RE: Joe M, Paul Wilson and Kim D. "Medical Coding".
Blessings all.
This'll probably be a long post, so here's the bottom line:
1. The medical coding will enable the government to finally have complete control over all medical care in the United States. And particularly rationing based on political correctness.
2. There is no future for medical coders. That occupation is being eliminated. Along with everyone who is working in medical records. (There will be a shortage of general practice physicians, PAs and nurse practitioners. And each one of them needs a nurse. Nurses are expensive so most places are hiring medical assistants. There will be more jobs at the top and bottom of the medical field, and few if you're in the middle.).
The government is actively driving all medical clinics and hospitals into the EHR (electronic health records). This is more then the simple electronic medical records, these are records that can easily be shared with all medical facilities, insurance companies and the government, and are also designed for easy "mining" of information. (I.e.: how many patients smoke and how many of them have been counseled not to smoke at least three times within a year; the number of patients seen with new onset low back pain, and how many of these were not x-rayed within the first 28 days; how many women over 50 years of age and what percentage have had their Pap smear and mammogram; how many patients have been diagnosed with coronary artery disease, and the percentage that have routine cholesterol checks and placed on a statin medication; Etc.). The doctors that meets the government's "standards," receive money. Those who missed it, will be forced to "try harder." $$$$
I have been working with an EHR, for almost a year now. When I use it, as it's designed, it will perform all of the coding. It will calculate all the charges including any extra time or procedure I might perform. When I choose a diagnosis, it will give me the ICD-9 codes. I am at our larger clinic, and we still fill out the paper charge slip along with our EHR billing. As soon as they determine that we are capturing all the charges, we will stop including the paper charges, like our smaller clinics have done. The smaller clinics have completely scanned all the old records into the computer and most of the jobs in medical records have been eliminated. They do need someone to still scan in all records that come in that are not yet in the EHR format. But the government has informed the medical community that the day is coming when those who are not on the EHR will not receive a higher level of reimbursement for Medicaid and Medicare as those that are on the EHR. And like in the past, what ever Medicare does, the other insurance companies will follow. And of course with the fascist Obamacare, government insurance is the only option.
As Kim D. has indicated, the more expansive ICD 10 codes are being forced upon the system. Like every other system, it can be used for good or for bad. But what these codes do do, is make a more precise "code" for each diagnosis. (The code is simply a set of letters and numbers that match a specific diagnosis. So billers and insurance companies are speaking the same language. When we order a lab test, there has to be a "diagnosis code" that would justify that test. If not, the patient will have to pay for it instead of the insurance company. I.e.: they won't pay for a diabetes test for someone diagnosed only with rheumatoid arthritis.).
Personal example:
I was unemployed without insurance for over a year, and then was employed starting December 20, 2010. I was not eligible for medical insurance through the company until February 1, 2011. I presented to the emergency room on February 6, 2011, and was diagnosed with atrial fibrillation. The ER physician stated in his medical record that this was a "new onset" atrial fibrillation. Meaning that I never had it before in the past. I believe it was coded simply as "atrial fibrillation." On February 8, I was seen by a cardiologist and underwent many tests and procedures for "atrial fibrillation." My insurance company refused to pay thousands of dollars claiming that the atrial fibrillation was a pre-existing condition. I sent them copies of the ER doctor's statement from the medical record that it was "new onset atrial fibrillation." The insurance companies response was, "we don't read the medical record." "You did not have a previous insurance carrier to verify that you did not have atrial fibrillation in the past. "It is our opinion that this is a pre-existing condition." "All Cardiology costs are your responsibility."
I then went to my personnel department and got a copy of my pre-employment physical done on December 20, 2010. It showed normal vital signs with a normal heart rate and rhythm. I eventually won my case and my cardiologist was finally paid in early October of 2011. I doubt if many people who are not in the medical field would've been able to persevere and win this type of case. Along with this I was being badgered by the cardiologist who was continually adding interest to my bill. If we hadn't "fired each other," in late April, I'm sure that he would have refused to continue my treatment until I started paying him cash. I might add that I actually won my case by the end of May. It took until the end of September for the Dr. to finally get his paperwork and coding corrected. The insurance company wasn't going to pay him or my subsequent cardiologist until the doctor got the codes right. And how many people are waiting for their doctor to, "complete the paperwork."
The new ICD 10 codes will mandate a more thorough and precise diagnosis. It will indicate if the condition is acute or chronic. Sometimes the condition is "acute on chronic". (I.e.: acute on chronic low back pain. A patient with a history of low back pain, reinjuring the low back.). The government will now have one number that tells them the whole situation. And with the EHR, they can also dictate the tests and treatments.
Information that most people are not aware of:
The "Obama stimulus package of 2009," included an incentive (whore money), of up to $64,000, paid out over five years, for every doctor or nurse practitioner who serves a significant percentage of Medicare or Medicaid patients. They must participate in an EHR, with e-prescribing and meet different standards which the government calls "meaningful use." The first-year bribe is over $21,000 paid directly to the doctor or nurse practitioner. The PA's were excluded (thank you Jesus) because reportedly, "the government didn't have enough money." The truth is, how the licensing is structured between PAs and nurse practitioners, the PAs are controlled by the doctors to a greater degree legally than the nurse practitioners, who can be more independent in most states.
During the first year, and every year thereafter, they must demonstrate that they are using an EHR and are prescribing electronically. Within the electronic prescribing, there must be a system that notifies the prescriber if there is some type of conflict with each medication prescribed (allergy, duplication, contraindication, etc.). But then they must also give a report showing that they are meeting other requirements of "meaningful use." And those are the things such as counseling cigarette smokers at least three times a year, or not ordering a back x-ray on a new back injury for at least 28 days. Your EHR has to be able to go through every patient you have seen and count how many people are smokers. The government I believe mandates for you to ask and record in the medical record every patients smoking status. And then you must indicate every time you have counseled those who smoke, about not smoking. And you are required to make a report to the government of the percentage of patients who have been counseled at least three times a year against the number of smoking patients. If you do not reach the number that the government states is "meaningful use," you do not get the money. (I do not know if there are penalties or you have to pay money back. But you have to "meet meaningful use."). And of course the government has yet to decide what items qualify for "meaningful use" in stages two through five. It kind of reminds me of Nancy Pelosi stating, "we have to pass the law, to find out what is in the law."
Therefore, the government is requiring your medical provider to gather data on you, and meeting different politically correct government standards in order to be paid. What do you think your doctor is going to do if it looks like he is not going to reach, "meaningful use?" He will either have to falsify his electronic records, or alter his "care" to be in alignment with the politicians and bureaucrats who are dictating your medical treatment. There is a website that I have seen that lists hundreds of possible items that the government is considering for future "meaningful use." Each criteria has some medical organization or study that supports its implementation. Some of them already have a notation that the recommendation is no longer valid. A lot of this is junk science or political payoffs.
The Department of Justice already has a website that I have been using for a couple years which lists every prescription written for a controlled substance. My clinic policy is that any patient that is on a controlled substance for a chronic problem be screened on this website at least twice a year. I know when my patients have received a controlled substance from another medical provider. They may be "doctor shopping", or seen in the emergency room or urgent care. Most of these people are on a "drug contract" that requires them to inform me if they receive a controlled substance from somebody else. Big Brother has been watching you.
It is somewhat amusing to me about this Obama whore money. The clinics who pay for the EHR sign their providers up for this program and have them sign on the dotted line, so that the money goes to the clinic. They present this as if this is money to purchase the EHR. But if you read the actual bill, the money goes to the doctor or nurse practitioner who is promising to "meet meaningful use." They are promising to use a system that will monitor and control their own practice of medicine. They are selling out their individual freedom to practice medicine how they feel it is appropriate for them and their patient. Now some of these providers have realized that they have been deceived by the clinics and have obtained lawyers. It's like two prostitutes fighting over the same $20 bill.
Now this entire "meaningful use" program is supposed to be only for those who have signed up for it and received the money. (I have not.). Nobody elses "numbers" are to be included in their meaningful use report. But it looks like the government is requiring the entire clinic, under any type of federal designation, to meet the same requirements. Just last week our medical director sent me an e-mail inquiring why a specific diabetic patient of mine hadn't had a hemoglobin A-1 C. within nine months. (It appears as if he did a "meaningful use" screening on me with regards to this lab test.). In his e-mail he stated that due to our federal designation, I have to meet these criteria. (Even though I did not take the money, I'm under the control of those who did.). I then gave him multiple valid and legal reasons why this test may not have been done. But you see, the government is looking at numbers, but I am treating individuals. There is a major difference. Now it just so happens that later I discovered, that the test was done in May. The labs were scanned into the computer (like a picture), and the results are not being picked up by the EHR. There are many flaws in the system which is making many very unhappy medical providers. We have recently lost some providers, and one basically had a mental breakdown the other day from the stress of the system.
"Mystery" Babylon is fallen, .. ......!
Hsa 6:1 ¶ Come, and let us return unto the LORD: for he hath torn, and he will heal us; he hath smitten, and he will bind us up.
Hsa 6:2 After two days will he revive us: in the third day he will raise us up, and we shall live in his sight.
Hsa 6:3 Then shall we know, [if] we follow on to know the LORD: his going forth is prepared as the morning; and he shall come unto us as the rain, as the latter [and] former rain unto the earth.