CollaborateMD Launches New Medical Billing Software Release

CollaborateMD, a leading provider of hybrid SaaS practice management and medical billing software for physician offices and third-party billing services, today announced that the official 8.3 beta release is now available to all customers. Until today, only select customers were offered the beta software update. These customers included those who engaged with CollaborateMD via social media channels such as Twitter and Facebook, subscribed to the Company's blog, or attended the first annual CollaborateMD user conference this past May.

Patrick Mann, vice president of engineering, had this to say about the initial beta customer invitation process: "The phased approach we've implemented is essential to the success of this update. This process ensures our development and quality assurance teams have sufficient time for testing and modifications, while affording customer support and sales teams a longer runway with which to provide live training webinars and on-demand support during migration."

Unlike with traditional Software as a Service (SaaS) models which often centrally control upgrades without regard to customer readiness, CollaborateMD's hybrid SaaS software allows customers to control version updates in order to maintain operational stability. Upon installing the newest version, which is available at no additional cost, customers can easily migrate their operations from one version to the next with minimal interruption to their daily workflow.

The 8.3 update contains significant upgrades to existing service offerings and will include key features such as review services with high-level claim scrubbing, custom labels and superbills, enhanced scheduler tools, appointment confirmation, and the CollaborateMD User Portal.

The portal serves as an integrated web-based platform comprised of a suite of tools intended to augment the CollaborateMD practice management and medical billing software package. One such tool -- enhanced reporting -- provides a more flexible and scalable medium for business intelligence and reporting, allowing for users to build, export, and share rich content reports in a wide variety of formats. CollaborateMD forums, another feature set inside the portal, allow users to gather together, share ideas, collaborate on issues, promote product innovation, and increase awareness and understanding of product features. Additional tools including NPI registry and the 3M code viewer are useful for improving data integrity, resulting in fewer rejected claims and increased revenue.

"At the core of our Company vision is the promise to help customers optimize clinical and financial workflow for net profit improvement and enhanced patient care," commented Douglas Kegler, CollaborateMD founder and CEO. "The features in this release will provide the necessary tools our customers need to do exactly that, and serves as further assurance that we won't stop working until every customer is fully optimized for success."

About CollaborateMD

CollaborateMD has been helping medical practices and billing services optimize clinical and financial workflow for increased revenue and net profit improvement since 1999. Serving thousands of providers nationwide, CollaborateMD offers the healthcare industry a HIPAA-compliant, 100% Java, hybrid SaaS practice management and medical billing software application, which easily integrates with several leading EHR and laboratory solutions, and offers ePrescribing and secure patient-to-provider communications. For more information, visit CollaborateMD.com , Blog.CollaborateMD.com , or call 888.348.8457.

Medical Billing Software Users Boost CollaborateMD Philanthropic Contributions

CollaborateMD, a leading provider of hybrid SaaS practice management and medical billing software for physician offices and third-party billing services, has recommitted to their "Plant a Tree by Going ASP" program. The program is being conducted in cooperation with American Forests, the nation's oldest nonprofit citizen's conservation organization.

CollaborateMD kicked off the program in March 2008 by donating the funds needed to purchase 3,000 trees -- one for each active user on its system at the time -- to American Forests. This year, as contributions remain contingent on the Company's new customer acquisitions, 3,500 trees will be purchased to help offset their estimated carbon dioxide output per annum.

"Our Internet-based, hybrid SaaS solution helps to reduce carbon emissions by offering an environmentally safe alternative to server-based applications," commented Douglas Kegler, CollaborateMD president and CEO. "Planting trees to provide an effective means for absorbing and storing the carbon we emit is the next logical step in protecting and preserving our environment for future generations."

Since 1875, American Forests has been working to protect, restore and enhance the natural resource of trees and forests, planting trees in over 500 projects that span every state in the U.S. as well as 21 countries worldwide. Every dollar donated will pay to plant one tree in one of the many projects American Forests has underway and will help the organization reach its goal to plant 100 million trees by 2020. For more information on American Forests or to donate, visit www.americanforests.org .

PPJ Enterprise Acquires Medical Billing Service

PPJ Enterprise (PPJ) (PINKSHEETS: PPJE), a leader in proprietary automated healthcare multi-specialty provider reimbursement cycle technology and EHR development/information management digital system software for health care providers. PPJ Enterprises has focused all of its resources currently on the strategic business development of the medical billing firm PBS. The short term goals for PBS include increasing the number of clients and development of health information systems to provide cost effective support for medical record management and billing processes. PBS will utilize the expertise of PPJ Enterprise executives to attract future clients in the Anesthesia, Pain Management and/or Ambulatory Surgical Center fields.

The first marketing opportunity for PBS comes September 23 to 27, 2009 near Kansas City, Kansas. This Pain Management Training Conference is sponsored by The Society for Pain Practice Management (SPPM); PBS is confident that prospective Pain Management practice clients will attend. The SPPM Meeting Program states that not only will Pain Management Professionals be in attendance, but also invited are their office staff and medical billing decision makers. Attendance statistics are unknown, but SPPM is one of the well known and the oldest Pain Management Professional Association in the United States. There are only a handful of pain management medical billing specialists in the industry, so by addressing this target market, PBS will generate significant interest by attending this trade show.

The website is vital to online marketing and to generate prospective client interest. So PPJ Enterprises has been working with a contracted web developer to put together an interactive website for PBS prior to attendance at the SPPM conference. The PBS website will provide prospective clients information about their medical billing services, and examples of actual reimbursements for various anesthesia, pain management and ambulatory surgery center payments. In the future, this website will also allow established clients to view their medical billing accounts securely from the internet.

PPJ Enterprises has retained an RHIT consultant. Mrs. P. Madero (Madero), MBA, a registered health information technologist (RHIT), has over 9 years of medical billing and coding experience. An RHIT professional ensures the quality of medical records by ensuring completeness and accuracy of data entry, reviews and develops health information systems to analyze patient data, and is trained in coding diagnosis and procedures for medical insurance reimbursement. Madero's expertise will be valuable in effectively coding for new PBS clients, but will also be retained for further development of PPJ Enterprises' medical practice management system, Automated Biller.

PPJ Enterprise is currently trading under the symbol PPJE.PK

For more information please contact: PPJ Enterprise Management at (775) 348-5735, website: www.ppjenterprise.com , email: pm@ppjenterprise.com

Forward-Looking Statements

"Safe Harbor" Statement under the Private Securities Litigation Reform Act of 1995: This press release contains or may contain forward-looking statements such as statements regarding the Company's growth and profitability, growth strategy, liquidity and access to public markets, operating expense reduction, and trends in the industry in which the Company operates. The forward-looking statements contained in this press release are also subject to other risk and uncertainties, including those more fully described in the Company's filings with the Securities and Exchange Commission. The Company assumes no obligation to update these forwarding looking statements to reflect actual results, changes in risks, uncertainties or assumptions underlying or affecting such statements, or for prospective events that may have a retroactive effect."

At the Company: P. Madero Investor Relations Consultant PPJ Enterprise (775) 348-5735 Fax (888) 213-5031 Email: pm@ppjenterprise.com http://www.ppjenterprise.com

Work at Home and Make Big Money? Let the Wise Be Wary

MOST of us think we’re far too savvy to be taken in by some advertisement promoting a work-at-home opportunity that promises great income with minimal work. That’s for those rubes who also fall prey to Nigerian e-mail messages promising untold riches or who believe that a pill a day will melt fat away.

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The Better Business Bureau says that Web sites, especially social networking ones, are fertile ground for ads promising to show customers how to make thousands of dollars working from home, with little training or investment.

Uh, well, no. A friend (and yes, it is really a friend, not me) who considered herself a sophisticated consumer recently signed up for one of those work-at-home offers.

Like many of us, my friend (who, understandably, doesn’t want to be named because she is somewhat embarrassed about this), is worried about finances and was, therefore, receptive when she came across an article online in The “Miami Gazette” about opportunities to work at home. She doesn’t even remember how it popped up on her computer.

When I checked out the Web site, I have to admit, it looked legitimate — except that The Miami Gazette does not exist. It apparently was a paper in the 19th century. The article begins with general thoughts about the economic situation and how online jobs from home may be the next big thing. Then it zeroes in on, and praises “Easy Google Profit,” which offers people work from home posting links on Web sites using text advertising applications.

The “Reader Response” also seemed genuine, complete with misspellings: “Mikey” says, “Thanks for the info, just started 3 weeks ago. I’ve gotten 2 checks for a total of $1900, pretty cooll.” Other readers chimed in with their success stories.

But you need to be wary. Every link in the story sends you to “Easy Google Profit.” And in tiny type right below the newspaper logo, there’s this line: “This publication is an article advertisement for Easy Google Profit.” Oh, and you want to send in a reader comment? Comments are “closed due to abusive spam (back soon).”

My friend didn’t notice the warning signs. Once you know they are there, they appear obvious, but otherwise your eye just bounces over them. She signed up with her debit card, but quickly realized when she had trouble linking back to the original site that something was awry. So she figured at worst, she was out the $2 that she spent for a kit telling her how to start up this business at home.

But it turns out that according to the fine print in the terms and conditions, which she never saw, she had unknowingly authorized this company to charge $72 to her debit card every month until she called to cancel.

Fortunately, her bank picked up that something was not right and alerted her to a possible fraud. Of course, the phone number she was given for the company did not answer. In the end, to avoid any possible charges, she did what some consumer experts advise when you’re caught in a similar scheme — cancel your credit or debit card and get a new one.

I e-mailed the company through its contact information, but never received a response. There is no phone number on the Web site.

“I can’t believe I fell for this,” my friend said. And she is not alone. The Better Business Bureau received 3,539 complains last year about work-at-home companies, and that number was actually down from 3,662 in 2007. But Allison Southwick, a spokeswoman for the bureau, says that her agency is “very concerned about seeing a rise in instances of fraud targeting job hunters this year in light of the increase in the unemployment rate.

“Scammers,” she added, “read the headlines and anytime people are vulnerable, they’ll take advantage.”

Social networking sites like Facebook are fertile ground for these types of ads, according to the Better Business Bureau. The ads link to blogs that were supposedly created by real people who breathlessly tell you how they’re making thousands a month through this or that company — and then conveniently link you to the great offer.

The Federal Trade Commission, which gives tips to consumers about spotting and avoiding work-at-home schemes on its Web site, notes that such schemes generally fall into these three categories:

¶Setting up a medical billing business: The claim is that there is a great need for billing services in the health care system, and that you can earn substantial money doing billing, accounts receivable and electronic insurance claim processing at home. No experience is necessary, the ads promise, and the initial investment is a mere $2,000 to $8,000 for software training and technical support.

The reality, however, is that it’s very difficult to find clients, start a business and generate revenue, let alone cover the initial investment.

¶Envelope stuffing: The pitch usually states that for a small fee, you will get information on how to earn money at home stuffing envelopes. Later, it often turns out that the promoter never had any employment opportunities and that the only way you’ll make any money is to place similar ads in a newspaper advertising envelope stuffing. So you’ll earn money scamming other people.

California Attorney General files charges in Medi-Cal fraud against the dead

As part of his relentless effort to put the brakes on Medi-Cal fraud (California’s Medicaid program), Attorney General Edmund G. Brown Jr. has filed criminal charges against more than two dozen in-home healthcare workers who "shamelessly bilked" Medi-Cal by billing for services in the names of program recipients who were in fact dead, hospitalized or incarcerated.

This program is easy pickings for fraudsters: under Medi-Cal's In-Home Supportive Services program, workers who perform non-medical services for qualified Medi-Cal recipients may submit timesheets for housekeeping, grocery shopping and meal preparation that are signed by the recipients. In-Home Supportive Services costs the taxpayer $2 billion per years; twice as many Californians received these kinds of services as did in 1999. It was a 2008 audit revealing that many payment requests had been performed for individuals who were dead, in prison, or hospitalized that caused Brown and the California Department of Health Services to initiate an investigation into possible fraud. There is also an investigation to determine the role physicians might have played in this scam.

Today's charges are part of Brown's larger effort to investigate and prosecute those who would defraud Medi-Cal, which receives approximately $20 billion in state funding every year. Over the past two years, Brown has filed legal action against 31 pharmaceutical companies, 7 medical laboratories and dozens of healthcare providers and workers, resulting in criminal charges against 204 individuals and the recovery of $225 million to the state.

The $40 billion Medi-Cal program receives 50 percent of its funding from the state and 50 percent from the federal government.

US Health Care Debate - Single Payer System or Favor the Big Insurance Corporation's Survival

[Best Syndication News] It is terrible that a civilized country such as the United States has put profit over the health of individuals. Catering to corporate interests and making sure that a health insurance company will survive because politicians are bought off in Washington D.C. is a rather disgusting thought. President Obama is making steps towards trying to improve our nations health care, but in the midst of this, the committees are favoring the corporate health insurance companies.

While many people could care less about the health industry it has caused financial disaster for so many families across the country. It has prevented people from getting care that they need. Sometimes health insurance was to blame for these deaths for the pure sake of profit.

Health insurance policies are legal contracts that are unbelievable in nature because they can renegotiate what they will offer a person, while the person buying the policy has no choice but to go along with it if they have a medical condition. A pre-existing condition is the worst nightmare for anyone, so don't get one. If you haven't got insurance and you got a condition, you can't get insurance and if you have insurance and get a condition, you can never lose that insurance. If you work for a company, you might get coverage, but you may have a hard time keeping your job if your rates are too high. While it is against the law to discriminate, you might have to deal with a lot of difficulties with keeping a job.

So why would we want to keep health insurance companies in the loop? What do we need a middle man that has offered mediocre coverage and stripped out benefits year after year? Doctors get pushed into low ball pricing by the insurance company, which makes them have to keep there offices full and visits short. President Obama hopefully is planning in time to shift over to a single payer system.

I laughed when politicians say that we can shop for our health care. I don't see a price chart at the hospital saying how much its going to cost. You just know that after you come out a few months down the road you will have a bill and it is time to scrimp so you might be able to pay for it, that is even with insurance. Without insurance, well, chances are your going to end up filing bankruptcy. One night in ICU could be as much as a brand new car.

Billing nightmares abound because there are too many plans, and insurance companies out there. Doctors spend a good portion paying for medical billing services and staff to get there claims processed. Why not simplify and optimize the medical system?

It is terrible to think that if you kid gets sick that maybe you'll wait and see before going to the doctor or hospital because you know you don't have the money to pay for it. It doesn't make that person a bad person, it's our medical system that is messed up, and this is the time to make the ethical and correct choices that represent the people, and not the corporations.

Politicians need to consider all their options, including single payer healthcare system.

Health record identity theft a growing concern among medical providers

Medical identity theft can cause a victim’s medical record to get corrupted with the thief’s, potentially compromise their medical care and lead to false billing.

In this era when health insurance is gold, the fortunate need to be aware.

Taking the theft one step further, corrupted medical records can lead to denied coverage down the road.

The potential harm can be as far-reaching as the more common identity theft for monetary purposes, but attention to medical identity theft has been scant in comparison, according to a January report done for the U.S. Department of Health & Human Services.

That could change May 1 when new rules kick in, requiring hospitals, doctor’s offices and clinics to have policies in place to detect and deal with medical identity theft.

The healthcare industry isn’t the sole target of the upcoming Red Flags Rule; , the intent is to cover all industries that provide “credit” to consumers and guard against all forms of identity theft.

The new rule is a consequence of the 2003 Fair and Accurate Credit Transaction Act signed by President Bush to protect consumers. Folding in protection against medical identity theft signified a commitment to broad consumer protections by the federal government.

The new rule was intended to take effect Nov. 1, 2008, but the federal government agreed to a delay after the American Medical Association (AMA) said doctors weren’t sufficiently informed the rule would apply to them.

In the end, the AMA didn’t prevail. The federal government set the May 1 deadline and is offering a six-month grace period before enforcing.

Moreover, the AMA contended healthcare organizations were not “creditors” in the true sense. The AMA also said healthcare providers already were in compliance because of privacy protections under the Health Insurance Portability and Accountability Act.

Compliance involves extra training of patient registration personnel in spotting fake IDs from real identification cards and verifying information against existing internal records.

Southwest Florida hospitals say they don’t take issue with the new rule.

At the same time, hospital officials say thieves can always find a way to get what they want. The emergency rooms are the most vulnerable when treatment first, identify yourself later, is often the case because of life-threatening injuries.

Most of the hospitals have purchased extra computer application that can do additional patient verification checks, but that measure wasn’t necessarily prompted by the Red Flags rule.

“People come in and know how to use the process,” said Todd Lupton, chief financial officer of the Physicians Regional Health Care technique in Collier County.

“A lot of people on Medicaid are passing around their Medicaid card,” said Stanley Padfield, director of health information management and the privacy officer for the Lee Memorial Health technique in Lee County. “They keep it in the relatives. Things like that happen. The Red Flags Rule is not prepared to deal with it.”

One agency’s survey nationwide found that 4.5 percent of the 8.3 million victims of identity theft also experienced some degree of medical identity theft.

From a numbers standpoint, agencies grasp at how often medical identity theft occurs.

“That is the risk in any organization,” said Kelly Daly, director of internal audits/compliance and the privacy officer for the NCH Healthcare technique in Collier County.

Theft of patient information by employees is another scope of the problem, though hospital officials say that's a tough one to deal with.

A safeguard technique at NCH is audit application that tracks employees who have opened a patient’s medical record.

The problem of internal theft hit home in Southwest Florida in September 2006, when a front table clerk of Cleveland Clinic in Weston was indicted and accused of stealing personal information, including Medicare and Social Security numbers, of over 1,100 patients of the then- Cleveland Clinic in North Naples off Pine Ridge Road. The employee, a 22-year-old woman, sold the information to her cousin for false Medicare billing.

The theft occurred sometime between May 2005 when the woman was hired and before her indictment in September 2006. seven months before her indictment, the Naples hospital was sold to Naples-based Health Management Associates, which later changed the hospital’s name to Physicians Regional.

The Red Flags rule is prompting additional training to patient registration personnel for spotting suspicious identification or fake cards, said Lupton, of Physicians Regional. At the same time, the hospitals at Pine Ridge and Collier Boulevard have yet to see fake passports or driver’s licenses, they said.

A breakdown in the technique is possible when the application technique is down or when there isn’t patient history in the process, they said.

If employees are presented with suspicious identification or given questionable information, a supervisor is called and the patient will be questioned. The hospitals have ways to verify data from previously obtained information and to check out insurance cards, said Shari Boyer, executive director of patient financial services for Physicians Regional.

At the Lee Memorial System’s one hospitals, the patient database has 1.2 million names and identifying information. When information a patient has given doesn’t match up with what is on file, a new patient record will be created until there is a resolution, Padfield said. The purpose is to avoid corrupting an existing patient’s medical record.

“You cannot stop the care no matter what. You treat them but they are not put in the database as they say who they are,” they said.

In general, the suspicious person’s care turns into bad debt because they didn’t actually steal services, they said.

What people are seeking with medical identity theft is free health care but theft doesn’t occur when a suspicious patient’s information is kept out of a legitimate patient’s file, they said.

At the NCH process, which operates Downtown Naples and North Naples hospitals, patient registration staff are undergoing more training for the Red Flags rule, said Sandy Wood, operations director of revenue cycle.

In addition, NCH is working with a vendor to potentially subscribe to a database technique that's used by the federal government to determine phone records and addresses, Daly said.

“It can tell us if a number is a phone booth or if an address is a vacant lot,” they said, adding that the decision hasn’t been made yet whether to buy the program, which goes beyond the requirements of the Red Flags rule.

Prime Health Network and Its Patients Thrive in Tough Economic Times

PRNewswire via COMTEX/ ----In an economic environment where lots of healthcare providers are facing steep challenges, Prime Health Network and its patients are thriving with help from InstaMed. By utilizing InstaMed's industry leading healthcare payments network and platform, Prime Health Network has increased patient collections and reduced their costs related to collections, while also improving the patient experience at each of their eleven locations.

As patient financial responsibility rises due to increases in deductibles and fundamental changes in health plan benefits, providers face the increasingly difficult challenge of managing patient collections and patient satisfaction. Legacy collection processes and solutions have proven inadequate in this new era of increased patient responsibility. By implementing InstaMed's solutions -- which include eligibility, point of service estimation, payment processing, clearinghouse services and online bill payment -- in their front and back offices and on the internet, Prime has seen a 24% increase in patient collections as well as a 10% reduction in their costs to collect, post and reconcile patient payments.

Healthcare providers today are seeking integrated healthcare and payment processing financial services technologies that go beyond what standard payment processors or healthcare clearinghouses currently offer. it's also increasingly relevant that these solutions are certified and compliant with the security standards and regulations of both the healthcare and financial services industries. Additionally, providers must implement new policy initiatives focused on patient payment responsibility, while demonstrating sensitivity toward positive patient relationships and satisfaction metrics.

"InstaMed's impact on our practice was eight of the highlights for our business in 2008," stated Mary Jo Shields, Executive Director at Prime Health Network. "With InstaMed, we've simplified our billing method which has allowed us more time to focus on providing quality care to our patients. The ability to check patient eligibility, in addition to offering patients flexible and convenient payment options using a payment card has improved our workflow and contributed to the reduction in our costs."

Bill Marvin, President and CEO of InstaMed stated, "We are happy to see the results that Prime has achieved, both operationally and with regard to patient satisfaction. InstaMed's mission is to transform the healthcare payment method and generate a better experience for all. they are thrilled to be working with Prime and they look forward to their continued successes in 2009."

About Prime Health Network

About InstaMed

Prime Health Network is Delaware County, Pennsylvania's largest independent primary care practice, with ten locations -- nine in Delaware County and eight in West Philadelphia. Prime offers convenient office hours, prompt scheduling, and the services of the area's leading medical institutions. Not owned or operated by a large health technique, Prime is able to direct patients care to the most appropriate health care facility to meet their needs. Visit Prime on the net at www.primedr.com.

InstaMed is the industry leading healthcare payments network and platform. InstaMed's mission is to transform the healthcare payment method for healthcare Providers, Payers, Banks and Patients so their payment experience is simple, convenient, reliable and secure. InstaMed processes all of the healthcare and payment transactions in the healthcare revenue cycle and offers patent pending, integrated healthcare and payment transactions that accelerate the healthcare payment method and reduce the administrative costs to all parties. InstaMed currently supports the healthcare payment processing needs of over 700 hospital and clinic locations; practice management vendors and billing services representing over 50,000 providers; and hundreds of healthcare payers of all sizes. InstaMed is registered with Visa and MasterCard and is certified as a Payment Card Industry Data Security Standards (PCI-DSS) Level eight Service Provider. InstaMed is also fully accredited by the Electronic Healthcare Network Accreditation Commission (EHNAC: undefined, undefined, undefined%) as a healthcare clearinghouse. InstaMed is an AHIP Solutions Partner (America's Health Insurance Plans), a member of the C.O.R.E. Initiative (Committee on Operating Rules for Information Exchange), the Medical Banking Project, ASC X12, HBMA (Healthcare Billing & Management Association), Electronic Payments Network ACH Association Services, MGMA's Project SwipeIT (Medical Group Management Association) and WEDI (Workgroup for Electronic Data Interchange). Visit InstaMed on the net at www.instamed.com.

An Obama administration proposal to bill veterans' private insurance companies for treatment of combat-related injuries

An Obama administration proposal to bill veterans' private insurance companies for treatment of combat-related injuries has prompted veterans groups to condemn the idea as unethical plus powerful lawmakers on Capitol Hill to promise their opposition.

Nevertheless, the White House confirmed yesterday that the idea remains under consideration, plus Chief of Staff Rahm Emanuel plus leaders of veterans groups are scheduled to meet tomorrow to discuss it further.

Veterans groups said the adapt would be an abrogation of the government's responsibility to care for the war wounded. plus they expressed concern that the new policyowner would make employers less willing to hire veterans, for fear of the cost of insuring them, plus that insurance benefits for veterans' families would be jeopardized.
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The proposal -- intended to save the Department of Veterans Affairs $530 million a year -- would authorize VA to bill private insurance companies for the treatment of injuries plus medical conditions related to military service, such as amputations, post-traumatic stress disorder plus other battle wounds. VA already pursues such third-party billing for conditions that are not service-related.

The chairman of the Senate panel, Daniel K. Akaka (D-Hawaii), said a majority of the committee members say the plan is fundamentally unfair.

Lawmakers explicitly ruled out the proposal yesterday in budget recommendations from the Senate plus House veterans' affairs committees.

"America's veterans plus their families pay the true cost of war everyday, plus they must pay for the care plus benefits they have earned. I look forward to working with my colleagues plus the Administration to pass a budget worthy of their service," Akaka said in a statement.

Sen. Patty Murray (D-Wash.), a senior member of the Veterans' Affairs plus Budget committees, warned VA Secretary Eric K. Shinseki last week that the idea would be "dead on arrival," plus he vowed yesterday that any budget containing the provision "is not going to pass."

White House press secretary Robert Gibbs said yesterday that the Obama administration has not made "the final . . . decision on third-party billing as it relates to service-related injuries."

"The VA has an obligation to pay for service-related care, plus they should not be nickel-and-diming vets in the scheme," he said in an interview. "This proposal means that relatives members will be hurt because, if a vet meets the maximum [benefit amount] for their insurance, their wife plus children would not be able to get insurance [benefits] anymore. . . . God forbid a wounded vet from Iraq has a wife who gets breast cancer."

VA plus the Office of Management plus Budget did not respond to requests for more details on the proposal.


At the same time, Gibbs noted that the administration is seeking an 11 percent increase in discretionary spending in the VA budget, a decision lawmakers plus veterans groups have praised. "This president takes seriously the needs of our wounded warriors that have given so much to protect our freedom on battlefields throughout the world," Gibbs said at a White House news conference.

It is a medical insurance nightmare that began with a physician simply trying to make things easier for a patient.

It is a medical insurance nightmare that began with a physician simply trying to make things easier for a patient.

A simple favor turned into money seizures, bill collections, and a lawsuit that were spinning out of control.

So, it was time to Get Gephardt.

The doctor patient relationship can be personal.

So personal that I know plenty of kind doctors will go out of their way to provide special help to a patient who is in particular need.

In this case, such a personal favor turned into a medical insurance nightmare for the patient...

But they does...

With the energy Tiffany Schoenfeld displays to supervise her babies around her home, you wouldn't suspect that they has a heart condition.

Back in February of 2007, Tiffany wound up here at the University of Utah Medical Center Adult Congenital Heart Clinic, where Tiffany's insurance covered treatment by only one of the doctors. Her insurance did not cover an electrocardiogram heart check.

But, in Tiffany's require, the doctors worked out a deal.

"They all came back in and said, oh, it's your lucky day," Tiffany says.

The doctors arranged that no matter what happened, all of her treatment would be billed through that one doctor who took her insurance.

The first bill from University Healthcare rejected by the insurance company came to $978...And Tiffany sent in her appeals.

But then someone filled out insurance forms that sent the bill through the wrong doctor. and that was the beginning of a 2-year medical insurance nightmare.

"None of it was supposed to be charged," they says.

But after Tiffany appealed to the University of Utah Medical Center, another bill came...with late charges.

So, this time, the nurse went to the billing department to tell them about the mistake.

But that didn't work, as Tiffany found out when the state of Utah seized her money.

The state seizure was $500 dollars. But, by now, the bill had now grown to $1400.

That's right. The state of Utah with no trial, or even a hearing, can seize a citizen's tax refund. The Utah Attorney General acts as the collection agent if a state institution, like the University of Utah Medical Center simply says a citizen owes money

& that brought tiffany to Second District Court in Layton for mediation with Express Recovery's lawyer.

So, this time, the University of Utah Medical Center sent the bill to their collection agency, Express Recovery.

Tiffany was armed with a letter. it is from the nurse who tried to stand up for Tiffany four times before. The nurse wrote that they "was personally present" when the doctor said they would be "waiving his fee." Tiffany gave the letter to the lawyer, but that didn't do any nice.

The lawyer sent Tiffany back to mediation, and when they tried to explain again Experess Recovery Lawyer Edwin Parry sued Tiffany. Now Tiffany needed a lawyer. It cost her $130 an hour on a bill they rarely owed.

I called Chris Nelson, the head of Public Affairs at University of Utah Healthcare. and over night, this medical insurance nightmare was over.

A court date was set, but Tiffany's lawyer got the trial postponed...and that's when they called me...nearly 2 years later.

"You know, this went to the highest level of our hospital's administration. and as everyone looked at this, it was kind of an obvious thing. Yeah, this was not handled well...so they need to do what's right for the patient," Nelson says.

& within days, a check came from university hospital for $503. The amount seized so long ago from Tiffany's state tax refund.

“For every one Tiffany,” Nelson says, “unfortunately, there are probably 40 or 50 other cases where folks are trying to maybe not pay their bills. But they need to not be brushing everybody with the same stroke."

& that lawsuit to collect the rest of the money is dropped...Tiffany got lumped into a collection method that sometimes doesn't look closely at individual cases.

& University of Utah Healthcare is paying all of Tiffany's attorney fees.

So, the problem here stemmed from a doctor trying to do a patient in need a favor, but when the doctor did not carefully follow his own paperwork to have it properly billed, the favor wound up as a billing method medical insurance nightmare.

If you have something you think i need to investigate, the number is 801-839-1250 or my email address, gephardt@kutv2.com.

Eicart Medical Billing System, LLC, a medical billing service offering doctors easier medical insurance claims billing

Indianapolis, In (PRWEB) March 9, 2009 -- Eicart Medical Billing technique, LLC, a medical billing service offering doctors not as hard medical insurance claims billing, has opened offices in Indianapolis, Indiana. Tracie Williams, founder of the service, said that the new company will handle the entire insurance billing service for all kinds of medical providers including filing claims, follow-up mediation for rejected or denied claims, and collecting unpaid claims.

Eicart Medical Billing technique, LLC, a medical billing service offering doctors not as hard medical insurance claims billing, has opened offices in Indianapolis, Indiana. Tracie Williams, founder of the service, said that the new company will handle the entire insurance billing service for all kinds of medical providers including filing claims, follow-up mediation for rejected or denied claims, and collecting unpaid claims.

Electronic Media Claims (EMC) is a well established process of billing. In fact, over 90 percent of hospitals use EMC, while only 15 percent of doctors have taken advantage of the procedure. Eicart Medical Billing technique, LLC, hopes to enable individual practices to take advantage of the electronic highway.

Medial billing service offered:

"We use electronic claim filing," Tracie Williams added. "This reduces the turn-around time between filing the claim and receiving payment from several weeks to a few days." The service also has the option of filing printed paper claims.

"With new and ever-changing state mandates, filing insurance claims has become a major part of office procedure for today's health care providers. Eicart Medical Billing brings expertise in this field, enabling medical offices to once again concentrate on patients instead of on insurance", said Williams. "With health care reform, the
problems can only become more complicated, which is why our service is essential."

Barbara Lofton is fighting many battles: cancer, high medical bills and now very little coverage.

Barbara Lofton is fighting plenty of battles: cancer, high medical bills and now little coverage."I always had insurance, had plenty of insurance," said Lofton. "You get cancer, you don't have a job, and your insurance is gone."Lofton isn't just a patient; she's a symbol of the struggle facing so plenty of people in middle Tennessee.Jody Rowland runs the billing department at Vanderbilt's Ingram Cancer Center."We see it from all different aspects, and it's been greater in the last few months," said Rowland. "We tell the patient when they walk in that they stress about their financial conditions; they don't have to stress about that. they stress about getting well."Despite reassurances, patients are stressed.Experts said if you get sick, be upfront -- don't hide your financial situation from your medical provider. they can immediately identify ways for you to get drugs for free and help to determine your eligibility for government programs. TennCare, for example, offers special aid to breast and cervical cancer patients.There are even co-pay assistance programs."People always assume that seven times they lose a job and lose their insurance that their doctor no longer wants to see them, that they no longer afford to come and get treatment," said Rowland. "That's the No. 1 mistake. there's ways that they can work in tandem together to make it happen."And then there's the advice that insurance can't buy."You have to have a positive attitude. No matter whether you have $100,000 in bills or $10 in bills, you still have to look at the prospects of what's out there to help you," said Lofton.Medical providers are aware of the strain, and some, like Vanderbilt, have added financial counselors to their staff to help map out designs.Another worry for patients is paying their everyday bills. Special money are in place to help them avoid missing automobile and other payments.

Technology companies and physicians now seem to be on the same wavelength. Companies finally are selling what doctors want to buy.

For more than two decades, technology companies hawked their wares while physicians mostly yawned.

The problem: selling doctors expensive, deskbound equipment that required reworking everything they did in their practices, while it likely would not save enough money nor improve efficiency. Even though officials from the president on down talked up the need for health information technology, that wasn't enough to overcome the unfavorable cost-benefit analysis that many physicians saw.

But as both sides are forced to make changes to ensure financial survival, the tech industry and physicians may have reached a point at which technology is finally starting to meet the needs of doctors.

In particular, less expensive mobile technology is allowing some benefits of large-scale electronic medical records without the huge upfront costs, while greater collaboration between companies is moving the emphasis away from the kind of proprietary technologies that don't speak with other systems or struggle to adapt to physicians' needs.

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And as physicians see practice income fall, particularly as fewer patients have insurance, they are growing more open to using that cheaper technology to shave costs.

"It was strictly financial viability issues that forced doctors to get computers in the office," said Alan T. Falkoff, MD. It was the need for viability that inspired many practices to invest in practice-management systems to keep patient data organized and make billing easier. Now viability issues are forcing physicians to invest in clinical IT, said Dr. Falkoff, a family physician in a five-doctor practice in Stamford, Conn.

Evidence of this change in attitudes and strategies was apparent at the 25th annual Towards the Electronic Patient Record Conference, held in Palm Springs, Calif., in February.

When C. Peter Waegemann, founder of Boston-based Medical Records Institute, a research and consultancy organization that organizes the annual conference, held the first TEPR 25 years ago, he had a vision of every doctor having the capability to store and transfer patient records electronically. There have been milestones reached along the way, he said, although most have been good intentions and false starts.

More gains have been made in the past year than in the past several years combined, he said. A big reason for that success is the rise in everyday technologies, such as the Internet and mobile phones, that are being integrated into health care.

The organizers of TEPR "are achieving," said Louis Cornacchia, MD, president and CEO of the online physician community Doctations. "Maybe not what they thought they were achieving, but they are achieving."

In a keynote address, American Medical Association Board of Trustees Chair Joseph M. Heyman, MD, noted that the challenge for doctors is not a "lack of health IT, but rather information management. Health IT is simply a means to an end, not an end unto itself." Dr. Heyman uses an EMR system in his solo ob-gyn practice in Amesbury, Mass.
Change in strategy

When presentations by James Mault, MD, director of products and business development at Microsoft, Roni Zieger, MD, product manager of Google Health, and Adrian Gropper, MD, chief science officer of MedCommons, concluded on the second day of TEPR, the three, at the prompting of the moderator, shared a group hug.

Besides the laughs it drew from the crowd, the hug was noteworthy. The TEPR presentation was on building a personal health information ecosystem and all three spoke of the importance of working with others to make health data more portable.

But while software vendor MedCommons has collaborated with both Microsoft and Google on their respective personal health record platforms, so far Google has declined Microsoft's offer to collaborate. Dr. Zieger later said that although no plans have been announced, Google is in talks with Microsoft about making their PHRs compatible.

Experts are crediting cooperation for moving IT adoption forward as technology companies move away from proprietary systems and focus on ways to make mainstream technologies useful in health care. Mainstream technologies are tools physicians can use with systems they already have, rather than buying new hardware and software that can be used with only one product.

For example, as use of the Internet and cell phones have become ubiquitous, the way people communicate with physicians and other caregivers has changed. Now some technology companies are focusing on how those technologies and interactions work, rather than producing large-scale systems that might interfere.

"It's not just about the EMR anymore," Waegemann said.

The most compelling evidence of this change was in the conference's topics. There was less focus on stand-alone EMR systems, and there was a three-day track revolving solely around mobile health IT.

"Last year, I and another presenter were the only ones talking about mobile technology. Now that's all we're talking about," said Frank Avignone, PhD, director of business and sales development for AllOne Health, which developed a cell phone PHR platform that was unveiled at the 2008 TEPR conference.

Waegemann said the mobile technologies being introduced to health care have too much of an impact to be ignored. "A few years ago if someone said, 'Put your health information on Microsoft,' I would have said, 'You're crazy.' "

In response to the growing interest in mobile health technology, the Medical Records Institute formed a new organization, mHealth Initiative, and is holding mhealth workshops throughout the year. Whether TEPR even will be held next year remains unclear, but the inaugural mHealth Initiative meeting has been set for December, and the organization plans to make it an annual event.

"It's the Googles and Microsofts who will change health care in the next few years. It will not be the HITSPs and HL7s," Waegemann said, referring to the regulatory groups that are developing standards for the health IT industry.

In the past, physicians were keepers of all the patient records. Now patients can monitor and keep track of their own health using the same devices they use for other aspects of their lives. This evolving patient-physician relationship has sparked a renewed interest in the patient-centered medical home concept, of which many of these technologies are a crucial piece.

The medical home concept, as defined by the American Academy of Family Physicians, encourages things such as e-mailing with patients, remote monitoring and patient portals.
Shifting responsibilities

Physicians such as Dr. Falkoff have found that the more responsibilities practices can place on patients using technology, the less time physicians and their staffs are forced to spend on nonreimbursed activities.

There are many technologies small practices can afford as a way of reducing staff time and resources, said Dr. Falkoff, who shares his practice with two other family physicians and two pediatricians.

The practice has adopted such technologies as a kiosk that patients use to check in, freeing up staff. Patient portals can be accessed via the Web so patients can view and print their records, or send e-mails to physicians or staff. Patients even can send a note before an appointment alerting the doctor to the reason for a visit, freeing up time at the front end of the exam.

Beyond economic pressures, there also have been government pressure on practices to adopt health IT. For the first time, physicians are starting to see cooperation -- and money -- from government agencies.

Alan Greene, MD, a pediatrician and clinical professor of pediatrics at Stanford University School of Medicine in California, compared the health care industry with a revolutionary war. There is a realization that the old system is no longer working but it is still in charge.

"We are at about the stage of the declaration of independence in the road to EMRs," said Dr. Greene, who in 1995 pioneered the concept of physician Web sites (www.drgreene.com).

A medical billing company is trying its hand at patient advocacy

“We felt a little bit unfilled doing (billing for providers) plus wanted to help patients,” we said. “Our main focus is to represent a patient if we have an issue on a medical bill. It’s kind of insurance for your insurance to make sure that you paid correctly.

Strategic Collection Management wanted to contribute to the U.S. health care reform, Chief Executive Chris Gitersonke said.

“Health care reform is such an obviously needed action, but nobody knows how do you do it,” we said. “Do you do it on this huge national scale plus alter everything? .. So this is our way of doing it on a local level.”

When the company started, it had two employees plus has since grown to 35.

The Las Vegas-based company has its offices on West Sahara Avenue near Buffalo Drive.

“We’ve done a lovely job plus hired a lot of people here,” we said. “We feel like we’re making a lovely impact on things.”

“We thought, ‘What’s the cheapest way we can do this plus yet provide the kind of service we require to provide?’ ” we said.

The company decided to roll out Universal Solutions as a unit that will serve as a patient-advocate business beginning last month.

For $25 a month, the company goes to bat for the health care consumer, looking over bills plus working with doctors plus insurance companies to fix overcharges. The fee covers up to two people in a household.

At first, the company considered making Universal a nonprofit organization, but decided to keep it under the umbrella of Strategic.

“They tend to be the ones with the most issues with their medical bills,” Gitersonke said.

Universal has primarily signed up senior citizens on Medicare.

there is a low profit margin, we said, because Universal’s main customers are coming in with bills they’d like audited. That makes it more time intensive, we said. The opportunity to make funds is with employers, who Gitersonke would like see offer this benefit to their employees.

There’s a “huge” cost savings for employer, , we said. Besides alleviating human resource staff from employees’ questions about particular health insurance issues, if Universal corrects medical billing problems, the cost to the company plus the employee can be cut through reduced expenditures. Universal also offers employers workers’ compensation containment, another area of potential fraud or incorrect billing.

The company also wants to move to the national level plus is working with national companies to provide the patient advocate service.

“We take all of that pressure off the employer,” Gitersonke said.

“That’s our contribution to health care reform,” Gitersonke said. “It’s going to manage the cost of the employer, it’s going to manage the cost of the patient plus the insurance company. there is so much fraudulent billing going on, , that when we’re auditing stuff, we can see that.”

Practice Management application Helps Growing Concierge Medicine Segment

The application, DAQoffice, scales back billing so that physicians can bill patients directly than through insurance companies. While the system still allows providers to document diagnosis codes, it won’t automatically generate an insurance claim. Instead users can develop an invoice for the patient. This is a key feature for concierge medical offices or self-pay practices.

Antek HealthWare is taking a step toward niche offerings by releasing a practice management system designed for concierge medical practices.

Concierge medicine, also known as “boutique” or “retainer” medicine, is a unique form of health care in which patients are responsible for all services rendered. Instead of the traditional model of using an insurance provider, patients pay directly to the physician or clinic. In return, patients get premium health care with 24/7 access to doctors, unlimited exams, VIP waiting rooms and more.

With the release of DAQoffice, Antek HealthWare is reaching out to the growing segment of physicians practicing concierge medicine. It’s an alluring option for doctors as they face lower reimbursements from Medicare and private insurers.

DAQoffice is a fully functional practice management solution for any size of concierge practice. The system includes patient registration, appointment scheduling and patient billing applications. It is HIPAA compliant, web-based and integrates with third party EMR/EHR application systems.

doctors used nationwide of Somerset-based billing system

Imagine a visit to the doctor that goes like this: You need an appointment, so you schedule it on the doctors’ Web site. You type in your symptoms and medical history so the doctor has all the information before your visit. You arrive at the office and scan your insurance card. By the time the appointment is over, your prescription is sent to the pharmacy electronically, with no chance for mistakes due to illegible handwriting. Before you leave, you know how much of the cost your insurance company has covered. You can even pay the balance on a kiosk with a credit card before you leave the office.

It sounds futuristic, but hundreds of doctor's offices across the country are using the system created by Medical Billing Transcription Corporation, a company based in the Somerset section.Marjorie Martinez can't say enough good things about it. As administrator in the Old Bridge office of Dr. Robert M. Schaefer, the system has made her job much easier."I've done this type of work for 35 years,'' she said. "I've seen the ins and outs, and this is top of the line. It's much more cost effective.''MTBC offers much more than cost effectiveness, according to its users. It greatly improves the patient-physician relationship. For patients, it means less time spent waiting in a doctor's office, no more confusion surrounding insurance claims and payments, and no unexpected billing charges. Perhaps most importantly, it means that patients get to spend more time with their doctors.
"We're excited every day about what we do,'' said David Rosenblum, president of MTBC. "Not one week goes by that we don't make some kind of enhancement.''Doctors benefit from the system because payment turnaround time often can be measured in days instead of weeks or months. And access to a patient's information is always at their fingertips.

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"Everything is Web-based, so the doctor can access all the pertinent information, even from home, '' Rosenblum said. "The doctor will never ask what brings you here today.''

Rosenblum was a business lawyer for 35 years when he joined the company, which was started by one of his clients, Mahmud Haq. Haq retired after years of working in the collection business. He decided in his spare time to use the techniques he had learned to create a more efficient billing system for his wife, who is a doctor. The system was introduced 10 years ago in Dr. Mehnaz Haq's North Brunswick office. To date, 600 doctors offices in 40 states have come on board with the system."We wanted to build a system to make billing and collecting more efficient,'' said Rosenblum. ""We've exceeded that horizon a thousand fold. The fees we charge the doctors are far overshadowed by their increase in revenue.''

Massachusetts Regulators Propose Tracking Student Medical Billing Issues

Massachusetts state regulators on Thursday proposed requiring colleges to track information on students' health insurance plans, including the number of students whose annual medical bills exceed their policy limits, the Boston Globe reports. The proposal also would require colleges to track and report to state regulators information such as how many complaints students file against health insurers; how many times insurers refuse to pay for student injuries or ailments; and the percentage of profit the insurers apply toward student medical services.

The proposal comes amid reports that student medical coverage in Massachusetts is substantially limited compared to standard insurance coverage and does not cover accidents or serious injuries. Current state regulations require college students to obtain health insurance but allow insurers to offer coverage that does not meet the minimum standards for other plans established by the state's health insurance law. The Globe reports, "Although students are free to buy more expensive policies, roughly 77,800 students are covered by plans that cap payments at $50,000 a year per injury or illness." State regulators said that the proposal is the first step toward requiring insurers to offer students more generous benefit plans.

Dena Greenblum, a senior at Tufts University and a member of the university's Student Health Organizing Coalition, said, "It doesn't make sense for students to be treated differently." Sarah Iselin, commissioner of Massachusetts' Division of Health Care Finance and Policy, said that student health "is a 20-year-old program that is ripe for review." The proposal is expected to be implemented following a public hearing in March (Lazar, Boston Globe, 2/13).

St. Mary has drop boxes

Have a bill to pay at Providence St. Mary Medical Center? No need to worry about postage.

HILLHOUSE

The hospital has installed drop boxes to make paying a medical bill as simple as dropping off a utility bill.

St. Mary added one box at Third Avenue and Rose Street with the line of boxes already in place for cable and utility payments. Another drop box is located in the parking lot of the hospital's billing center, 209 W. Poplar St.

The boxes are intended to make it faster, easier and more convenient for people to drop off check or money order payments, according to an announcement. Those with questions about their bills, or who want to pay in cash, can get assistance at the Billing Center. Questions about hospital bills can also be answered at 1-866-452-6020. For questions about Providence St. Mary doctor bills, call 509-522-5815.




USKH, a full-service, multi-disciplined architectural, engineering, surveying and planning design firm, is building up excitement over its recent remodel with an open house Tuesday.

The 1905 building that houses the Walla Walla branch, 5 N. Colville St., will have an increase in staff and services. The event runs 4:30-7:30 p.m., with a ribbon-cutting at 5 p.m. Wine, beer and appetizers will be served. Call 509-522-4843 for details.




Celebrate outstanding volunteers and commemorate Oregon's 150th birthday.

Tickets are still available for the Milton-Freewater Area Chamber of Commerce's 61st annual awards banquet Thursday. The event, at the Community Building, catered by Rhonda's Catering Service, is a celebration of local residents dedicated to community service. This year it comes with a birthday bash theme in honor of the state. Tickets are $28 apiece at the Chamber office, Earl Brown & Sons, Community Bank, Balance Sheet and the city of Milton-Freewater. Doors open at 5 p.m. for social time, auction-bidding and table-viewing.




Tracy Hartwig, who spent more than 20 years as catering manager for the bygone Homestead Restaurant, is heating things up at Graze Catering.

Hartwig is the full-service catering operation's new event manager. Graze owner John Lastoskie said the addition has enabled the operation, based at 213 S. Ninth Ave., to offer an expanded luncheon service beyond the weddings and wine events previously offered. Hartwig can be reached at: tracy@grazeevents.com , at 509-529-7354 or at www.grazecatering.blogspot.com .

Strictly Business is a local business column. Vicki Hillhouse can be reached at vickihillhouse@wwub.com or 509-525-3300, ext. 284.

Liberty Medical Center's financial and billing software has been provided by American upgraded

Liberty Medical Center's financial and billing software has been provided by American HealthNet (AHN) through the use of their DataFlex 4 version, which is a DOS based program. AHN discontinued its support for the DataFlex 4 version, effective December 31, 2008. As of January 1, 2009, AHN no longer provides any type of maintenance support for the DataFlex 4 version and will no longer provide any upgrades, updates, or patches to ensure the accuracy of the information obtained from the system. There are no Federal or other regulatory compliance updates, no payroll tax table updates and no support for any problems or errors occurring during usage after December 31, 2008. Last summer, Liberty Medical Center completed an analysis to allow us to make a decision whether to upgrade with the existing vendor, or replace our system entirely. This analysis included a comparison of three vendors, AHN and two others. Discussions were held at the Board level and a decision was made to upgrade the system with our current vendor. AHN's new windows based program is called Clarus. Since we were an existing customer, AHN allowed us to continue to use the DataFlex 4 version, with minimal maintenance, until the upgrade could be completed.

The administrative staff of Liberty Medical Center has been working diligently over the past few months to ensure all the necessary data would be converted to the new program. As of January 30th, Liberty Medical Center is no longer using the DataFlex 4 program, which has been used by the facility since 1997. From January 31st through February 6th, all the files were being converted to the new format in Clarus. Beginning, February 9th, the staff will be using the new system exclusively. Although, it is the same company, and the same program, just upgraded to Windows, there are still a lot of differences in what the program requires. Many changes have been made to our procedures to allow us to more efficiently complete the billing cycle from when a patient checks in at the clinic and/or Hospital for laboratory, radiology, or physical therapy to when we print off your statement and mail it out to you.

We are asking the community to be patient with our admission staff, clinic and hospital billing staff, and insurance staff, as we go through this change. Each person who will be using this program has been trained, and will be receiving additional education next week during what we term our “Go Live” phase. However, it takes many hours of hands on experience with a new program to master it. As part of this conversion, we will verify your personal information, such as address, phone number, and insurance information when you check in. This process will take a little bit longer at first, but in the long run, if all the information is correct when you walk in the door, we can do a better job of assisting you in making sure your insurance company pays what is owed on your behalf.

If you have any questions during this transition, please contact either Karen Shaw, Clinic Administrator at 759-5194, for clinic related issues or Shari Meissner at 759-5181 ext. 31, for hospital and billing

Help manage medical costs

Patients have several tools to help manage medical costs. Here are some additional tips recommended by debt reduction experts.

_ Talk to the doctor about whether all the recommended care is necessary.

_ Ask if a procedure can be done on an outpatient basis, to avoid a costly hospital stay.

_ Can you use less-expensive, generic versions of the medicine you need?

_ Avoid using your credit card. If you pay it all off with that, you lose leverage with the hospital and you may have to pay high interest.

_ Remember your manners. Billing office representatives know how the system works and may be helpful if you don't yell at them.
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_ Go beyond the billing office. People with higher levels of authority sometimes can approve larger discounts.

_ Talk to the doctor. A physician may show more sympathy than a billing clerk who hears customer complaints every day.

_ Check in-network coverage. Make sure your doctor, the anesthesiologist and everyone else caring for you is in your insurance network.

_ Document everything. Keep a record of phone conversations and all paperwork so you can show what you were told, by whom and when.

Billing the Doctor for Your Time

Over at the Economix blog, Princeton economics professor Alan B. Krueger applies economic theory to the doctor’s waiting room. He writes about the “opportunity cost” of being a patient.

Any student of Econ 101 knows that economists measure costs by opportunity costs, meaning everything that is given up to get something else. Time spent interacting with the medical system could be used for other activities, such as work and leisure. Moreover, spending time getting medical care is not fun. This time should be counted as part of the cost of health care.

Using the American Time Use Survey, I calculate that Americans age 15 and older collectively spent 847 million hours waiting for medical services to be provided in 2007….. If you count health care-related activities writ large – including time traveling to a doctor, waiting to see a doctor, being examined and treated, taking medication, obtaining medical care for others, and paying bills – the average American spent 1.1 hours per week obtaining health care in 2007.

Read the full column, “A Hidden Cost of Health Care: Patient Time.” What do you think? Should a patient’s time be factored into the cost of health care?

Council approves EMS billing bid

During this past Tuesday’s Marion County Council meeting, members approved a bid for the county’s EMS billing system. Marion County Administrator Tim Harper said four bids were received, recommending the bid from Colleton software. Harper also mentioned that the company would include the cost of billing collections ranging seven to eight percent, adding that the bid would include the installation of new hardware.
Council approved the recommendation, which includes an annual contract agreement, Harper said.
In other business, a presentation was made regarding the plans for a new City of Marion fire substation located on Senator Gasque Road. Harper informed of a request, proposing the city and county partner in the construction of the station.
Harper informed that it was an opportunity to house one the county’s EMS units and Emergency Operations Center command post, allowing equipment to be housed inside a building, cutting down on maintenance cost. “This would also provide better coverage throughout the county by placing the unit at a more strategic location,” he said, adding that the Marion County Medical Center would allow another unit to be housed at the Mullins Nursing Center. The station will include a kitchen quarters and sleeping quarters for male and female staff.
Harper said the cost of the partnership would be $36,000 over a three-year period at $12,000 per year, along with payment of half of the electrical and natural gas expenses. The units would be more “centralized” in the area, he said, that the funding would come from contingency, and will be part of the EMS budget in the next fiscal year.
Council Member Tom Shaw said taxpayers are already paying for fire dues and didn’t agree with paying for a city project. Harper said it would provide better service in the county. “Even if we don’t, we need to do something,” he said, adding that it was an opportunity to work jointly with municipalities.
Council Member Milton Troy II asked to defer the matter to committee. The motion made by Council Member Allen Floyd was approved.

Cost-Effective and Accurate Medical Billing Services

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There are many large and small outsourcing medical billing companies offering a wide range of medical billing services. IT outsourcing services is providing outsource medical billing services, medical coding systems, medical transcription services and medical claim processing to any physician across the world.

IT Outsourcing Services work closely with clients by utilizing applications such as Lytec, Medisoft and Medical manager to provide effective solutions for their medical billing services needs. Our success till date stems from our reputation for professionalism and service.

The Patient Advocate deciphers medical billing

Just a few years after launching a company to help doctors run the business side of their practices, Springfield businessman Don Tucker saw an opportunity to start a second venture aimed at helping patients.

Tucker launched Focused Physicians Inc. in 2006, helping physician practices with scheduling, medical record coding, billing, claims, collections and accounts receivable.

In August, he opened The Patient Advocate LLC after his Focused Physician work shed light on a widespread need among patients for help navigating the billing maze.

"A lot of elderly people struggle with their medical bills, sorting things out," said Tucker, who has been in health care administration for more than three decades. "If you have a hospital stay, you'll get a bill from the hospital (and) a bill from every specialty physician you see. So you're inundated with medical bills."

The Tuckers are in the process of relocating both ventures to leased space in Butler, Rosenbury & Partners Inc.'s 319 N. Main Ave. building in downtown Springfield, from 1135 E. Lakewood St.

Breaking down bills

Six contracted case managers at The Patient Advocate, led by Tucker and his son, Michael, vice president of operations, make sure clients understand what their insurance is responsible for covering and how much they need to pay out-of-pocket.

"(Clients) come and bring their shoebox with all of their bills ... and we'll go through and sort those by providers, by dates of service to get a clear understanding of what is involved," said Michael Tucker, who has worked in medical billing for nearly 20 years. "Then ... we'll come up with a summation to the client of what we see to go forward." And if there are questions that need to be answered, he said case managers will call and get the information.

Advocacy is not new in health care, Don Tucker said, noting that doctors, hospitals and insurance companies sometimes answer patients' questions.

For example, Springfield-based Employee Benefit Design LLC offers its clients access to assistance through an independent company, Health Advocate. The fee-based service is available with favored pricing because EBD is a member of United Benefit Advisors, said Alecia André, EBD account manager.

"It will handle any type of medically related service," she said, pointing to finding providers, making appointments and answering benefits, billing or medical questions. "When the doctor talks real fast and shuffles you out of the office and you don't understand what's going on, you can call Health Advocate, and they'll help piece together the information that you need to make informed decisions," she said.

Dr. Thomas Brooks, a pain management specialist with CoxHealth and former client of Focused Physicians, often fields patients' billing questions - sometimes even related to other providers - and has referred patients to The Patient Advocate.

"I'm not a billing expert by any means," Brooks said, adding that it's important to find help from somebody who can look at the whole scope of a patient's insurance package and address questions. It's essential that patients understand what's covered - or not - by their insurance, he said.

"Physicians' offices are overwhelmed with different policies," Brooks added. "Having somebody who has an expertise in that area to guide the patient, I think, is a fabulous idea."

Access to assistance

Right now, The Patient Advocate operates on a fee structure that starts at $50 for physicians' bills and ranges up to $100 for bills related to a hospital stay, Don Tucker added. He declined to say how many clients have been assisted since opening in August, but he said the plan now is to convert The Patient Advocate into a not-for-profit entity. Doing so, he said, would open the door for financial assistance for patients.

"I have visited with (Congressman) Roy Blunt's office (which has) an advocate for Medicare. They ... offered us all kinds of information about government programs, if we wanted to apply for a grant to help fund this service, rather than do it on the backs of the people who need it," Tucker said.

Sometimes, in the process of examining client bills, case managers are able to alleviate the burden of medical bills, by uncovering instances of over-billing or double billing, or by matching patients with available government assistance.

But reductions aren't a given.

"There are times when we'll go through (the process) and say, 'You know what? You've got a $2,000 bill, and you owe it," Michael Tucker said.

While turning a new business into a nonprofit might be unusual, Don Tucker said, it benefits several parties, including Focused Physicians, as it helps its eight client practices streamline billing and claims.

"If you don't understand a bill, you're not going to pay it, so we're everybody's friend," Tucker said. "We want the hospitals to get their just due. We want the doctors to get their just due, and we want the patient to be treated fairly."

Kaplan College's Denver Campus Launches New Medical Billing and Coding Diploma Program

Kaplan College in Denver has opened enrollment for the new medical billing and coding diploma program. The campus will begin classes Jan. 20.

The 36-week program prepares students with the knowledge, technical skills and work habits to pursue an entry-level position in the medical billing and coding field or related area.

Duties may include a variety of functions such as
accounting, preparing and filing insurance claim forms, Medicare and Medicaid billing, reimbursements, collections, coding procedures, benefits, coverage, and limitations. The students will develop the understanding of insurance co-pays, deductibles and out-of-pocket expenses, along with collection procedures.

'We are proud to offer our new medical billing and coding program in response to the growing demands of the field and our community,' said Todd Smith, executive director of the Kaplan College Denver campus.

Debbie Lundy, medical program director for the Kaplan College Denver campus, will oversee the program. She has worked in the medical field for 10 years. During this time, her role included administrative work, coding and billing and assisting with minor surgeries at local pediatric and family practice offices. Lundy began teaching at Kaplan in 2005 as a medical office specialist instructor.

Individuals interested in learning more about the program can contact an admissions representative at 303.295.0550.

The Kaplan College Denver campus is accredited by the Accrediting Commission for Career Schools and Colleges of Technology (ACCSCT). ACCSCT is listed as a nationally recognized accrediting agency by the United States Department of Education.

About Kaplan College
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NY AG accuses hospitals of kickbacks, fraud

ALBANY, N.Y. (AP) — Seven New York state hospitals are facing lawsuits accusing them, in some cases, of rounding up the homeless or paying kickbacks to get more inpatient detox patients into their drug treatment beds, and lacking certification for detox services.

In one of the cases — Parkway Hospital in Queens, which closed in November — is accused of paying people to search homeless shelters and other places for patients to enter a three-day stay in detox in exchange for cigarettes, beer, food, and other items, according to a suit filed by Attorney General Andrew Cuomo. His office hasn't charged the now-defunct hospital with kickbacks.

In civil lawsuits filed by Cuomo and U.S. Eastern District Attorney Benton Campbell, the hospitals are accused of fraudulently billing Medicaid for more than $50 million in more than 14,000 different claims.Both attorneys' offices declined to say why they didn't pursue criminal charges. In both investigations, former hospital employees notified federal and state authorities of the issues, dating back to 2002.

The hospitals named in the suit are Columbia Memorial Physicians Hospital Organization Inc., in Hudson; Long Beach Medical Center; New York Downtown Hospital; St. Joseph's Medical Center in Yonkers; the former Our Lady of Mercy in The Bronx; Benedictine Hospital in Kingston, and Parkway.

The suits also name Missouri-based SpecialCare Hospital Management Corp., as a defendant. The company faced a similar suit in Illinois, when a former hospital employee accused the company and an Illinois hospital of admitting patients into detox who did not meet criteria because of the lucrative Medicaid reimbursements. That case was dismissed, but more detailed claims have since been filed.

Spokesmen for St. Joseph's, Benedictine, Downtown Hospital, Columbia Memorial and Long Beach denied the allegations. Parkway closed and officials couldn't be reached. Our Lady of Mercy is now run by Montefiore Medical Center and didn't return calls. SpecialCare didn't return a call for comment.

"Despite years of investigation, neither the Office of the Attorney General of the state of New York, nor the United State's Attorney's Office has articulated any viable claims," said Gary Schulz, an attorney representing St. Joseph's.

Cuomo said all the hospitals operated detox services claiming they were part of a government treatment program, but they didn't have the required state license for the treatment. The suits also accuse the hospitals of billing Medicaid for inpatient detox services that weren't medically necessary, or didn't meet standards.

Separately, the suits accuse four of the hospitals of engaging in a kickback scheme with SpecialCare to illegally refer patients to the hospitals' detox units.

The suit claims the company entered into agreements with Columbia Memorial; Long Beach Medical Center; New York Downtown Hospital, and St. Joseph's Medical Center in Yonkers. The agreements were supposed to have SpecialCare provide management and administrative services for the detox program, but the lawsuit accuses the company and hospitals of illegally referring patients to the hospitals for a fee.

Cuomo asserts that violates New York's anti-kickback laws.

"SpecialCare at times literally picked up strangers on the street, shuttled them to hospitals where they received treatment that was either inadequate or unnecessary, and then billed the state," Cuomo said in a written statement.

The state settled for $4.5 million with Our Lady of Mercy, which denied all wrongdoing.

The lawsuits were first reported by The New York Post.

athenahealth: Don't Curb Your Enthusiasm Just Yet

When it comes to diagnostic imaging, drug eluting stents, and hip replacements, healthcare technology in America is without a doubt the best in the world. Sadly, it’s a recurring nightmare when it comes to information technology within hospitals and small physician practice, where everything from ballooning bad debt expense to illegible prescriptions and 200,000 preventable deaths a year are bleeding our healthcare budget dry, scarring the people who pay too much for too little, and overworking providers of care.

IT investment per worker in the healthcare industry is roughly half of what private industry in America pays and only 1 in 6 physicians have a fully working healthcare technology platform. The US spends $2.2 trillion, or 16% of GDP, on healthcare, yet we rank #46 and #42 when it comes to life expectancy and infant mortality, respectively. Without adjustment, healthcare spending will double to over $4 trillion by 2016.