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

IT outsourcing services is one of the leading and professional ITES services company. With its vast experience ITES outsourcing services has outshine its competitors and emerged as the leading company supporting ITES services outsourcing. We are serving in BPO, KPO and IT outsourcing service industries from all over the world. IT outsourcing services brings innovative and streamlined products and services.

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
Kaplan College is part of Kaplan Higher Education, which serves 100,000 students through more than 70 campus-based schools across the United States and in Europe. It also has online programs through Kaplan Virtual Education, Kaplan University and Concord Law School of Kaplan University. Kaplan Higher Education schools offer a spectrum of academic opportunities, from high school diplomas to graduate and professional degrees, including a Juris Doctor degree. Kaplan Higher Education is part of Kaplan, Inc., a subsidiary of The Washington Post Company (NYSE: WPO). For more information, visit portal.kaplancollege.com.

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.