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Billing and Coding

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https://www.readbyqxmd.com/read/28538984/accuracy-of-medical-claims-for-identifying-cardiovascular-and-bleeding-events-after-myocardial-infarction-a-secondary-analysis-of-the-translate-acs-study
#1
Patricia O Guimarães, Arun Krishnamoorthy, Lisa A Kaltenbach, Kevin J Anstrom, Mark B Effron, Daniel B Mark, Patrick L McCollam, Linda Davidson-Ray, Eric D Peterson, Tracy Y Wang
Importance: Pragmatic clinical trial designs have proposed the use of medical claims data to ascertain clinical events; however, the accuracy of billed diagnoses in identifying potential events is unclear. Objectives: To compare the 1-year cumulative incidences of events when events were identified by medical claims vs by physician adjudication and to assess the accuracy of bill-identified events using physician adjudication as the criterion standard. Design, Setting, and Participants: This post hoc analysis of a clinical trial assessed the medical claims forms and records for all rehospitalizations at 233 US hospitals within 1 year of the index acute myocardial infarction (MI) of 12 365 patients enrolled in the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) study between April 1, 2010, and October 31, 2012...
May 24, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28534667/commentary-on-the-use-of-96119-in-billing-for-neuropsychological-services
#2
Leslie D Rosenstein
OBJECTIVE: This commentary seeks to outline the problematic issues with the use of 96119 in billing for neuropsychological evaluations. Issues covered include billing for the provider's time when using technicians as well as the use of trainees when billing Medicare. METHOD: Resources from the Centers for Medicare and Medicaid Services (CMS) were reviewed along with a search of available documentation from regional carriers and the general literature. CONCLUSIONS: There has been much confusion in the professional community regarding billing for neuropsychological evaluation services when utilizing technicians and/or trainees...
May 23, 2017: Clinical Neuropsychologist
https://www.readbyqxmd.com/read/28534228/glove-changing-practices-of-mall-food-vendors-in-new-jersey
#3
Corey H Basch, Miryam Z Wahrman, Sarah A MacLean, Alan Quisido, Carlo Ponsica, Nandish Patel
Gloves can serve as barriers to decrease the transfer of microorganisms from hands to food. Glove changing by food vendors is particularly important when handling paper currency, as bills can carry and transmit microbes from person to person. The purpose of this study was two-fold: (1) To ascertain the extent to which gloves are changed after monetary transactions in food vendors at a major mall in New Jersey; and (2) to document the level of bacterial contamination and the presence of coliform bacteria on paper currency handled by these vendors...
May 22, 2017: Journal of Community Health
https://www.readbyqxmd.com/read/28531909/racial-and-ethnic-disparities-in-interval-colorectal-cancer-incidence-a-population-based-cohort-study
#4
Stacey A Fedewa, W Dana Flanders, Kevin C Ward, Chun Chieh Lin, Ahmedin Jemal, Ann Goding Sauer, Chyke A Doubeni, Michael Goodman
Background: Interval colorectal cancer (CRC) accounts for 3% to 8% of all cases of CRC in the United States. Data on interval CRC by race/ethnicity are scant. Objective: To examine whether risk for interval CRC among Medicare patients differs by race/ethnicity and whether this potential variation is accounted for by differences in the quality of colonoscopy, as measured by physicians' polyp detection rate (PDR). Design: Population-based cohort study...
May 23, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28510524/lost-in-translation-why-patient-friendly-communication-strategies-are-more-important-than-ever
#5
Barbara Antuna
Efforts to improve patient communication must become a priority. Too often, the language we use in health care is a kind of code that serves billing and other purposes. Jargon may be an efficient and precise way for insiders to communicate, but it is impossible for patients to understand.
March 2017: Managed Care
https://www.readbyqxmd.com/read/28507288/identifying-individuals-with-physician-diagnosed-chronic-obstructive-pulmonary-disease-in-primary-care-electronic-medical-records-a-retrospective-chart-abstraction-study
#6
Theresa M Lee, Karen Tu, Laura L Wing, Andrea S Gershon
Little is known about using electronic medical records to identify patients with chronic obstructive pulmonary disease to improve quality of care. Our objective was to develop electronic medical record algorithms that can accurately identify patients with obstructive pulmonary disease. A retrospective chart abstraction study was conducted on data from the Electronic Medical Record Administrative data Linked Database (EMRALD(®)) housed at the Institute for Clinical Evaluative Sciences. Abstracted charts provided the reference standard based on available physician-diagnoses, chronic obstructive pulmonary disease-specific medications, smoking history and pulmonary function testing...
May 15, 2017: NPJ Primary Care Respiratory Medicine
https://www.readbyqxmd.com/read/28506545/travel-for-abortion-services-in-alabama-and-delays-obtaining-care
#7
Kari White, Janet M Turan, Daniel Grossman
BACKGROUND: In 2013, Alabama required women seeking abortion to have a consultation visit followed by a 24-hour waiting period. These requirements may adversely affect return for timely care among those traveling long distances for services. METHODS: Using de-identified billing data from two Alabama clinics for all abortion encounters in 2013, we calculated the distance traveled from women's residential zip code and the number of days between their in-person consultation and procedure visits...
May 12, 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/28505161/effect-on-healthcare-utilization-and-costs-of-spinal-manual-therapy-for-acute-low-back-pain-in-routine-care-a-propensity-score-matched-cohort-study
#8
Jochen Walker, Ulf Kai Mertens, Carsten Oliver Schmidt, Jean-François Chenot
Spinal manual therapy (SMT) is a popular treatment option for low back pain (LBP). The aim of our analysis was to evaluate the effects of manual therapy delivered by general practitioners and ambulatory orthopedic surgeons in routine care on follow up consultations, sick leave, health service utilization and costs for acute LBP compared to matched patients not receiving manual therapy. This is a propensity score matched cohort study based on health claims data. We identified a total of 113.652 adult patients with acute LBP and no coded red flags of whom 21...
2017: PloS One
https://www.readbyqxmd.com/read/28502551/variation-in-hospital-costs-and-reimbursement-for-endovascular-aneurysm-repair-a-vascular-quality-initiative-pilot-project
#9
Gary W Lemmon, Dan Neal, Randall R DeMartino, Joseph R Schneider, Tej Singh, Larry Kraiss, Salvatore Scali, Apostolos Tassiopoulos, Andrew Hoel, Jack L Cronenwett
OBJECTIVE: Comparing costs between centers is difficult because of the heterogeneity of vascular procedures contained in broad diagnosis-related group (DRG) billing categories. The purpose of this pilot project was to develop a mechanism to merge Vascular Quality Initiative (VQI) clinical data with hospital billing data to allow more accurate cost and reimbursement comparison for endovascular aneurysm repair (EVAR) procedures across centers. METHODS: Eighteen VQI centers volunteered to submit UB04 billing data for 782 primary, elective infrarenal EVAR procedures performed by 108 surgeons in 2014...
May 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28499291/a-survey-of-25-north-carolina-health-departments-districts-on-knowledge-attitudes-and-current-practices-to-seeking-reimbursement-from-third-party-payers-for-sexually-transmitted-disease-services
#10
Cheryl L Kovar, Susan Carter
BACKGROUND: North Carolina Administrative Code 10A Chapter 41A.0204 (a) states "local health departments shall provide diagnosis, testing, treatment, follow-up, and preventive services for syphilis, gonorrhea, chlamydia, … These services shall be provided upon request and at no charge to the patient." Although health departments/districts may bill governmental or nongovernmental insurance providers for sexually transmitted disease (STD) services, current billing practices are unknown...
June 2017: Sexually Transmitted Diseases
https://www.readbyqxmd.com/read/28493177/what-is-single-payer-health-care-a-review-of-definitions-and-proposals-in-the-u-s
#11
Jodi L Liu, Robert H Brook
BACKGROUND: Single-payer systems have been proposed as a health care reform alternative in the United States. However, there is no consensus on the definition of single-payer. Most definitions characterize single-payer as one entity that collects funds and pays for health care on behalf on an entire population. Increased flexibility for state health care reform may provide opportunities for state-based single-payer systems to be considered. OBJECTIVE: To explore the concept of single-payer and to describe the contents of single-payer health care proposals...
May 10, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28492029/billing-and-up-coding-what-s-a-doctor-patient-to-do
#12
J M Grant-Kels, A Kim, J Graff
No abstract text is available yet for this article.
December 2016: International Journal of Women's Dermatology
https://www.readbyqxmd.com/read/28480277/epidemiology-of-cryptococcosis-and-cryptococcal-meningitis-in-a-large-retrospective-cohort-of-patients-after-solid-organ-transplantation
#13
Ige A George, Carlos A Q Santos, Margaret A Olsen, William G Powderly
BACKGROUND: Cryptococcosis is the third most common invasive fungal infection in solid organ transplant (SOT) recipients. There are no nationally representative data describing the incidence, risk factors, and outcomes of cryptococcosis after SOT. METHODS: We assembled a large cohort of adult SOT recipients using Classification of Diseases, Ninth Revision, Clinical Modification billing data from Healthcare Cost and Utilization Project State Inpatient Databases of Florida (2006-2012), New York (2006-2011), and California (2004-2010)...
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/28480184/trauma-surgery-without-proper-compensation-under-the-current-korean-national-health-insurance-system
#14
Kyoungwon Jung, Yunjung Heo, John Cook-Jong Lee, Mijin Lee, Suni Son, Hee Suk Park, Joo-Ok Kim, Jeong Hee Lee
PURPOSE: This study aimed to evaluate the situations and problems of the current health insurance fees for trauma surgeries. METHODS: We reviewed the medical records and billing data from trauma surgeries performed in the hospital from August 2012 to July 2014. The name and number of surgeries were investigated and the code and number of operations prescribed by surgeons were compared with the number of cases actually billed to insurance. In addition, the results returned by the Health Insurance Review & Assessment Services (HIRA) after deduction were investigated and compared to verify the insurance review findings...
May 2017: Annals of Surgical Treatment and Research
https://www.readbyqxmd.com/read/28479117/health-care-services-utilization-during-the-last-6-months-of-life-among-patients-with-bladder-cancer-who-underwent-radical-cystectomy-in-quebec-canada
#15
Ahmed S Zakaria, Fabiano Santos, Alice Dragomir, Wassim Kassouf, Simon Tanguay, Armen Aprikian
INTRODUCTION AND OBJECTIVES: Management of bladder cancer imposes a great economic challenge on the health care system; with the greatest share of this burden attributed to radical cystectomy (RC) and prolonged postoperative follow-up. Our aim was to characterize health care services utilization and evaluate associated cost predictors during the last 6 months of life in patients who had RC. METHODS: We conducted a retrospective study within a cohort of 2,988 patients who had RC from 2000 to 2009...
May 4, 2017: Urologic Oncology
https://www.readbyqxmd.com/read/28477388/phenotypic-and-molecular-differences-between-giant-cell-tumor-of-soft-tissue-and-its-bone-counterpart
#16
Irene Mancini, Alberto Righi, Marco Gambarotti, Piero Picci, Angelo Paolo Dei Tos, Steven D Billings, Lisa Simi, Alessandro Franchi
AIMS: Giant cell tumor of soft tissue (GCT-ST) is a primary soft tissue neoplasm histologically similar to GCT of bone (GCT-B). Recently, it has been reported that >90% of GCT-B have a driver mutation in H3F3A gene. Since the relationship between GCT-ST and GCT-B is unclear, we compared a series of GCT-ST and GCT-B for the presence of H3F3A mutations and for several immunophenotypic markers. METHODS AND RESULTS: Eight cases of GCT-ST were retrieved from our institutional archives...
May 6, 2017: Histopathology
https://www.readbyqxmd.com/read/28472232/privacy-preserving-evaporative-cooling-feature-selection-and-classification-with-relief-f-and-random-forests
#17
Trang T Le, W Kyle Simmons, Masaya Misaki, Jerzy Bodurka, Bill C White, Jonathan Savitz, Brett A McKinney
Motivation: Classification of individuals into disease or clinical categories from high-dimensional biological data with low prediction error is an important challenge of statistical learning in bioinformatics. Feature selection can improve classification accuracy but must be incorporated carefully into cross-validation to avoid overfitting. Recently, feature selection methods based on differential privacy, such as differentially private random forests and reusable holdout sets, have been proposed...
May 4, 2017: Bioinformatics
https://www.readbyqxmd.com/read/28471239/does-question-wording-predict-support-for-the-affordable-care-act-an-analysis-of-polling-during-the-implementation-period-2010-2016
#18
Kristen Holl, Jeff Niederdeppe, Jonathon P Schuldt
The Patient Protection and Affordable Care Act (ACA) continues to be the subject of fierce political debate in the United States. Drawing on issue framing theory, together with research on wording effects in survey responding, we tested how common differences in the wording of ACA surveys relate to apparent public support for the law. We report on a content analysis of N = 376 U.S. national opinion surveys fielded during a more than six-year period, beginning 23 March 2010 (when President Obama signed the bill into law) and ending 8 November 2016 (Election Day), and use ordinary least squares (OLS) regression models to predict public support for the law as a function of variation in question wording...
May 4, 2017: Health Communication
https://www.readbyqxmd.com/read/28435501/impact-of-clinical-decision-support-on-radiography-for-acute-ankle-injuries-a-randomized-trial
#19
Shahein Tajmir, Ali S Raja, Ivan K Ip, James Andruchow, Patricia Silveira, Stacy Smith, Ramin Khorasani
INTRODUCTION: While only 15-20% of patients with foot and ankle injuries presenting to urgent care centers have clinically significant fractures, most undergo radiography. We examined the impact of electronic point-of-care clinical decision support (CDS) on adherence to the Ottawa Ankle Rules (OAR), as well as use and yield of foot and ankle radiographs in patients with acute ankle injury. METHODS: We obtained institutional review board approval for this randomized controlled study performed April 18, 2012-December 15, 2013...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28431536/-popping-nana-back-into-bed-a-qualitative-exploration-of-paramedic-decision-making-when-caring-for-older-people-who-have-fallen
#20
Paul Simpson, Ric Thomas, Jason Bendall, Bill Lord, Stephen Lord, Jacqueline Close
BACKGROUND: Older fallers constitute a large proportion of ambulance work, and as many as 25% are not transported to hospital following paramedic assessment. The objective of this study was to explore the decision making process used by paramedics when caring for older fallers. METHODS: A qualitative study was conducted using constructivist grounded theory methodology. Purposive sampling was used to recruit paramedics to participate in semi-structured interviews and focus groups...
April 21, 2017: BMC Health Services Research
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