Victor O. Penna, MD, RDMS, RVT on LinkedIn: WILL AI EUREKA REPLACE YOUR DOCTOR?   Eureka represents a groundbreaking… (2024)

Practice of Telemedicine - DEA Public Listening Sessions, Part twoHere are the four questions DEA wants to see addressed during its public meetings scheduled for September 12 and 13, 2023. Again, there will be in-person and virtual opportunities to attend. Reservations will be taken starting Monday, August 7, 2023.·If telemedicine prescribing of schedule III-V medications were permitted in the absence of an in-person medical evaluation, what framework, including safeguards and data, with respect to telemedicine prescribing of schedule III-V medications do you recommend to help DEA ensure patient safety and prevent diversion of controlled substances? ·Should telemedicine prescribing of schedule II medications never be permitted in the absence of an in-person medical evaluation? Are there any circ*mstances in which telemedicine prescribing of schedule II medications should be permitted in the absence of an in-person medical evaluation? If it were permitted, what safeguards with respect to telemedicine prescribing of schedule II medications specifically would you recommend to help DEA ensure patient safety and prevent diversion of controlled substances? ·If practitioners are required to collect, maintain, and/or report telemedicine prescription data to DEA, what pieces of data should be included or excluded? What data is already reported to federal and state authorities, insurance companies, and other third parties? ·If pharmacies are required to collect, maintain, and/or report telemedicine prescription data to DEA, what pieces of data should be included or excluded? What data is already reported to federal and state authorities, insurance companies, and other third parties?

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Dietz launches Med Graph AI to predict medical treatments and expenses for patients with NCDs.Dietz.asia recently received a fund from NIA to support our MedGraph Project. Med Graph applies AI to automatically diagnose and predict the medical treatment and expenses for NCDs patients. The solution can be applied in various organizations, including hospitals, business enterprises and insurance. MedGraph allows organizations to enhance and adapt their health service program by mitigating individuals’ risk of NCDs. As a result, the burden of unplanned medical expenses can be managed.MedGraph applies machine learning to classify the historical data from the number of NCDs patients in the hospitals in Thailand in order to support the prediction of required clinical lab tests, the number of visits and potential treatment. To support transparency in the prediction, the knowledge graph is applied to explain the rationale of machine learning model prediction, which medical practitioners can retrace and recheck. This embraces the confidence and safety of using the solution for both patients and practitioners.This solution has many advantages. For example, in terms of human resources management, the enterprise can better estimate the expenses of medical costs that it must cover for its staff. Individuals can early find the potential diseases they may have so that they can adapt their lifestyle and behaviour to avoid them. As the medical expenses can be predicted, the enterprise can minimize the risk of increasing costs by applying an additional health insurance program to cover them.We aim to deploy our solution to organizations with more than 100 employees, of which there are more than 100,000 organizations region-wide. The market value is estimated to be 1 billion USD.

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Diving Deeper into the World of Prior AuthorizationsBefore we delve further into this topic, let me enlighten you on the basis of my knowledge. I am in possession of 4 spinal fusions (awaiting the fifth in March), along with full replacements of both hips and knees. Also, I’m not new to the healthcare revenue cycle, knotting my tie in this field for the past 30 years.Drifting away from the string of amazed expressions, let's unwind the bare threads of Prior Authorization (PA). So you are a healthcare provider. You have a list of services to be "authorized", to align with the health plan of your patient. Sounds tricky? Well, it's not THE uncrackable code, rather a bit laborious and time-consuming.What comes as a hurdle in most cases? It's the MISSING DOCUMENTED justification for the service. What’s there on your plate - clinical documentation, test results, and plan of care, should mirror a comprehensive picture. It should depict the trajectory of care provided so far, the reasons for not opting for other options, or failure of such attempts, and finally, the necessity of the requested procedure.Moving on to denied PAs, it's mostly due to insufficient clinical documentation or prerequisites. To approve a highly invasive or costly procedure or medication, health plans require the execution of other clinical approaches. This maintains a fiscal balance and optimality of care for both, the patient and the health insurance.Adding a layer of prerequisite such as physical therapy for back pain before considering surgery is cost-efficient and effective. It saves the patient from the burden of 20% coinsurance, post-surgical pain, stress, and anxiety, especially when the same resolution is achievable through a non-invasive outpatient care regime.Next stop - receiving the payment for the "authorized" service. Here is where things start getting knotty and confusion sets in. Your PA submission should include the patient's diagnosis code and not just a vague term like ‘back pain’. Also, list the procedure you'll perform, in terms of the specific CPT code(s), rather than just mentioning it.Discrepancies between the information originally submitted and "authorized," and the information sent on the claim, or documented in the surgical notes, cause payment denials. It could be the result of coding or clerical errors.There are ways of minimizing such administrative issues - hiring an external company for quarterly chart audits, employing a certified coder, and submitting the PA through your clinical staff or certified coder. Your revenue cycle team should also be persistent and not take 'No' for a reply, considering insurance companies allow up to 3 appeal attempts.Hire professional staff to support your Healthcare Business operations round the clock for Clinical Customer Service, Prior Authorizations, Pharmacy Coding, Billing, and rejections.To request services, get in touch via email at info@staffingly.com or give us a call 24/7 at (800) 489-5

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Beyond Doctor, Data, and Desire: New Factor Could Improve Medical Decision-MakingTraditionally, doctors have relied on three pillars when making medical decisions: their clinical expertise, the latest scientific evidence, and the patient’s values and preferences. However, a new perspective argues that another crucial element deserves a seat at the table – the healthcare system itself.The Existing Model: Balancing Expertise, Evidence, and Patient ChoiceThe Sackett model, widely used in evidence-based medicine, emphasizes the importance of considering all three elements:Clinical Judgment:A doctor’s experience and knowledge play a vital role in interpreting medical evidence and applying it to individual cases.Scientific Evidence:The latest research findings and clinical trials guide treatment decisions.Patient Values and Preferences:Understanding a patient’s individual needs, goals, and preferences is essential for shared decision-making.The Missing Piece: The Healthcare System’s InfluenceThis article proposes adding a fourth factor to the model: the healthcare system and service organization. This includes:Health System:Health insurance coverage, availability of services and treatments, and access to assistive devices.Service Organization:The range and training level of healthcare professionals, along with the availability of diagnostic and treatment equipment within a specific facility.The authors argue that these factors significantly influence the options available to both doctors and patients:Limited Resources:Limited insurance coverage or a lack of specialized services in a particular region might restrict treatment options.Equipment Availability:The absence of necessary diagnostic tools or specialized equipment within a facility could hinder a doctor’s ability to recommend the best course of action.Benefits of Expanding the Model: Transparency and Patient TrustBy explicitly acknowledging the role of the healthcare system, this expanded model offers several advantages:Transparency:It provides a more comprehensive picture of the decision-making process, allowing patients to understand the limitations and possibilities within the healthcare system.Increased Patient Acceptance:Patients are more likely to trust and accept treatment recommendations when they understand the context and rationale behind them.Improved Decision-Making:Doctors can make more informed decisions by considering the practical limitations imposed by the healthcare system alongside other factors.Looking Ahead: Refining the Model and Its Impactfull article here: https://lnkd.in/eqtiSbYJ

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Hello Everyone,This time I want to share a dashboard, "HealthCare Provider Dashboard" - This dashboard focuses on healthcare-related data and metrics.1. Key Metrics Overview:Billing Amount: £3M with an average billing amount per visit of £594.Total Medication: £546K with an average medication cost of £109.Total Treatment: 3M treatments with an average treatment cost of £526.Total Insurance: £2M with an average insurance coverage of £456.Total Room Charges: £180K with an average room charge of £36.Pocket-Pay: £726K with an average pocket pay of £146.2. Geographical Distribution:Billing Amount by City and State: Displayed on a map of the United Kingdom, showing billing amounts across various cities and states (England, Northern Ireland, Scotland).3. Procedures Analysis:% Procedure by Procedure: A line chart showing the percentage distribution of procedures like X-Ray, CT Scan, MRI Scan, Ultrasound, and Blood Test.Billing Amount by Procedure: A table listing total billing amounts for each procedure, with X-Ray having the highest billing amount (£932,262).4. State and Department Filters:State Filter: Allows filtering by England, Scotland, Northern Ireland, and Wales.Department Filter: Includes options for Cardiology, General Surgery, Neurology, Orthopedics, and Pediatrics.Insurance Provider Filter: Includes Allianz, Aviva, and AXA.5. Diagnosis and Service Analysis:Billing Amount by Diagnosis & Service: A bar chart showing billing amounts for different diagnoses (e.g., Hypertension, Appendicitis, Asthma, Fracture, Migraine) by service type (Emergency, Inpatient, Outpatient).6. Billing Amount by Department:A bar chart displaying billing amounts in percentage as well across various departments, with detailed figures for each department.7. Interactive Elements:The dashboard is interactive, allowing users to drill down into specific data points, filter data by state, department, and insurance provider, and view detailed insights.This Power BI dashboard provides a comprehensive view of healthcare data, including financial metrics, procedural analysis, geographical distribution, and departmental billing, enabling users to make informed decisions and gain insights into healthcare operations.

Mastering the Intricacies of Prior Authorization Services in HealthcareAs a healthcare provider, it’s not uncommon to have patients who suffer from multiple medical conditions. Let's consider John, a 60-year-old patient with diabetes and cardiovascular disease. These complications require a series of medications, medical procedures, and consultations. However, to ensure financial feasibility and appropriate medical care, these services need to get "prior authorization" (PA).Prior authorization is a process undertaken by a healthcare provider to obtain approval from a patient’s health insurance for treatment procedures. It involves a meticulous process to justify the service provision with complete DOCUMENTED clinical records. This documentation must clearly define the justification for the medical procedure, presenting test results, care plans, and the need for the particular procedure over alternative methods.Often in PA processes, denials arise due to incomplete or vague clinical documentation. The other critical factor contributing to denials can be unfulfilled prerequisites. For instance, a PA request for a surgical approach to cure John's recurring angina episodes might get denied if non-surgical methods like medication and lifestyle changes weren't attempted first, or were attempted without sufficient documentation.Remember, detailed and accurate clerical work is vital. To reduce the chances of PA denials, clearly, state the patient's diagnosis, citing the specific ICD-10 codes, not just generic terms. Then, specify the procedure with relevant CPT codes. Silly as it might sound, many denials result from improper coding or oversights during documentation.In a turbulent sea of codes and documentations, there's a lighthouse - consider employing a certified coding expert or an outside company for chart audits. Remember to be resilient with appeal attempts; sometimes, persistence pays off.In pause, remember that such processes are put in place to safeguard the patients, healthcare providers, and insurance companies from unwarranted expenses. Amidst the bureaucratic hassle, the goal is to ensure the most appropriate, affordable, and effective care for patients, like our hypothetical patient John, battling multiple medical conditions.To make your healthcare businesses more efficient, consider employing an extended professional team focused on Prior Authorizations, Clinical Customer Service, Pharmacy Coding, Billing, and handling rejections. It's proven to yield up to 70% savings on staffing costs!To request services, please email us at info@staffingly.com or Call 24/7 (800) 489-5877 or Visit us at https://staffingly.com/#priorauthorization #healthcare #medicalcoding #healthinsurance #medicalbilling #patientcare

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Navigating Healthcare SystemsINTRODUCTION:Healthcare systems play a critical role in ensuring access to quality medical services and promoting overall well-being. However, navigating the complexities of healthcare can be daunting, particularly for individuals facing barriers such as cost, lack of information, or systemic inequalities. In this comprehensive blog post, we explore the intricacies of healthcare systems, from their structures and functions to practical strategies for accessing and optimizing care.UNDERSTANDING HEALTHCARE SYSTEMS:Healthcare systems encompass a variety of organizations, institutions, and professionals dedicated to providing medical services and promoting health.While healthcare systems vary from country to country, they typically share common goals, including: Providing Accessible Care: Healthcare systems aim to ensure that individuals have access to medical services when needed, regardless of their socio-economic status, geographic location, or other factors.Delivering Quality Care: Healthcare systems strive to deliver high-quality medical care that meets established standards of safety, effectiveness, and patient satisfaction.Promoting Public Health: Healthcare systems engage in public health initiatives aimed at preventing disease, promoting healthy behaviors, and improving population health outcomes.Managing Costs: Healthcare systems must balance the delivery of quality care with cost containment efforts to ensure sustainability and affordability.COMPONENTS OF HEALTHCARE SYSTEMS:Healthcare systems consist of various components, each playing a distinct role in delivering and coordinating medical services. Key components include:Healthcare Providers: Healthcare providers, including physicians, nurses, specialists, and allied health professionals, deliver direct patient care across a variety of settings, such as hospitals, clinics, and private practices.Healthcare Facilities: Healthcare facilities, such as hospitals, clinics, nursing homes, and rehabilitation centers, serve as physical locations where medical services are provided to patients.Health Insurance: Health insurance programs, whether public or private, help individuals and families cover the costs of medical care, including doctor visits, hospitalizations, prescription medications, and preventive services.Pharmaceutical Industry: The pharmaceutical industry plays a vital role in healthcare by researching, developing, and manufacturing medications to prevent, treat, and manage various medical conditions.Government Agencies: Government agencies, such as the Department of Health and Human Services in the United States or the National Health Service in the United Kingdom, oversee healthcare policy, regulation, and funding at the national level.

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How to automate medical data extraction: A quick guidehttps://ift.tt/ybZS9pkMedical data extraction remains a significant hurdle, with the sector requiring 7.7x more administrative workers than other industries. Automating healthcare data extraction can help healthcare providers reduce operational spending and streamline their processes while improving patient care. These systems capture and extract crucial information from a variety of medical documents—patient records, insurance forms, lab results, and more. The extracted data is processed and neatly organized into structured formats. The result? Doctors, nurses, and admins can quickly access critical patient data, leading to smarter decisions and a better patient experience.This guide will help you quickly get up-to-speed with medical data extraction. We'll show you how it's transforming healthcare, its benefits, and practical steps to implement it in your practice.Reduce patient wait times, amplify the workforce and improve efficiency across your healthcare ecosystem with automated document processing and workflows. Start your free trial today. Try Nanonets for FreeThe current state of healthcare documentationHealthcare documentation is the backbone of patient care, but it's also become a monster that's eating up valuable time and resources. Over 71% of clinicians report feeling overwhelmed by the sheer volume of information available. By 2025, it's estimated that the United States will need to hire an additional 2.3 million new frontline healthcare workers due to inefficient data extraction from medical documents. This staggering number highlights a critical issue in the industry.In the current healthcare system, medical professionals spend countless hours sifting through patient records, insurance claims, and medical reports. This manual process is not only time-consuming but also prone to errors. Reduce patient wait times, streamline workforce, and boost efficiency in your healthcare system through automated document processing and workflows.Here's a breakdown of common document types that healthcare providers are likely grappling with:Electronic Health Records (EHRs)Electronic Medical Records (EMRs)Clinical notes and progress reportsLab and imaging resultsInsurance claims and billing informationRegulatory compliance documentsUnstructured data, like handwritten notes, adds complexity to information management. Each document type may also require specific handling, storage, and retrieval processes. For healthcare administrators, managing this diverse ecosystem efficiently is crucial for maintaining smooth operations and ensuring quality patient care. Relying on manual data entry and document processing may stress your entire healthcare organization. It can:Slow down patient careIncrease the risk of errorsBurden healthcare workers with administrative tasks Increase the risk of HIPAA violations and data breaches Manual data e...