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Taking Charge of Your Health


so the question came in I’ve recently
started working on the PV side of a large Health Network and I’m overseeing
the keycode in comparison code process I’ve done mostly facility coding so this
is a whole new area for me can you provide any insight on this or how other
facilities handle this when I saw this question came it come in I pounced on it
because I oh okay I know exactly what they’re talking about but then I read it
again and then I sent a call to Jennifer and said you know what I don’t think
this is what I thought it was so we talked about it a little bit and just a
heads up the person that that put in this question didn’t give us permission
to use their name we usually ask and and which they probably don’t care but still
if we don’t hit this exactly with what you were talking about let us know and
we’ll go back and redo it ultimately this is all about statistics right
that’s what key codes and comparison codes are about for example we in the
facility side they want to do comparisons for how many people have
mersa you know are they treating for MRSA
how many people have antibiotic resistant MRSA right and how many people
have had a fall how many people have had are they treating for diabetes how many
people that have diabetes that have had an amputation etc etc except they’re you
know because they are using that information to determine how much money
the facility is going to generate because of the diagnosis and that’s how
inpatient or facility is done and our person who submitted this question has
done facility work whereas with outpatient it’s completely different
it’s not based on the illness that a patient has it’s based on what the
providers are doing for the patients so in that key comparison they would be
looking at things like how many new patients are we getting in
in a specific amount of time how many times are established patients coming
back how many of our established patients came back for flu shots
how many established patients are getting their preventive care done our
colonoscopies our prostate examinations our breast mammograms to make sure we
don’t have to answer all of those they’re wanting to have done and
statistically the payers pay for those to be done because they want early
detection if there’s a problem because it costs the payers if we catch cervical
cancer early as compared to late so of course we want them to come in and get
their paps done now it’s not just about that as well it could be how many of our
patients again are we treating that have diabetes in the outpatient we need to
know because maybe it would be beneficial for us to hire a diabetic
nurse or someone to come in and do the toenails of a patient be our diabetic
clients because there’s not a podiatrist in the area and so things like that
they’re projecting its statistics and they want to know the cost the key codes
and comparisons is there an easy way to do that it’s all done in the computers
the different platforms that you use now third-party administrators TP A’s
do this and I suspect that our person that asked this question ended up
getting a job with a TPA so what is a TPA they are a third party that handles
the administration side of doing many of these services and collecting statistics
for you and they can be also organizations that collect the premiums
and issuing reimbursements and stuff and helping to pay out medical claims they
do several things though it’s only limited
to the services that they provide as we scroll down we’ll see some of those
services in the top this is the largest third-party administrators and I think
this was would have to look at the link 2018 I believe is when this was out you
may be familiar with some of those and if you’re not it’s not surprising
because TPAs are hired by large network providers to help them with a behind the
scenes the business side of running an outpatient or even a facility so as we
scroll down now that you’ve got that and again I linked that in the footnote so
you can get more it came from a great article about TPA so what what services
are we looking at and therefore what statistics that this person needs to be
aware of for those key key codes they could do just the administrative
services but they could also be doing auto liabilities professional liability
maybe medical malpractice they’re pulling the statistics pulling these
codes to find out what the payer needs to be aware of as well as the provider
the next page here will give another list of some of the top things that they
provide for loss and control programs emergency response plans these are all
things that are based again statistics losts and adjusting industrial hygiene
inspections how about return to work programs and I thought workers
compensation audits you know if you are a coder and you’ve ever met a coder
that’s involved in workman’s comp it’s a completely everything about workman’s
comp is a separate identity in and above itself the the payer for workman’s comp
does stuff different the anybody else also forensic accounting
now when we say forensic accounting that may make you think what what are we
talking about exactly it’s you think the forensics go in and
do an investigation and when say somebody’s injured or say let’s say Co
buddies a homicide shows you know forensic files and things they go in and
they investigate to see what was the cause of the problem or what was the
cause of anything maybe there’s an uptick in some diabetic encounters or
maybe it’s going down they want to know why so they do a forensic audit and
again that could be what our person is talking about they also involve a lot of
times counseling and again that’s because the statistics that they’re
doing they could do only only the statistics they could do counseling and
they could do other services again it’s only limited to how big the organization
is that you hire to do these services for you but most of the we’ll do
counseling as well so not only are they identifying what you need to have done
or they’re providing a service where they’re coming in and doing the behind
the scenes the business side for you but when they see a statistic that needs
attention they’ll come in and give counseling as provide counseling so you
could be hired as a coder or through an attorney’s office to help with that I
know that Shandra that used to be with us a lot of you guys know her she has
lots and lots of credentials and she works for Italy she did work for an
attorney and all those statistics were specifically so that she could train and
counsel these organizations that were struggling and having problems and I
think that’s it if you have any other questions about TPAs or the codes that
are commonly used in comparison and stuff think about high revenue codes so
facility it’s all diagnosis as a patient it’s going to be based on
age demographics and geography of an area where you live and again it all
boils down to statistics do you need more medical certification and business
training learn more at WWE you

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