Journey from a Software Developer to an Author

Stating with a punch line, an inspiration to all – Each one of us is born as author. But you never realized until you express yourself in writing J

It’s a blog about my journey from a software developer to how I became an author over the time. First off, I still work as a software developer and I consider myself as an enthusiastic part time author. This did not happen over the night, it took several years. I spend most of my time in reading latest ongoing developments in software industry; do spend time in writing articles targeting beginners to advanced level.

Here’s how it got started. After graduation, when I first started working with .NET Technology, I was in-fact new to .NET but had some understanding in developing web applications etc. As you all know where to find solutions or help when you get stuck with problems. Yes, I started googling and landed up in finding articles in CodeProject. For those of you not aware of what CodeProject is, its world’s largest number one technical community of over 10 million peoples who share or express their ideas, thoughts in terms of articles, tips, blogs etc. It’s completely free and open for all. At first, I registered myself and started following up with the latest articles. As I gained some knowledge, I made up my mind to publish an article related to .NET Technology. I was very excited to see my own articles with lots of comments from peoples all over the world, which helped me in understanding the readers’ expectations etc.  Enough about me, now let us focus on some other aspect that you might want to know.

Writing a technical article is not an easy task. First you need to really have a good understanding and hands on experience in the area you are interested in writing articles. You should or try to express yourself and make the readers enjoyable. Have some patience; it might take few weeks, months or years to gain these skills. You need to have a defined set of goals before you start writing an article. Here are few tips to get started  

1.       First and foremost, make yourself available.

2.       Come up with a good topic that you wish to share. Start with the know concepts which you are most knowledgeable off.  

3.       Never say I will start tonight or tomorrow as it will never happen and you will keep postponing. Just do it right away when you had thought about writing one.

4.       Open up a text editor. Microsoft word, Office Org or if you wish you can use Google online word document etc.

5.       Ok now you had come to a point in sharing something to the world or with someone and opened up a blank document, now you might be wondering how to keep going. Here’s what you need to do.

a)      You have to list the topics that you wish to cover. You don’t have to be too specific. Just jot down all the topics that you are interesting in sharing.

b)      If you slice any technical article, all it contains is a huge blocks of texts, images, code snippets, flowcharts etc. Mostly every single developer would be interested in learning the concepts with the implementation. So it’s always good to come up with code samples as you don’t want to make the readers to get bored with a bunch of theoretical concepts.

c)       Start with a draft copy and keep going and try to express your thoughts.

d)      Once you have a draft copy, you can read yourself and see whether it makes some sense. You may have to do some minor corrections or add missing explanations etc. You can do all these things in no time.

e)      It’s always a good practice to have someone look into your article and proof read the same. As they might come up with suggestions that will help in improving article.

  

Important Process In Medical Billing

Medical billing is the process of submitting the claims and get paid behalf of provider.
The physician doesn’t get paid for his services immediately after they are rendered. Majority of the patients have insurance coverage and details of such coverage are provided to the physician before treatment.
It is the responsibility of the physician to submit claims to the insurance company and get paid for his services. Submitting Claims and getting paid is a lengthy process and involves a lot of rules and regulatory systems and is very complicated. The physician needs to adhere to all these rules before submitting claims. This is the concept of Medical Billing. Sometimes the physician cannot provide his entire attention to this activity. He entrusts this activity to Billing Companies. This is a process of the physician providing rights to Billing Companies to bill Medical Insurance claims in order to save his time energy, and money.
After the provider renders services to the patient, the billing company will submit bills to the insurance company/ payer, using the insurance information that was last provided, as well as information about the reason for the examination, and the exact type of procedure performed.
Medical coding is the process of converting Medical terms to numeric code and it required Medical knowledge skills.
Below are list of process each one is very important.


1. Insurance verification.
2. Demo and Charge entry process.
3. Claim submission.
4. Payment posting.
5. Action on denials or Denial management or Account receivables.

Unconfirmed Diagnosis

Unconfirmed Diagnosis

When a provider is not certain of a diagnosis, capture the known manifestations, signs, symptoms, or abnormal test results.

Example:  The diagnosis documented, as “rule out malignant neoplasm of the pancreas” cannot be coded, as the diagnosis is unconfirmed.  The documentation indicates a “mass on the pancreas.”  The terms “mass” and “neoplasm” are not synonymous.  Therefore, the most appropriate code would be 577.9, unspecified disease of pancreas.  

Although ADM permits designation of uncertain (unconfirmed) diagnoses with a “u” instead of a number, unconfirmed diagnoses are not traditionally coded.  If a “u” designator is used for a diagnosis in ADM, then that data is only available at the local server.  The “u” designated diagnosis cannot be the only diagnosis captured (there must be a primary diagnosis other than the “u” diagnosis).  Currently, Air Force is the only Service that permits use of a “u” designator in ADM. 

Example:  A patient comes in with chest pain, and the provider wants to rule out myocardial infarction.  The provider would document the specific symptom of chest pain as the primary diagnosis and document the myocardial infarction code as an unconfirmed diagnosis.  The provider could document the myocardial infarction code as an unconfirmed (u) diagnosis if that Service permits the designation.  

HCPCS Codes

Health Care Financing Administration Common Procedure Coding System. (pronounced "hick-picks"). This is a three level system of codes. CPT is Level I. A standardized medical coding system used to describe specific items or services provided when delivering health services. May also be referred to as a procedure code in the medical billing glossary.

The three HCPCS levels are:

Level I - American Medical Associations Current Procedural Terminology (CPT) codes.

Level II - The alphanumeric codes which include mostly non-physician items or services such as medical supplies, ambulatory services, prosthesis, etc. These are items and services not covered by CPT (Level I) procedures.

Level III - Local codes used by state Medicaid organizations, Medicare contractors, and private insurers for specific areas or programs.

CPT Codes

Current Procedural Technology as it is better known as is basically maintained by the American Medical Association. This code can be found on the paperwork and documentation of any healthcare related experience. There are 3 types of codes:

The category I codes are permanent and are listed in the CPT code book. They are recognized clinically and can be identified by their 5-digit code. They illustrate a particular service or procedure.

The category II Performance Management codes are useful for collecting data on the efficiency of a particular service or care provided. They also provide proper test results that would help establish the performance standards of the service. These codes are also categorized as supplemental tracking codes and are immensely helpful for reducing the organizational load of healthcare professionals.

The category III Emerging Technology codes were introduced in the year 2001 and depicted the latest trends in procedures, services and technology. Since its inception it has been well accepted by healthcare professionals using CPT codes.

Taxonomy Code and How it affects Reimbursement

Taxonomy Codes are an administrative code set for identifying the provider type and area of specialization for health care providers. They are alphanumeric and are ten characters in length. Taxonomy codes allow providers to identify their specialty. A provider can have more than one taxonomy code.

Taxonomy Codes have 3 distinct levels.

Level I is the provider type which is a major grouping of health care providers. For example: Dentists, Osteopathic Physicians, and Chiropractors.

Level II is Classification or a more specific service or occupation related to the provider type.

Level III is the Area of Specialization. This is a more specialized area of the classification in which a provider chooses to practice or make services available. This is usually based upon the sub-specialty certificate.

Taxonomy Codes allow the provider to identify their specialty at the claim level so this can directly affect your reimbursement from insurance companies. If you have an inaccurate taxonomy code linked to your NPI number then your services may be paid at a lower reimbursement rate, or outright denied by an insurance company.

What is the difference between CPT codes and ICD-9 codes?

Current Procedural Terminology (CPT) is a listing of descriptive terms and identifying codes for reporting medical services and procedures as they are performed by physicians. The purpose is to provide a uniform language to describe medical, surgical, and diagnostic services. The book is prepared by the American Medical Association.

International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes are for the diagnosis, condition, problem, or other reason for the encounter. The ICD-9-CM, diagnosis, is used in conjunction with the CPT procedure book. This book is prepared by Practice Management Information Corporation.

ANSI 5010

ANSI  5010 is an upgraded replacement for the current ANSI 4010A1 EDI (Electronic Data Interchange) transaction sets that our plans use to communicate with hospitals, physicians and other health care providers and business associates about payments, procedures, diagnoses and other health care information. The ANSI 5010 version will support transmission of significantly more information than 4010A1, and will handle greater amounts of detail much more efficiently.

Deadline

All health insurers, providers, and other “covered entities” are required to migrate from the ANSI 4010-A1 standard transaction set to ANSI 5010 byJan. 1, 2012, to be compliant with the U.S. Department of Health and Human Services (HHS) mandate.

What is ANSI X12 version 4010?

ANSI X12 is the EDI (Electronic Data Interchange) standard used primarily in North America. Any EDI standard provides specifications for the layout of common business documents, such as Purchases Orders, Invoices, Advance Ship Notices, Medical Claim Forms, and the like. EDI standards boards meet from time to time to discuss modifications to the standard. Version 4010 then, is just one of the versions of the ANSI X12 standard, just like 3040, 4020, 5010, etc. A new version of the standard does not render previous versions obsolete however; two parties exchanging X12 documents may use any version of the standard they wish.

The current standards mandated in US for certain electronic medical transactions industry wide are in the ANSI, American National Standards Institute, X12 standing committee, n, insurance subcommittee, transaction sets. A transaction set is an electronic model of a paper transaction or form. The Standards for medical transactions are 837 for medical claims, 835 for medical claim payments, 270 eligiibility inquiry and 271 eligibility response, 276 claim status, 277 claims status response, 820 enrollmnet and 834 premium payments. These are currently mandated, 2008, to be in version 4 release 1 known as 4010. An ANSI standard needs an implementation guide to determine how much of the standard is used and how it is used. There are actually three types of claims represented by different implementation guides in the 837 transactin set. They are known in the industry as 837P for professional services, 837I for institutional services and 837D for dental services. Copies of these standards may be found at the web site of the Centers for Medicare and Medicaid Services contractor, WPC-EDI.com. There is a an expectation that the new standards will be anounced in early 2009 to be the version 5 release 1, known as 5010. The 5010 is essentially an updated 4010 with some of the confusion removed.

https://www.cms.gov/ElectronicBillingEDITrans/Downloads/InstitutionalClaim4010A1to5010.pdf

This document helps you to understand the 4010A1 - 5010 Institutional changes. A High Level document to understand and Implement the changes required for 5010

https://www.cms.gov/ElectronicBillingEDITrans/Downloads/ProfessionalClaim4010A1to5010.pdf

This document helps you to understand the 4010A1 - 5010 Professional changes. A High Level document to understand and Implement the changes required for 5010