through their employer or the government, the Affordable Care Act legislation will create a competitive marketplace for buying coverage from insurers at the state-specific level.
- INR (International Normalized Ratio) and PT (Prothrombin Time) or "Pro Time"
- Prothrombin time (PT) evaluates the ability of blood to clot properly, it can be used to help diagnose bleeding. The PT may be ordered when a patient who is not taking anti-coagulant drugs has signs or symptoms of a bleeding disorder, which can range from nosebleeds, bleeding gums, bruising, heavy menstrual periods, blood in the stool and/or urine to arthritic-type symptoms (damage from bleeding into joints), loss of vision, and chronic anemia. Sometimes the PT may be ordered when a patient is to undergo an invasive medical procedure, such as surgery, to ensure normal clotting ability. The International Normalized Ratio (INR) is used to monitor the effectiveness of blood thinning drugs such as warfarin (Coumadin). These anti-coagulant drugs help inhibit the formation of blood clots. They are prescribed on a long-term basis to patients who have experienced recurrent inappropriate blood clotting. This includes those who have had heart attacks, strokes, and deep vein thrombosis (DVT). Anti-coagulant therapy may also be given as a preventative measure in patients who have artificial heart valves and on a short-term basis to patients who have had surgeries, such as knee replacements. The anti-coagulant drugs must be carefully monitored to maintain a balance between preventing clots and causing excessive bleeding. Information provided by the American Association of Clinical Chemistry site here (1-2010).
- Integrated Healthcare Delivery System
- An integrated delivery system (IDS) is a network of healthcare providers and organizations that provide or arrange to provide a coordinated continuum of services. Services provided by an IDS can include a fully equipped community and/or tertiary hospital, home healthcare and hospice services, primary and specialty outpatient care and surgery, social services, rehabilitation, preventive care, and health education (Washington Hospital Association).
- Interoperability (hospitals)
- (as defined by HIMSS- Health Information and Management Systems Society) -not yet defined for ambulatory care
- Must have all ancillary systems online - Lab, radiology, & pharmacy (Stage 1)
- Must be leveraging a clinical data repository (Stage 2)
- Utilizing clinical documentation to record patient status during treatment (Stage 3)
- Computerized Physician Order Entry (CPOE) mechanisms in use (Stage 4)
- Be able to exchange Continuity of Care Documents (CCD) with other entities (a portion of Stage 7)
- Interoperability (in general)
- The ability of disparate computer systems to easily talk to each other and exchange information. For instance, your practice management system talks to your lab system and your PACS and your EMR and the hospital EMR and ....
- It's A Dog's World Training Video
- This 14-minute video is a staple for training medical office staff to see things from the patient's perspective. The video tells the parallel stories of Bob, a patient with a hurt shoulder, and his dog Max, visiting the veterinarian for a hurt paw. The two patients are treated quite differently by their healthcare personnel. The video is in its second edition, and comes with a Leader's Guide, Power Point Program, Participant Worksheets and branded materials (reminder cards, notepads, stuffed dogs, lanyards, pens, etc.) The video can be purchased ($700) or rented ($225). Be sure to check with your local hospital to see if they own the video and make it available for borrowing. Purchase is not cheap, but it does get the point across extremely well and has good support materials for training staff on customer service. If managers use it for training existing employees, then incorporate it into new employee orientation, and use the concepts as performance requirements for annual evaluations, the cost/benefit ratio is excellent. I've seen it a number of times and it still makes me laugh!
- Jumping the Shark
- Jumping the Shark means that the craze has ended. The Urban Dictionary describes it as "a term to describe a moment when something that was once great has reached a point where it will now decline in quality and popularity. Origin of this phrase comes from a Happy Days episode where the Fonz jumped a shark on waterskis. Thus was labeled the lowest point of the show."
- KLAS (technology evaluation company)
- Pronounced like "class", KLAS is an independently owned and operated healthcare technology company headquartered in Orem, Utah whose mission is "To improve healthcare technology delivery by honestly, accurately, and impartially measuring vendor performance for our provider partners."
The name KLAS comes from the first initials of the founders' names: Kent Gale, Leonard Black, Adam Gale, and Scott Holbrook.
KLAS evaluates technology products in the categories of:
- healthcare software vendors (since 1997)
- professional services to healthcare providers including implementation, planning and assessment, vendor selection, technical consulting, IT outsourcing, and business process outsourcing (since 2004)
- research on medical equipment, including CR/DR and MRI scanners (since 2005)
KLAS data and reports represent the combined opinions of actual people from provider organizations comparing how vendors, products, and/or services performed when measured against the participant’s objectives and expectations. KLAS findings are a unique compilation of candid opinions and are real measurements representing those individuals interviewed. Findings are not meant to be conclusive data for an entire client base. KLAS provides the findings as valuable data points to be used with other data points in the reader’s overall analysis. We encourage our clients, friends, and partners using KLAS research to take into account the following statements as they include KLAS data in their other due diligence.Reports can be purchased by healthcare providers for +/- $1000. Considering the amount of time and money invested in technology, $1000 sounds like a reasonable price to me.
- Living Will
- A Living Will is a type of Advance Directive which comes into play when you are terminally ill (expected to live less than 6 months.) A living will allows you to describe the kind of care you want based on certain life-states.
- A term referring to a service that:
- collects mail delivered to a special practice Post Office Box (typically only payments)
- opens the mail and discards the envelopes
- separates the checks from the accompanying paperwork
- scans or copies the checks and the accompanying paperwork
- itemizes the checks on an electronic or manual deposit slip
- deposits the checks in the practice's bank account or makes scanned copies available to the bank
- returns the original checks/paperwork to the practice, or holds it in-house for a period before shredding
- makes the electronic or paper copies accessible to the practice for posting to the practice management system
- Long Tail (Courtesy of hittail.com)
- Magnet Hospital or Institution
- The Magnet Recognition Program was created by the American Nurses Credentialing Center (ANCC) to recognize healthcare organizations that provide nursing excellence. Institutions designated as "magnet" hospitals are recognized for their ability to attract and retain professional nurses.
- Malware is malicious software installed on your machine, usually without your knowledge. You may be asked to download an anti-virus software that is actually a virus itself. Or you may visit a page that installs software on your computer without even asking. The software is really designed to steal credit card numbers or passwords from your computer, or in some cases, harm your computer. Once the malware is on your computer, it’s not only difficult to remove, but it’s also free to access all the data and files it finds, send that information elsewhere, and generally wreak havoc on your computer. (definition courtesy of Google Chrome's "20 Things I Learned About Browsers and the Web")
- Managing By Walking Around (MBWA)
- Considered by many to be the most useful and realistic management theory ever, MBWA is the concept that you need to be present in the area you are managing to be an effective manager. MBWA includes:
- making rounds in every area several times daily
- touching base with each employee to see how they are, if they are having any issues and if there is anything they need help with
- modeling appropriate behavior and customer service by greeting patients, picking up the phone if there is no one else to do it, picking up paper off the floor, etc.
- checking to make sure machines are operating properly, staff are following protocols, there are no bottlenecks anywhere, and there are no signs of trouble brewing.
- Match Day and Stable Marriage
- "Stable Marriage" is a data matching system that solves the question of how to match one set of people with another set of people based on asking each of the groups what they prefer the most.
This system is probably best known as that which matches medical school graduates with residency programs for which they have a preference. Each applicant presents a ranked list of programs and each program presents a ranked list of applicants. Being matched is the answer to providing each with the answer that most closely matches the needs and desires of each.
Brian Eule is the author of Match Day: One Day and One Dramatic Year in the Lives of Three New Doctors and says this about Match Day:
Match Day is the culmination of four years of study, and months of an intense process leading up to this moment. These students have applied to hospitals and residency programs, selecting the field of medicine they hope to work in, the city they hope to live in. They have interviewed with doctors and program directors. They have created lists ranking their top choices, as have the residency programs, submitting it to a computer program to make their match. And they have waited, wondering where they will work and train in just a few short months after their medical school graduations. Today, inside those envelopes, a fragment of a sentence on a single sheet of paper, will inform them where they will begin this important stage of their lives.Brian's comments appeared on KevinMD's blog.
- Maturialism is, well, it seems to be me! It is a population segment that trendwatching.com describes as "experienced, less-easily shocked, outspoken consumers who appreciate brands that are a little bit more daring and outspoken" according to website MarketingCharts.com.
- MAUDE (Manufacturer and User Facility Device Experience)
- MAUDE stands for Manufacturer and User Facility Device Experience and is the FDA’s database of voluntary reports of adverse events caused by medical devices. EMRs can fall under the category of medical devices and there are some reports about deficits in EMR CPOE (Computer Physician/Provider Order Entry) related to their ability to choose specific drug dosages for prescribing. You can find MAUDE here.
- Meaningful Use
- To qualify as a “meaningful user,” eligible providers must demonstrate use of a “qualified EHR” in a “meaningful manner.” ARRA defers to the secretary of Health and Human Services (HSS) to set specific guidelines for determining what constitutes a “qualified EHR”; however, it does specify that e-prescribing, electronic exchange of medical records, and interoperability of systems will be determining criteria. Starting in 2011, providers deemed to be “meaningful users” of EHR systems will be eligible to receive $40,000 - $60,000 in incentive payments paid out over five years in the form of increased Medicare and Medicaid payments.
- Meaningful Use
- The 2009 Health Information Technology for Economic and Clinical Health Act (HITECH Act) is part of the American Recovery and Reinvestment Act (ARRA) which included funding for Medicare and Medicaid incentives for the ‘Meaningful Use” (MU) of certified electronic health records (EHRs). The intent of the legislation is to promote the use of EHR technology to:
- Improve quality, safety, efficiency, and reduce health disparities
- Engage patients and families in their healthcare
- Enhance care coordination
- Support population and public health
- Medicaid is a medical assistance program that pays medical bills for people who meet certain eligibility requirements (such as income, age, or disability) which are based on Federal regulations and State law. Medical benefits may be authorized for services such as hospitalizations, physician services, medications and different levels of care in nursing and residential facilities.
Medicaid may help pay for certain medical expenses such as:
- Doctor Bills
- Hospital Bills
- Prescriptions (Excluding prescriptions for Medicare beneficiaries)
- Vision Care
- Dental Care
- Medicare Premiums
- Nursing Home Care
- Personal Care Services (PCS), Medical Equipment, and Other Home Health Services
- In-home care under the Community Alternatives Program (CAP)
- Mental Health Care
- Most medically necessary services for children under age 21
- Medical Loss Ratio
- This is the fraction of the collected insurance premium revenue dedicated to providing health services and improving the quality of care compared to the total revenue that includes expenditure for business administration, marketing, and profit.
- Medical Record
- The medical record is a set of electronic or paper documentation relating to the care of a patient. The electronic record may also be called an Electronic Medical Record (EMR) and the paper medical record may also be called a patient chart.
- Medicare Drug Coverage Gap/“Donut Hole”
- This is a voluntary medication benefit program that started in 2006. Participants with a standard plan have 75 percent of their drug costs covered until they reach a cost of $2,830. Any expense higher than this is paid out of pocket until the cost reaches $4,550. Once costs reach this amount, 95 percent of costs are covered by Medicare.
- Medicare Timely Filing Limit (as of January 1, 2010)
- MM6960 ”“ Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months
"The Centers for Medicare & Medicaid Services (CMS) is updating edit criteria related to the timely filing limits for submitting claims for Medicare Fee-for-Service (FFS) reimbursement. As a result of the PPACA, claims with dates of service on or after January 1, 2010 received later than one calendar year beyond the date of service will be denied by Medicare. "The entire article available here (pdf.)
- Medicare Window
- The Medicare Window is the 30-day period during which Medicare will pay for a patient to be readmitted to a Skilled Nursing Facility (SNF - pronounced "sniff") facility under the following criteria:
- the patient has received Part A benefits covering a stay in an acute hospital or skilled nursing center within the past 30 days
- the patient requires rehabilitative services or skilled nursing care
- the patient has days remaining on their skilled nursing Part A, 100-day benefit period
- the patient has physician orders for readmission
- Medicare: Participating, Not Participating and Opting Out
- If the provider participates ("par"), he agrees to accept the Medicare-approved amount as payment in full ”” called accepting assignment ”” and Medicare will pay 80 percent of this approved amount, after the deductible is met. The patient is responsible for the deductible and the other 20 percent. The provider cannot charge patients any more than the Medicare-approved amount. If the provider does not participate ("non-par"), he does not accept the Medicare-approved amount as payment in full (does not accept assignment), but nonetheless treats Medicare patients. He can charge up to 15 percent more for his services (called the limiting charge) than the Medicare-approved amount and can request full payment up front from patients. He probably should request payment in full, because Medicare will send the payment to the patient when the provider does not accept assignment. If the provider opts out of Medicare entirely, he is not subject to the Medicare limits on charges and does not submit claims to Medicare. In this situation, the provider asks the patient to sign a private contract in which the patient accepts responsibility for the full cost of the services. In the case of this contract, Medicare will not pay for any portion of the services the patient receives.
- MML (Medical Markup Language)
- The MML is the specification for optimum exchange of clinical data between different clinical institutions. The database can be considered to be a kind of table. Each institution uses a uniquely defined table. Therefore, the exchange of a simple data set such as that includes address, name, diagnosis, etc. may lead to different sequence of data between institutions. If such data is transmitted as is, the data sequence changes. To allow for proper exchange, the database for all clinical systems should be integrated into the same structure. However this is impractical as all systems currently operating throughout the country world have to be rewritten. The MML (Medical Markup Language) is a standard format for data exchange which we have studied for the purpose above. The latest version MML has been developed via XML technology. To ensure that the specification is available for multiple electronic medical chart systems, the data is converted into MML documents (MML instances) for data exchange with other institutions. (Fig. 1) The institution receiving the data converts the MML data into its own format for mapping to the database. This allows for the data exchange for clinical institutions throughout the country while maintaining the uniqueness of each institution. Each system is designed by each vendor on a competitive basis. The principle of competition will lead to the development of a better system of operation. (definition by Hiroyuki Yoshihara, MML-WG, Electronic Health Record Research Group)
- MRSA (pronounced "mer - sa") is Methicillin Resistant Staphylococcus Aureus is a strain of Staph bacteria that is resistant to many commonly-used antibiotics. Multiple reasons exist for the development of MRSA, but overusage of antibiotics in humans as well as animals are major factors. (1-2010)
- NCCI (National Correct Coding Initiative)
- The CMS (Centers for Medicare and Medicaid Services) developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The CMS developed its coding policies based on coding conventions defined in the American Medical Association's CPT manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services (Coding Policy Manual). The Coding Policy Manual should be utilized by carriers and FIs (Fiscal Intermediaries) as a general reference tool that explains the rationale for NCCI edits. Carriers implemented NCCI edits within their claim processing systems for dates of service on or after January 1, 1996. More information from CMS here.
- NIST (National Institute of Standards and Technology)
- NIST is the federal technology agency that works with industry to develop and apply technology, measurements, and standards. NIST recently (August 2010) released the approved testing procedures for evaluating EHRs and EHR modules to the standards, implementation specs and certification criteria for The Office of the National Coordinator for Health Information Technology (ONC's) Temporary Certification Program. These procedures will be used by federally authorized testing and certification bodies (ATCB's) who will be announced in September 2010. (Information courtesy of Healthcare Technology News.)
- NNT (Number Needed to Treat)
- Number Needed to Treat (NNT) is “a measurement of the impact of a medicine or therapy [that estimates] the number of patients that need to be treated in order to have an impact on one person.” A perfect NNT would be one ”” treat one person, and one person benefits. The higher the NNH, the better. A group of emergency medicine physicians recently launched the site www.TheNNT.com for the purpose of aggregating information from studies about the effectiveness of different treatments. It's really pretty neat (yes, I'm a boomer) and I'm going to tell my docs about it.
- Non-doctor providers - what's the difference between a NP and a PA?
- A Nurse Practitioner is a registered nurse (RN) who also has a Master’s degree and clinical experience. A NP chooses a particular specialty during their training and works under the supervision of a physician. NPs can have their own patient panels and can write prescriptions in most states. They are trained in the nursing model.
A Physician Assistant is a licensed professional who has passed the national certificated exam that is administered by the National Commission on Certification of Physician Assistants. They do not choose a specialty during training, but complete a clinical rotation through various specialties. PAs work under the supervision of a physician, can have their own patient panels and can write prescriptions in most states. They are trained in the medical model.
NPs and PAs are also called:
- mid-level providers (MLPs)
- physician extenders
- non-physician providers (NPPs)
- NPI Number (National Provider Identifier)
- The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires issuance of a unique national provider identifier (NPI) to each physician, supplier, and other provider of health care (45 CFR Part 162, Subpart D (162.402-162.414).
To comply with this requirement, the Centers for Medicare & Medicaid Services (CMS) began to accept applications for, and to issue NPIs, on May 23, 2005.
Beginning May 23, 2007 (May 23, 2008, for small health plans), the NPI must be used in lieu of legacy provider identifiers. Legacy provider identifiers include:
- Online Survey Certification and Reporting (OSCAR) system numbers;
- National Supplier Clearinghouse (NSC) numbers;
- Provider Identification Numbers (PINs); and
- Unique Physician Identification Numbers (UPINs) used by Medicare.
- Employer Identification Numbers (EINs); or
- Social Security Numbers (SSNs).
- Occam's Razor (sometimes spelled "Ockham")
- William of Ockham was a 14th-century English logician, theologian and Franciscan friar and although Occam's Razor bears his name, it is suspected that he did not originate it, only that he repeated it repeatedly! Occam's Razor is the principle that "entities must not be multiplied beyond necessity." The popular interpretation of this principle is that the simplest explanation is usually the correct one. However, this is often confused, as the 'simple' "is really referring to the theory with the fewest new assumptions." Occam's Razor is also referred to as the law of parsimony, law of economy or law of succinctness, and has also inspired expressions such as "parsimony of postulates", the "principle of simplicity", the "KISS principle" (Keep It Simple, Stupid).
- Office of the National Coordinator for Health Information Technology. In 2004 the position was created by by Presidential Executive Order. In March 2009, President Obama appointed David Blumenthal, M.D., M.P.P. to the position. The primary purpose of this position is to aid the Secretary of HHS in achieving the President’s goal for most Americans to have access to an interoperable electronic medical record by 2014 (from the HHS.gov website.)
- A study currently under way, called the OpenNotes project, is looking at what happens when doctors' notes become available for a patient to read, usually on electronic medical records. In a report on the early stages of the study, published Tuesday in the Annals of Internal Medicine, researchers say that inviting patients to review the records can improve patient understanding of their health and get them to stick to their treatment regimens more closely. The year-long OpenNotes study, funded with a $1.5 million grant from the Robert Wood Johnson Foundation, involves 25,000 patients and their primary-care physicians at Beth Israel Deaconess, Geisinger Health System in Danville, Pa., and Harborview Medical Center in Seattle. "We want to break down an important wall that currently separates patients from those who care for them," says lead investigator Tom Delbanco, a Harvard Medical School professor who treats patients at Beth Israel. (excerpted from "What the Doctor is Thinking" WSJ, July 20, 2010)
- The early creators of the Internet discovered that data and information could be sent more efficiently when broken into smaller chunks, sent separately, and reassembled. Those chunks are called packets. So when you send an email across the Internet, your full email message is broken down into packets, sent to your recipient, and reassembled. The same thing happens when you watch a video on a website like YouTube: the video files are segmented into data packets that can be sent from multiple YouTube servers around the world and reassembled to form the video that you watch through your browser. (definition courtesy of Google Chrome's "20 Things I Learned About Browsers and the Web")
- The WHO (World Health Organization) Level 6 requirement for a pandemic requires serious outbreaks in communities in two or more different WHO regions.
According to the WHO, a pandemic can start when three conditions have been met:
- Emergence of a disease new to a population.
- Agents infecting humans, causing serious illness.
- Agents spreading easily and sustainably among humans.
- Pareto Principle (the 80/20 rule)
- Popularly called the 80/20 Rule, the Pareto Principle states that in any system, you can generally count on 80% of the effect to come from just 20% of the causes. My favorite truism is that 20% of your staff creates 80% of your problems.
- Participatory Medicine
- Participatory Medicine is a model of medical care in which patients are active in the management of their health. For a comprehensive article on Participatory Medicine in the AmedNews (January 2010) click here.
- Patient Registry
- To deliver the most appropriate care to specific cohorts within a population, providers are encouraged to keep lists of patients who have common conditions or concerns. These registries can be paper-based or preferably computerized. With these lists, physicians and other providers can institute disease or condition management programs for patients with illness burdens or track others for their completion of appropriate screenings, for example.
- Patient Safety
- The domain dedicated to preventing and reducing the harm that may be caused during a patient’s interaction with the medical system. This can help improve healthcare outcomes while reducing costs.
- Pay Wall
- You see a tidbit about an article that sounds interesting, but when you click on the link you get just a few lines of the article and are encouraged to subscribe to an organization so you can gain access to the rest of the article. You have just hit a Pay Wall.
- Payment Integrity
- Payment integrity is the process by which the correct payments for the correct covered lives, for the correct services are paid to the correct provider(s). This process involves detecting and minimizing fraud, waste, abuse, and misuse of healthcare dollars.
- PECOS (Provider Enrollment and Chain/Ownership System)
- Q: How do I know if I need to enroll in the Medicare PECOS (Provider Enrollment and Chain/Ownership System) or if I am already enrolled in PECOS?
A: You need to be enrolled in PECOS (pronounced "pay-cose") if:
- You participate in Medicare or do not participate in Medicare but see Medicare patients. (See "Medicare" under the Definitions tab above for additional explanation of the difference.)
- You write prescriptions or orders for durable medical equipment (walkers, canes, crutches, etc.), prosthetics or supplies for Medicare patients, even if you have opted out of Medicare and do not receive payments from Medicare. A list of provider types is here:
- ”¢ doctor of medicine or osteopathy ”¢ doctor of dental medicine ”¢ doctor of dental surgery ”¢ doctor of podiatric medicine ”¢ doctor of optometry ”¢ doctor of chiropractic medicine ”¢ physician assistant ”¢ certified clinical nurse specialist ”¢ nurse practitioner ”¢ clinical psychologist ”¢ certified nurse midwife ”¢ clinical social worker
- You are a mid-level provider who does not bill Medicare under your own name/billing number, but who does write prescriptions or orders for durable medical equipment and/or refer patients to other providers.
- Personal Health Record
- A personal health record (PHR) is a patient’s healthcare profile. Unlike an electronic medical record or electronic health record, these data are collected and maintained by the individual. In the future, PHRs will be electronically connected to provider EHRs for secure and private exchange of approved information.
- Phishing takes place when someone masquerades as someone else, often with a fake website, to trick you into sharing personal information. (It’s called “phishing” because the bad guys throw out electronic bait and wait for someone to bite.) In a typical phishing scam, the attacker sends an email that looks like it’s from a bank or familiar web service you use. The subject line might say, “Please update your information at your bank!” The email contains phishing links that look like they go to your bank’s website, but really take you to an impostor website. There you’re asked to log in, and inadvertently reveal your bank account number, credit card numbers, passwords, or other sensitive information to the bad guys. (definition courtesy of Google Chrome's "20 Things I Learned About Browsers and the Web")
- PHR or ePHR
- An electronic, cumulative record of health-related information on an individual, drawn from multiple sources, that is created, gathered, and managed by the individual. The integrity of the data in the ePHR and control of access to that data is the responsibility of the individual.
- Pillbox is a website that was developed to aid in the identification of unknown solid dosage pharmaceuticals. The system combines high-resolution images of tablets and capsules with FDA-approved appearance information (imprint, shape, color, etc.) to enable users to visually search for and identify an unknown solid dosage pharmaceutical. This system is designed for use by emergency physicians, first responders, other health care providers, Poison Control Center staff, and concerned citizens. Description courtesy of the Pillbox website. Click here.
- Pipes, Sally C.
- According to the Pacific Research Institute website:
"Sally C. Pipes is Taube Fellow in Health Care Studies, president and chief executive officer of the Pacific Research Institute, a San Francisco-based think tank founded in 1979. Prior to becoming president in 1991, she was assistant director of the Fraser Institute, based in Vancouver, Canada.
"Her first book, Miracle Cure: How to Solve America’s Health Care Crisis and Why Canada Isn’t the Answer with a foreword by Milton Friedman was released September 28, 2004."
"In October 2008, her second book The Top Ten Myths of American Health Care: A Citizen’s Guide with a foreword by Steve Forbes, was published."
In her new book published in 2010, The Truth About Obamacare, Ms. Pipes discusses her views that the Affordable Care Act will not save money or lead to improved health care for America.
- From by Jeffrey Hall Dobken, MD via www.KevinMD.com "POLST stands for “Physician Orders for Life-Sustaining Treatment”. It is a next generation replacement for an Advanced Directive and DNR (“Do Not Resuscitate”) order. Advanced planning documents turn out to be less than useful, especially in urgent care settings, and many patients receive more aggressive care than they might want because universal, transferable physician orders are unavailable or, simply, not applicable because a patient is in a different care setting."
- PPI (Physician Preference Item)
- Physician Preference Item (PPI) is a term used to describe a range of medical supplies including orthopedic implants and cardiovascular devices which physicians choose on behalf of their patient. PPIs are estimated to be a significant portion of a facility's supply costs, and as such, are now the target of potential policy changes away from the current philosophy which allows physicians a free choice when it comes to devices and implants. Devices and implants are often bundled into the facility cost of a procedure/surgery, and many payers will not pay separately for a device/implant, leaving the hospital or ASC (ambulatory surgery center) to "eat" the cost.
- Pre-existing Conditions
- Pre-existing conditions are health concerns that exist prior to an individual’s enrollment in a health plan. Historically, illness burden has precluded an individual from qualifying for coverage or finding affordable rates.
- Preventive Services
- Preventive care services have a threefold purpose. They can reduce health risks by engaging in wellness promotion. They can promote screening or testing to ensure early detection and diagnosis of conditions, and they can provide interventions to prevent disabilities, mortality, and morbidity caused by disease.
- Principles, Laws, & Effects You Need to Know (courtesy of Wikipedia)
- Amara's law ”” "We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run." (think EMR)
- QALY (Quality-Adjusted Life Year)
- The quality-adjusted life year (QALY) is a measure of disease burden, including both the quality and the quantity of life lived. It is used in assessing the value for money of a medical intervention. The QALY model requires utility independent, risk neutral, and constant proportional trade off behavior. The QALY is based on the number of years of life that would be added by the intervention. Each year in perfect health is assigned the value of 1.0 down to a value of 0.0 for death. If the extra years would not be lived in full health, for example if the patient would lose a limb, or be blind or have to use a wheelchair, then the extra life-years are given a value between 0 and 1 to account for this.
- QR (Quick Response) Bar Code
- Recorded Future (a company)
- Recorded Future is a temporal analytics engine that evaluates topics of interest. The topic's exposure and conversation in the media generate a timeline, activity line and sentiment temperature index that one might predict future activity from.
The Recorded Future site suggests some potential uses of their services:
- Financial Analyisis & Trading
- Competitive Intelligence Research
- Brand monitoring
- Recruiters / Search Firms / Head Hunters
- There are two models for search firms, retained and contingency.
A retained firm works for the organization and is paid a flat fee upfront (a retainer) to launch the search and an additional fee when the position is filled. Retained firms usually visit your community to understand your needs and culture, carefully sourcing candidates who will be a good fit for your organization. Retained firms are often the answer for hard-to-recruit for locations or specialties.
A contingency firm works for the candidate and is paid if/when you hire a candidate they found for you. There is an agreement that you sign before they present any candidates stating that you will agree to pay them if you hire anyone they have introduced to you, typically within 12 months of the introduction. You may sign an agreement with as many contingency firms as you like. There is a great variance in candidates sent by different firms - some are pre-screened and some are not. Because their goal is to place candidates, they may well be presenting a candidate to you and to your competition simultaneously. Make sure that a contingency firm presents a name to you before sending a CV in case another firm has also presented the same candidate. Some firms charge a flat fee and some charge a percentage of the hired employee's first year gross salary. Contingency firm fees hover around $10K for mid-level providers (nurse practitioners and physician assistants) and around $20K for physicians.
Some recruiters have the reputation of being out for themselves and not serving their clients (candidates and organizations), but instead only serving themselves. The professional organization for physician recruiting organizations is the National Association of Physician Recruiters (NAPR) which has a Code of Ethics that members must adhere to. You can research member firms here.
On the NAPR website, it notes a collaboration with MGMA:
MGMA, in collaboration with NAPR, surveys its membership to obtain the most recent physician starting salary placement compensation data. This is the fourth year of data collection and the third year of stand-alone publication for the Physician Placement Starting Salary Survey report. The report provides accurate data on the range of physician placements to assist recruiters and health care organizations in benchmarking salaries and other employment terms. The report also allows users to compare and learn more about the factors affecting first-year placement compensation. All survey participants receive a complimentary copy of the Physician Placement Starting Salary Survey
- Revenue Cycle
- The revenue cycle for a medical practice is the process of collecting reimbursement for a provided service. Some of the common steps are:
- Development of a "retail" fee schedule and a financial policy (payment practices.)
- Negotiating and signing payer contracts to accept specific fee schedules for services.
- Providing services to patients and collecting patient-responsibility portions at the time of service.
- Posting charges for services rendered and billing payers (filing claims.)
- Receiving payments from payers; appealing payments when not compliant with contracts.
- Sending statements to patients for any remaining portions due.
- Writing balances off the accounts receivable or sending patients to collection agencies/reporting agencies (credit bureaus) or pursuing legal action if patient payments are not made.
- Risk Pool
- If individuals had to pay for their healthcare costs each year without insurance, some families would become bankrupt when faced with a catastrophic illness and a very large medical bill. The insurance industry was born to help large groups of people share the risk burden each year. Each participant bears only a fraction of the total risks and costs through premium insurance payments by joining the risk pool.
- Ryan White CARE Act
- The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was enacted August 18, 1990 by the U.S. Congress. Ryan White was an Indiana teenager who contracted AIDS through a tainted hemophilia treatment and was expelled from school because of the disease. White became a well-known advocate for AIDS research and awareness until his death on April 8, 1990.
- The act is the United States's largest federally funded program for people living with HIV/AIDS. The act sought funding to improve availability of care for low-income, uninsured and under-insured victims of AIDS and their families.
- Unlike Medicare or Medicaid, Ryan White programs are "payer of last resort," which fund treatment when no other resources are available. As AIDS has spread, the funding of the program has increased. In 1991, the first year funds were appropriated, around US$220 million were spent; by the early 2000s, this number had almost increased 10-fold. The Ryan White Care Act was reauthorized in 1996, 2000 and 2006. The program provides some level of care for around 500,000 people a year and, in 2004, provided funds to 2,567 organizations. The Ryan White programs also fund local and State primary medical care providers, support services, healthcare provider training programs, and provide technical assistance to such organizations.
- Information courtesy of Wikipedi.
- Safety Net (Healthcare)
- A healthcare safety net hospital or health system is one that provides a significant level of care to low-income, uninsured, and vulnerable populations.
- Safety Net Hospital
- Safety net hospitals are defined as providing a "disproportionate share of services to Medicaid and uninsured patients."
- SBAR (communication format)
- SBAR stands for Situation, Background, Assessment and Recomendation and is pronounced "S - BAR."
SBAR is a standard format initially utilized by nurses to bring a physician up to speed on a problem. At some point in time, it was realized that nurses and physicians communicate differently. Generalizing, nurses want to "tell the story" of a problem and physicians want "the headlines."
The IHI (Institute for Healthcare Improvement) says:
The safety attitudes questionnaire administered at Kaiser Permanente identified that physician and nurse perceptions of teamwork were significantly different. Physicians tended to view the care environment as fairly collaborative, whereas nurses saw it as much less so. To address the issue, Kaiser Permanente developed a communication tool that was adapted from the US Navy, called SBAR. SBAR is an easy-to-remember, concrete mechanism useful for framing any conversation, especially critical ones, requiring a clinician’s immediate attention and action. It allows for an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety. S=Situation (a concise statement of the problem) B=Background (pertinent and brief information related to the situation) A=Assessment (analysis and considerations of options ”” what you found/think) R=Recommendation (action requested/recommended ”” what you want)
- Second Life (SL)
- Second Life is a virtual world accessible via the Internet. A free program called the Second Life Viewer enables its users called Residents, to interact with each other through avatars (two-dimensional representations of people.) Residents can explore, meet other residents, socialize, participate in individual and group activities, and create and trade virtual property and services with one another, or travel throughout the world, which residents refer to as the grid. Second Life is for people aged 18 and over, while Teen Second Life is for people aged 13 to 17. (definition adapted from Wikipedia) Among many other applications, SL is used to simulate situations in healthcare and teach clinical students in an almost real-world setting. In 2009, Medical Group Management Association (MGMA) used Second Life as part of its virtual conference.
- Shadow Billing (hospitals)
- "Shadow billing", synonymous with "no pay" or "information only" claims, is an unofficial term that refers to the process wherein hospitals submit claims to their Medicare Administrative Contractor (MAC) for inpatient services provided to Medicare beneficiaries who are enrolled in a Medicare Advantage (MA) plan. These claims are submitted, as per instructions from CMS through a series Transmittals, for the purpose of requesting supplemental Indirect Medicare Education (IME), Graduate Medical Education (GME), and Nursing Allied Health Education (NAHE) payments, and for the proper reporting of Medicare beneficiary days to be counted in the Medicare fraction of the Disproportionate Share Hospital (DSH) calculation. (Definition courtesy of IMA Consulting.)
- Smartphones in Healthcare
- A smartphone is a mobile phone with PC-like functionality and advanced capabilities ”“ essentially a miniature computer that combines phone, email, texting, and Inter- net service. According to a study by Manhattan Research, 64 percent of U.S. physicians own smartphones and analysts predict penetrationwill increase to 81 percent by 2012. Since most nurses and physicians have either used a smartphone or a mobile phone, the learning curve that usually occurs when new devices or equipment is introduced to a workplace would prove minimal. Smartphones, such as the iPhone, natively support the latest network security protocols and standards that are essential to protect confidential patient data. (courtesy of voalte) Other resources:
- SOAP Note
- SOAP stands for Subjective, Objective, Assessment and Plan. It is a standard format for documenting a patient encounter and can be used both for face-to-face encounters as well as triage phone calls.
Subjective = what the patient reports as the problem, symptoms, location, duration, severity, etc.
Objective = the visual and physical examination of the patient (does not apply to phone triage)
Assessment = the diagnosis, or possible diagnosis of the problem
Plan = what the next step in treating the problem will be (medication, tests, referral, follow-up) or in the case of phone triage (work-in appointment vs. home instructions vs. ER)
- Social Media
- Social media is media designed to be distributed through social interaction using Internet and web-based technologies. Social media use is said to be the defining factor in the idea that the current period in time will be defined as the "Attention Age."
Wikipedia lists the following information and examples of social media:
Social media can take many different forms, including Internet forums, weblogs, social blogs, wikis, podcasts, pictures, video, rating and bookmarking. Technologies include: blogs, picture-sharing, vlogs, wall-postings, email, instant messaging, music-sharing, crowdsourcing, and voice over IP, to name a few. Many of these social media services can be integrated via social network aggregation platforms like Mybloglog and Plaxo. Examples:
- Blogs: Blogger, LiveJournal, Open Diary, TypePad, WordPress, Vox, ExpressionEngine, Xanga
- Micro-blogging / Presence applications: FMyLife, Jaiku, Plurk, Twitter, Tumblr, Posterous, Yammer
- Social networking: Bebo, Elgg, Facebook, Geni.com, Hi5, LinkedIn, MySpace, Ning, Orkut, Skyrock
- Social network aggregation: NutshellMail, FriendFeed
- Events: Upcoming, Eventful, Meetup.com
- Wikis: Wikipedia, PBworks, Wetpaint
- Social bookmarking (or social tagging): Delicious, StumbleUpon, Google Reader, CiteULike
- Social news: Digg, Mixx, Reddit, NowPublic
- Opinion sites: epinions, Yelp
- Photography and art sharing: deviantArt, Flickr, Photobucket, Picasa, SmugMug, Zooomr
- Video sharing: YouTube, Viddler, Vimeo, sevenload
- Livecasting: Ustream.tv, Justin.tv, Stickam, Skype
- Music and audio sharing: imeem, The Hype Machine, Last.fm, ccMixter, ShareTheMusic
- Reviews and opinions
- Product reviews: epinions.com, MouthShut.com
- Business reviews: Customer Lobby, yelp.com
- Community Q&A: Yahoo! Answers, WikiAnswers, Askville, Google Answers
- Social Networking
- Social media researchers Danah Boyd of Microsoft Research New England in Cambridge, Mass., and Nicole B. Ellison of Michigan State University define social networking as having three distinct features
- they must provide a forum where users can construct a public or semipublic profile;
- create a list of other users with whom they share a connection;
- and view and move around their list of connections and those made by others.
- SRDP (self-referral disclosure protocol)
- SRDP is the requirement for physicians to disclose ownership in ancillary entities and to provide patients with alternatives.
- SSO (single sign on)
- A SSO server stores passwords in a safe database and makes it available to the user transparently during the login process. The end result is that the user has to sign in just once.
- Starting and Ending the Day Protocols
- Starting the Day:
- Disarm the burgler alarm.
- Turn on the lights.
- Check the condition of the office - did the cleaners miss anything? Check the patient bathrooms for cleanliness and supplies.
- Check that yesterday's specimens were picked up by the lab.
- Make coffee.
- Turn on the copiers to give them a chance to warm up. Make sure all copiers and faxes are full of paper.
- If you're using paper charts, make sure there aren't any "unfound" charts for the day's patients.
- Check the fax machines to see if any faxes arrived overnight.
- Have a morning huddle with the staff. Discuss which providers are working, any problems from yesterday, any unusual things expected today, any schedule changes, any staff assignment changes, and any protocol reminders.
- Make sure the lab/clinic person has performed the lab controls and checked the refrigerator/freezer temperatures and documented them.
- Unforward the phones from the answering service, disconnect the answering machine, and have a staff member take any messages from overnight.
- Open the safe and remove the check-out change drawers, placing them at check-out. Make sure change is available.
- Unlock the doors.
- Make sure all patients have left the practice.
- Lock the doors.
- Check to make sure the coffee pot is off and the lunch room has been tidied by the staff.
- Confirm who is on first and second call.
- Turn the phones over to the answering service (make sure they have the call provider name(s)) or the answering machine (make sure it states how to contact the provider(s) on call).
- As appropriate, send emails or distribute lists with the next day's schedule if the providers are rounding, performing surgery, or working at alternate sites.
- If using paper charts, make sure charts are pulled for next day's patients.
- Turn off radios, fans, heaters, copiers, etc.
- Make sure fax machine is loaded with paper.
- Have staff sign off all computers. Perform computer backup, if not automatically run.
- Lock the change drawer and the day's deposit in the safe.
- Lock the sample closets, Rx pads, and all on-site medications.
- Turn off the lights, lock the doors and set the burgler alarm.
- Statutorily Excluded
- Statutorily excluded refers to Medicare benefits that are never covered according to law. "Statutory" refers to written law.
Medicare does not pay for all health care costs. Certain items or services are program or statutory exclusions and will not be reimbursed by Medicare under any circumstances. When a patient receives an item or service that is not a Medicare benefit, they are responsible for payment, personally or through any other insurance that they may have. Most practices use the Advance Beneficiary Notice of Nonpayment (ABN) to alert the patient to their personal financial responsibility for the service, although use of the ABN is not required for statutorily excluded services. See the Library tab for a link to the current ABN form.
Some items that are statutory exclusions are:
- Personal comfort items
- Routine immunization(s); other than pneumococcal, flu and hepatitis B
- Self-administered drugs and biologicals
- Cosmetic surgery
- Routine physical examinations (exception is the Welcome to Medicare Exam ); laboratory tests and X-rays; other than covered screening diagnostic tests (e.g. mammography)
- Eyeglasses or contact lenses (in the absence of aphakia or surgical removal of cataracts)
- Eye exams for the purpose of prescribing, fitting or changing eye glasses or contact lenses in the absence of disease or injury to the eye
- Eye refractions
- Hearing aids
- Routine dental services (e.g., care, treatment, filling, removal or replacement of teeth)
- Supportive devices for the feet
- Routine foot care (e.g., cutting or trimming of corns or calluses, unless inflamed or infected; routine hygiene; palliative care, trimming of nails)
- The term Steampunk denotes a time when steam power was still widely used””usually the 19th century, and often Victorian era England””but with prominent elements of ...either science fiction or fantasy, such as fictional technological inventions like those found in the works of H. G. Wells and Jules Verne! Steampunk fashion relys heavily on "brass bits, buckles and buttons"! Not healthcare, but interesting nonetheless!
- Internet Protocol Suite, or TCP/IP for short. TCP/IP created a set of rules that allowed computers to “talk” to each other and send information back and forth. TCP/IP is somewhat like human communication: when we speak to each other, the rules of grammar provide structure to language and ensure that we can understand each other and exchange ideas. Similarly, TCP/IP provides the rules of communication that ensure interconnected devices understand each other so that they can send information back and forth. (definition courtesy of Google Chrome's "20 Things I Learned About Browsers and the Web")
- TED stands for Technology, Entertainment and Design. TED started in 1984 as an annual conference held in Long Beach, California with the goal of bringing together people from the three fields to give 18-minute talks about innovation and possibilities. The TED Talks site has more than 400 talks by people from an expanded array of fields and the videos of their talks are available to be shared and reposted without cost.
From the TED Talks site:
Our mission: spreading ideas. We believe passionately in the power of ideas to change attitudes, lives and ultimately, the world. So we're building here a clearinghouse that offers free knowledge and inspiration from the world's most inspired thinkers, and also a community of curious souls to engage with ideas and each other. This site, launched April 2007, is an ever-evolving work in progress, and you're an important part of itTED has also spawned the TED Prize which is "designed to leverage the TED Community's exceptional array of talent and resources. It is awarded annually to three exceptional individuals who each receive $100,000 and, much more important, the granting of "One Wish to Change the World." After several months of preparation, they unveil their wish at an award ceremony held during the TED Conference. These wishes have led to collaborative initiatives with far-reaching impact."
- Telehealth is the practice of using electronic information systems with telecommunications technology to support the long-distance delivery of care. The practice of telehealth gives care providers the ability to diagnose, receive, and transfer appropriate health data, address questions, provide information, and oversee treatments and therapies for patients who are difficult to care for face to face (i.e., location).
- The Accountable Care Organization
- An Accountable Care Organization (ACO) is a care-delivery model in which physicians, specialists, and hospitals are aligned in providing efficient and effective care for a patient population. Instead of the present fragmented, fee-for-service delivery of care, this model emphasizes collaboration of providers accountable for the health status and outcomes of care provided to their panel of patients.
- The Patient-Centered Medical Home
- A Patient-Centered Medical Home (PCMH) is a model of care by which a personal primary care physician, who has an ongoing trusted relationship with a patient, provides comprehensive and continuous care with care coordination to meet the patient’s multiple care needs including: wellness, risk reduction, preventive services, as well as acute, chronic, and end-of-life care. This model focuses on improving accessibility, comprehensiveness, collaboration, record-keeping, patient safety, and the quality of care for the patients treated within them.
- Unified Communications (UC)
- Unified communications (UC) is the integration of real-time communication services such as instant messaging (chat), presence information, telephony (including IP telephony), video conferencing, call control and speech recognition with non-real-time communication services such as unified messaging (integrated voicemail, e-mail, SMS and fax). UC is not a single product, but a set of products that provides a consistent unified user interface and user experience across multiple devices and media types. UC allows an individual to send a message on one medium and receive the same communication on another medium. For example, one can receive a voicemail message and choose to access it through e-mail or a cell phone. If the sender is online according to the presence information and currently accepts calls, the response can be sent immediately through text chat or video call. Otherwise, it may be sent as a non real-time message that can be accessed through a variety of media. (Definition courtesy of Wikipedia.)
- UX (User Experience)
- The term "user experience" refers to a concept that places the end-user at the focal point of design and development efforts, as opposed to the system, its applications or its aesthetic value alone. It's based on the general concept of user-centered design. (Definition courtesy of Simply.com)
- Value-Based Insurance Design
- Recent studies demonstrate that health outcomes can be influenced by a patient’s insurance coverage and benefit policy. Therefore it is possible to design insurance packages that improve outcomes and add value. An example of this involves identifying effective clinical practices and reducing the financial barriers associated with those treatments and services encouraging greater adherence with care protocols.
- VistA (Veterans Health Information Systems and Technology Architecture)
- VistA, (Veterans Health Information Systems and Technology Architecture) which was originally developed in the 1970's by the Veterans Administration, is an open-source (meaning that the code is available for others to collaborate upon and improve) clinical documentation system that is used by all the 160-plus VA hospitals in the United States, plus all of their outpatient ambulatory clinics. Providing care to over 4 million veterans, employing 180,000 medical personnel and operating 163 hospitals, over 800 clinics and 135 nursing homes , about a quarter of the nation's population is potentially eligible for VA benefits and services because they are veterans, family members or survivors of veterans. The VistA system has been in use by the Veterans Administration for more than 20 years, and as such is one of the most mature electronic medical records in existence. As the Veterans Administration does not bill third-party payers, VistA is not a billing system. VistA was released to the public through the Freedom of Information Act by the Veterans Administration and today is publicly available on CDs for a nominal fee. Althought the software is free, there is a cost to install, implement and maintain it. WorldVistA was formed to extend and collaboratively improve the VistA electronic health record and health information system for use outside of its original setting. The system was originally developed by the U.S. Department of Veterans Affairs (VA) for use in its veterans hospitals, outpatient clinics, and nursing homes. WorldVistA has a number of development efforts aimed at adding new software modules such as pediatrics, obstetrics, and other functions not used in the veterans' healthcare setting. WorldVistA seeks to help those who choose to adopt the VistA system to successfully master, install, and maintain the software for their own use. WorldVistA will strive to guide VistA adopters and programmers towards developing a community based on principles of open, collaborative, peer review software development and dissemination.
- Voice Broadcast
- Voice broadcasting is sending a pre-recorded voice message to a large set of phone numbers at the time same. Can either be a voice call (meaning the recipient must answer the call for the message to play) or voice mail (meaning the message will play only if the recipient doesn’t answer.)
- Voice Recognition
- Voice recognition (VR), sometimes called speech recognition (SR), is a technology that translates the spoken word into the written/electronic word. In healthcare it is most commonly used for physician notes in the medical record. The physician dictates the information and either edits the information himself/herself, or a staff member edits the information. The physiican note can be printed for inclusion in the paper chart, or can be imported into the electronic chart. Some electronic medical record (EMR) software products have speech recognition built-in, and some have the ability to integrate with speech recognition software.
- VoIP (Voice over Internet Protocol)
- Also known as IP telephony, voice over broadband (VoBB), broadband telephony and broadband phone, VoIP refers to communication transported via the Internet. Traditional voice transfer is referred to as PSTN, which stands for public switched telephone network. You may also hear the term POTS, which means Plain Old Telephone System. The process for VoIP is the conversion of the analog voice signal to digital format and compression/translation of the signal into Internet protocol (IP) packets for transmission over the Internet - the process is reversed to be received.
- Walking the Path (Path of the Blue Eye Project)
- Walking the Path is the official blog of the Path of the Blue Eye Project. This initiative is designed to encourage collaboration and knowledge sharing among health marketing communications pros from around the world.
- Webinar (Courtesy of webinarlistings.com)
- A Webinar (short for web-based seminar) is an online seminar put on by a host, where the participants watch the seminars from their computers. Typically, they are either watching a Powerpoint presentation, a live demonstration on the internet or an application, or a live video of people. Normally participants have the ability to interact, including the ability to give, receive and discuss information, rather than just receive it. Other names for a Webinar include: online seminar, online training, online education, virtual seminar, web seminar, webcast or web conference.
- A widget is a small graphical device that does a highly focused, often single, specific task. Web widgets can be embedded in web pages or run on the desktop of a PC (Windows or Mac) using software such as Apple’s Dashboard software or Yahoo! Widgets Engine.