Evaluating Compliance Strategies Essay Example for Free

Evaluating Compliance Strategies Essay The compliance process is very important in medical billing and coding. After a patient is seen, physicians document the patients visit. Medical administrators then post the medical codes of the visit in the practice management program (PMP) and prepare the claim. It is important to prepare claims correctly in order to stay in compliance. A correct claim connects a billed service to a diagnosis. The diagnosis has to relate to the billed service to treat the patients ailment. The connection is referred to as code linkage. It is important to correctly link procedures and diagnosis because if they arent correctly link the payer will reject the claim and will not pay for the services which then makes the patient responsible for payment. To be in compliance, medical insurance specialists need to know each payers billing rules stated in each insurance policy. These are subject to change and updated frequently so medical insurance specialists also use payer bulletins, websites, and maintain communication with payer representatives to make sure they are staying in compliance. Medicare also has its own set of rules and regulations. The Medicare National correct coding initiative (CCI) controls improper coding. CCI edits are used by computers to check claims for errors that would lead to improper payment of services. The CCI prevents two procedures from being billed that could not have been performed together. Private payers also have code edits similar to the CCI. Compliance errors sometimes occur. Submitting an improper claim may just be a simple mistake such as a typo, or sometimes it may be a deliberate act of fraud. Other common errors that are sometimes made are truncated coding, incorrect gender or age of the patient, assumption coding, altering documentation, coding without proper documentation, reporting services provided by unlicensed providers, and coding a unilateral service twice instead of choosing the bilateral code. For these reasons there are several billing and coding compliance strategies that have been put in place. One compliance strategy used by healthcare professionals is to carefully define bundled code and know global periods. A medical insurance specialist needs to be clear on what individual procedures are contained in bundled codes and what the global periods are for surgical procedures. Another strategy is to benchmark the practices E/M codes with national average. By comparing the practice reports with national averages, upcoding is able to be monitored. Another strategy is to use modifiers appropriately, and be clear on professional courtesy and discounts to uninsured and low income patients. The strategy that I find the most useful and am in support of is to maintain compliant job reference aids and documentation templates. Job reference aids are a form of a cheat sheet that lists procedures and CPT codes that are most often used by each individual practice. I think that the only way this strategy can be improved is to make sure that the job reference aids are updated frequently when new services are added to the practice, and when codes change or new ones are added. This can be accomplished by keeping track of when codes are updated or changed. There are many implications of incorrect medical coding. An improper claim will get rejected or denied by the payer. When this happens the physician will need to either file an appeal, or correct the issue. If the error can be corrected the claim can be resubmitted, however this is still unfortunate because the process will take longer than if it had been done right in the first place. When coding errors are made due to fraudulent attempts, the person who prepared the claim will lose their job and face legal action. Also, sometimes the physician in charge of the practice will be liable and possibly sued, because he/she is responsible for their employees and their actions. Medical coding, physician, and payer fees are all related to the compliance process. Any services performed by a physician will need to be correctly coded so that they can be paid for. Medical coding must be done properly in order to stay in compliance. Physicians must be honest and provide proper documentation of any and all services performed in order for an insurance company to accept a claim and pay for the services that were performed. As long as everyone works as a team, and works in honesty, it is easy to stay in compliance. And by using the strategies I have outlined, compliance is not difficult to follow.

The Effect of Colonialism in Things Fall Apart by Chinua Achebe Essay

This essay is about the effect of Colonialism seen in the book Things Fall Apart. Through out the whole book you can see different impressions on the tribe, many other people, and the relationships between the white man and the black man.   Ã‚  Ã‚  Ã‚  Ã‚  "Does the white man understand our custom about land?" "How can he when he does not even speak our tongue? But he says that our customs are bad; and our own brothers who have taken up his religion also say that our customs are bad. How do you think we can fight when our own brothers have turned against us? The white man is very clever. He came quietly and peaceably with his religion. We were amused at his foolishness and allowed him to stay. Now he has won our brothers, and our clan can no longer act like one. He has put a knife on the things that held us together and we have fallen apart." (Achebe, 17) This discussion of the white man not understanding the customs and traditions, comes ever since the arrival of the colonialists, Obierika seems to voice Achebe's own thoughts on colonialism. Upset by the fact that the white men have come and completely disregarded the Igbo sense of justice, Obierika points out the impossibility of the colonialists understanding anything about the Umuofians without speaking their language. Then he points out the foolishness of belittling unfamiliar customs.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Obierika does not lay the whole blame on the white man’s side. He feels also that the Umuofians who have con...

Pakistan Electricity: Solutions and Ongoing Projects

Written by: Afreen Baig http://economicpakistan. wordpress. com/2008/01/05/electricity/ â€Å"History† After the construction of the Hydro-Electric Tarbela Dam and the Mangla Dam, by General Ayub Khan and General Yahya Khan in the 1960’s, our governments failed to conceive and initiate major electricity projects. The inept governments of PML-N and PPP, that still consider themselves vital to democratic dialogue within the provinces, failed to create dialogue within provinces, on the most important issue facing Pakistan’s energy survival – the Kalabagh Dam. Their governments failed to plan for the future growth and energy requirements. Recently the government of PPP has scraped the project altogether. â€Å"Unexpected Economic Boom & Energy Consumption in the last 10 years† Pakistan’s $75 billion economy boomed into a $160 billion economy, with the consumption of gas, electricity and coal increasing YEARLY to an average rate of 7. 8 percent, 5. 1 percent and 8. 8 percent, respectively. The number of electricity consumers grew from 15. 9 million in 2005-06 to 16. 7 million in 2007, showing a growth of about 70 percent over the last 10 years. The major Energy consumption sectors of the country are: Industrial (38. percent), Transport (32. 8 percent), Residential and Commercial (25 percent), Agriculture (2. 5 percent) and others (2. 2 percent). As regards Electricity, the Household sector has been the largest consumer over the last 10 years, on average consuming 44. 8 percent, followed by Industrial sector (29. 4 percent), Agriculture (12. 2 percent), Commercial sector (5. 9 percent), Street lights (10. 6 percent), the officials say. â€Å"Record Sales of Electronic Items† Recently, we got good news from Pakistan Haier. In May, Pakistan Haier made new RECORD air-conditioner, refrigerator monthly output. The sale volume reached all time high, the year-on-year sale increase of Air-conditioner, Refrigerator, Washing machine, Micro wave and TV are 136%, 58%, 180%, 210% and 106% respectively. Similarly, many other Electronic Companies have created record sales. â€Å"Projects executed and under Construction† The first unit of 290-megawatt of Ghazi Brotha Hydel Project (GBHP) went into operation in June 2003, and contributed around 50mw of electricity to the national grid. Four more units were added every quarter, and by 2004 the GBHP was contributing 1,450 mw. Nuclear power plant Chashma-2, will soon come on-line, and will add another 300MW to the national grid. Mangla Dam uprising will give another 644 GWh of power. Gomal Zam Dam is under final stage of construction, and upon completion it will produce 17. 4MW In 1999, our installed capacity was merely 15,860 MW. (With Hydel 4826 + Thermal 10,897 + Nuclear 137) In 2005-06, our installed capacity increased to become 20,495 MW. (With Hydel 6499 + Thermal 13,534 + Nuclear 462) â€Å"Concrete steps under the PML-Q Government† President Pervez Musharraf launched the Rs 130 billion (US 2. 6 billion) Neelum-Jhelum Hydroelectric project aimed at producing 969 MW power. Work on 11 projects with an accumulative power generation capacity of more than 12,000MW would start by 2009. These projects include Bunji (5,400MW), Dasu (4,000MW), Kohala (1,100MW), Spatgah and Palas Valley (1,230MW). Wind and Solar Technology: Pakistan is seeking to explore alternative sources of energy production and use Wind and solar technologies with the aim to produce 9,700 MW wind power by 2030, thereby providing electricity to 7,874 off-grid villages in Sindh and Baluchistan. 25 wind water pumping systems have been installed in Balochistan. Over 140 micro wind turbines of 500 Watts each are operational in Sindh and Balochistan, providing electricity to 691 houses in 18 remote, off-grid villages. Hydel Power: The government is giving top priority to Hydel power with the potential of producing 40,000 MW Power of which only 15 percent had been exploited so far. In 2001, the Water and Power Development Authority of Pakistan identified 22 sites for launching Hydropower projects to meet the ever-increasing demand for cheap power. It indicated that about 15,074 mw could be generated on the completion of these projects, which would also meet the water irrigation requirements for the growing agriculture sector. Pakistan Sugar Mills: Association (PSMA) has informed the government that sugar mills can produce 2,000MW of electricity in the next five years. Pakistan Atomic Energy Commission: (PAEC) has decided to establish an Engineering Design Organization (EDO) for the indigenous development of nuclear power plants (NPPs) in the country. The PAEC informed authorities that it was planning to add about 1,260MW through Hydel power, 880MW from Alternate energy, 4,860MW from Gas, 900MW from Coal and 160MW from Oil by 2010. The Karachi Electric Supply Corporation (KESC) is investing in a new 220-megawatt power plant that will help control the power shortages in the city, said. The plant will start generating 192MW by March and the remaining 28MW will start being distributed by December 2008. Thar Coal: The government has decided to develop the Thar coal for power generation on a priority basis to overcome energy crisis following. Out of six various companies that inked MoU with concern authorities to establish coal power projects; two companies have started drilling work in their respective areas. Confirmed estimates that its reserves were equivalent to at least 850 Trillion Cubic Feet (TCF) of gas – about 30 times higher than Pakistan’s proven gas reserves of 28 TCF. By using only 2% of the existing coal reserves, we can generate around 20,000 MW (20 GW) for almost 40 years These estimates were confirmed by separate bankable feasibility studies conducted by Chinese and Russian experts. 85 Billion Tons of coal deposits in Pakistan were second only to 247 Billion Ton reserves in the United States and much higher than 157 and 115 Billion Ton reserves of Russia and China, respectively. Thar coal reserves were equivalent to at least 400 Billion Barrels of oil – equivalent to oil reserves of Saudi Arabia and Iran put together. One estimate puts Pakistan’s coal energy at 576 Billion Barr els of oil which is equivalent to the combined oil reserves of the 3 largest producers. The government is planning to set up 5,000-megawatt power generation facilities using coal as fuel within next few years. â€Å"Ongoing Power Projects† The Ongoing Power Projects for which allocations have been made in 2007-08 Budget, are Mangla Dam Raising Project (Rs 20 billion), Mirani Dam (Rs 500 million), Sabakzai Dam (Rs 200 million), Kurram Tangi Dam (Rs 2. 84 billion), Sadpara Multipurpose Dam Rs (900 million), Gomal Zam Dam (Rs 1. 8 billion), the Greater Thal Canal Phase I (Rs 8. 5 billion), the Greater Thal Canal Phase II (Rs 2. billion), construction of 20 small dams in NWFP (Rs 870 million), Bhasha/ Diamer Dam (Rs 500 million), Khan-Khawar hydro project (Rs 1. 3 billion), Dubir Khawar hydro project (Rs 2. 1 billion), transmission arrangements for power dispersal of Ghazi Barotha (Rs 1. 67 billion) and Neelam-Jhelum hydro project (Rs 10 billion). New projects for the next fiscal year include the Sukkur Barrage Rehabilitation and Improvement project (Rs 100 million), Akhori Dam PC I (Rs 200 million), construction of Jaban Hydroelectric Power Station and Jaban Hydroelectric Power Station (Rs 40 million). Upcoming Immediate Projects† Three rental power houses would start generating 1,067 megawatts of electricity by end of year 2008, respectively. Agreements had been signed with China to establish power plants at Nandipur and Chichu ki Malian, and tenders had been issued for two 500MW power plants at Dadu and Faisalabad which would be run by gas and furnace oil. An 800MW power plant would be set up at Guddu. (c) ECONOMIC PAKISTAN and PRESIDENT MUSHARRAF http://economicpakistan. wordpress. com/2008/01/05/electricity/ http://presidentmusharraf. wordpress. com/

Self Awareness Log No. 2 - 1185 Words

Self-Awareness Log No. 2 Best Thing that Happened at your Site Interning at the Division of Family and Child Services (DFCS) has been a wonderful experience. Observing the day to day duties of Family Protection Specialist (FPS) and supervisors at DFCS has led to a more in-depth compassion for clients and their families, while acquiring the necessary skills to function as a social worker in today’s society. The best thing that happened at my site was being able to assist the Regional Director (RD), Anita Twiner-Watkins. She was constructing an organizational chart of all of her Area Social Work Supervisors (ASWS) and FPSs. I collaborated with the RD and created an organizational chart, which she forwarded to her superiors in Jackson,†¦show more content†¦This was the case for me when I was acknowledged by the RD, in a staff meeting, for taking the initiative to assist her with the organizational chart. The recognition placed pressure on me to become more involved as an intern and allow my skills to be utilized at DFCS. The experience was incredibly humbling as a future social worker. Criticisms Receiving feedback about work performance is essential, especially if it comes in the form of constructive criticism. My Field Supervisor, Jessie Bether, has expressed a need to see me take more initiative on the home visits. She stated she wanted to see me become more involved in interviewing clients and following a case from the beginning, this half of the semester. She stated she has witnessed a considerable amount of growth in me and wants me to take on more responsibility other than shadowing my worker. Productivity In my observation of the day to day operations at DFCS, I have noticed that there is a great deal of cliques at the site. These cliques can often be productivity killers at DFCS, with over 700 children being in custody. Conversations are easy to start and hard to end at this facility. I attempt to keep idle conversations to a minimum by making sure I am constantly in contact with my worker, supervisor or keeping busy with completing upcoming assignments. My field supervisor has made it abundantly clear to me that she expects me to initiate my work week. The