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Archive for the ‘Medical Business Associates’ Category

A Look into Online Pharmacies

Thursday, November 10th, 2011

When someone says “online pharmacy,” what do you think? Discounted drugs, no need for a prescription, illegal activity… counterfeit or adulterated medications?

Online pharmacies tend to fall into the illegal activity and counterfeit medication categories. While there are some legal and legitimate online pharmacies out there (more on that in a minute), you need to be aware that more and more online shops are popping up selling expensive medications at better than wholesale prices.

Due to the fact that counterfeit versions of at least 40 of its drugs have been found in more than 100 countries, drug maker Pfizer and a national pharmacy standards group started a website warning consumers about counterfeit prescription drugs and explaining how to find legitimate online pharmacies.

One way to weed out the bad online pharmacies is to look at their prices. If they are too good to be true – they are. For instance, Pfizer’s drug Viagra typically is sold to distributors for around $18 per tablet. One online pharmacy sells 25mg tablets for between $1.09 to $2.49, and another list 130mg tablets from 99 cents to $1.31 per pill. How can they sell an $18 per pill drug for as little as one dollar? Where is the profit in that?

Scope of the Problem

While it is very difficult to measure how much illegal pharmacies are making from selling counterfeit medications, a case was recently in the spotlight concerning these online pharmacies. In August 2011, the U.S. Department of Justice demanded Google to forfeit $500 million in revenue generated by online ads for online pharmacies. $500 million on advertising is a big chunk of change – if these pharmacies can afford that, this business model is obviously lucrative.

Legitimate Online Pharmacies?

The controversy exits with online pharmacies. I am sure you have people (including your physicians) telling you not to purchase medications over the internet. However, there are legitimate safe online pharmacies. How can you find them? The National Association of Boards of Pharmacy (NABP) developed the VIPPS accreditation program, which evaluates Internet pharmacy practice. A VIPPS accreditation verifies that the online pharmacy is a virtual equivalent to a brick and mortar shop down the street. But please, keep a watchful with online pharmacies – it should be noted that there are only 29 online pharmacies holding VIPPS accreditation.

Don’t Want to Be Duped?

Now you are thinking, “How can I protect myself from these online predators?” First of all, the easiest way is to avoid online pharmacies. However, there may be some instances where you cannot avoid it. What should you do then?

  1. Buy drugs only from trusted retailers (VIPPS accreditation) and stay away from non-regulated online pharmacies.
  2. If traveling abroad, please bring medications with you and avoid purchasing from countries with a high counterfeit mix (most notably African countries).
  3. The easiest and most resourceful way to avoid counterfeit products is to education yourself on the medications you take. An informed consumer is an empowered consumer. If the drug isn’t acting how it was when you took last month’s supply, it could be counterfeit. If the bottle looks tampered with, check with your pharmacist.
  4. If you have any questions or are worried about your medication, talk with your pharmacist about any recent counterfeit products or check the FDA or drug manufacturer’s website.

CommunityHealth – Illinois Largest FREE Health Clinic

Friday, November 4th, 2011

I would like to introduce an organization that is extremely important to the Chicago community – CommunityHealth. I support CommunityHealth and its mission as a board member, contributions in kind, and direct cash donations.

Healthcare is expensive and costly. I can tell you from personal experience that many individuals go without badly needed primary care services as a result of the expense.

On that note, I have had the privilege of working for a great organization – CommunityHealth – which provides free healthcare services to the underserved and uninsured. If you have 2 minutes, I would appreciate you watching this short video explaining just how important CommunityHealth is to the community, and what you can do to help.

Donate to Chicago Community Health

To all my clients, friends, and loyal readers, if you take the time to donate $500, I provide you with a free copy of my healthcare advocacy book – Personal Healthcare Portfolio: Your Personal Health & Wellness Record (a $20 value). If you donate $1,000 you will receive a copy of all three of my books (PHP, Healthcare Fraud: Audit & Detection Guide, and Electronic Health Records: Auditing & Detecting – a $130 value).

To donate to CommunityHealth please click here. Remember, unlike other organizations who have large overhead costs, $.97 of every $1 donated goes directly to patients in need. Your money matters.

Fight for Your Rights – Patient Advocacy at Its Best

Monday, August 29th, 2011

Recently an employee came to me terribly worried about her child. Her daughter had been finally diagnosed with a severe lactose allergy after months of testing, countless doctors’ visits, and numerous theories of the cause for her tiredness, chronic hives, and other symptoms. However, my employee’s daughter wasn’t out of the gate yet. She takes a few medications to help with her allergies and her Attention Deficit Disorder.

Lactose in Drugs Can Affect Allergies

Now, here is the problem. What happens when these necessary medications contain lactose or eggs – two ingredients the child is allergic to? First, you need to ask your doctor or pharmacists what ingredients are in your medications – all the ingredients. Many medications use lactose as a filler. You also need to be aware of vaccines as well – many (including the flu vaccine) contain lactose.

For my employee, she asked her pharmacist if her child’s medication could contain lactose. Her pharmacist firmly replied that is takes too long to look up the ingredients of drugs. (Subsequent calls to other pharmacies did not pose this same problem, so hopefully in her case it was a moody pharmacist). However, if you receive this reply, first indicate that your child has a severe allergy and could be seriously harmed or even die if the product contains any milk (or peanuts, eggs, etc.). Second, ask to speak with another pharmacist. If you don’t receive an adequate answer find a pharmacy that will accommodate your questions and go directly to the drug manufacturer’s site to look up the ingredients in your child’s medication.

The good news is, that with most lactose allergies, many people can continue taking medication that includes milk. According to Walgreens, “Most people who are lactose intolerant can tolerate the lactose in oral medication because it usually takes around 12 to 18 gm of lactose—about the amount in 8 to 12 oz of milk—to cause the symptoms that include gas, bloating, diarrhea, and abdominal pain. Most oral medications contain far less than this amount. However, some individuals may still experience those symptoms from very small amounts of lactose. In these cases, lactase enzyme supplementation may help. These supplements, available over the counter, help by breaking down lactose. Probiotics, which contain beneficial bacteria that may help break down lactose, are another possible remedy.” So for those of you that only have a mild lactose intolerance, medications including milk might be fine for you to take (please consult your physician or pharmacist before doing so).

Again, be the informed patient. Most people might not think that the medication that is supposed to be helping them, might actually be severely hurting them. Keeping a Personal Health Record will help you keep control of your allergies and inform your healthcare providers on changes in your health condition.

Thanks for reading!

Your healthcare resource – Rebecca Busch

Submitting Bills into Evidence

Wednesday, July 20th, 2011

In Illinois in order to submit medical bills into evidence at trial, an opinion is typically required to show that the medical services and charges were usual, customary, and reasonable. An earlier case is often cited Arthur v. Catour, 216 Ill.2d 72 that “to introduce an unpaid bill into evidence, a party must establish that the bill is reasonable for the services of the nature provided.”

Citing a more recent Illinois case, the plaintiff (citing Betty Kunz v. Little Company of Mary Hospital and Health Care Centers, et al., Nos. 1-06-1707 & 1-06-1814) “can establish reasonableness by introducing the testimony of a person having knowledge of the services rendered and the usual and customary charges for such services.”

The skill sets required for this type of analysis include understanding the environment of the services rendered, in addition to healthcare reimbursement.  The method for how healthcare is paid for is complex and layered with components such as understanding ICD (diagnosis codes) and CPT codes (procedure codes). You also have to look at how these services are rendered in the provider environment.  The generation of a provider bill is a multi-layered process. If you have one party that does not stipulate to the bills, then it becomes important to have those bills reviewed by qualified medical auditors.

The following provide some helpful hints of the information you should request:

1.       Provider request list:

  • CMS-1500 claim form for all professional bills and their itemized statement
  • UB claim for all facility claims
  • Any ancillary service, like durable medical equipment or pharmacy charges – ask for an itemized statement
  • Please inform the provider that you are seeking all ICD and CPT codes associated with the services rendered

2.       Obtain relevant medical records representing services rendered.

3.       Have your medical audit specialist review the information and identify any anomalies or bills with insufficient information.

4.       If you hit road blocks such as “this information is only for insurance companies”, please remind the provider that billing information contains protected health information (PHI) and according to HIPAA, the patient is entitled to obtain their entire PHI.

5.       Finally with the right information you will be in a position to have an opinion generated on the bills associated with your case.

Send me a note if you get “stuck” or hit a “road block” in the process!

Thanks for reading!

Your healthcare resource – Rebecca Busch

Cutting Healthcare Costs through Patient Advocacy

Tuesday, July 12th, 2011

During a recent conversation with a colleague, she informed me how she has been responsible for taking care of her elderly mother, driving her to appointments, filling her prescriptions, etc. She mentioned that her mother’s previous doctor always ordered tests – looking at her bone density, mammograms, chest X-rays – the whole nine yards. Initially, this didn’t surprise me, her mother is 87 and has emphysema and osteoporosis – the doctor is just trying to keep her healthy. However, after my colleague enlightened me, I thought about the subject a little differently.

First of all, let’s look at the age. Her mother is 87. She has stated repeated that these tests hurt her (mammograms especially, and she has very sensitive skin that tears easily). Even if these tests were positive or showed some sort of abnormality, she would most likely elect not to have surgery, radiation, or other forms of treatment.  Her mother’s attitude, “I am 87, I want to live a pain free, non-complicated life. Going to the doctor every month isn’t fun for me, or my daughter who has to take work off in order to drive me.”

I mentioned previous doctor in the first paragraph because my colleague’s mother was so fed up with all these tests and appointments that she went to a new doctor. The new doctor was very candid. She said, “Yes, I can order these tests. Yes, I could see you once a month. However, you’re pretty healthy and these tests aren’t going to tell us anything that we don’t already know, or that we could fix.” Now, the doctor could have been reimbursed by Medicare and secondary insurance for these tests – the mother wouldn’t have had to “pay” out-of-pocket anything. But, in that sense, we all are paying for unnecessary tests and visits.

This is only part of the problem. Luckily my colleague and her mother were informed enough to understand that they can say, “No” to these unnecessary tests and procedures. Other individuals might be scared into participating. This is an instance were having a patient advocate on hand, informing the patient of his/her rights would be ideal. A second ear to listen to diagnoses and conditions, and a trained mind to realize that an elderly person who is sensitive might not want these tests because they hurt or the results won’t produce anything the person doesn’t already know.

The moral of this story is to speak up when communicating with your physician. If you find yourself wondering why your physician is ordering tests, consult with another physician. Patients can cut healthcare costs on the front end by being savvy consumers.

Thanks for reading!

Your healthcare resource – Rebecca Busch

Healthcare Reform and Businesses

Tuesday, June 14th, 2011

Current Healthcare Statistics:

•          Small businesses on average pay about 18% more than big businesses for the same health insurance policies

•          Small business health insurance premiums have risen 113% over nine years, a growth rate of nearly 9% annually

•          99% of large firms offer healthcare coverage, while 78% of firms with 10 to 24 workers offer coverage; that drops down to just 49% among firms with fewer than 10 workers

•          Of the 45 million uninsured Americans in 2007, 22.3 million (about half) were self-employed or worked for small businesses

Healthcare Reform Changes that Affect Your Business Right Now:

•          If you have 25 or fewer employees with annual wages of less than $50,000, you can get tax credits of up to 35% of the premiums paid under the new healthcare reform.

•          Catch: Employers need to cover at least 50% of the total premium cost for their employees

•          The credit will go up to 50% in 2014 and can be used for two consecutive years after that.

•          Businesses with 10 or fewer employees and annual wages of less than $25,000 will receive full access to the tax credit.

•          Small businesses that are tax-exempt are eligible for tax credits of up to 25% of the amount they contribute toward an employee’s health insurance premium.

•            4 million businesses are expected to be eligible for the credit this year

•          Holes: The IRS form that small business owners will fill out next year to claim the tax credit for 2010 is in draft form, and the IRS has not yet created instructions for how to use it

•          The Congressional Budget Office estimates that the credit could save small businesses $40 billion by 2019

What Can You Do to Trim Costs Right Now?

1.       Add a wellness or health management program

2.       Change plan design

3.       Perform a dependent eligibility audit

4.       Give incentives for employees to participate in wellness programs to improve the overall wellness of the group

Thanks for reading!

Your healthcare resource – Rebecca Busch

Avoiding Fraud, Medical, and Billing Errors in the Healthcare Arena

Monday, March 21st, 2011

A HealthGrades report indicates that there have been between 400,000-1.2 million error-induced deaths during 1996–2006 in the United States. On top of that, $60 to $80 billion is lost each year in the healthcare system due to fraud, waste, and abuse. How can you protect yourself from these alarming numbers?

As a patient you have many resources at your fingertips. Before you even visit a healthcare facility or provider, perform a due diligence check on both the facility and the provider.

How to Research a Doctor

First, confirm your physician’s NPI number – all physicians are required to have a NPI number for Medicare billing. Even if a physician is not billing Medicare, they need to have a NPI number to refer patients to other physicians.

Here is a free site to find your physician’s and facilities’ (where you will be receiving the treatment) NPI number.

Second, authenticate your physician’s and facilities’ information with the NPI registry. Here you will be able to confirm the provider’s legal business name and/or location, contact information, and NPI number. The NPI Registry is a free service located here.

Third, research the background history of your provider to see whether he/she has been disciplined, fined, or has had a suspended license. The State of Illinois License Lookup allows you to confirm all licenses distributed by the State of Illinois including MD, RN, PharmD, DO, etc.

Finally, a simple Internet search on the provider/facility may garner surprising results. Oftentimes, pending lawsuits and court filings appear at the top of Internet searches if the provider/facility is involved.

If you suspect anything, remember to request a copy of your medical records and billing statements. By performing your own mini-investigation you will be able to determine if your provider is supplementing or omitting information from your medical records or billing statements.

Useful sites:

NPI Registry

NPI Number Lookup

State of Illinois License Lookup

When Do You Need a Patient Advocate?

Saturday, January 15th, 2011

Health and healthcare are private, yet extremely important issues that affect your life every day. If you aren’t feeling well, that affects your mood. If you have a headache, you’re less likely to be productive. If you’re worried about your health or that of a loved one, that stress can lead to more illness and frustration.

Who are you supposed to turn to when your healthcare situation gets out-of-hand, like you aren’t staying on top or your bills (even afraid to open them) or you haven’t researched adequate treatment options and you’re scared to confront the doctor? Patient advocates are an invaluable resource during troubling health experiences.

When might hiring a patient advocate make sense?

1.       You’re overwhelmed with your bills.

2.       You recently obtained power of attorney of the health of a family member or loved one.

3.       You feel “stuck.” You aren’t receiving answers to questions on care or insurance and are unsure of what to do next.

4.       You have a chronic condition that requires constant monitoring.

5.       You receive advice/an opinion and it doesn’t make sense to you.

6.       You are told that no options exist.

What is a patient advocate?

A patient advocate will help you sort through your bills and develop a personal health record or portfolio of all your important health information. A patient advocate will research treatment options with you and provide multiple physicians/other resources in your area or that best treat your condition. A patient advocate will also contact insurance carries and providers on your behalf to sort through your healthcare finances.

Remember a patient advocate can truly be a life saver. However, all patient advocacy services are not alike. Research the advocacy organization and know the credentials of your advocate.

Good luck and great health!

More on Employers Pushing the Rising Cost of Healthcare onto Employees, Families

Friday, December 31st, 2010

The Kaiser Family Foundation and the Health Research and Educational Trust (HRET) perform an annual survey regarding the nature of employer-sponsored health benefits at nonfederal private and public companies nationwide. This is the twelfth such survey. The results are grim, for employees at least.

It’s no longer news that healthcare costs are on the rise. Most have begun to brace themselves for cost increases as a result of healthcare reform. In our recent blog post on the NNNN survey we reviewed the plans of large employers to pass the cost increase onto employees in 2011. For the most part, we are prepared to see our healthcare costs rise after the reform takes effect. But we don’t have to wait to feel these increases. Across the board, the average employee has already seen these increases. The survey certainly shows increases- especially in premiums for family and individual plans. The most notable increase may be that seen in the employee contribution.

Historically, employers and employees have shared the burden of rising premium costs. In 2010, however, employers did not increase their dollar-amount contribution. As a result, employee contribution rose 14% from 2009. Employer contribution did not rise.

The survey reports that 27% of employees have deductibles of $1,000 or more for single coverage. This is up from 22% in 2009. The average deductible is considerably less for workers with PPOs or HMOs. Prescription drugs, physicians visits, and preventative care are usually covered (with, of course, a co-pay or coinsurance) before a deductible is met. The out-of pocket maximum varies considerably for workers and plans.

Where are you better off, a large firm or a small firm? For the most part, it’s hard to tell. But, if you’re hoping to pay less of your premium, start sending your resume to small companies. 35% of employees at small firms pay nothing towards single coverage premium and 13% pay nothing towards family coverage. Only 6% at large firms pay nothing for single coverage and 1% towards family coverage.

Employers were not shy about reporting the changes nor the reasons for them.  Increased cost sharing, reduction in the scope of coverage, and increased employee contribution were all responses to the poor economy.

Keep in mind that this survey was conducted from January to May 2010. After our previous post on Large Employers passing rising health costs onto employees, we can only imagine what the survey will show in 2011.

Attention Patients: Be Aware of Medical Errors this Holiday Season

Friday, December 24th, 2010

With the holidays right around the corner, many of us will be rushing around, finishing up holiday shopping, attending parties, eating too much… the list goes on.

However, people still get hurt and sick around the holidays and are in the hospital. Hospital staff is lighter around the holidays, giving providers some much needed family time. On the other hand, less providers and tired staff can lead to medical errors.

A recent article by Dr. Bialek of www.covermd.com looks at the top ten most common medical errors in the United States.

1. Technical medical error
Ex: Provider cutting the wrong artery in a heart surgery, leading to complications or death.

2. Failure to use indicated tests
Ex: Patient having chest pains, but doctor failing to perform an EKG and patient has a heart attack.

3. Avoidable delay in treatment
Ex: Patient complains of stomach pains, isn’t seen quickly by ER attendees because of more urgent manners, patient’s appendix erupts causing severe internal bleeding.

4. Failure to take precautions
Ex: Patient is weak and has a history of falling. Nurse takes patient from the bed to the bathroom, unaware of patient’s weakness. Patient falls and fractures hip.

5. Failure to act on test results
Ex: Patient feels dizzy and sick. Doctor orders blood test, believes it’s an infection and sends the patient off with antibiotics. Test results come back, but doctor fails to look at them thinking she just has an infection. Patient ends up in a diabetic comma.

6. Inadequate monitoring after a procedure
Patient has a routine surgery. After surgery, patient is on narcotics. Nurses fail to monitor the patient, although patient’s parents are in the room. They do not realize that the patient has stopped breathing.
Another important list is errors with serious consequences. These occur mostly in intensive care units, operating rooms, and emergency departments.

7. Inadequate patient preparation before a procedure
Patient goes in for surgery. The provider fails to check with the patient to see what medications the patient is taking before surgery is performed. The patient is currently taking a blood thinner. During surgery and bleed occurs and the patient dies.

8. Inadequate follow-up after treatment
Patient has surgery. After surgery the doctor tells the patient to call for any changes in temperature, feeling, etc. Patient feels drowsy and nauseous from anesthesia and blames it on that. When the patient calls the doctor, the doctor tells the patient to wait 24 hours. Patient comes down with a deadly infection.

9. Avoidable delay in diagnosis
Patient comes in after blacking out after being assaulted. Provider waits 12 hours for a CT scan. Patient’s brain is bleeding and never wakes up.

10. Improper medication dose and/or method of use
Ex: A drug mix up causes a patient to take 10 times the normal dose. Patient dies a result.