By Lucia Francesca Bruno, J.D., LL.M., M.B.A.

For the past century, information technology has reinvented the familiar and revolutionized the art of medicine.  As health care professionals struggle to keep pace with an ever-changing and consolidating industry, traditional forms of health care have succumbed to modern technology and fiscal constraints.  No longer are patients and providers afforded the luxury of being in the same place at the same time.  Recent developments in patient-service delivery systems have transformed the doctor/patient relationship; paving the way for advances in telemedicine and the credentialing and privileging …

By David Green

Last June, Andemarian T. Beyene, 36-year-old man with tracheal cancer received a special gift:  a brand new trachea, made from a synthetic scaffold seeded with his own stem cells.  Following this surgery—the first of its kind—he made a full recovery and was discharged from the hospital four weeks later.  The procedure made international headlines, and shone a much-needed spotlight on two important problems that it might help in part to resolve:  long wait times for organ transplants, and immune rejection of implanted organs.  In what follows, we offer …

By Rebecca Roberts, Ph.D.

Bisphenol A (BPA) is an environmental estrogen that can affect development and health by disrupting normal hormonal signaling.  Estrogen, working at very low blood concentrations, triggers responses in cells and tissues and is critical during fetal development and in normal health and reproduction.  BPA binds to the same cellular receptors as estrogen and may lead to detrimental health effects.

In June of this year, the American Medical Association formally recognized BPA as an endocrine-disrupting agent.  Physicians can play an important role in educating their patients about this pervasive …

By Franklin J Rooks J. PT, MBA, Esq.

Introduction

The insurer’s denial of previously authorized benefits is one of the most frustrating experiences for a medical practice’s billing staff.  But, on the frustration scale, there is another insurance company practice that can push it over the top: retroactive benefit denials that occur after the insurance company has already made payment.  From the insurer’s perspective, a retroactive denial made after the provider has received payment results in an overpayment to the provider, which must be repaid.  To make matters worse, insurance carriers sometimes …

By Martha Swartz, M.S.S., J.D.

 

With economic pressures on physicians mounting and regulatory incentives to affiliate with larger entities expanding, an increasing number of physicians are becoming employees of larger medical groups or health care systems. Restrictive covenants are becoming a mainstay of physician employment agreements. While the American Medical Association Council of Ethical and Judicial Affairs has found them to “disrupt continuity of care, and potentially deprive the public of medical services”, it has found them “unethical” only if they are “excessive in geographic scope or duration … or if …

By Martha Swartz, M.S.S., J.D.

What is a PPO? As a health care institution or individual provider, it is difficult to provide services in Pennsylvania and New Jersey without participating in at least one preferred provider network (PPO).  PPOs are a form of managed care in which: an intermediary (PPO) forms a network of health care providers and connects the health care providers to third party payers such as insurance companies, employers, and third party administrators (Payers). The providers offer their services to the PPO at a discounted rate because they …

By Lucia F. Bruno, J.D., LL.M., M.B.A.

Urgent care medicine has emerged as one of the fastest growing specialties in the United States.  Many family practitioners view this new form of health care as a convenient compromise to the traditional practice of medicine; absent the time and travel between offices, nursing homes and hospitals.  Likewise, emergency room physicians perceive urgent care medicine as a viable way to use their triage skills without the stress associated with a hospital setting. With approximately 8,700 urgent care centers (UCCs) nationwide and an increased percentage …

By Michael G. Calahan, PA, MBA

No longer just a rumor, the switch-over from ICD-9-CM to ICD-10-CM is now a sure deal and the established start date remains October 1, 2013.  Providers must be an active part of the conversion process, as many of the issues to be tackled are provider-driven.  Take, for example, medical record (MR) documentation.  MR documentation represents the beginning, middle and end of the current ICD-9-CM life cycle; it is foundational to the entire process of diagnosis coding and nothing materialized to date promises to change with …

[caption id="attachment_2742" align="alignleft" width="240" caption="."][/caption]

By Ron Wince

Although Accountable Care Organizations (ACOs) have been discussed for years, health care reform has put them in the spotlight. Now, health care leaders are trying to determine the best way to move forward and transition to this new model of care. While the idea behind ACOs is to get the provider and payer chain working together to provide better-coordinated, more seamless care, the various definitions of an ACO are widely varied. From the perspective of a Medicare/Medicaid patient, there is a major …

[caption id="attachment_3626" align="alignleft" width="204" caption="."][/caption]

By Kerin Draak

The International Statistical Classification of Diseases and Related Health Problems, commonly referred to as ICD, is the international diagnosis classification set that translates the provider’s qualitative assessment into a quantitative value for reporting purposes. Most health care providers document their clinical impressions or assessments in words and not in numerical or even alphanumeric combinations. It is important that the ICD diagnostic code or value assigned to a provider’s clinical assessment matches as closely as possible for accurate reimbursement, statistical analysis and for quality patient …