Thursday, May 15, 2008
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2:59 PM
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 Researchers at the U.S. Department of Energy's Argonne National Laboratory have developed a chip that can save lives by diagnosing certain cancers even before patients become symptomatic.
The new technology, known as a biochip, consists of a one-centimeter by one centimeter array that comprises anywhere between several dozen and several hundred "dots," or small drops. Each of these drops contains a unique protein, antibody or nucleic acid that will attach to a particular DNA sequence or antigen.
A tumor, even in its earliest asymptomatic phases, can slough off proteins that find their way into a patient's circulatory system. These proteins trigger the immune system to kick into gear, producing antibodies that regulate which proteins belong and which do not.
"Antibodies are the guardians of what goes on in the body," said Tim Barder, president of Eprogen, Inc., which has licensed Argonne's biochip technology to search for new biomarkers that indicate cancer. "If a cancer cell produces aberrant proteins, then it's very likely that the patient will have an antibody profile that differs from that of a healthy person. You can look for similarities and differences in autoantibody profiles to look for clues and markers that provide early indicators of disease."
In their hunt for cancer indicators, Eprogen uses a process called 2-dimesional protein fractionation, which sorts thousands of different proteins from cancer cells by both their electrical charge and their hydrophobicity or "stickiness."
The 2-D fractionation process creates 960 separate protein fractions, which are then arranged in a single biochip containing 96-well grids. Eprogen scientists then probe the microarrays with known serum or plasma "auto-antibodies" produced by the immune systems of cancer patients.
Monday, May 12, 2008
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12:18 PM
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Charge-entry is one of the key departments in Medical Billing. Key department?? Yeah, that’s true. It is the keying-in department in Medical Billing. After receiving the super bills from the Doctor’s office, it gets passed through the coding & pre-coding department, and then comes to the charge-entry department. It is only here in this department, the claim/bill is actually created. The charge-entry person creates an individual account for every patient demographics that comes for the first time, and also assigns individual account #for the same.
A patient account # is a 9 digit # created for our own internal reference, and for our record purpose. These 9 digits are segmented as per their relevance. The first two digits represents the company #, next three digits are for the Julian date (it is the number of days counted from January 1st till the current day), next one digit for the year, last three digits for patient serial #. It is one of the important aspects of charge-entry, which helps us to access any patient’s account easily in the software. Then, as a non-stop person, he looks into the patient demographics, and enters the patient’s information, Insurance information, and Doctor’s information (tax id #, Upin #, Facility address etc) in the software, and thus makes a particular patient’s account accessible with complete information as and when needed.
A Charge-entry person also has one other vital role to perform. That is, to look-up the codes entered in the claim, and to assign the relevant charges for those codes. This is also one of the key functions in Medical Billing as there should not be any up billing done by assigning an incorrect charge for the codes. Likewise, he does a commendable job by entering all the relevant information needed, and creates a claim ready for auditing, and then for transmission to the insurance company
Medical billing is the process of submitting and following up on claims to insurance companies in order to receive payment for services rendered by a health care provider. The same process is used for most insurance companies, whether they are private companies or government-owned.
Billing Process The billing process is an interaction between a healthcare provider and the insurance company (payer). The interaction begins with the office visit: a doctor or their staff will typically create or update the patient's medical record. This record contains a summary of treatment and demographic information related to the patient. Upon the first visit, the provider will usually give the patient one or more diagnoses, in order to better coordinate and streamline his/her care. In the absence of a definitive diagnosis, the reason for the visit will be cited for the purpose of claims filing. The patient record contains highly personal information, the nature of illness, examination details, medication lists, diagnoses and suggested treatment.
The extent of the physical examination, the complexity of the medical decision making, and amount of background information (history) obtained from the patient are evaluated to determine the correct level of service that will be used to bill the insurance. The level of service, once determined by qualified staff, is translated into a five digit procedure code from the Current Procedural Terminology . The verbal diagnosis is translated into a numerical code as well, drawn from the International Classification of Diseases,Ninth Edition or ICD-9. These two codes, a CPT and an ICD-9, are equally important for claims processing.
Once the procedure and diagnosis codes are determined the biller will transmit the claim to the insurance company (payer). This is usually done electronically by formatting the claim as an ANSI 837 file and using Electornic Date Interchange to submit the claim file to the payer directly or via a clearinghouse. Historically claims were submitted using a paper form — in the case of professional (non-hospital) services, and for most payers, the CMS-1500 form was used. The CMS-1500 form is so name for its originator, the Centers for Medicare and Medicaid Services . To this day a sizable portion of medical claims get sent to payers using paper forms.
The insurance company (payer) processes the claim. The insurance company has medical directors to review claims and evaluate their validity for payment, using a rubrics for patient eligibility, provider credentials, and medical necessity. Approved claims are reimbursed for a certain percentage of the billed services. Failed claims are rejected and notice is sent to provider.
Upon receiving the rejection message, the provider must decipher the message, reconcile it with the original claim, make required corrections, and resubmit the claim again. This exchange of claims and rejections may be repeated multiple times until a claim is paid in full or the provider relents and accepts an incomplete reimbursement.
The frequency of rejections, denials, and overpayments is high (often reaching 50%)(HBMA 7/07), mainly because of high complexity of claims and data entry errors.
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Researchers at the U.S. Department of Energy's Argonne National Laboratory have developed a chip that can save lives by diagnosing certain cancers even before patients become symptomatic.
