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Thursday, May 24, 2007

Get a Job, Work at Home

abc NEWSIt May Not Be "Easy Money," But There Are Ways to Make a Living by Working From Home

Tory Johnson is "Good Morning America's" workplace contributor. (ABC News)Medical Transcriptionist - this work is focused on translating a doctor's report to an electronic record of a person's medical history, diagnosis and treatment. As the health care industry moves toward electronic health records as the standard - allowing easier storage and accessibility of an individual's history by physicians anywhere — there is an increased demand for medical transcriptionists.

There are about 100,000 registered MTs in the United States now - the majority of them work from home. Technology is paving the way for more people to pursue this line of work from anywhere in the country. I talked to a dozen companies that hire home-based agents, and they're all eager for new hires — both part-time and full-time employees as well as independent contractors. Some of the biggest employers in this field are Focus Infomatics, MedQuist and Spheris.

Training: In addition to needing high-speed Internet access and a PC, training is required, which can take up to a year — either through online distance learning or at just about any community college in the country. The cost ranges from about $1,000 to $3,500. Keep in mind that learning medical terminology is like learning a foreign language. It takes diligence and motivation. Accuracy and speed are essential, which means the people best suited for this job are well-coordinated and disciplined and have an exceptional ear. Before selecting a school, ask about its job placement record and research the employers they claim to work with. Tory Johnson

Money: Medical transcriptionists are paid by the line, so it's a field where productivity drives compensation. Expect to earn between $30,000 and $40,000 annually once you're well-trained.

Medical Coding - Coders translate the verbal names for diseases, ailments and treatments into numerical codes. Changing government regulations and the growth of managed care have increased the amount of paperwork involved in filing insurance claims, all of which are based on these codes. No codes, no payment!

Training: You still have to know general medical terminology and pharmacology to do medical coding, but codebooks and software support your efforts. Again, you can learn this online or at a community college or technical school. A top school can assist with job placement upon completion of coursework. Expect to work in an office for a period of time before being able to work from home full-time.

Coders can earn an average of $30,000 to $35,000 annually.

The American Association for Medical Transcription and the American Health Information Management Association can be good sources of information to assist your efforts in identifying schools and employers for becoming either a transcriptionist or coder.

Source: http://mtindia.info/news/latest/get-a-job-work-at-home.html

AAMT and Prometric announce the launch of the ‘Registered Medical Transcriptionist’ Credential

New International Credential to enhance training & career prospects for young Indian medical transcriptionists

American Association for Medical Transcription, in association with Prometric, announced the Registered Medical Transcriptionist (RMT) credentialing exam – a newly developed global ‘level-1’ credential in the arena of Medical Transcription. This program is aimed at helping the existing talent pool to scale up and meet the global standards and quality benchmarks. The two organizations also announced a special ‘India price’ for AAMT’s existing Certified Medical Transcriptionist (CMT) exam.

Medical Transcription is a booming industry with exponential growth prospects and opportunities for committed players. While globally the industry potential is around USD 30-33 billion, in India it is around USD 300 million. Currently, there are around 18,000 medical practitioners in the country and this is expected to almost double within the next 2-3 years.

Career Path in Medical Transcription
Previously, the lack of globally recognized programs in this domain hampered the evolution of proper talent and career prospects in the industry. With the introduction of RMT, a level 1 exam, on top of the existing CMT exam offered by AAMT, both of which are globally accepted credentials, it will now encourage students as well as existing MT professionals to acquire knowledge and brace up their skills in the field. This will not only help them to perform better while on job, but will also open a whole new world of opportunities and offer long-term career prospects for them.

Source:http://www.mtindia.info/

Poor Medical Dictation Can Put Patients' Lives In Danger

Doctors are putting their patients in danger with medical dictation so bad that professionals can't even understand them, according to a Problem Solvers investigation.

Medical transcriptionists said they have been dealing with sloppy physician records for years. A transcriptionist transcribes the doctor's diagnosis and treatment for the patient's medical record. Holfeld reported that sometimes, transcribing becomes an impossible task. "We should be held accountable for quality, but it's difficult to be held accountable for quality when the challenges on the dictation are pretty overwhelming," medical transcriptionist Brenda Hurley said.

Hurley is a former president of the Florida Association of Medical Transcriptionists. She and her colleagues are joining a national campaign to expose the potential side effects of bad dictations. "If it takes multiple levels of quality assurance review, it's going to take longer to get back to the patient's chart," Hurley said. Joyce Peck was just days away from kidney surgery when she met with us two weeks ago. She caught a mistake before her surgery. "Potentially they could have taken out the wrong kidney and then I would have been left with no kidneys," Peck said. "I caught it," Peck said.

"One place it's left kidney and the next place it's right kidney," Peck said. The diagnosis of a renal malignancy -- cancer -- was caught in a radiologist's apparent flubbed dictation. "Whew," Holfeld said. "What did you think at that point?" "I didn't know what to think -- who was right?" Peck said. In fact, MRI scan confirmed it was the right kidney and not the left. Peck is recovering from kidney surgery. She shared her story as a personal public warning.

Source: http://www.mtindia.info/


Tuesday, May 22, 2007

Medical Transcription as per U.S. Department of Labor

Medical Transcriptionists


Significant Points
  • Job opportunities will be good.
  • Employers prefer medical transcriptionists who have completed a postsecondary training program at a vocational school or community college.
  • Many medical transcriptionists telecommute from home-based offices as employees or subcontractors for hospitals and transcription services or as self-employed, independent contractors.
  • About 4 out of 10 worked in hospitals and another 3 out of 10 worked in offices of physicians.



Nature of the Work

Medical transcriptionists listen to dictated recordings made by physicians and other health care professionals and transcribe them into medical reports, correspondence, and other administrative material. They generally listen to recordings on a headset, using a foot pedal to pause the recording when necessary, and key the text into a personal computer or word processor, editing as necessary for grammar and clarity. The documents they produce include discharge summaries, history and physical examination reports, operative reports, consultation reports, autopsy reports, diagnostic imaging studies, progress notes, and referral letters. Medical transcriptionists return transcribed documents to the physicians or other health care professionals who dictated them for review and signature, or correction. These documents eventually become part of patients’ permanent files.
Check
http://www.bls.gov/oco/ocos271.htm
for more details

Thursday, May 17, 2007

True Doctor Stories

A man comes into the ER and yells, "My wife's going to have her baby
in the cab!" I grabbed my stuff, rushed out to the cab, lifted the
lady's dress, and
began to take off her underwear. Suddenly, I noticed that there
were several cabs, and I was in the wrong one.

Dr. Mark MacDonald, San Antonio, TX
* * * * * * * * * * * * *
At the beginning of my shift, I placed a stethoscope on an elderly
and slightly deaf female patient's anterior chest wall. "Big
breaths," I instructed.
"Yes, they used to be,"remorsefully replied the patient.

Dr. Richard Byrnes, Seattle, WA
* * * * * * * * * * * *
One day, I had to be the bearer of bad news when I told a wife that
her husband had died of a massive myocardial infarct. Not more than
five minutes later, I heard her reporting to the rest of the family
that he had died of a "massive internal fart."

Dr. Susan Steinberg, Manitoba, Canada
* * * * * * * * * * *
I was performing a complete physical, including the visual acuity
test. I placed the patient twenty feet from the chart and
began, "Cover your right eye with your hand." He read the 20/20 line
perfectly. "Now your left." Again, a flawless read. "Now both," I
requested. There was silence. He couldn't even read the large E
on the top line. I turned and discovered that he had done exactly
what I had asked; he was standing there with both his eyes covered.
I was laughing too hard to finish the exam.

Dr. Matthew Theodropolous, Worcester, MA
* * * * * * * * * * * * * * * * * *
During a patient's two week follow-up appointment with his
cardiologist, he informed me, his doctor, that he was having trouble
with one of his medications. "Which one?" I asked. "The patch. The
nurse told me to put on a new one every six hours, and now, I'm
running out of places to put it!" I had him quickly undress and
discovered what I hoped I wouldn't see. Yes, the man had over fifty
patches on his body! Now the instructions include removal of the old
patch before applying a new one.

Dr. Rebecca St. Clair, Norfolk, VA
* * * * * * * * * * * * *
While acquainting myself with a new elderly patient, I asked, "How
long have you been bedridden?" After a look of complete confusion
she answered...
"Why, not for about twenty years -- when my husband was alive."

Dr. Steven Swanson, Corvallis, OR
* * * * * * * * * * *
I was caring for a woman from Kentucky and asked, "So, how's your
breakfast this morning?" "It's very good, except for the Kentucky
Jelly. I can't seem to get used to the taste," the patient replied.
I, then, asked to see the jelly, and the woman produced a foil packet
labeled "KY Jelly."

Dr. Leonard Kransdorf, Detroit, MI
* * * * * * * * * * * * *
And Finally . . . . .

A new, young MD doing his residency in OB was quite embarrassed
performing female pelvic exams. To cover his embarrassment, he had
unconsciously formed a habit of whistling softly. The middle-aged
lady upon whom he was performing this exam suddenly burst out
laughing and further embarrassed him. He looked up from his work
and sheepishly said, "I'm sorry. Was I tickling you?" She
replied, "No doctor, but the song you were whistling was, 'I wish I
was an Oscar Meyer Wiener'."

Life is Great!

Source:

The month was right!

Written documentation on a patient's chart in with PID, "Patient had her sister
move into her ovaries in December."

It was supposed to read that patient had a cyst removed from her ovaries in
December.

Source:



MedicalTranscription-Humor-Zone

Medical TermsAccording to Blondes

*Apologies go out to anyone who really is a blonde*

Artery The study of paintings.
Bacteria Back door to the cafeteria.
Barium What doctors do when treatment fails.
Bowel A letter like "A", "E", "I", ETC.
Caesarean section District in Rome
Cat Scan searching for kitty
Cauterize Made eye contact with her
Colic Sheep dog
Coma Punctuation mark
Congenital Friendly
D & C Where Washington is
Dilate To live a long time
Enema No a friend
Fester Quicker
Hang nail Coat hook
Impotent Distinguished
Labor pain Getting hurt at work
Morbid Higher offer
Nitrate Cheaper than the day rate
Node Was aware of
Out-patient Person painted
Post-op Letter carrier
Recovery room Place to re-upholster
Rectum Dang near killed him
Rheumatic Amorous
Secretion Hiding something
Tablet Small table
Terminal Getting sick at the airport
Tibia A country in north africa
Tumor More than one
Urine Opposite of "you're out"
Varicose Nearby
Vein Conceited

By: Mary Usner posted on Yahoo Groups [MedicalTranscription-Humor-Zone]

Top 10 Odd MR Statements

(Supposedly found on patients' charts.)

10. "The skin was moist and dry."
9. "The patient lives at home with his mother, father, and pet turtle, who
is presently enrolled in day care three times a week."
8. "The patient was in his usual state of good health until his airplane ran
out of gas and crashed."
7. "The patient was to have a bowel resection. However, he took a job as
stockbroker instead."
6. "I saw your patient today, who is still under our car for physical
therapy."
5. "While in the emergency room, she was examined, X-rated and sent home."
4. "She stated that she had been constipated for most of her life until 1989
when she got a divorce."
3. "When she fainted, her eyes rolled around the room."
2. "She is numb from her toes down."
1. "The baby was delivered, the cord clamped and cut, and handed to the
pediatrician, who breathed and cried immediately."

Source: Yahoo Groups (MedicalTranscription-Humor-Zone)

Physician's Guide to the Alphabet

Tuesday, May 15, 2007

common spices & their medical values

1. Asparagus


Asparagus

Use :

  • Kidney problems.
  • Dissolves uric acid deposits.
  • Promotes urination

Preparation :

  • Boil in water and drink.

2. Basil Tea


Basil Tea

Use:
  • Colds, flu
  • Cramps
  • Bladder

Preparation :

  • Add fresh herb or seeds to boiled water to make tea for migraines and bed time restlessness.
  • Douche for yeast infections.
  • Gargle and mouthwash to eliminates
    Candida.
  • Pregnant women should avoid medicinal use of basil.

3. Black Pepper

Black Pepper


Use:

  • Take at first sign of any disease
  • Pain relief from toothache
  • Brings down a fever.

4. Celery

celery

Use :

  • Sedative.
  • Seed and stalk reduces hypertension.
  • Celery seed tea for the kidneys as a cleanser.

5. Chamomile flowers

chamomile


Use:

  • Fever and restlessness in children

6. Cinnamon

cinnamon


Use :

  • Diarrhea
  • Dysentery
  • General Indigestion
  • Yeast infection
  • Athlete's foot
  • Reduces cancer causing tendencies of many food additives
  • Cold

Preparation :

  • Cinnamon ground or taken with milk is a good balance after a heavy meal or dessert
  • Simmer sticks with cloves for 3 min, add 2 tsp. lemon juice, 2 tsp. honey, 2 tbs. whiskey as cold medication.
  • Boil 8-10 sticks in 4 cups water, simmer 5 min, steep 45 min, then douche or apply to athlete's foot.


7. Cloves


cloves


Use:

  • Toothache
  • Nasuea
  • Vomiting
  • Sore gums
  • Topical pain relief of arthritis
  • Antiseptic mouthwash
  • Alcohol craving suppressor

Preparation :

  • Chew for toothache, nausea or vomiting.
  • Use oil for pain relief for sore gums and toothache.
  • Add clove oil to neutral oils for topical pain relief of arthritis.
  • Small amounts of clove in a tea for nausea. 3 cloves in two cups of boiled water, steeped for 20 minutes, as an antiseptic and mouthwash. Former alcoholics can suck on one or two cloves when the craving strikes to curb the desire.


8. Freshly Brewed Coffee

coffee

Use :

  • Alleviate headaches Clean bowels Break mucus congestion

Preparation :

  • Caffeine in coffee is used to alleviate headaches (particularly those caused by caffeine withdrawal)
  • Coffee enemas with olive oil are used to cleanse the bowels and are one of the safest and most thoroughly cleansing enemas available.
  • Hot black coffee sipped through a straw helps break up mucus congestion in the lungs.
  • Caution and common sense must be used to avoid dependency.

9. Garlic

garlic


Use :

  • Chronic and acute bacterial colds and flus
  • Bronchitis, asthma, whooping cough
  • High and low blood pressure
  • Removing parasites and infections
  • Sexually transmitted diseases
  • Hypoglycemia
  • Diabetes
  • Destroys intestinal parasites
  • Reduces cholesterol
  • Repels insects
  • Reduces sting effects of insects and red ants

10. Ginger

ginger


Use :

  • Cold / Flu
  • Suppressing cough
  • Cramps
  • Nausea
  • Stiffness
  • Detoxify meat
  • Blood Thinner
  • Ease bruises & sprains
  • Stimulate delayed period
  • Break up congestion and fever

Preparations :

  • Ginger prepared in tea form is useful for cramps, nausea, thinning blood, as a substitute for coumadin, break up congestion and fever.
  • Use externally for stiffness
  • Add in cooking to detoxify meat, especially chicken. Boil 2/3 cup of freshly chopped root in 1 gallon water, wrapped in cheesecloth (or old nylon stocking) until the water is yellow.
  • Then soak towel and lay on bruises and sprains while still hot, to ease them.
  • Ginger is one of the few herbs that easily passes the blood/brain membrane and is used in conjunction with other herbs that are meant to have an effect on the mind.
  • Pregnant women should avoid medicinal concentrations of ginger.

11. Lemon

lemon


Use :

  • Colds
  • Cough

12. Mint (Peppermint)

mint


Use :

  • Migraines
  • Nervousness
  • Stomach disorders
  • Heartburn
  • Abdominal cramps, stomachache
  • Herpes

Preparation :

  • Herpes sufferers can take 2 cups of tea a day to ease the symptoms when the virus is active.
  • Mints are used to buffer the action of other herbs that have uncomfortable effects on the stomach and intestines.
  • Can be used in any combination for flavor.

13. Mustard

mustard


Use :

  • Sprained backs
  • Deep rattling coughs

Preparation :

  • 1 ½cups of dry yellow mustard in a bathtub of water for sprained backs.
  • Make a paste with water and apply to knee and elbow sprains till blisters appear!
  • 1 tsp. each mustard and ginger powder mixed with 2 ½tbs. of olive oil for deep rattling coughs. Rub over chest and back and put on an old T-shirt (or cover with cloth diaper).

14. Nutmeg and mace

nutmeg and mace


Use :

  • Gas Indigestion
  • Nausea
  • Vomiting
  • Kidney problems

Preparation:

  • Make a paste of powder with cold water and then add to boiled water.
  • 1 tbs. 1/4 tbs of powdered nutmeg is enough to produce a floating euphoria for hours.
  • Can cause erections for men during that time.
  • Side effects are bone and muscle aches, burning eyes, sinus drainage, and limited diarrhea.

15. Onion bulb

onion bulb


Use:

  • Cold
  • Cough
  • Life prolonger
  • Dressing for burns
  • Bee and wasp stings
  • Asthma

Preparation :

  • Interviews with hundreds of people who lived to 100 plus all indicated a heavy intake of onions in the diet.
  • Onion is an excellent dressing for burns.
  • Crush sliced onions with a little bit of salt and apply to burns.
  • Apply sliced onion to bee and wasp stings. For asthma, puree an onion, cover it with brandy and let sit overnight, strain it, filter it through a coffee filter, and refrigerate.
  • Take 2 tbs. 20 minutes before expected onset or before going to bed.

16. Parsley

parsley


Use :

  • Purifier
  • Halitosis
  • Tumor inhibitor
  • Kidney stones and other kidney related problems
  • Painful urination
  • Sexual stimulant

Preparation :

  • Chew for halitosis.
  • A few sprigs provide 2/3 the vitamin C of an orange, lots of vitamin A, and the important amino acid histidine, which is a tumor inhibitor.
  • Parsley tea is good for kidney problems, painful urination, and kidney stones.
  • One cup of parsley to 1 quart of water makes a strong tea.
  • Two cups of parsley to 1 quart of water, steep an hour and drink warm, as an aphrodisiac.
  • In Spain they have found that feeding parsley to sheep will bring them into heat at any time of year!

17. Rosemary Tea

rosemary


Use:

  • Headaches
  • Body aches
  • Breath purifier
  • Aid in digestion of fat
  • Free radicals reducer
  • Stress Headaches
  • Muscular stiffness and pain

Preparation :

  • Flower tea for the breath.
  • Boil water with rosemary in it to make it safe to drink.
  • Diuretic and liver aid, increases bile flow.
  • Two handfuls of flowering tips into 2 cups of good brandy, soak 10 days, strain and seal.
  • Mouthful twice daily.
  • Oil of rosemary is a natural anti-oxidant, and stress reliever
  • Sniff for headaches.
  • Chop a double handful of twigs and put in a pint of olive oil for one week, and use as a muscle liniment.

18. Spearmint

spearmint


Use :

  • Cold, flu
  • Mild fever
  • Antispasmodic
  • Prevents vomiting
  • Relieves stomach
  • Intestinal gas
  • Diaphoretic
  • Reduces pain

19. Tea

tea


Use :

  • Relieve migraines Dental plaque remover

Preparation :

  • Caffeine relieves migraines.
  • Tea drinkers suffer less hardening of the arteries than coffee drinkers.
  • Black tea kills dental plaque.

20. Vinegar

vinegar


Use :

  • Blood cleanser
  • Arthritis cure
  • Reduce inflammation

Preparation :

  • Naturally brewed apple cider vinegar is one of the finest blood cleansers and arthritis cures known.
  • Take 1 tbs. per day of equal parts vinegar and honey in water to taste to cleanse the blood and reduce inflammation from arthritis.
  • Be sure to use naturally brewed vinegar, as the white cheap stuff in the grocery store is actually acetic acid, a petroleum by-product, and pretty well useless except as a window cleaner!

21. Walnut Hulls, Black

black walnut


Use :

  • Athletes foot
  • Fungal infections, parasites
  • Abscesses
  • Boils

22. Watercress herb

watercress


Use :

  • Cold / Flu

Saturday, May 12, 2007

What HIPPA really is?

From: http://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountability_Act

Health Insurance Portability and Accountability Act


The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996.

According to the Centers for Medicare and Medicaid Services' (CMS) website, Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs.

Title II of HIPAA, the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.

The AS provisions also address the security and privacy of health data. The standards are meant to improve the efficiency and effectiveness of the nation's health care system by encouraging the widespread use of electronic data interchange in the US health care system.


Title I: Health Care Access, Portability, and Renewability

Title I of HIPAA regulates the availability and breadth of group and individual health insurance plans. It amends both the Employee Retirement Income Security Act and the Public Health Service Act.

Title I prohibits any group health plan from creating eligibility rules or assessing premiums for individuals in the plan based on health status, medical history, genetic information, or disability.[1] This does not apply to private individual insurance.

Title I also limits restrictions that a group health plan can place on benefits for preexisting conditions. Group health plans may refuse to provide benefits relating to preexisting conditions for a period of 12 months after enrollment in the plan or 18 months in the case of late enrollment.[2] However, individuals may reduce this exclusion period if they had health insurance prior to enrolling in the plan. Title I allows individuals to reduce the exclusion period by the amount of time that they had “creditable coverage” prior to enrolling in the plan and after any “significant breaks” in coverage.[3] “Creditable coverage” is defined quite broadly and includes nearly all group and individual health plans, Medicare, and Medicaid.[4] A “significant break” in coverage is defined as any 63 day period without any creditable coverage.[5]

To illustrate, suppose someone enrolls in a group health plan on January 1, 2006. This person had previously been insured from January 1, 2004 until February 1, 2005 and from August 1, 2005 until December 31, 2005. To determine how much coverage can be credited against the exclusion period in the new plan, start at the enrollment date and count backwards until you reach a significant break in coverage. So, the five months of coverage between August 1, 2005 and December 31, 2005 clearly counts against the exclusion period. But the period without insurance between February 1, 2005 and August 1, 2005 is greater than 63 days. Thus, this is a significant break in coverage, and any coverage prior to it cannot be deducted from the exclusion period. So, this person could deduct five months from his or her exclusion period, reducing the exclusion period to seven months. Hence, Title I requires that any preexisting condition begin to be covered on August 1, 2006.

Title I also forbids individual health plans from denying coverage or imposing preexisting condition exclusions on individuals who have at least 18 months of creditable group coverage without significant breaks and who are not eligible to be covered under any group, state, or federal health plans at the time they seek individual insurance.[6]

[edit] Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform

Title II of HIPAA defines numerous offenses relating to health care and sets civil and criminal penalties for them. It also creates several programs to control fraud and abuse within the health care system.[7][8][9] However, the most significant provisions of Title II are its Administrative Simplification rules. Title II requires the Department of Health and Human Services (HHS) to draft rules aimed at increasing the efficiency of the health care system by creating standards for the use and dissemination of health care information.

These rules apply to “covered entities” as defined by HIPAA and the HHS. Covered entities include health plans, health care clearinghouses, such as billing services and community health information systems, and health care providers that transmit health care data in a way that is regulated by HIPAA.[10][11]

Per the requirements of Title II, the HHS has promulgated five rules regarding Administrative Simplification: the Privacy Rule, the Transactions and Code Sets Rule, the Security Rule, the Unique Identifiers Rule, and the Enforcement Rule.

The Privacy Rule

The Privacy Rule took effect April 14, 2003, with a one-year extension for certain "small plans". It establishes regulations for the use and disclosure of Protected Health Information (PHI). PHI is any information about health status, provision of health care, or payment for health care that can be linked to an individual.[12] This is interpreted rather broadly and includes any part of a patient’s medical record or payment history.

Covered entities must disclose PHI to the individual within 30 days upon request.[13] They also must disclose PHI when required to do so by law, such as reporting suspected child abuse to state child welfare agencies.[14]

A covered entity may disclose PHI to facilitate treatment, payment, or health care operations[15] or if the covered entity has obtained authorization from the individual.[16] However, when a covered entity discloses any PHI, it must make a reasonable effort to disclose only the minimum necessary information required to achieve its purpose.[17]

The Privacy Rule gives individuals the right to request that a covered entity correct any inaccurate PHI.[18] It also requires covered entities to take reasonable steps to ensure the confidentiality of communications with individuals.[19] For example, an individual can ask to be called at his or her work number, instead of home or cell phone number.

The Privacy Rule requires covered entities to notify individuals of uses of their PHI. Covered entities must also keep track of disclosures of PHI and document privacy policies and procedures.[20] They must appoint a Privacy Official and a contact person[21] responsible for receiving complaints and train all members of their workforce in procedures regarding PHI.[22]

An individual who believes that the Privacy Rule is not being upheld can file a complaint with the Department of Health and Human Services Office for Civil Rights (OCR).[23][24]

[edit] The Transactions and Code Sets Rule

The HIPAA/EDI provision was scheduled to take effect October 16, 2003 with a one-year extension for certain "small plans"; however, due to widespread confusion and difficulty in implementing the rule, CMS granted a one-year extension to all parties. As of October 16, 2004, full implementation was not achieved and CMS began an open-ended "contingency period." Penalties for non-compliance were not levied; however, all parties are expected to make a "good-faith effort" to come into compliance.

CMS announced that the Medicare contingency period ended July 1, 2005. After July 1, most medical providers that file electronically will have to file their electronic claims using the HIPAA standards in order to be paid. There are exceptions for doctors that meet certain criteria.

Key EDI transactions used for HIPAA compliance are:

EDI Health Care Claim Transaction set (837) is used to submit health care claim billing information, encounter information, or both. It can be sent from providers of health care services to payers, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit health care claims and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and/or payment of health care services within a specific health care/insurance industry segment.

For example, a state mental heath agency, may mandate all healthcare claims, Providers and health plans who trade professional (medical) health care claims electronically must use the 837 Health Care Claim: Professional standard to send in claims. As there are many different business applications for the Health Care claim, there can be slight derivations to cover off claims involving unique claims such as for Institutions, Professionals, Chiropractors, and Dentists etc.

EDI Health Care Claim Payment/Advice Transaction Set (835) can be used to make a payment, send an Explanation of Benefits (EOB) remittance advice, or make a payment and send an EOB remittance advice only from a health insurer to a health care provider either directly or via a financial institution.

EDI Benefit Enrolment and Maintenance Set (834) can be used by employers, unions, government agencies, associations or insurance agencies to enrol members to a payer. The payer is a healthcare organization that pays claims, administers insurance or benefit or product. Examples of payers include an insurance company, health care professional (HMO), preferred provider organization (PPO), government agency (Medicaid, Medicare etc.) on any organization that may be contracted by one of these former groups.

EDI Application Advice (824) this transaction set can be used to report the results of an application system's data content edits of transaction sets. The results of editing transaction sets can be reported at the functional group and transaction set level in either coded or free-form format. It is designed to accommodate the business need of reporting the acceptance/rejection or acceptance with change of any transaction set. The Application Advice should not be used in place of a transaction set designed as a specific response to another transaction set (e.g., purchase order acknowledgment sent in response to a purchase order.)

EDI Payroll Deducted and other group Premium Payment for Insurance Products (820) this transaction set can be used to make a premium payment for insurance products. It can be used to order a financial institution to make a payment to a payee.

EDI Health Care Eligibility/Benefit Inquiry (270) is used to inquire about the health care benefits and eligibility associated with a subscriber or dependent

EDI Health Care Eligibility/Benefit Response (271) is used to respond to a request inquire about the health care benefits and eligibility associated with a subscriber or dependent

EDI Health Care Claim Status Request (276) this transaction set can be used by a provider, recipient of health care products or services or their authorized agent to request the status of a health care claim.

EDI Health Care Claim Status Notification (277) This transaction set can be used by a health care payer or authorized agent to notify a provider, recipient or authorized agent regarding the status of a health care claim or encounter, or to request additional information from the provider regarding a health care claim or encounter. This transaction set is not intended to replace the Health Care Claim Payment/Advice Transaction Set (835) and therefore, is not used for account payment posting. The notification is at a summary or service line detail level. The notification may be solicited or unsolicited.

EDI Health Care Service Review Information (278) This transaction set can be used to transmit health care service information, such as subscriber, patient, demographic, diagnosis or treatment data for the purpose of request for review, certification, notification or reporting the outcome of a health care services review.

EDI Functional Acknowledgement Transaction Set (997) this transaction set can be used to define the control structures for a set of acknowledgments to indicate the results of the syntactical analysis of the electronically encoded documents. The encoded documents are the transaction sets, which are grouped in functional groups, used in defining transactions for business data interchange. This standard does not cover the semantic meaning of the information encoded in the transaction sets.

These standards are X12 compliant, and are grouped under the label X12N.

Implementation Guides are available from the Washington Publishing Company for a fee, now that CMS is not subsidizing the publications.

The National Council for Prescription Drug Programs' Telecommunication Standard version 5.1 is also used for the transmission of third-party pharmacy claims. The NCPDP Telecommunication Standard version 5.1 is available to NCPDP members at NCPDP's website.

The Security Rule

The Final Rule on Security Standards was issued on February 20, 2003. It took effect on April 21, 2003 with a compliance date of April 21, 2005 for most covered entities and April 21, 2006 for “small plans”. The Security Rule complements the Privacy Rule. It lays out three types of security safeguards required for compliance: administrative, physical, and technical. For each of these types, the Rule identifies various security standards, and for each standard, it names both required and addressable implementation specifications. Required specifications must be adopted and administered as dictated by the Rule. Addressable specifications are more flexible. Individual covered entities can evaluate their own situation and determine the best way to implement addressable specifications. The standards and specifications are as follows:

  • Administrative Safeguards - policies and procedures designed to clearly show how the entity will comply with the act
    • Covered entities (entities that must comply with HIPAA requirements) must adopt a written set of privacy procedures and designate a privacy officer to be responsible for developing and implementing all required policies and procedures.
    • The policies and procedures must reference management oversight and organizational buy-in to compliance with the documented security controls.
    • Procedures should clearly identify employees or classes of employees who will have access to protected health information (PHI). Access to PHI in all forms must be restricted to only those employees who have a need for it to complete their job function.
    • The procedures must address access authorization, establishment, modification, and termination.
    • Entities must show that an appropriate ongoing training program regarding the handling of PHI is provided to employees performing health plan administrative functions.
    • Covered entities that out-source some of their business processes to a third party must ensure that their vendors also have a framework in place to comply with HIPAA requirements. Companies typically gain this assurance through clauses in the contracts stating that the vendor will meet the same data protection requirements that apply to the covered entity. Care must be taken to determine if the vendor further out-sources any data handling functions to other vendors and monitor whether appropriate contracts and controls are in place.
    • A contingency plan should be in place for responding to emergencies. Covered entities are responsible for backing up their data and having disaster recovery procedures in place. The plan should document data priority and failure analysis, testing activities, and change control procedures.
    • Internal audits play a key role in HIPAA compliance by reviewing operations with the goal of identifying potential security violations. Policies and procedures should specifically document the scope, frequency, and procedures of audits. Audits should be both routine and event-based.
    • Procedures should document instructions for addressing and responding to security breaches that are identified either during the audit or the normal course of operations.
  • Physical Safeguards - controlling physical access to protect against inappropriate access to protected data
    • Controls must govern the introduction and removal of hardware and software from the network. (When equipment is retired it must be disposed of properly to ensure that PHI is not compromised.)
    • Access to equipment containing health information should be carefully controlled and monitored.
    • Access to hardware and software must be limited to properly authorized individuals.
    • Required access controls consist of facility security plans, maintenance records, and visitor sign-in and escorts.
    • Policies are required to address proper workstation use. Workstations should be removed from high traffic areas and monitor screens should not be in direct view of the public.
    • If the covered entities utilize contractors or agents, they too must be fully trained on their physical access responsibilities.
  • Technical Safeguards - controlling access to computer systems and enabling covered entities to protect communications containing PHI transmitted electronically over open networks from being intercepted by anyone other than the intended recipient
    • Information systems housing PHI must be protected from intrusion. When information flows over open networks, some form of encryption must be utilized. If closed systems/networks are utilized, existing access controls are considered sufficient and encryption is optional.
    • Each covered entity is responsible for ensuring that the data within its systems has not been changed or erased in an unauthorized manner.
    • Data corroboration, including the use of check sum, double-keying, message authentication, and digital signature may be used to ensure data integrity.
    • Covered entities must also authenticate entities it communicates with. Authentication consists of corroborating that an entity is who it claims to be. Examples of corroboration include: password systems, two or three-way handshakes, telephone callback, and token systems.
    • Covered entities must make documentation of their HIPAA practices available to the government to determine compliance.
    • In addition to policies and procedures and access records, information technology documentation should also include a written record of all configuration settings on the components of the network because these components are complex, configurable, and always changing.
    • Documented risk analysis and risk management programs are required. Covered entities must carefully consider the risks of their operations as they implement systems to comply with the act. (The requirement of risk analysis and risk management implies that the act’s security requirements are a minimum standard and places responsibility on covered entities to take all reasonable precautions necessary to prevent PHI from being used for non-health purposes.)

The Unique Identifiers Rule (National Provider Identifier)

Effective May 2006 (May 2007 for small health plans), all covered entities using electronic communications (e.g., physicians, hospitals, health insurance companies, and so forth) must use a single new National Provider Identifier (NPI). The NPI replaces all other identifiers used by health plans, Medicare (i.e, the UPIN), Medicaid, and other government programs. The NPI does not replace a provider's DEA number however, or a provider's state license number or tax identification number. The NPI is 10 digits (not alphanumeric), the last digit being a checksum. The NPI cannot contain any embedded intelligence; in other words, the NPI is simply a number that does not itself have any additional meaning. The NPI is unique and national, never re-used, and except for institutions, a provider usually can have only one. An institution may obtain multiple NPIs for different "subparts" such as a free-standing cancer center or rehab facility.

The Enforcement Rule

On February 16, 2006, HHS issued the Final Rule regarding HIPAA enforcement. It became effective on March 16, 2006. The Enforcement Rule sets civil money penalties for violating HIPAA rules and establishes procedures for investigations and hearings for HIPAA violations, however its deterrent effects seems to be negligible with few prosecutions for violations. [1]

Effect on research and clinical care

The enactment of the Privacy and Security Rules has caused major changes in the way physicians and medical centers operate. While respect for patient privacy was already informally considered a cornerstone of medical professionalism, the complex legalities and potentially stiff penalties associated with HIPAA, as well as the increase in paperwork and the cost of its implementation, were causes for concern among physicians and medical centers. An August 2006 article in the journal Annals of Internal Medicine detailed some such concerns over the implementation and effects of HIPAA.[25]

Effects on research

HIPAA restrictions on researchers have affected their ability to perform retrospective, chart-based research as well as their ability to prospectively evaluate patients by contacting them for follow-up. A study from the University of Michigan demonstrated that implementation of the HIPAA Privacy rule resulted in a drop from 96% to 34% in the proportion of follow-up surveys completed by study patients being followed after a heart attack.[26] Another study, detailing the effects of HIPAA on recruitment for a study on cancer prevention, demonstrated that HIPAA-mandated changes led to a 73% decrease in patient accrual, a tripling of time spent recruiting patients, and a tripling of mean recruitment costs.[27]

In addition, informed consent forms for research studies now are required to include extensive detail on how the participant's protected health information will be kept private. While such information is important, the addition of a lengthy, legalistic section on privacy may make these already complex documents even more user-unfriendly for patients who are asked to read and sign them.

These data suggest that the HIPAA privacy rule, as currently implemented, may be having negative impacts on the cost and quality of medical research. Dr. Kim Eagle, professor of internal medicine at the University of Michigan, was quoted in the Annals article as saying, "Privacy is important, but research is also important for improving care. We hope that we will figure this out and do it right."[25]

Effects on clinical care

The complexity of HIPAA, combined with potentially stiff penalties for violators, can lead physicians and medical centers to withhold information from those who may have a right to it. A review of the implementation of the HIPAA Privacy Rule by the U.S. Government Accountability Office found that health care providers were "uncertain about their [legal] privacy responsibilities and often responded with an overly guarded approach to disclosing information...than necessary to ensure compliance with the Privacy rule."[25]

Costs of implementation

In the period immediately prior to the enactment of the HIPAA Privacy and Security Acts, medical centers and medical practices were charged with getting "into compliance". With an early emphasis on the potentially severe penalties associated with violation, many practices and centers turned to private, for-profit "HIPAA consultants" who were intimately familiar with the details of the legislation and offered their services to ensure that physicians and medical centers were fully "in compliance". In addition to the costs of developing and revamping systems and practices, the increase in paperwork and staff time necessary to meet the legal requirements of HIPAA may impact the finances of medical centers and practices at a time when insurance company and Medicare reimbursement is also declining.

Legislative information

  • House: 104 H.R. 3103, H. Rept. 104-469, Pt. 1, H. Rept. 104-736
  • Senate: 104 S. 1028, 104 S. 1698, S. Rept. 104-156
  • Law: Pub. L. 104-191, 110 Stat. 1936
  • HHS Standards for Privacy of Individually Identifiable Health Information; Final Rule: 45 CFR Parts 160 and 164
  • HHS Security Standards; Final Rule: 45 CFR Parts 160, 162, and 164

Transcription Companies in Nepal

Logicpoint Nepal
3rd Floor,Logic Point Building
+977-1-2092188
info@logicpoint.com.np
www.logicpoint.com.np

Golden Network
G.P.O Box : 13884
Kathmandu,Nepal
+977-1-4411074
+977-1-5543436
info@gnnepal.com
www.gnnepal.com

Nepmed International
4th Floor, Mountain Plaza
Kantipath
opposite Jyoti Bhavan
PO Box 291
Kathmandu, Nepal
(977-1) 4215589
(977-1) 4228304
info@nepmed.com
www.nepmed.com

Creative Technology
Medical and Non-medical transcription services
977-21-530935
madhu.sarda@creative.com.np
www.creative.com.np

iWay Nepal
Phone: 4421278, FAX: 4431696
POBox 569
New Plaza, Putalisadak
Kathmandu
www.iway.com.np

National Technologies
Above National Cyber Cafe
College Road, Biratnagar-14
Nepal
(00977)-21-535267
nationaltechno@ntc.net.np
www.nationaltechno.com

Vision TransTech
Kathmandu, Nepal
+977-1-4220071
info@visiontranstech.com
www.visiontranstech.com

A Glossary of Health Professional Titles

It can be daunting to try to figure out those initials after a health professional’s name. The list below explains some of the titles you may see; it does not include every medical title. We’ve given a bit of an explanation for the less-common ones.

AAMA: The practitioner is a member of the American Academy of Medical Acupuncturists, which is open only to medical doctors (MD) and doctors of osteopathy (DO).

ATI, MATI: Designates teaching members of Alexander Technique International (the "M" is optional).

BAMS: Bachelor of Ayurvedic Medicine. The practitioner has completed an approved program at an ayurvedic university in India or Sri Lanka.

BCIAC: Refers to Biofeedback Certification Institute of America certification.

BSW, MSW: Bachelor of science in social work, master’s of science in social work. Social workers offer a broad range of services from emotional support to referrals for community resources. Most states require social workers to pass a licensing exam.

CA: Certified Acupuncturist. Certified by state-approved program.

CAR: Certified Advanced Rolfer. Designates a Certified Rolfer (CR) with at least three years' certification and continuing education credits who has completed additional course work from the Rolf Institute.

CCH: Certified to practice classical homeopathy; available to all professionals through the Council for Homeopathic Certification.

CR: Certified Rolfer. This designation requires training at the Rolf Institute and a college-level understanding of anatomy, physiology, kinesiology and psychology.

DAc: May indicate advanced training in acupuncture. Also used as a licensure title in some states instead of Licensed Acupuncturist.

DAMS: Doctor of Ayurvedic Medicine and Surgery. The practitioner has completed an approved program at an ayurvedic university in India or Sri Lanka.

DC: Doctor of Chiropractic. Chiropractors are trained in four-year chiropractic colleges and are licensed in all 50 states. However, chiropractors are not medical doctors and are not licensed to perform surgery or prescribe drugs.

DHANP: Homeopathy certification available only to naturopathic practitioners through the Homeopathic Academy of Naturopathic Physicians.

DHt: Homeopathy certification available only to MDs and DOs through the American Board of Homeotherapeutics.

Dipl Ac: Diplomate in Acupuncture by the National Certification Commission for Acupuncture and Oriental Medicine.

DO: Doctor of Osteopathy. DOs complete a training, certification and licensing program that is almost exactly the same as that of an allopathic medical doctor (MD). They are licensed to perform surgery and write prescriptions.

DOM: Doctor of Oriental Medicine.

GCFP: Designates a guild-certified Feldenkrais practitioner, which requires completion of a professional training program accredited by the Feldenkrais Guild, including 800–1000 hours of training over a three- to four-year period.

LAc, LicAc: Licensed Acupuncturist.

LNC: Licensed nutritionist counselor.

MAc: Master of Acupuncture. Graduate of a masters level program in acupuncture accredited by the Accreditation Commission for Acupuncture and Oriental Medicine, which is recognized by the U.S. Department of Education.

MD: Doctor of Medicine.

MOM: Graduate of a masters program in Oriental medicine accredited by the Accreditation Commission for Acupuncture and Oriental Medicine.

NASTAT: Designates membership in the North American Society of Teachers of the Alexander Technique, which requires members to complete 1,600 hours of training over at least a three-year period at a NASTAT-certified school.

ND: Doctor of naturopathy. Naturopathic physicians undergo a four-year training program that includes training in homeopathy, clinical nutrition, manipulation, herbal medicine and hydrotherapy. It’s best to consult one who is a graduate of one of the accredited naturopathic medical schools, and licensed.

NMD: Doctor of Naturopathic Medicine in the state of Arizona.

OMD or DOM: Designates an Oriental Medical Doctor or Doctor of Oriental Medicine, and refers to training beyond that required for a state acupuncture license. Chinese MDs who are licensed in China and U.S. practitioners who complete OMD or DOM degree programs at foreign schools also use these titles.

OT: Occupational Therapist.

PA: Physician Assistant.

PharmD: Doctor of Pharmacy.

PT: Physical Therapist.

RAc: Registered Acupuncturist. Licensure title used in some states for professional acupuncturists instead of Lac.

RN: Registered Nurse.

Source: http://www.arthritis.org/conditions/alttherapies/glossary.asp