Cracking the Code to Healthcare Billing, Coding and Reimbursement

Medical billing, coding, and reimbursement are the triumvirate that constitute the heart of a healthcare financial system. These three systems work in tandem with each other; yet, one miss in the cog in the wheel results in utter chaos. The whole system can go into disarray.

A marathon, four-hour session that is being organized on October 17 by GlobalCompliancePanel, a leading provider of professional training for all the areas of regulatory compliance, will explain all these elements in detail, so that confusions regarding the same can be eliminated.

At this session, which meets AAPC guidelines for 6.0 Core A continuing education units, Rich Hendriksen, Chief Executive Officer and founder of Nokomis Health, will be the expert. Kindly log on to https://www.globalcompliancepanel.com/virtual-seminar/4-hour-virtual-seminar-on-medical-claims-boot-camp—cracking-the-code-to-healthcare-billing,-coding-and-reimbursement-10309LIVE to register for this valuable session.

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At this course, the expert will explain the fundamentals of medical billing, coding, and reimbursement. He will show how all of these components work with each other. He will demonstrate how to practically apply all the latest industry knowledge and standards. As a result of this learning, those who work with medical claims and claims data stay ahead of the game. They will learn the following:

• The claim flow process from registration through adjudication and payment
• How physicians and hospitals set and manage charges
• Critical data elements on the two major claim forms and what they mean
• How and why the major coding systems are utilized
• How various reimbursement methods are used by payors.

The expert will organize the learning in this session into three parts: the life cycle of a claim, coding systems, and reimbursement. He will explain each of these in depth.

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About the expert: Rich has 30 years of experience in healthcare systems, coding, billing, and reimbursement. He has led managed care departments and provider contracting units at a variety of organizations, including hospitals, clinics, and health plans.

Rich has worked with over 70 different organizations, ranging from hospitals and clinics to third-party administrators, law firms, and internet-based companies. As a respected industry expert, he is well known for his unparalleled depth of knowledge in all aspects of healthcare coding, billing and reimbursement.

To understand AI advancements in health care, there are two storylines we must follow

If ever there were an industry that could reap the benefits of AI, it is healthcare. The adoption of this technology to actually make medicine better is obvious. However, with this adoption comes a slew of ethical issues.

Let’s start with some numbers: In 2018, the US spent $3.65 trillion on healthcare. That works out to $11,121 per capita, a 4.4% increase over 2017. In addition:

• Spending on hospitals, doctors, and other clinic services was $2.16 trillion, holding steady at 59% of total health care spending.
• The spending category that experienced the most substantial year-over-year increase was the general cost of administering health insurance, which rose 7.7% in 2018.
• Spending on prescription drugs purchased in retail pharmacies went up 3.3% in 2018, higher than the 0.4% rate in 2017.
• A majority of the more significant spending totals were due to higher overall prices, while the “use and intensity” of health care services played a smaller role.

The per capita spend in western economies, other than Switzerland, which was about 80%, was 50% or less. The worse news is that the US has slipped to 36th in the world in quality of healthcare. (The above data is from Centers for Medicare & Medicaid Services and CIA World FactBook.)

Another lesser-known statistic is the magnitude of iatrogenic disease. From Wikipedia: an iatrogenic disorder occurs when the deleterious effects of the therapeutic or diagnostic regimen causes pathology independent of the condition for which the regimen is advised.

In other words, they are harmed by medical practice. According to a Johns Hopkins study, 251,454 deaths stemmed from a medical error – making it the third leading cause of death in the US, just behind cancer and heart disease.

All industries are facing the problem of which areas to apply AI. In an article in Healthcare IT News, some advice for the healthcare industry was: while AI may have the potential to discover new treatment methods, the report finds strongly entrenched ‘ways of working’ in the healthcare industry that are resistant to change. The authors warn that ‘simply adding AI applications to a fragmented system will not create sustainable change.’ Good advice for any industry.

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Reviving cerebrum foundational microorganisms may hold key to future MS medications

Researchers have figured out how to make more seasoned cerebrum undifferentiated organisms in rodents progressively young. The disclosure could prompt improved medications for maturing related illnesses that corrupt the mind and sensory system.

The examination concerns oligodendrocyte begetter cells (OPCs), which are a kind of foundational microorganism, or juvenile cell. OPCs are basic for the sound working of the cerebrum and the remainder of the focal sensory system.

OPCs develop, or separate, into oligodendrocytes, which are the phones that produce the myelin sheath that encompasses nerve filaments and jam the electrical sign that they convey.

Annihilation of myelin is a distinctive component of numerous sclerosis (MS), and maturing related changes to OPCs add to the procedure. Maturing can likewise decrease OPC work in sound people.

Scientists at the University of Cambridge in the United Kingdom found that expanding firmness in the maturing mind hinders the capacity of OPCs.

When they transplanted OPCs from more established rodents into the cerebrums of more youthful rodents, the matured OPCs started to capacity like energetic OPCs.

Stiffening of stem cell niche:

The team eventually established that the loss of function in the OPCs was a result of something happening in their microenvironment, or stem cell “niche.”

“Here we show,” write the authors in a recent Nature paper, “that the OPC microenvironment stiffens with age, and that this mechanical change is sufficient to cause age-related loss of function of OPCs.”

It appears that the stem cell niche reflects the aging-related changes in the “chemical and mechanical signals” that it sends to the OPCs residing in it.

Once the transplanted aged OPCs sensed that they were in a more youthful, soft environment, they began to behave more like vigorous, younger OPCs.

To explore what was going on in more detail, the team ran some laboratory experiments with OPCs and “biological and synthetic scaffolds to mimic the stiffness of young brains.”

‘Molecularly and functionally rejuvenated’

The researchers observed that when they grew aged OPCs on soft material scaffolds, they started to behave more like youthful OPCs.

The aged OPCs were “molecularly and functionally rejuvenated” as a result of being on the softer material.

Conversely, placing young OPCs on scaffolds comprising stiffer material, caused them to behave like older ones.

“We were fascinated,” says co-senior study author Dr. Kevin J. Chalut, “to see that when we grew young, functioning brain stem cells on the stiff material, the cells became dysfunctional and lost their ability to regenerate, and in fact began to function like aged cells.”

Dr. Chalut works in the Department of Physics and the Stem Cell Institute at the University of Cambridge.

He observes, however, that the more interesting finding was seeing the old OPCs growing in the soft material, and how “they began to function like young cells — in other words, they were rejuvenated.”

“This suggests a new way forward to override the age-related loss of function in this important stem cell system,” he adds.

Read more at https://www.medicalnewstoday.com/articles/326066.php

Easy Ways You Can Turn Hipaa Compliant Into Success

The first presentation explains the history of HIPAA, why it came into being and its evolution. This covers what HIPAA is, what steps have to be performed to be HIPAA compliant and what HIPAA compliance is.  It also provides definitions to key HIPAA terms, how to define a Business Associate and how to contract with Business Associates.

The second part of the first presentation is an overview of how to manage the HIPAA compliance project.

The second session describes what a Risk Assessment is and how to perform the risk assessment. The materials take the participant through the factors of HIPAA compliance and how to perform a HIPAA Risk Assessment. This encompasses taking the participants through how to do a HIPAA Privacy Risk Assessment, how to do a HIPAA Security Assessment and how to interpret the results, set priorities and develop a plan for addressing the Risk Assessment findings.

The third session takes the participants through how to prepare a set of HIPAA Policies and Procedures. This includes how to reference the HIPAA regulations in preparing the policies and procedures, how to reference the prior HIPAA Risk Assessments and how to prepare the HIPAA training materials.

The fourth session provides the participants with an orientation of the role the IT services in the healthcare organization in addressing the organization’s HIPAA compliance. This encompasses understanding what role IT hardware and software plays in the HIPAA compliance process, what responsibilities IT vendors should have and how to work with vendors. The materials will discuss IT security in the context of an overall organization security program including the value and approach of an IT security vulnerability test.

 

In the last session participants will review what a HIPAA breach is and what to do when a HIPAA breach occurs. This includes determining if a notification occurred, notification requirements and mitigation options.

There will be a wrap up and discussion session providing an opportunity for the participants to discuss specific issues they may have or get direction regarding particular approaches for HIPAA compliance.

The need for HIPAA compliance has evolved since the HIPAA laws were passed in 1996. In addition, as technology has advanced into more use of the internet and web-based hardware and software resources, compliance has also become more difficult and complex.

Now both covered entities (providers of health care services) and their business associates (support vendors) have to implement comparable compliance measures.

Breaches are almost impossible to escape – recent studies show that approximately 90% of covered entities and business associates have had at least one breach of a patient’s protected health information.  And, HIPAA federal penalties can be significant.

Compounding the issue is that almost all states have incorporated the HIPAA regulations, in one form or another, into their state health care privacy laws and/or the courts have accepted the HIPAA regulations as the standard of care for protecting a patient’s health information.

It is important for the health care organization to know what is expected by the regulations.

To satisfy your HIPAA compliance requirements, health care management and staff need to understand the HIPAA privacy and security regulations, understand how to assess your health care organization’s HIPAA compliance status, understand the role of each of the members of your workforce in meeting your compliance requirements and know what to do if there is a breach of your patient health data.

This webinar provides an in-depth review of these subjects and leaves the participant with a solid understanding of what has to be done to be HIPAA compliant.

People who will be benefits from this

• Health Care Organization Ownership and Senior Management
• Office Management
• Business Associates
• Physicians
• Ancillary Service Organizations (Pharmacies, Labs, Radiology)
• HIPAA Compliance Professions
• Health Care System Vendors

A guide to practical Risk Management [ISO14971 and IEC62304]

Gaps, incorrect or incomplete implementation of safety functionality can delay or make the certification/approval of medical products impossible. Most activities cannot be retroactively performed since they are closely linked into the development lifecycle. Diligent, complete and correct implementation of risk management from the start of product development is therefore imperative. This course will introduce all necessary steps to design, implement and test critical medical devices in a regulatory compliant environment. This course will additionally address the software risk management and the resulting interfaces to device level risk management.

To comprehensively summarize all risk related activities and to demonstrate the safe properties of a device the ‘Safety Case’ or ‘Assurance Case’ document is a well-established method to collect all safety related information together in one place. This documentation will most likely become mandatory for all devices (currently only required for FDA infusion pump submissions). This course will introduce the basic concepts and content of safety assurance cases and will illustrate the usefulness for internal and external review of safety related information.

Risk management with emphasis on the application of risk management principles and requirements to the medical device development cycle. Risk management has become the method of choice to ensure an effective and safety oriented device development. International consensus, reflected in globally applicable standard requirements, has led to risk management being a mandatory component of almost any activity in the medical device industry.

The course will emphasize the implementation of risk management into the development and maintenance process. It will use real-life examples and proven tips and tricks to make the application of risk management a practical and beneficial undertaking. This seminar will address the system level issues of risk management as well as the increasingly important software and usability related issues of critical systems. It will help to comply with regulatory requirements with minimized overhead and resource burden. To make the combines effort to design, implement and verify a safe device transparent the concept of an assurance case will be introduced.

The course is mainly based on international consensus requirements such as ISO14971, IEC62366 and IEC62304. It will cover European (MDD), US (FDA) and international risk management requirements from a regulatory and practitioner’s perspective.

Following personnel will benefit from the course:

• Senior quality managers
• Quality professionals
• Regulatory professionals
• Compliance professionals
• Project managers
• Design engineers
• Software engineers
• Process owners
• Quality engineers
• Quality auditors
• Medical affairs
• Legal Professionals

How to interpret and use more than just a standard tool-box

How to apply statistics to manage risks and verify/validate processes in R&D, QA/QC, and Manufacturing, with examples derived mainly from the medical device design/manufacturing industry. The flow of topics over the 2 days is as follows:

• ISO standards and FDA/MDD regulations regarding the use of statistics.
• Basic vocabulary and concepts, including distributions such as binomial, hypergeometric, and Normal, and transformations into Normality.
• Statistical Process Control
• Statistical methods for Design Verification
• Statistical methods for Product/Process Qualification
• Metrology: QC Sampling Plans the statistical analysis of measurement uncertainty, and how it is used to establish QC specifications
• How to craft “statistically valid conclusion statements” (e.g., for reports)
• Summary recommendations

The various statistical methods used to support such activities can be intimidating. If used incorrectly or inappropriately, statistical methods can result in new products being launched that should have been kept in R&D; or, conversely, new products not being launched that, if analyzed correctly, would have met all requirements. In QC, mistakenly chosen sample sizes and inappropriate statistical methods may result in purchased product being rejected that should have passed, and vice-versa.

This provides a practical approach to understanding how to interpret and use more than just a standard tool-box of statistical methods; topics include: Confidence intervals, t-tests, Normal K-tables, Normality tests, Confidence/reliability calculations, Reliability plotting (for extremely non-normal data), AQL sampling plans, Metrology (i.e., statistical analysis of measurement uncertainty ), and Statistical Process Control. Without a clear understanding and correct implementation of such methods, a company risks not only significantly increasing its complaint rates, scrap rates, and time-to-market, but also risks significantly reducing its product and service quality, its customer satisfaction levels, and its profit margins.

• FDA, ISO 9001/13485, and MDD requirements related to statistical methods
• How to apply statistical methods to manage product-related risks to patient, doctor, and the designing/manufacturing company
• Design Control processes (verification, validation, risk management, design input)
• QA/QC processes (sampling plans, monitoring of validated processes, setting of QC specifications, evaluation of measurement equipment)
• Manufacturing processes (process validation, equipment qualification)

• QA/QC Supervisor
• Process Engineer
• Manufacturing Engineer
• QC/QC Technician
• Manufacturing Technician
• R&D Engineer

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How the Things Will Change The Way You Approach [Phase I Gmps]

Early clinical trials are conducted to establish initial safety of a drug. The studies are generally in small number of healthy subjects and use lower doses of the drug product. Therefore, only small amounts of investigational material are required. In order to not undertake substantial costs and to reduce regulatory burden during these early stages, the FDA has established guidelines to allow early stage investigational products to be manufactured under less stringent GMPs.

This workshop will review the current regulations, guidance documents for early stage manufacturing and GMPs in detail. Regulatory strategies and logistical considerations for early development stage product, including vendor selection and management, stability, labeling, and documentation requirements will also be reviewed and explored.

So, that you may understand differences between GMP requirements for early and later stage clinical development. Explore and discuss ways to develop and implement strategies for early GMPs for phase I clinical studies.

• Directors
• Managers
• Supervisors in Regulatory Affairs
• Manufacturing
• Quality Assurance, and Clinical Operations

Facts – Until You Reach Your the New EU Medical Device Regulation

The Commission adopted a package of measures on innovation in health. The package consisted of a Communication and two regulation proposals to revise existing legislation on general medical devices and in vitro diagnostic medical devices. In particular, the Directives on active implantable medical devices (90/385/EEC) and on medical devices (93/42/EEC) are intended to be replaced by a Regulation on medical devices, while the Directive on in-vitro diagnostic medical devices (98/79/EC) is intended to be replaced by a Regulation on the same subject.

The revisions therefore affected all kinds of medical devices including in vitro diagnostic medical devices, from home-use items like sticking plasters, pregnancy tests and contact lenses, to X-ray machines, pacemakers, breast implants, hip replacements and HIV blood tests.

This will look at what to expect when the new regulation is implemented. Including: the transition period, Effect on Notified Bodies, Impact of the MDR on Quality Management Systems (QMS), technical documentation, clinical trial requirements, UDI and combination products.

-> Because the current Directive will be significantly altered and replaced by a Regulation which is legally binding on all Member States.

• Clinical Trial Managers
• Regulatory Affairs
• Medical Officers
• The updated Regulation
• Implementation Dates and Transition
• Main changes and Products Affected
• Effect on Medical Device Manufacturers

New EU Medical Device Regulation

Effectively Dealing with Harassment and Its Relationship to Discrimination, Retaliation, and Hostile Work Environments

In any case of workplace harassment, an employer’s behavior must meet a certain standard in the eyes of the law. Just posting an anti-harassment policy, while a positive step, is insufficient to prove that an employer took workplace harassment seriously.

Workplace harassment isn’t limited to sexual harassment and doesn’t preclude harassment between two people of the same gender. The harasser can be a boss, a supervisor in another department, a co-worker, or even a non employee. The victim doesn’t necessarily have to be the person being harassed; it can be anyone affected by the harassing behavior.

Harassment can also be considered a form of employment discrimination under various federal, state and local laws. In order to be considered discrimination, the harassment must be based on some protected trait. Under federal law, those traits include race, color, national origin, gender, pregnancy, age, religion, disability, and genetic information. Many state and local governments have enacted similar anti-discrimination laws.

Retaliation claims are costly and time-consuming for employers. Missteps in handling sensitive employee issues could result in the organization writing a check with a lot of zeros.

Additionally, workplace harassment may constitute a hostile work environment. Some conduct can be so severe on its own that even one incident can create a legal claim of workplace harassment.

How companies investigate potential misconduct can affect the company’s reputation as well as its bottom line.  Because cultural and generational diversity is changing the landscape of the U.S. workforce, that diversity can become fuel for all types of litigation. Understanding how to recognize harassment and effectively conduct workplace investigations can greatly reduce the chances of an organization being sued.

An employer can avoid or reduce liability by taking appropriate preventative measures. Participants will learn the best practices employers can employ to minimize the likelihood of retaliation violations.

Employers first need to understand exactly what harassment is: unwelcome conduct from a boss, coworker, group of coworkers, vendor, or customer whose actions, communication, or behavior mocks, demeans, puts down, disparages, or ridicules an employee. Physical assaults, threats, and intimidation are severe forms of harassment and bullying.  Harassment may also include offensive jokes, name-calling, offensive nicknames, pornographic images on a laptop, and offensive pictures or objects. Interfering with an employee’s ability to do his or her work also is considered a form of harassment.

Employees can also experience harassment when they are not the target of the harasser because of the negative work environment that can develop because of the harassment. This is referred to as a hostile work environment. Additionally, workplace harassment can result in claims of discrimination and retaliation.

Employers often overlook the importance of promptly investigating complaints of harassment and taking quick and appropriate corrective action. Since an employer’s prompt and effective response to complaints can limit or eliminate its liability in a discrimination, harassment, or retaliation lawsuit, it is imperative that employers implement an effective mechanism to investigate and resolve workplace complaints.

Charges of harassment in the workplace can result in costly consequences for companies. In 2017, the EEOC handled 84,254 charges and secured more than $125 million for victims of harassment and discrimination in private, federal, state, and local government workplaces.

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Concerned about health and safety on the job?

Are you one of those concerned about health and safety on the job? You’re not alone. Across the length and breadth of the US, the millions of workers who are employed in the various sectors, be it manufacturing or services, or technological or agricultural, are prone to injury at the workplace. Not one kind of job or working condition or employment or workplace is free from the potential to cause injuries or illnesses. This is why there is every reason to be concerned about health and safety on the job.

Yet, there are a good number of security safeguards that have been put in place in the form of legislations from the Occupational Safety and Health Administration (OSHA). OSHA has been primarily enacted with the purpose of giving employees rights to a safe workplace. Why every employee needs to be concerned about health and safety on the job is best answered by these disconcerting statistics:

OSHA is about dispelling concerns about health and safety on the jobConsidering the damage that concerns about health and safety on the job can cause to the workforce as well as to the economy, the US legislated OSHA way back in December 1970. The main intention of this historic piece of legislation was to ensure safety of workers at the workplace not just through suggestions, but through actionable steps.

The hallmark of this legislation is that it empowers employees to demand a safe workplace. If an employer is seen to be violating the provisions of OSHA or if the employee feels that there is some form of potential danger to her physical wellbeing at the workplace; she has the right to complain to OSHA without fear of being retaliated against.

A host of rights to assuage concerns about health and safety on the jobAmong the main features of OSHA is that it requires the employer to publish employee rights about their safety at the workplace. This enables them to allay concerns about health and safety on the job, as they have a ready reference to which they can go back in case of a doubt about the implementation aspects of any provision of OSHA. Employees who are concerned about health and safety on the job have the following rights:

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