The following article is from an article in 1997, but many of the elements of limitation are still needed - one of the big differences today is that producers are following closely the prescription for the reporting of test track, but the bill for physical medicine and rehabilitation services - in particular, therapeutic procedures, has been inserted.
One can imagine that we are one year of income in a month? Want to know how to increase your weekly income $ 8000 to $ 10,000?These are just some of the questions set by national organizations, providers of doctors surveyed fraud with the promise of prosperity.
This is an unfortunate reality that some doctors have greed in mind, not of patient care and the use of patients as the vehicles in their search for wealth. And for them, the soft tissue is just what the doctor ordered!
Soft tissue lesions is best described as an aberration of the skin, muscles, tendons and ligaments, sprains and strains of belonging and itsSyndromes, which are self-limiting in nature and with or without treatment, in which 90% will heal spontaneously resolved in 90 days. These are minor injuries, which are subject of complaints by patients, or to inform the patient that the doctor, and for the most part, objectively verifiable, and prove almost impossible to identify or refute them. As a result of damage of soft tissues that may be of vital importance for fraud doctor!
The National Insurance Crime Bureau (NCIB), whichProperty & Casualty insurance operations arm of insurance against crime, identified the soft tissue damage that fraud in connection with typical lesions require. And the relationships that are unscrupulous medical providers and lawyers, the largest monetary incentives to participate in this type of fraud. NCIB relations, the frequency and cost of this information is on the rise, reveals a study by the Insurance Research Council that the reports were filed by soft tissue lesions, 83% of applicants in AT-fault car accidents in 1992, up to 75% in five years, and argue that the costs are about four times higher on average than 15 years ago. The NCIB is estimated that the average American household pays an additional $ 200 prizes each year for 20 billion dollars annually to pay the insurance fraud problem!
These minor wounds is a major problem for insurers and consumers - no coincidence - but with the specific intent and design of the provider of local, national controlDo> Travel the country for doctors willing to do anything to make more money, he found. Many of them are attracted to that used for wealth, and to do exactly that - what you need! Here is the ideal environment for soft tissue medical fraud, could be used as soft tissue injuries to the limitation in blatantly and expensive system of fraud, and follow a recipe for wealth! This recipe calls for specific ingredients:
Use every means to involve professional associationsFraud and calling for people with insurance get in the door.
Turn everyone with insurance, regardless of medical condition or need, in patients.
Keep patients return, regardless of the need to run until the insurance, or cut off.
Bill for tests of no insurance, at no value of diagnostic tests and unnecessary treatments.
Do not use aggressive tactics, legal and political connections in order to pay the insurer.
ThisRecipe is only making money, not the best people. We trust that the doctors have the experience, knowledge and commitment to get better. We expect a lot of health professionals, and most offer an honest and caring. But doctors in this recipe, the use of their profession, position in society, and trust to steal the result of tests costly tests and treatment! Evident from the ingredients listed above, especially numbers one and four.
Ingredients of a greatdisturbing, not only for the financial impact may have, but more importantly for the concern for public safety, they create for patients. This agent calls seeking to doctors, people with insurance, provide little or no consideration for the welfare of the patient, to be used as vehicles to steal. One of the tactics most commonly used to achieve these ingredients' practice sessions, which are supposed to be available as a public service by doctors concerned about our health, because we can be hurt and do not knowit!
The "practice sessions" are offered through advertising, coupons, store events are free dinners, phone calls and / or letters, not the public service! The exam free is a bait and switch scam, with the test (bait) offers physicians the ability to hard sell people with assurances about the need for treatment and for patients (SWITCH). The first to consider what "for" insurance is available, as determined by questionnaires in which actual injury is difficult to make a difference in"Free Exam" scams, but this assurance is the basis for treatment. Doctors with this tactic are to find the dice rolling Revenue = INSURANCE!
Consider the bait the words "Free Exam, you may be injured and not know it. Now, someone could be injured and not know?" I know when I'm bad, right? How do doctors diagnose soft tissue injuries, the people who do not know, I am injured? If you are not hurt, you have the (subjectively) complaints, the physician shouldThe diagnosis of this disease? Moreover, they should be examined, free of why a doctor for us? The doctors are really so concerned about our health, the fact that they provide us with a free doctor? I do not think so, what do you think?
Favorite targets of these tests are car accident victims on behalf of police reports. The police report not only documents, car accident, but also provides contact information and insurance on the victim (s). Both medical professionals and lawyers to see the money in the formfuture insurance benefits, and aggressively urging victims of car accidents by e-mail and telephone. Victims may be contacted from various sources of accidents, and businesses to collect, established in other parts of the country for local professionals.
The fourth component of the formulation is of particular interest and importance to combat fraud, with the completion of this ingredient to operate, doctors proved beyond any shadow of doubt, cheat! The bill for the services is not possiblesupply and for others that are absolutely unnecessary for the diagnosis of soft tissue lesions. When called to account for billing services, and I know what it is billing codes, the evidence is strong to stop these doctors.
Terminology applicable procedure codes or CPT are used by most healthcare providers, including doctors have the recipe for the payments. The American Medical Association announced the CPT codes, so that all service providers could accurately report services and collect the correctCompensation. These codes are used to the amount of work, the decision and instruction of the health risks to patients and providers, using the code to the code (s) to select the correct identification of the service (s) executed.
A simple way to determine which billing services, the use of CPT codes, and break bills into the categories of services: exam TREATMENT. Calculate the various categories can be found in the respective amounts submitted invoice. Normally, the calculations below, we find thatless than half the bill of the doctor) for treatment (services to assist the patient in achieving a better state of health, and most of the bill for the tests and trials. In addition, the models are identified, with services exactly the same for all patients in the invoice.
Moreover, if we know what set of CPT performance in the office of the medical prescription is required, you can stop our evidence to the respective regulations expensive. These doctors are not choosing codes that mostto determine exactly what their services. Many of the tests are fully charged, which are impossible for patients with soft tissue injury result. Many of the load test set of objective data, which is impossible in a subjective injuries. And most will be deducted from the treatment is limited to services that do not need a doctor to administer. Each category of service deserves a closer look.
Examinations - CPT has five levels of tests based on the type of representation of medical problems and risks ofPatients in the targeted problem (minimum) and complete (seriously). CPT reports three main components of an examination: 1) history, 2) physical examination, and 3) the medical decisions. Each component will be different requirements, depending on the level of service reported, which must be met, or exceeded, auditing services Bill. Work more and the decision by the physician is required and the higher the level of proof.
The recipe calls for doctors to bill for examinations complete. CPT reported that usuallyDoctors will have 60 minutes, completed in the presence of the patient and / or family to address a global process of testing, where doctors: 1) a complete history, 2), a complete physical examination, and 3) to make medium-high complexity of medical decisions on patients with moderate to high risks of morbidity and mortality) (death and / or prolonged failure without treatment. The full review is complete and is conducted in patients with serious health problems.
AlthoughStudies show that the preferred billing codes that doctors may, however, none of the required components of a full examination to be done. The health risks of their soft tissues are much less patient than the risks for patients who need a comprehensive review. Soft tissue injuries are not serious illnesses. CPT is a code that is exactly the test on the soft tissues of a patient? Yes, because it really is, but is not complete, and, most importantly,not pay as well! Display, these highly trained and qualified medical professionals to avoid knowingly steal the code and the evaluation report does not expressly provided for a proper service!
Mar-tests in addition to the amount of money required tests, the recipe calls for doctors to bill for expensive diagnostic tests. These tests specify the objective data in subjective soft tissue injuries. Is it possible? Not that it makes the target of prejudice? Even if possible, what differencewould be objective data on damage until the patient is determined that it will heal in time, with or without treatment? The difference is the bill to increase patients' costs for tests and value. Normally the tests, the costs will be operated by an unlicensed assistant in less than 10 minutes on a particular region of the body, more than double what the doctor charged for the examination of the entire body.
CPT has made specific codes for many of the tests by doctors in the following accountrecipe. However, the provider of the national organizations scams ask you to use the codes for the service of wrong question. Most of them stated objective tests are not medically or scientifically valid and do not provide the objective data relied upon. In most cases the tests are still not taught in accredited schools, but at the weekend seminar, taught by people with a financial interest in specific tests. This lack of validity, has not stopped themDoctors.
Do not think that in all the tests and the total turnover reported that these doctors all the information necessary to say (a condition of what they had to treat patients identified)? The tests do little or nothing to do better with patients, but are the ingredients for wealth. The national organizations of fraud chosen provider soft tissues as a basis for prosperity, because it is not to prove this injury exists. The other side to earn more money,Responsible for applying the evidence to prove that the damage is present. You can not have both!
TREATMENT - CPT code will be monitored numerous management, with specific requirements for each of two ways: 1) medical supplies broken, and 2) the doctor. Some codes that require treatment by a doctor predicted. Others require only that a doctor monitor the treatment of the proper treatment was provided, properly applied, on the right area of the body, and for the correspondingTime. The treatment must have a relationship with the injury and the treatment itself is limited to soft tissue injuries, but specific requirements must be met before settlement processing services.
The majority of treatment charged by doctors for the recipe, the same in all patients, regardless of need or individual condition and are operated by unlicensed assistants. The recipe, with the specific purpose of making more money, the results of medicalThe practice of a philosophy of the revolving door of medical care. Time is money, and how many patients as possible in a single day (see the report in the vicinity of few hundreds), physicians and patients in shuffle in less than 10 minutes. With all the evidence, "FREE, comprehensive examinations and tests, which are also reported, in which doctors can treat the time, all these patients? Perhaps this is another reason, the national organization, has chosen the soft tissues -- is self-limiting and spontaneouslySolution!
National organizations of provider fraud (practice owners) a heavy toll. These organizations draw large numbers of doctors are educated and trained, that the wealth that promoted consciously and deliberately, in the systems expensive and systematic fraud by the organizations will be represented. These are criminals who happen to be doctors! They have contempt for society, the state abuse, and our trust to steal. Have littleRegard for the welfare of patients. They have the courage of its insurers outright fraud and costly to stop. Make significant use of the judicial system to ensure success / compliance. Forcing consumers to bear the costs of fraud.
They believe police officers have little or no interest for their crimes. The end, they think they are untouchable. A fatal mistake! Honest doctors are teaching the finer points of fighting fraud, healthcare fraud. Insurers, regulators and law enforcementare developing a more sophisticated attacks. The political climate is such that two aspects are crucial, "health" and "crime" is getting great attention and concentration at the highest levels of government. Crimes like these are committed by medical staff through a coordinated anti-fraud team of the country attacked.
"The eyes see only what is known of the spirit" brought a quote to my attention some years ago by the physician to stop these crimes committedActivities, and it is appropriate here. If you know what happens to criminals who make the doctors - you can see how to stop them!
Published: John Cooke Fraud Report, "January / February 1997
Friends Link : 55 inch LCD TV Promotion Kindle dx Nuvi 1390T GPS
แสดงความคิดเห็น