Otorhinolaryngology Surgery: Taking augmented reality into operation room


Over the last few years, technological advancements in medicine have created new ways for surgical interventions requiring minimizing invasiveness in the internal anatomy, along with new developments in visual examination to provide treatments. Further, a new and safer approach has been devised using ‘augmented reality’ which combines ‘computer generated images of preoperative imaging data with real-time views of the surgical field.’

The background:

The basis of computer assisted surgery (CAS) lies in the field of neurosurgery where actual mechanisms were used along with CT images on computers. Improvements along the way came with additions as MRI images, computer graphics, tracking devices, sensors etc. Today, CAS is applied in other fields such as ear, nose and throat surgery (ENT), cardiac and minimally invasive surgeries, eye surgery and many other disciplines. Further to advancements in CAS is the ‘Augmented Reality’ technique. It lies between reality (real world) and virtual reality (a computer simulated environment) which interacts with the human, finally, displaying the image on a 3D stereo display.

Augmented Reality:

In the preoperative phase, the surgeon usually has an idea of where the target abrasion is and plans his route of operation. But with augmented reality, it becomes easier to mark structures on radiographic images, which are further augmented on live video camera images, and view the targeted area thereby creating a ‘semi-immersive’ environment. It has been created by the technology company Scopis, based in Berlin. This technology can also be used for other surgical procedures such as spinal, craniofacial, cardiac, maxillofacial, orthopedic and neurological operations. This system records the planning stage and actual surgery.

Otorhinolaryngology surgery:

Surgeons are using this artificial intelligence technique to treat patients that require ear, nose and throat surgeries. This has first been tried in Canada where surgeons have used augmented reality with mixed reality to perform a surgery in the otorhinolaryngology field (sinus surgery). This technology makes use of scans and an endoscopic camera which then directs the route of the surgery i.e. real-time positioning in patients) and helps in avoiding important nerves such as optic nerves or the internal carotid artery. This state-of-the-art technology is known as Target Guided Surgery (TGS).

For this endoscopic sinus surgery (ESS) that uses ‘Computer Assisted ENT Surgery using Augmented Reality’ (CAESAR), especially for the frontal recess surgery, it allows for instrument tracking which facilitates viewing and cannulation of the frontal sinus outflow passageway without dissecting the actual frontal recess anatomy. This procedure uses the orthogonal computed tomography images (CT) images. Navigation during the surgery becomes very easy in the cadaveric model of ESS, also reducing the possibility of complications. In simple terms, it becomes extremely easy for the surgeon to view structures, virtually and superimposed (augmented), which otherwise might go unnoticed by the human eye. This includes operations of calibration, tracking and registration simpler, also allowing comparisons and alternatives for the operations.

The benefits:

Augmented reality technique assists in fixing and mending of other anatomic targets during the course of operation, further allowing for accurate localization of the anatomy. In addition, augmented reality technology is easily enabled or disabled (intraoperatively too) by fixing an endoscopic adapter. Planning and viewing in augmented reality makes it easy to sketch markings, 3D structural arrangement, target the path and osteotomy lines. While a surgeon is performing the surgery, an alarm zone can guide and warn him visually and aurally when he is advancing towards the designated mark or constitution.

Augmented Reality is one of the new approaches which surgeons have begun to use for operations by utilizing video frames, images and 3D graphics, in real time. The basis lies in planning and real-time positioning.

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ASC Medical Billing: Key Points to Note


ASC stands for Ambulatory Surgery Centers or Outpatient Surgical Center that is a healthcare facility where patients need not be admitted. The patient is simply taken in, treatment is provided and after-care procedures are levied; after which he can leave. ASC is perfect for minor injuries or treatments and is cost-effective, safe, and easy and is widely practiced in many countries. ASC billing procedures are also covered by Medicare; thus ensuring an outsourced medical billing company looks after the costs of the same.

Although ASC and ASC medical billing services has become very common these days and the entire process is simplified in terms of rendering treatment and billing. Also, there are some key points that come in handy and should be followed while undertaking any ASC treatments.

Listed below are some of the points to bear in mind during ASC and outsourced ASC medical billing:

  • The ASC facility service reimbursement rate comprises of the following:

– The use of an ASC facility, operating and recovery rooms along with good preparation area, emergency equipment and observation room, plus the use of a waiting room or lounge by the patients and relatives

– Administrative services such as scheduling, record keeping, housekeeping and related items as well as coordination for discharge, utilities and rent

– Services connected to the procedure and other related amenities provided by nurses, orderlies, technical staff and others involved in the patient’s care

  • ASC cannot be levied to patients under the following conditions:
  • If they are not emergent or life threatening (for example, in case of a heart transplant or reattachment of a severed limb)
  • They cannot be performed safely in a physician’s office
  • They can be optional
  • They can be critical
  • Procedures that do not involve key blood vessels or result in major blood loss, and cannot involve extended invasion of a body cavity.
  • A great number of modifiers are used on ASC billing. These include the following:
  • Repeat procedure or service by same physician
  • Repeat procedure by another physician
  • Unplanned return to the operating/procedure room for a related procedure on the same day
  • Unrelated procedure or service by the same physician on the same day
  • Bilateral procedure
  • Numerous procedures (not for Medicare)
  • Reduced services
  • Staged or related procedure or service by same physician on same day
  • Distinct procedural service
  • Discontinued outpatient procedure prior to administration of anesthesia
  • Discontinued outpatient procedure after administration of anesthesia
  • Services covered under ASC:
  • Ambulance Services
  • Artificial Legs, Arm, and Eyes
  • Implantable Durable Medical Equipment
  • Non-Implantable Durable Medical Equipment
  • Leg, Arm, Back and Neck Braces
  • Physician’s Services
  • Prosthetic Devices
  • Independent Laboratory Services

Going ahead, it is also important to ensure that the outsourced medical billing services are taken care of in the right manner and at the right time. A good way to look at it is to ensure your billing processes are efficient and correct since ASC is much quicker than regular hospitalization and leaves you little time to make important decisions; making it necessary to get it right.

Posted in Accounts Receivables, Ambulatory Surgical Centers, Claims Denials, Medical Billing, Medical Coding, Practice Administration, Practice Management, Revenue Cycle Management (RCM) | Tagged , , , , , , , , | Leave a comment

How can woundcare nursing change your life?


The image of nursing has come a long way from the Florence Nightingale. Traditionally and generically, nurses have more than often been regarded as the healers of the medical world – healing patients with comforting words, tending their wounds and dressings. The nursing profession is now no longer just a “calling” but offers a more professional platform for the nursing professional. It offers them a multitude of avenues and specialization, and thus nursing is no longer thought of having just a good bedside manner and compassion.

The National Nurses Week is celebrated from May 6-12 annually to regard some of the great sacrifices and care provided to the patients across the state.

Nursing spans across from the basic cleaning of the wound to critical care, and across a range of settings from the small clinic and hospitals to the battlefields; and in today’s more technologically advanced world of wound care from gene therapy to gauze, it is but the nurse

who principally cares for the patients with wounds.

Wound healing encompasses dressings and infection control & the promotion of therapeutic nutrition, mobility, psychosocial support, hygiene, and comfort. This entire gamut of wound healing is under the practice of a nurse, albeit a certified wound care specialist who goes through a rigorous nursing curriculum and countless hours of specialized training, to address not just the clinical needs but also the patients’ physiological needs.

In 1968, the Wound Ostomy and Continence Nurses (WOCN) Society was formed and today after nearly 50 years is regarded as the oldest wound care society, and its WOCN Board certification is considered the gold standard for wound nursing, having certified over 6,100 nurses worldwide.  It began with a mission to promote educational, clinical and research opportunities to advance the practice and guide the delivery of expert health care to individuals with wound, ostomy, and continence issues. Today, the WOCN Board certification is offered at two levels: basic/baccalaureate level and advanced practice/master’s level. Tri-specialty or individual specialty in wound and/or related fields of continence and ostomy care are also offered.

Importance of Wound care

Wound care as a specialty is thus increasing in importance as more and more Americans suffer from complex conditions that can lead to chronic and hard-to-heal wounds.

Studies have shown that a rough population prevalence rate for chronic non-healing wounds in the United States is 2percent of the general population. Although, prevalence rate of chronic wounds is regarded as similar to that of heart failure, research has put forth a conservative estimate of the staggering cost of caring for these wounds which is said to exceed $50 billion per year, said to be 10 times more than the annual budget of the World Health Organization. According to the AAWC fact sheet (May 2014), 4.8 million Americans are stated to have a skin wound or ulcer that would need to be treated.

Three key patient groups that are growing and will need wound care services: diabetes patients, the elderly and the bariatric population. Wound care patients need wound care equipment and supplies throughout their care, which can last for a long time.

And, the three key categories a wound care provider can offer: dressings and bandages, therapeutic support surfaces, and negative pressure wound therapy (NPWT). These offer points of specialization, along with a wide range of items that support a very broad wound care business.

What does Wound care Nursing Involve?

Wound care nursing is an especially fulfilling practice because as a nurse you actually help the body heal. Wound care nurses require a lot of patience, respect for the patient, and ambition to stay up-to-date on current procedures and techniques. Besides, they work not just with the patient but with the family by educating and providing care instructions for patients and families. Chronic wounds need continual care and nurses who specialize in wound care need to be particularly vigilant in order to prevent any complications like infection.

Opportunities for Wound care Nurses

Given the categories of patient groups that need wound care nursing and the specialties within wound care itself, the opportunity is broad. With the right level of commitment, and passion wound care nurses can establish themselves as an expert resource in the healthcare marketplace. The median salary of a wound care nurse is $64,076 with a range of $41,701 – $83,160. An entry-level Wound Care Nurse with less than 5 years of experience can expect to earn an average total compensation of $57,000 based on 267 salaries provided by anonymous users. Average total compensation includes tips, bonus, and overtime pay. A Wound Care Nurse with mid-career experience which includes employees with 5 to 10 years of experience can expect to earn an average total compensation of $61,000 based on 162 salaries. An experienced Wound Care Nurse which includes employees with 10 to 20 years of experience can expect to earn an average total compensation of $63,000 based on 118 salaries. A Wound Care Nurse with late-career experience which includes employees with greater than 20 years of experience can expect to earn an average total compensation of $64,000 based on 60 salaries.

The Roles and Duties of a Wound Care Nurse

  • Evaluate and observe wounds
  • Debride, clean, and bandage wounds
  • Understand and determine treatment required
  • May involve specializing in certain wound types like foot ulcers etc
  • Work with patients and caregivers to monitor wounds
  • Prepares proper documentation for Medicare reimbursement and write orders to promote wound healing and the prevention of skin breakdown

Thus, the employment outlook for a wound care nurse is very good. Given the aging population and changing lifestyle, demand for wound care nurses in a variety of settings from acute care in hospitals to nursing home care, will always be on the up and up. It offers stability, is fairly independent specialty and offers flexibility in the area of nursing.

So if one has a bit of compassion and the need to heal others, then one doesn’t need to be a physician. Being a wound care nurse can bring a lot of fulfillment to your life just by easing your patient’s pain and providing relief. Yes you do need a strong heart and nerves of steel when cleaning wounds. But to provide relief and ease the pain at the end of the day, makes one sleep knowing that your patient will rest easy in the days to come!


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7 Questions to Ask Before You Step Towards Outsourcing Your Cardiology Billing

7 Questions to Ask Before You Step Towards Outsourcing Your Cardiology Billing

To attain cent percent perfection at cardiology billing is a far-fetched dream for most specialty clinics because of the extensive experience and knowledge it requires.  ICD-10 comes with added complexities which raise the stakes for achieving accuracy. Add to its billing code changes and PMP for treatment of certain imaging procedures that often result in billing errors and stock of trouble for cardiologists keeps piling upward. Billing for cardiology practices requires taking into account   multiple procedure rules and complicated contractual adjustments, involving data collection from various sources. Use of modifiers in conjunction with CPT Codes makes it a complex procedure. For example, the codes 93451, 93456, and 93503 cannot be reported with modifier 51. Thus, cardiology billing requires biller to have updated knowledge about deleted codes, revised codes and new codes. A medical practitioner trying to pace up with advancement of cardiac care standards finds it difficult to manage such complexities of billing and coding. Recruiting and retaining staff for in-house billing can incur a lot of money, time and carries risk.

Outsourcing cardiology medical billing to an efficient medical billing and coding company can help you move past the steep cost of in house billing at the same time letting you avoid time wastage and averting risks. Moreover, hiring a billing and coding professional helps you with revenue generation, denial management and managing patient inflow and referrals etc. However, narrowing down to a medical billing company to outsource the needs of your cardiology specialty clinic can be confusing. Here are seven questions to ask before you step towards outsourcing you cardiology billing:

Question I: Does The Billing Company Have Adequate Experience/ Credentials To Handle The Technicalities That Come With Cardiology Billing?

It’s important to be informed about the credentials of medical billing company before you consider handing them over your billing and coding work. You can inquire if they are registered or licensed by the state they are in (if their state requires it). They also need to carry professional liability insurance. Gain knowledge their agreement procedure like if they provide any written contract for their services detailing out each party’s responsibilities in the association.

You need to know if the billing company understands the factors affecting your specialty i.e. cardiology. Get details about the number of past clients they have dealt with same billing needs as yours. Don’t hesitate to get references, to contact current and previous clients and ask for their opinions of the service’s performance.

Question II: What Kind Of Training Does The Staff At The Medical Billing Company Have?

Ask if they hold any certification from a professional billing organization and also if the staff of billers and coders professionally certified. It’s also important for a thriving service to provide ongoing education and guidance to its employees. Good billing companies have a written compliance plan in place, which you as a client must review. The team must have certified billers and coders to carry on the exercise and optimize the revenues of your business.

Question III: What Is The Procedure To Protect The Privacy Of Information?

Check if the service has a compliance officer, or some other who ensures the company provides secure email communications consistent with HIPAA requirements. If the billing company uses home-based employees they need to be more upbeat about their HIPAA compliance.

Question IV:  What Are the Company’s Technical Capabilities?

Does the company electronically process and submit claims, either directly to Medicare or through a clearinghouse? How often are the claims submitted to the clearinghouse? What is the process that they follow for third-party payers? Reach an agreement with the service about provision of help with forms, super bill design, office processes, etc.

Question V: How Does The Biller Handle Claim Changes?

Obtain knowledge about the service’s protocol for changing CPT® or ICD-9-CM codes. You also must ask about the protocol they follow for missing information?

Question VI: How Are The Billing Company’s Follow-Up Practices?

You need to know how successful they are with appeals. Inquire about the parameters they use to decide if they will appeal a denial or underpayment. A strong and efficient accounts receivable (A/R) follow-up procedure is a must for thriving practice revenue. Ask how often the service follows up on payer accounts.

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Refining Your RCM Strategy for Orthopedic Practice


The healthcare rules and regulations are pushing healthcare industry towards lowering the cost of services and equipment beyond the tipping point. For healthcare providers, the major challenge is changing the current process for the Revenue Cycle Management (RCM).

Dr. Brian an Ohio-based orthopedic center works as an independent orthopedic center the major chunk of their resources was used for scheduling prior appointments with a patient which included the verification of patient insurance history. The second reason where the clinic used to waste their money was in managing claims. These are two reasons that have drained the revenue from the orthopedic clinic and many other orthopedic practices. Such aspects have leaked some of the viable staff from the current settings.

With new codes and technology already adding the backburner to your reimbursement why not take your viable resources to place which would add value to the process of reimbursement. As an orthopedic physician, you can save a significant amount of resources by hiring a remotely working company on your Revenue Cycle Management (RCM).

Orthopedic Surgeon Dr. Brian “There is significant resource drain in the current system. We are not able to make the best use of our resources, some of our patients are unhappy because the front-desk doesn’t reply back. We need to change the way our resource are handled and how are current revenue management system works?”

Dr. Brain approached us to make some changes in the current process they follow while a patient calls in to book an appointment and the further RCM process.  MedicalBillersandCoders.com (MBC) made some significant changes in the Admin work rather than in practice. MBC used some key aspects to reduce denial rate and free-up the staff which has been engaged in the insignificant paperwork. As soon as a patient books their appointment the insurance number is verified by our billers, this reduces the likelihood of errors when the patient comes in on the appointed time and reduces the administrative load.

The next step starts after complete diagnoses and treatment or after the step-by-step treatment where a team of expert coders work on your documentation and notes-audio/ written to provide with the perfect super bill and generate an impeccable CMS-1500.

For Dr. Brain MBC has reduced the claim denial from 11 percent to 4 percent.

Before MBC provided its services to Brain’s orthopedic clinic they did not view the revenue cycle management as significant as compared to their practice. The partnership with MBC has totally transformed our medical practice.

The brain also added that “The RCM documentation process is long and tedious; if we start appreciating the process once we understand how the process works. MBC has helped my staff greatly in that forefront; we mentally changed the way we look at an RCM process. Every staff member now knows what their responsibility is and understands the significance of documentation. As a doctor and many of my staff members don’t know much about revenue generation so MBC has provided a platform to explain to us how the reimbursement process works.”

Leveraging new technology to transform the roles of our staff members. Without wasting a significant amount of time on the patient’s eligibility through calling various insurance companies we significantly reduce the time period for scheduling a patient appointment.

As the markets become blended independent practices may find it difficult to stay afloat without affiliating any large organization. A channelized-strong RCM partner will allow private practices to avoid leakages in the RCM process.

Posted in Accounts Receivables, Claims Denials, ICD-10 Coding, Medical Billing, Medical Coding, Orthopedic Billing, Orthopedics billing & coding, Orthopedics billing companies, Orthopedics billing guide, Orthopedics billing guidelines, Orthopedics billing outsourcing, Orthopedics billing providers, Orthopedics billing services, Orthopedics billing vendors, Orthopedics coding, Orthopedics coding services, Orthopedics rcm outsourcing, Orthopedics revenue management, Practice Administration, Practice Management, Revenue Cycle Management (RCM) | Leave a comment

Revitalize your Practice Revenue and Upgrade Clinical Performance with Specialty Billing Agencies


Many practices are attempting to accomplish more within less income. This is mainly due to the changes in the Affordable Care Act, altercations in the reimbursement models, and an expansion in consumerism in the healthcare industry. Indeed, Forbes recently highlighted that the normal provider across all medical specialties is witnessing their top line income drop by over $50,000 every year since the new healthcare law became effective.

In case you’re taking a gander at weak income streams, there are steps you can take to revitalize your current streams and examine new choices to amplify your bottom line.

Here are 5 handy tips for physician to adjust their medical billing and coding requirement and in turn augment their income ways.

  1. Execute Smart Scheduling

Begin by investigating your patient mix and determining your proportion of capitated versus fee for service clients; try and allocate your appointments in similar extents. For instance, if 70% of your patients are in FFS plan and 30% are under capitated contracts, your schedule should approximate that.

Put aside a schedule block every day for capitated patients and leave your same-day and expanded hours appointments for your more lucrative FFS clients as much as possible. FFS patients have more healthcare options, and you would prefer not to pass up a major opportunity for the additional income by dismissing them, sending their dollars to different providers.

Make sure to create and communicate compelling triage strategies before you execute your new schedule plan and keep in mind to have an automated patient correspondence system to affirm appointments and fill any last minute cancelations in your timetable.

  1. Diminish the Paperwork Burden

If you haven’t yet installed an Electronic Health Record (EHR) or in case you’re working with one that isn’t modified for your work process, it’s an ideal opportunity to modernize and go one step ahead of your peers. Experience the templates and make sure your billing and coding prerequisite are exact and mirrors the procedures you gave to the patients. Execute efficient time saving elements such as e-prescribe and coordinated lab and imaging, also urge patients to utilize your patient portal for appointments refills, and other routine correspondences.

  1. Reduce Costs with Outsourcing and Technological Platforms

Now is the best time to assess your genuine expenses for keeping administrations in house. Do you maintain coding, billing and transcription staff? If the answer is a yes, and you still feel that in-house billers are not up to mark with their undertaking, outsource the services to an efficient medical coding and billing agency to revitalize your practice revenue and upgrade the clinical performance, particularly if they offer enhanced services at a lower cost. For small to medium practitioners outsourcing works hands on, as they don’t have to dig deep to search for profits every month, as the offshore billing agency is able to handle those requirements.

  1. Implementing EMR and EHR

Make sure you’re utilizing the most up to date versions of Electronic Medical Records and Electronic Health Record systems for preparing and processing medical bills. This is the most effortless approach to abbreviate the income cycle so your finances are working for you, not benefitting anything else.

  1. Follow Up on Claim Denials

Some insurance agencies are famous for incorrect admissions and denials, so it’s imperative to dedicate resources to ensure you’re getting what your due in your insurance contracts. If there’s a repeating issue with billing or coding, find a way to rectify it, or as already mentioned above, utilize the services of a outsourced medical billing and coding agency.

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Difference between invasive, non-invasive and interventional cardiology


Maintaining a healthy lifestyle is directly co-related to a healthy heart.

But due to changing routines and eating habits, there are times where heart problems occur. In such cases, it is the cardiologist who diagnoses the problem and treats it with utmost care. The cardiologist performs all the necessary tests and other procedures associated with the heart while surgeries are performed by a cardiac surgeon.

There are three approaches while dealing with heart ailments: invasive, non-invasive and interventional cardiology. These are sub specialties of cardiology and either one or a combination of these techniques can be used to treat heart ailments.

The difference:

Invasive: This is a minimally invasive procedure for identifying the anomalies of the heart. Such procedures are generally minor surgeries which require breaking into the skin of the patient. These involve perforation, catheterization, incision etc. Such procedures are used in conditions such as angioplasty (blocked arteries are opened by ballooning to increase blood flow) and stenting (a stent – thin metal needle is inserted to open a clogged vein). Further, invasive procedures are conducted for coronary angiography, coronary artery bypass grafting, valve replacement surgery, electrophysiology studies and arrhythmia ablation, right heart catheterization, permanent pacemaker insertion, automatic implantable cardiac defibrillators (acids), closure of cardiac defects including medication for acute chest pain. Devices used are usually laparoscopic and remote controlled for these procedures.

Non-invasive: This procedure is non-invasive and usually comprises of external tests rather than any insertion of fluids, needles or other such instruments in the body for diagnosing heart disorders, cardiovascular diseases or other cardiac conditions. This specialty usually prevents further complications of the heart. In all, it does not involve any breakage of skin or body part. These procedures are as simple as listening to a heartbeat, taking a pulse and blood pressure along with the instruments being non-invasive to perform such tasks. This evaluation is also useful in cases where patients are suspected of having a valve disease, chest pain, or other history of heart ailments. Further conditions treated in this manner are: nuclear cardiology, echocardiography (to identify pumping of blood, infections or any structural abnormalities), cardiac electrophysiology (electrical currents for generating and evaluating heartbeats), exercise treadmill stress tests (how one performs under stress), holter – heart monitors, echocardiogram, trans-esophageal echocardiogram, myocardial perfusion scan and CT scans (for diseases of the heart and atherosclerosis). In most of these procedures, imaging using ultrasound waves, tape recorders or electrical currents are used to monitor the heart’s activity. Infrared imaging, electrocardiography and other testing systems are also used which are completely harmless.

Interventional: These cardiologists perform interventional actions/treating of serious heart ailments to ensure that blood is delivered to the heart and subsequently to other parts of the body. This approach makes use of a small catheter which is used to repair arteries or vessels or other parts of the heart’s surrounding areas i.e. treatment of structural heart diseases. The father of interventional cardiology is known to be Andreas Gruentzig after he created the coronary balloon angioplasty method. Sometimes, angioplasty and stenting could be referred to as interventional procedures as they are catheter based and require the action of opening blocked arteries. Other conditions treated by this method are: coronary artery disease (narrowing of arteries), heart valve disease (valves not functioning well with regards to blood flow), peripheral vascular disease (clogged or hard arteries and veins), pericardiocenteses, transesophageal echocardiograms and plaque removal (atheroectomy). Invasive and interventional cardiology are closely related where cardiologists work on similar techniques to address the patient’s ailment.

The community of cardiologists perform an array of cardiology activities while making a difference in the health of the heart and ultimately – life.

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