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http://descantabauchi.wordpress.com/?p=253 Thu, 09 Oct 2008 11:50:30 +0000 Alberto Vesentini http://descantabauchi.es.wordpress.com/2008/10/09/la-russa-il-rosso/ Sotto le mentite spoglie di un uomo di destra si nasconde un temibile il ghigno della spia sovietica.

Potrebbe essere questa la breve trama della telenovela tra Roberto Maroni e Ignazio La Russa che oggi ha visto la sua ennesima puntata. Con colpo di scenaaaa, come direbbe Mike.
Notizia di ieri è la proposta della Lega del "permesso di soggiorno a punti". Fai il bravo? Aumenta il punteggio. Scendi a zero? Pùssa via, vadarviaiciàp e torna a casa.
Il punteggio aumenta se, ad ogni controllo, dimostri di esserti integrato, non avere problemi con la giustizia e conoscere l'italiano.
Ignazio rispedisce al mittente: per sapere questo basta il certificato penale. Ma va? 1 a 0 per Igny!
La Russa fa una cosa democratica, quasi di Sinistra...che ci sia una rivoluzione in atto? Nààààààà.
Infatti Igny spalleggia la proposta (assurda) di aumentare a 18 mesi la permanenza nei CPT (centri di permanenza temporanea): già così sono messi male, tenendo "rinchiusi" dei clandestini in attesa del permesso di soggiorno e sempre in subbuglio a causa del sovraffollamento degli stessi CPT, in più ne aumentano la permanenza... Ieri il CPT di Lampedusa, geograficamente il posto preso di mira dagli sbarchi massicci, stava esplodendo...Poco tempo fa alcune prostitute, che avevano ricevuto grazie alla legge Carfagna il foglio di via e l'obbligo di presentarsi ai CPT per l'espulsione, sono state "rilasciate" perchè non c'era posto per loro...

Varato il Decreto Legge per far fronte alla crisi economica. State tranquilli, non c'è nessun pericolo. E poi fanno un DL con fiducia annessa (quindi massima urgenza!)... Poi chiedono all'opposizione, PD in primis, di collaborare di più per queste manovre: anche Veltroni capisce che lo pigliano per i fondelli e giustamente (ma tramite la Finocchiaro, lui da solo non fa neanche più l'amore con la moglie, manda Letta...) fa sapere che se vanno avanti a DL come cavolo fanno a discuterne...

Siamo ad una svolta per la nomina del Presidente di Vigilanza RAI: dopo 16 (sedici) sedute andate a vuoto perchè il PdL non si presenta alle votazioni (facendo così cadere il quorum), l'entourage più stretto di Silvio vuole una rosa di nomi. Nessuno aveva posto obiezioni sulla candidatura di Leoluca Orlando che pareva essere l'unico candidato, ora il PdL vuole presentarne uno suo...Se ci hanno pensato per ben 16 sedute, probabilmente sarà un nome nuovo, fresco...Staremo a vedere, io già me lo immagino: Bettino Craxi. Tanto, già tutto il governo è una Sua creatura, dal suo fiscalista (Tremonti) al suo avvocato (Ghedini)...

@ Momenti di ordinaria follia: vigili urbani troppo vigili?
@ Nota positiva della giornata: Tremonti fa outing per il suo governo. Hanno fatto notare l'ennesima porcata (grazie a Report, sto programma filo-comunista eh?!?) e lui ha preso distanze e provvedimenti. Bravo Giulietto, almeno una volta...

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http://milanovalencia.wordpress.com/?p=739 Wed, 08 Oct 2008 07:47:52 +0000 MI VA http://milanovalencia.es.wordpress.com/2008/10/08/zero-in-condotta/

la foto è di malì

Le proposte su una regolamentazione del traffico immigrati come fosse traffico stradale fanno riflettere su come siamo davvero alla frutta. Anzi su come la frutta stessa sia andata a male dentro il frigo durante la nostra assenza.
Continuazione al tema matrimoni di cittadinanza (sulle nuove frontiere, sbarrate, dei diritti dei gay parlerò senz'altro un'altra volta) è senza dubbio la situazione in Italia.
Un'idea sulle cifre degli sbarcati ce l'abbiamo, nonostante questo governo abbia sbandierato le azioni di contenimento e di esplusione, gli sbarchi aumentano e i centri di accoglienza, che davvero mi pare una bestemmia chiamarli così, straripano di gente che riceverà probabilmente un foglio di via che metterà in tasca e rimarrà a spasso, sotto un ponte, o per cantieri a fare il muratore senza casco e senza protezioni, a trenta euro al giorno come prezzo equo per morire.
Da mesi circolano idee nuove in pentola, per trovare una soluzione alla escalation di sbarchi e di clandestini, ma soprattutto si necessita di una regola per trovare un metro di giudizio per determinare la facoltà o meno di restare.
Dopo i punti tolti per un divieto di sosta che hanno fatto diminuire le soste vietate, a tal punto che leggevo in piazza Erbe a Padova che il Comune ha incassato nell'ultimo anno sei, dico sei, milioni di euro per sanzioni amministrative, a dimostrazione che i punti contano e che la gente ci pensa due volte prima di parcheggiare dove non possa; dopo il tutor che fluidifica il traffico nelle autostrade e crea colonne serie di macchine che vanno a centotrenta che poi si schiantano al di fuori del tragitto controllato, ecco la proposta geniale: il permesso a punti.
I punti si perdono per mancanza di integrazione e per cattiva conoscenza della lingua italiana.
Infrazioni, da chi giudicate e su quale metro non è dato di sapere, che porterebbero via via alla perdita del permesso di soggiorno.
Gramellini sulla Stampa nell'esprimere la sua perplessità per l'invenzione, si chiede: e se ciò venisse esteso a noi italiani?
Quanti di noi potrebbero dire che sono integrati e conoscono bene la lingua italiana?
Quanti di noi hanno senso sociale? Quanti non grugniscono in ascensore e quanti lasciano aperto il portone quando vedono arrivare quello del piano di sotto?
Quanti di noi non hanno un solo dubbio su come si scriva una parola o su quale sia il passato remoto di cuocere?
Ma il ministro Gelmini prevenendo il tutto ha riistituito l'educazione civica, in modo tale da supportare questa Italia claudicante, grazie Ministro.
Tutto questo bailamme di punti e bollini da supermercato verrebbe arginato per gli immigrati dalla scelta di sposare un italiano o un'italiana, certo.
Ma davvero, quando i matrimoni valgono poco più di niente, l'unico modo per ottenere un diritto senza che nessuno te lo porti via rimane quello di sposarsi?
Ho sbagliato a non intuire che il business fosse quello di continuare con la carriera forense.
La menzogna ha sempre pagato ottime parcelle. Male che vada il carcere non è la peggiore delle sanzioni, pensa alle strade di Castelvolturno, per avere un'idea dei gironi danteschi.
E poi vuoi mettere i punti che si acquistano per buona condotta?

(E.)

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Medical billing is the process of submitting and following up on claims to health insurance companies in order to receive payment for services rendered by a healthcare provider. The same process is used for most insurance companies, whether they are private companies or government-owned.

Billing Process

The billing process is an interaction between a healthcare provider and the insurance company (payer). The interaction begins with the office visit: A doctor or their staff will typically create or update the patient's medical record. This record contains a summary of treatment and demographic information related to the patient. Upon the first visit, the provider will usually give the patient one or more diagnoses, in order to better coordinate and streamline his/her care. In the absence of a definitive diagnosis, the reason for the visit will be cited for the purpose of claims filing. The patient record contains highly personal information: the nature of illness, examination details, medication lists, diagnoses, and suggested treatment.

The extent of the physical examination, the complexity of the medical decision making, and the background information (history) obtained from the patient are evaluated to determine the correct level of service that will be used to bill the insurance. The level of service, once determined by qualified staff, is translated into a five digit procedure code from the Current Procedural Terminology (CPT). The verbal diagnosis is translated into a numerical code as well, drawn from the The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). These two codes, a CPT and an ICD-9-CM, are equally important for claims processing.

Once the procedure and diagnosis codes are determined, the biller will transmit the claim to the insurance company (payer). This is usually done electronically by formatting the claim as an ANSI 837 file and using Electronic Data Interchange (EDI) to submit the claim file to the payer directly or via a Clearinghouse. Historically, claims were submitted using a paper form; in the case of professional (non-hospital) services, and for most payers, the CMS-1500 form was used. The CMS-1500 form is so named for its originator, the Centers for Medicare and Medicaid Services. To this day about 30% of medical claims get sent to payers using paper forms which are either manually entered or entered using automated recognition or OCR software.

The insurance company (payer) processes the claims. The insurance company has medical directors review the claims and evaluate their validity for payment, using rubrics for patient eligibility, provider credentials, and medical necessity. Approved claims are reimbursed for a certain percentage of the billed services. Failed claims are rejected and notice is sent to provider.

Upon receiving the rejection message, the provider must decipher the message, reconcile it with the original claim, make required corrections, and resubmit the claim. This exchange of claims and rejections may be repeated multiple times until a claim is paid in full, or the provider relents and accepts an incomplete reimbursement.

The frequency of rejections, denials, and overpayments is high (often reaching 50%), mainly because of high complexity of claims and data entry errors.

Electronic Billing Process

A practice that has interactions with the patient must now under HIPAA send most billing claims for services via electronic means. Prior to actually performing service and billing a patient, the healthcare provider may use software to check the eligibility of the patient for the intended services with the patients insurance company. This process uses the same standards and technologies as an electronic claims transmission with small changes to the transmission format, this format is known specifically as X12-270 Health Care Eligibility & Benefit Inquiry transaction. A response to an eligibility request is returned by the payer through a direct electronic connection or more commonly their website. It is called an X12-271 "Health Care Eligibility & Benefit Response" transaction. Most practice management/EMR software will automate this transmission, making them hidden from the user.

This first transaction for a claim for services is known technically as X12-837 or ANSI-837, and it contains a large amount of data regarding the provider interaction as well reference information about the practice and the patient. Following that submission, the payer will respond with an X12-997, simply acknowledging that the claim's submission was received and that it was accepted for further processing. When the claim(s) are actually adjudicated by the payer, the payer will ultimately respond with a X12-835 transaction, which shows the line-items of the claim that will be paid or denied; if paid, the amount; and if denied, the reason.

Due to limited technology, many payers (especially states' Medicaid) still adjudicate claims manually; this results in significant delays - up to 48 hours or even weeks to issue 835 responses to properly submitted 837 transactions. In many cases this manual processing subverts the entire point of Congress in mandating a standardized electronic billing process. These delays can also present catastrophic problems to the availability of healthcare for those patients with difficult payers - such as happened in California with the state Medicaid program referred to as "Medi-cal".

Payment

In order to be clear on the payment of a medical billing claim, the healthcare provider must have complete knowledge of different insurance plans that insurance companies are offering, and the laws & regulations that preside over them. Large insurance companies can have up to 15 different plans contracted with one provider. That is why the amount is settled between the provider and the company before he or she, provides his services and is paid according to the each contract that has its own fee schedule, billing rules and billing address.

Based on the amount negotiated by the doctor and the insurance company, the original charge is reduced. The amount that is paid by the insurance is known as an allowable. For example, although a psychiatrist may charge $80.00 for a medication management session, the insurance may only allow $50.00, so a $30 reduction would be assessed. This is called a "provider write off" or "contractual adjustment." After payment has been made a patient will typically receive an Explanation of Benefits (EOB) from his insurance company that outlines these transactions.

The insurance payment is further reduced if the patient has a copay, deductible, or a coinsurance. If the patient in the previous example had a $5.00 copay, the doctor would be paid $45 by the insurance. The doctor is then responsible for collecting the out-of-pocket expense from the patient. If the patient had a $500.00 deductible, the contracted amount of $50 would not be paid by the insurance company. Instead, this amount would be the patient's responsibility to pay, and subsequent charges would also be the patient's responsibility, until his expenses totaled $500. At that point, the deductible is met, and the insurance would issue payment for future services.

A coinsurance is a percentage of the allowed amount that the patient must pay. It is most often applied to surgical and/or diagnostic procedures. Using the above example, a coinsurance of 20% would have the patient owing $10 and the insurance company owing $40.

In Medicare the physician can either be 'Participating' in which he will receive 80% of the allowable Medicare fee and 20% will be sent to the patient or can be 'Nonparticipating' in which the physician will receive 80% of the fee, and may bill patients for 15% or more on the scheduled amount.

For example the regular fee for a particular service is $100, while Medicare's fee structure is $70. Therefore the physician will get $56, and the patient will pay $14. Similarly Medicaid has its own set of policies which are slightly more complex than Medicare.

History

For several decades, medical billing was done almost entirely on paper. However, with the advent of medical practice management software also known as health information systems it has become possible to efficiently manage large amounts of claims. Many software companies have arisen to provide medical billing software to this particularly lucrative segment of the market. Several companies also offer full portal solutions through their own web-interfaces, which negates the cost of individually licensed software packages.

Due to the rapidly changing requirements by U.S. health insurance companies, several aspects of medical billing and medical office management have created the necessity for specialized training. Medical office personnel may obtain certification through various institutions who may provide a variety of specialized education and in some cases award a certification credential to reflect professional status.

HIPAA

The billing field has been challenged in recent years due to the introduction of the Health Insurance Portability and Accountability Act (HIPAA).

HIPAA is a set of rules and regulations which hospitals, doctors, healthcare providers and health plans must follow in order to provide their services aptly and ensure that there is no breach of confidence while maintaining patient records.

Since 2005, medical providers have been urged to electronically send their claims in compliance with HIPAA to receive their payment.

Title I of this Act protects health insurance of workers and their families when they change or lose a job. Title II calls for the electronic transmission of major financial and administrative dealings, including billing, electronic claims processing, as well as reimbursement advice.

Medical billing service providers and insurance companies were not the only ones affected by HIPAA regulations - many patients found that their insurance companies and health care providers required additional waivers and paperwork related to HIPAA.

As a result of these changes, software companies and medical offices spent thousands of dollars on new technology and were forced to redesign business processes and software in order to become compliant with this new act.