Health Care's Next Challenge in Cyberspace - Electronic Medical Records

Successful managed care demands advanced information technology that can manage the patient's care. Electronic medical records can streamline patient management, provide instant access to data by multiple users, promote preventive medicine, facilitate research, improve billings, and minimize professional liability. But they also pose far more serious and unique legal challenges to health care professionals than traditional, paper-based patient records.

The quest for health care reform and the dynamic growth of integrated delivery systems have led to significant developments in the application of information technology to the health care industry. Multi provider organizations now link computers on different floors, at different offices, and in different states to share patient information throughout an integrated network.

The computerized medical record relies on a series of products and software packages considered only an emerging technology a few years ago. In a recent survey of information systems trends in health care organizations conducted by Coopers & Lybrand for Modern Health care, seven in 10 respondents indicated that systems which make patient information and histories accessible throughout their organizations are operational or under implementation. The average annual projected spending on information systems during the next three years is $8 million.

Major Changes in the Delivery of Care:

This move to a digital medium changes fundamentally how providers deliver care and which data are essential to them. For example, one health maintenance organization in Philadelphia plans to launch a new medical management system in May that allows a patient's electronic record to travel with him or her throughout the health maintenance organization's delivery network.

Rather than make an appointment with a primary-care gatekeeper, a subscriber seeking medical care will contact a 24-hour call center staffed by case managers who are registered nurses. The case managers will have immediate electronic access to every available piece of information on that patient from a computerized medical record stored at a regional data repository. The nurses will reach conclusions about possible care based on "triage algorithms" and the patient's responses, and then direct the patient in self-care or to a primary care physician, specialist, or emergency room.

Physicians can access the patient's medical records, review best practice protocols, schedule specialist appointments, obtain treatment authorizations, order laboratory tests, and compare their performance with their peers.

The health maintenance organization claims that the new system will improve both medical decision-making and preventive care. The call centers can also remind subscribers to take medications or make appointments for periodic tests.

Under evaluation at one cancer center is a system that will link the terms and conditions of managed care contracts to physicians at the point of care. The system will identify the most appropriate treatments, determine whether the treatments are covered, and obtain preauthorization for procedures.

Risks for Computerized Records:

From the perspective of professional liability, the computerized medical record poses less risk than multiple medical histories in different locations, all with different, or contradictory, information. A physician in an emergency room can access vital data, and check a patient's allergies or prescription medication, even if the patient is unable to describe or recall his or her medical history. The electronic record improves patient care by ensuring that the correct information, such as the proper medication or dosage, is retrievable and legible.

However, the advantages that attend the electronic medical record in a multiprovider network, including the final link which connects the institution with the office-based physician, increase the risk that its confidentiality cannot be adequately maintained. In hospitals, nursing homes, physicians' offices, home health agencies, and health maintenance organizations or other managed care plans, billing clerks, data entry operators, nurses, secretaries, and other personnel may have easy access to exponential amounts of centralized medical information.

The increased volume and sophistication of computerized patient information also make that information more valuable to users who wish to sell, exploit, or abuse it. A single breach of a patient record system's security can result in almost instantaneous transmissions of thousands of confidential records. In information systems which are not well monitored, remote access may pass without notice. Integrated delivery systems and multiprovider networks must secure that information from access by electronic trespassers while at the same time allowing routine access by qualified users.

New Security Threats:

The laws which govern the confidentiality of health care information require proper system and data security. If a system lacks reasonable security in design, operation, or maintenance, a court could determine that the records stored on that system are not sufficiently reliable to be admissible in a legal proceeding. As a result, a health care provider might not be able to defend itself properly in a malpractice case, or a patient might not be able to substantiate the right to custody in a domestic relations proceeding. Other breaches of system security, such as computer sabotage (viruses, worms, bombs, and Trojan horses), can compromise the accuracy of patient records and potentially harm the patients. The patient's providers may be liable for that harm.

If a patient record system slows down or crashes, users may be unable to access records, whether a breach is deliberate or inadvertent. Inaccessibility of patient records not only poses potential harm to the patient but may delay or preclude proper reimbursement and result in peer review actions as well. Health care providers should consider separate back-up systems for their medical records repositories.

One approach to limit access to electronic records is to maintain two levels of information -- one with easy access for basic information, and another with limited access for more sensitive information. Another approach requires the entry of a special code or password. Advanced technology now also permits biometrics-based authentication, which relies on some physical characteristic of the user, such as fingerprints or voice patterns. Other good security methods such as data encryption and compression techniques raise questions whether a record that has been compressed or encrypted -- or retranslated from its compressed or encrypted form -- is the "original" record for evidentiary or regulatory purposes.

Facilities which contract with outside computer service firms for automated record storage should require that their service agreements include provisions governing confidentiality of patient data, storage security, and indemnification for wrongful disclosure.

Other Risks:

Records subject to access throughout an integrated network may lead to claims that providers who review a record must act on the information in it, even though a particular provider would not ordinarily pursue an unrelated medical problem. For example, if an orthopedic surgeon notes that a patient has complained consistently about chest pain, he or she must consider whether to instruct the patient about coronary artery disease. If a managed care organization collects sufficient data to indicate a case of child abuse, a reportable infectious disease, or an impaired professional, it may be obligated to report that information to the proper authorities.

Another concern relates to the verification of patient records. Computerization may facilitate the improper addition of notes. A user may wish to make the record appear as if information was timely added, or may wish to alter incorrect information to make it appear that it was originally correct. Also, verification of a valid signature of a computerized record or entry is problematic. An increasing number of states are now requiring certain standards for electronic authentication of medical record entries and electronic signatures or computer-generated signature codes. Electronic records also raise special concerns regarding their durability.

Finally, if a network uses teleradiology -- the electronic transmission of digitized images -- the "reading" physician may not be licensed in the state where the patient is located, or may not have privileges at the patient's hospital. Teleradiology raises issues of licensure and jurisdiction by the local board or courts.

Read More at: http://library.findlaw.com/2004/Sep/19/133570.html

Indian lawyers a model in English for US firms

If you have the flair, flaunt it and make a fast buck out of it. That's what desi lawyers are doing with their proficiency in English.

Many top US law firms are hiring Indian lawyers to edit and make grammatical and syntax corrections in legal drafts/contracts prepared by their lawyers. A Fortune 100 client of a US law firm, SmithDehn LLP, has specifically requested that legal research, analysis, writing, editing — exercises that cost millions of dollars in the US — be done by Indian attorneys.

A recent American Bar Council Journal article compared the scenario to a "man bites dog" story. It says highly-trained LPO (legal process outsourcing) attorneys in India have been assigned the task of correcting grammatical and other mistakes of partners and associates at some of the top 100 law firms in the US.

"Indian LPO companies have taken a lot of heat from US lawyers for siphoning work, but they now may need to steal themselves against editors," said the article. It further said, "High quality and effective English writing has been out of fashion in the US for several decades."

Russell Smith, CEO of Mysore-based LPO firm SDD Global Solutions, said, "We never expected lawyers in India to be correcting the grammar and legal writing efforts of US attorneys. But the fact is, it is happening today. Also, American lawyers are too busy, law firms are under huge cost pressure and therefore unable to take time to do a perfect or near-perfect draft copy."

Till some time ago, Indian lawyers were seen to use lofty English — British- style pomposity, a vestige of colonial rule. Their sentences were long and winding. There were too many usages of passive and indirect speech. "Today, they are good with plain, crispy, clear and clean English writing. In fact, LPO has made them think global and grow global. American lawyers are liking it, a high-quality second look at the draft," said Russell.
Read More at : http://timesofindia.indiatimes.com/india/Indian-lawyers-a-model-in-English-for-US-firms/articleshow/6216775.cms

Ten Tips to Maximize Revenue - Revenue Cycle Management

The purpose of this article is to gain a better understanding of what you can do to efficiently manage the revenue cycle and how to maximize potential revenue.

1: Review payer contracts:
Payer contracts often contain complex reimbursement language and formulas that can be difficult to monitor and manage. It is important to know what you are agreeing to when you sign any contract, but especially when it comes to payer contracts. Be sure you know and understand the expected reimbursement and contractual allowances before you sign. Contract negotiations can be difficult, especially if you are a solo practitioner.

You have limited power to negotiate unless your specialty is in high demand and there are limited providers available in your geographic area. When negotiating, be sure to optimize trade-offs and to understand the total value of the agreement prior to contract execution. It could be beneficial to take less reimbursement on office visits if you can get more money on high dollar surgical procedures, but make sure you evaluate this against your current or expected volumes.

2: Know the Law:
Here in Indiana under the "Prompt Pay" law, payers must pay or deny a clean claim within 30 days of receipt if filed electronically and within 45 days of receipt if filed on paper. Check the laws in your state to see if there are payer deadlines. While the definition of a clean claim could be disputed, no response from a payer within the 30 to 45 day window should result in immediate follow up. Medicare reimbursements are dispersed within 14 days of electronic claim submission, so inquiry on those unpaid claims should occur within 15 to 20 days.

Most practice management systems will allow batching of unpaid claims by insurance type so that inquiry can be made on multiple claims with one phone call or internet inquiry. Pending claims should be worked on a daily basis, beginning with accounts with the highest balance and oldest age first, such that every unpaid account is reviewed at least once every 30 days.

3: Clean claims = fewer denials:
A serious concern in healthcare reimbursement today is decreased or delayed reimbursement due to claim denials. The challenge is how to quickly identify the source of the denials and fix the problems. Education is the key to clean claims. Providers, front desk, billers and clinical staff all contribute to the information that is submitted on a claim. Each individual needs to understand how their role impacts claim payment. When denials are received, they should be identified with a reason code and posted in the practice management system so a denial report can be generated at month-end. This gives managers a clear picture of where further education is needed.

4: Respond promptly to claim denials:
After receiving a claim denial it is important to correct the claim and rebill it to the insurance carrier promptly. Claims often go unpaid and bump up against timely filing limits when the biller keeps a "zero pay folder" to work in the future. Denied claims should be addressed daily as they are received.

Each insurance carrier handles resubmitted claims differently so it is important to know what each carrier expects. With some carriers, if the claim is simply rebilled electronically with no notation, the claim will be denied as a duplicate. Some carriers will allow the provider's office to fax a corrected claim directly to their claims processing department. Others require that the claim be resubmitted either electronically or on paper.

5: Review payments carefully:
Payers will often make mistakes when processing claims that need to be appealed for proper reimbursement. The person posting payments must pay attention and question anything that does not look right. Some things to watch for include:

• dropped or missed procedures
• one procedure bundled into another and paid based on one code instead of two
• modifiers dropped that justify bundled procedures
• multiple units ignored
• payment based on the wrong fee schedule

The best practice management systems have the ability to load payer fee schedules so you know when payments are posted whether they were paid correctly or not.

6: Appeal claims paid in Error:
Any services paid incorrectly should be appealed. Sometimes errors can be addressed over the phone, but often they require a formal appeal letter. It is important when appealing claims that a cover letter be submitted explaining why the claim is being appealed. The cover letter also notifies the carrier of any attached documentation accompanying the claim. Further documentation may include progress notes, lab or other test results, operative notes, fee schedules, copies of CPT guidelines or Medicare policies to support the appeal. Keep copies of all appeals and the results for reference with future appeals.

7: Don't get frustrated, get help!
Practices should not hesitate to contact their State Insurance Commissioner's office if they feel they are getting the run-around from a particular payer after reasonable attempts to collect. Find your state insurance commissioner at the National Association of Insurance Commissioners website.

Commissioner's offices may be called with general questions, but in order for them to investigate a disputed claim they must have written documentation with as many details as possible.

Documentation should include a copy of the insurance card, the claim form, and documentation reflecting all efforts to resolve the claim, as well as responses from the payer. A separate complaint should be filed for each patient involved. Most insurance companies respond quickly when the State Insurance Commissioner becomes involved.

8: Patient Balances:
Sometimes asking patients for payment puts the office staff in an uncomfortable position, especially when the patient becomes disgruntled. However, most insurance companies require that the patient's co-pay be collected at the time service is rendered. Staff members working at check-in and check-out should be comfortable asking for payment. Often providing a script requesting payment helps staff members to be more comfortable and consistent with requesting payments. Contracted providers are obligated to collect the co-pay at the time of service. Failure to do so could be a breach of contract.

The most important thing an office can do is to develop an office financial policy with regard to patient payments. Developing an office policy is important to ensure that all patients will be treated the same with regards to financial payment. A financial policy makes the patient aware of their responsibilities with regards to payment for services. Outline in your policy the exact process which will be followed should the patient refuse to pay on their account.

Attempts to collect outstanding balances should be made each time the patient is seen. The cost of pursuing payment after the patient leaves only decreases the value of the dollar collected. The more time that passes the less valuable the dollar becomes and the more difficult it is to collect. Patients know whether you are an office that expects payment or one that will extend free credit. The most successful practices use one or more of these techniques:

• Notify patients when scheduling and confirming appointments that they should 1) bring insurance cards and photo ID to each visit; and 2) come prepared to pay copays and outstanding balances at the time of service. Let them know up front what credit cards you accept.

• Collect copays and outstanding balances at check-in rather than check-out. Staff should be direct without being rude when asking for money. Confidently stating "Your copay is $35. Will you be paying with cash, check or credit card?" is better than asking "You have a balance of $132. Would you like to make a payment today or should we bill you?" Why pay today if you don't have to? Your office is not a bank and should not routinely extend credit.

• Start payment plans at a maximum of three to six months and a minimum of $25. It costs money to send statements and process multiple payments. Offer discounts if the balance is paid in full to get the account settled quickly.

• Don't spend money on statements to collect $5 and $10 balances. Collect small balances the next time the patient is in the office.

9: Hire and retain the best employees
Generating revenue is the most important task in the financial success of the medical office. The people hired for these roles should be seen as an investment. Ongoing training is critical to their success as the rules and regulations are constantly changing. The cost of one seminar could easily be recouped in a couple of correctly billed surgeries. Incorrect claims or missed charges could be costing you millions. Invest in your billers and do everything you can to retain the best employees. Workers who feel valued will usually deliver exceptional results.

10: Monitor benchmarks and key performance indicators
Benchmarks and key performance indicators should be reviewed monthly. Let your billers know what is expected so they can monitor and achieve the goals. Analyze trends on a monthly basis and identify any warning signs before they become serious. The following benchmarks are "best practice" and may be used as a baseline, but each specialty and/or practice may want to adjust these or reference MGMA benchmarks by specialty:

• Average number of days revenue in A/R at a maximum of 35 days
• A/R greater than 90 days less than 20% of total A/R
• Credit balances less than 4% of total A/R
• Bad debt write-off less than 2% of total charges
• Net collection percentage 96% or greater

Top-ranked Criminal Justice College Degrees

In 2009, U.S. News & World Report surveyed the nation's criminal justice university programs and measured each one using a number of diagnostic criteria.

This article presents the top three criminal justice college degree programs, and offers additional choices for students to consider.
Criminal Justice – University of Maryland

The University of Maryland was ranked as having the top graduate criminology and criminal justice university program in the country by U.S. News & World Report.

Maryland's Department of Criminology and Criminal Justice offers a bachelor program in addition to its graduate and post-graduate offering, which include:

* Traditional Master of Arts in Criminal Justice – students are required to take a minimum of 30 credit-hours of specialized courses, including six hours dedicated to the production of a graduate thesis. While the program typically takes two years to complete, students may not extend the degree for longer than five years;
* Professional Master of Arts in Criminal Justice – this research-based degree, offered both in College Park, Maryland and in China, is geared toward training students for management and agency positions rather than hands-on investigative work. As with the traditional degree, it is 30 credit-hours.
* PhD in Criminology and Criminal Justice – this program is only available to those who have earned a graduate criminal justice degree.

For more information on criminal justice degree programs and tuition rates, contact UM at (301) 405- 4699.
Criminal Justice College – University at Albany (SUNY)

University at Albany, ranked as one of the top three criminal justice programs by U.S. News & World Report, offers a bachelor degree program in addition to its graduate and PhD offerings.

Students in the Master of Arts in Criminal Justice program focus on information technology models, learning how to efficiently manipulate data, in addition to traditional theory courses. The School of Criminal Justice has working partnerships with the New York City Police Department, New York State Police, and the Japanese National Police which students are able to take advantage of.

Students in this criminal justice college program are required to complete 30 credit-hours, which include theory and statistics courses, and must pass a comprehensive exam to graduate.

For more information on the graduate program, or for details on either the bachelor or PhD criminal justice degree programs, contact Albany at (518) 442 - 5212.
Criminal Justice College Degree – University of Cincinnati

UC's School of Criminal Justice, ranked by U.S. News & World Report as one of the top three in the United States, offers both undergraduate and graduate criminal justice college degree programs, including a traditional and online graduate program.

In both the traditional and online programs, students are required to take between 45 and 48 credit-hours, which can be completed either part-time or full-time. Students in the online criminal justice university program are able to complete it fully online via an asynchronous class schedule, which allows students to log in and learn whenever they choose.

For students studying part-time, the program can be completed in two years, which those studying full time can often complete it in a single year.

For additional information on admissions and tuition, contact UC at 1-800-645-5078.
Additional Ranked Criminal Justice Programs

Below is a listing of the top fifteen criminal justice university programs as ranked by U.S. News & World Report in 2009:

* University of Maryland
* University at Albany (SUNY)
* University of Cincinnati
* University of Missouri, St. Louis
* Penn State University
* University of California, Irvine
* Florida State University
* Michigan State University
* Rutgers, the State University of New Jersey (Newark)
* CUNY, John Jay College
* Temple University
* Arizona State University
* Northeastern University
* University of Florida
* University of Pennsylvania

The above schools offer some of the finest undergraduate and graduate criminology and criminal justice programs in the United States, and are good first options for students to consider.
Considering a Criminal Justice University Program

Students interested in a criminal justice degree are encouraged to shop around and find the program which is the best educational fit, considering financial, geographic, and academic factors.

Read More at: http://americanuniversities.suite101.com/article.cfm/top-ranked-criminal-justice-college-degrees

Medical Coding

Choosing medical coding as profession can be perfect for a lot of people because it is a profitable way to make a living that does not come bundled with the usual stresses of a regular 9-5 job. In fact, choosing a medical coding profession is choosing to make an income with flexible scheduling and work at home benefits. The issue remains though: is continuing education required for a profession in medical coding?

The answer to the question most certainly is yes. To improve your employment opportunities, it would be valuable for you to obtain the essential training required to familiarize yourself with the different fine points of medical coding.
Demand

One must be able to comprehend and become skilled at all there is to discover about medical coding. This is because a medical coder is responsible for assigning exact codes to various medical services and procedures to allow health care providers to be able to invoice for services provided. This is one of the reasons why medical coders are in demand in the business.

If you have an inclination for organization and take pleasure in administrative employment, learning medical coding will be straightforward for you. There are dedicated courses and trainings available for persons who want to study the special techniques used in medical coding. However, not all of the accessible courses will give you the essential certifications needed to advance your profession in this field. It will however, prepare you with the knowledge to pass essential examinations to allow you to obtain certifications.

You will discover that going the extra mile and investing time and funds into continuing instruction for a medical coding profession will take you far. After all, medical coders are in demand by several institutions like hospitals, medical clinics and offices. If you have the correct authorization and documentation for this work then more opportunities present themselves to you.
Certification

The American Academy of Professional Coders offers diverse types of certifications after persons have passed their examination. Each certification is nationally accepted and while you can still get a medical coding occupation without these certifications, your choices for employment are narrow. If you are serious regarding a profession in medical coding, it is better to take the examinations and attain these certifications.

Most specific trainings that medical schools offer for persons who choose a profession in medical coding result in being prepared to take the examinations provided by the American Academy of Professional Coders. For this singular purpose, it is beneficial to obtain additional education.

The American Academy of Professional Coders offers Procedural Coder Certification to those who pass a specific examination. After passing the examination and being a Certified Procedural Coder, the person can then be considered for a variety of important opportunities as a medical coder in different specialized health care facilities, offices and clinics.

That sort of certification is fundamental, and if one wishes, they can take the other types of examinations offered by the American Academy of Professional Coders. They offer field certificates that will allow an individual to establish their skill within their present focus or they can even use this to launch their medical coding profession into a different type of specialization overall.

Read More at: http://healthfieldmedicare.suite101.com/article.cfm/medical_coding

Family Law

Family life is never static, but is filled with ups and downs that either enhance or weaken delicate family dynamics. Sometimes, families look forward to upcoming marriages or the adoption of a new child. Other times, families are devastated by loss or the anticipation of an impending divorce. When your family faces difficult times or exciting change it is important to contact a family law lawyer that will take the time to help you explore your options and reach a conclusion that is in the best interest of you and your family.

Family law matters are often complex and are usually handled during periods of high stress and emotion. It can be difficult to make life-impacting decisions under such circumstances. For this reason, it is important to have a family law lawyer help you wade through the chaos. An experienced attorney should be able to help you see the larger issues at play and provide the advice you need to make informed decisions about your future.

There are always questions that arise when families face new possibilities or change structure. A family law attorney should be able to answer any questions you may have, like:

# How will I support myself after a divorce when my spouse was the primary income earner?
# How do I fight for sole custody of my children?
# What should be included in a prenuptial agreement?
# How do I protect my interests in divorce proceedings?
# What do I need to be aware of when considering adoption?
A family law attorney can help individuals in a wide range of matters regarding marriage, divorce, adoption, child custody, spousal support, domestic abuse, grandparents rights and any other matters related to family law.

If you are going through a divorce or need assistance with the legal issues involved with adoption or getting married, seek advice from a family law attorney. A skilled attorney should be able to help you understand the legal ramifications of decisions you have to make and fight to protect your best interests.
More Details at:http://www.alllaw.com/topics/family/

India Top Ten KPO Companies

1. Genpact: Formerly GECIS, Genpact had revenues of US$ 493 million in 2005. The relatively small KPO unit is a complementary arm to its main BPO business. Genpact’s KPO specializes in competitive intelligence, campaign management, program tracking, customer relationship management, customer value mapping, research, database generation, and others. The KPO has staff strength of 1200 people, of which more than 90% has advanced degrees.

2. Pangea3: Based in Mumbai, Pangea3 provides services areas such as patent research, analysis and prosecution support; document review, litigation and due diligence; contract drafting management and administration; legal research and business information research. With an employee strength of 100, its revenues are expected to be US$ 2.5 million this year.

3. ICICI OneSource: Acquiring a US-based research firm, Pipal in 2004, ICICI OneSource offers high-end customised business research and collections, analytics and information services. It had revenues of US$ 42 million in 2003-04.

4. EXL Service: This BPO acquired Inductis, a leading strategy and analytics company serving the financial services and insurance industries, in June 2006 to form an independent subsidiary. Inductis had revenues of US$ 20 million in 2005. The new entity will focus on consulting, research and analytics.

5. Copal Partners: Founded in 2001, Copal Partners provides company and sector research to its clients, which include Wall Street investment banks, hedge funds, private equity firms and private and public corporations. It was formed by professionals from McKinsey & Co., Citigroup, and GE Capital. In 2005, it entered into an agreement with Reuters to provide financial institutions with customized company research and sector analysis. With revenues of US$ 6 million, it plans to expand to 400 employees by the end of 2006.

6. Evalueserve: Based in Gurgaon, it has 650 people engaged in market research and business intelligence. Nearly 45% of the company’s revenues come from math related projects. Evalueserve has a research firm called Global Sourcing Now, which specialises in high-quality research reports.

7. Ugam Solutions: Ugam Solutions entered the area of market research analytics in 2001, much before the term KPO was coined. Their business involves the study of consumer minds, their behaviour and habits, for evolving a basis for business development initiatives of global companies. It has now grown to a 400-member organization.

8. Vee Technologies (BPO, LPO, KPO): Vee Technologies provides services areas such as patent research, analysis and prosecution support, document review, litigation Support; contract drafting management, legal research and Analysis. The division is a premier services provider in India, with onshore offices at Chadds Ford, Pennsylvania, PA and delivery centers in San Antonio, TX, and the Caribbean.

9. WNS: A Mumbai-based BPO, WNS has just started its KPO division for market research with 300 people. It operates in the knowledge services business segment and offers high-end services such as market, investment and business research.

10. 24/7 Customer: This BPO was listed in the Leaders category of IAOP’s (International Association of Outsourcing Professionals) Global 100 list. Its KPO focuses on customer analytics, where it studies consumer behaviour and analyses data pertaining to related activities such as campaigns and marketing activities.