LIBRARY of Journals:     AAPC MEMBER MAGAZINE

AAPC WOODLAND HILLS CHAPTER WEBSITE

Advance Trade Journal E-Mags

AHIMA Coding Resources

AHIMA Body of Knowledge

For the Record

Purdue OWL: APA Research Paper Style Guide


Medical Claims Class Resources
 

Online Textbook Study Exercises = 5 Points Extra-Credit Each! (Print tests when scored.)

Medical Insurance Billing Quizzes ONLINE FREE


Additional Extra Credit:

 

Extra-Credit Online! 15 test points each!!!! (print test scores)

Medicare Online Training Website (Approved Tests: ICD-9, CMS-1500, World Of Medicare)

Great Suggestions for Searching/Researching the Internet 




Documentation of Medical Records Click here



Patient Advocacy Information

Kiplinger Article: Don't Get Buried in Medical Debt! (even if uninsured)

Alliance of Claims Assistance Professionals (Patient Advocates)


Medical Textbook/Coding Books Sources

Amazon.Com Books

Ingenics Code Books and Articles


Free On-line Medical Dictionary

Medterms

Free On-line Medical Terminology/Anatomy/Pathology, Etc.

Free-Ed Medical Terminology

Des Moines University Medical Terminology


 
 

Free On-line Typing Course (Select QUERTY)

Powertyping.com

Basic Typing Concepts and Practice Lessons

Free Math Review (If you are rusty!)

Math Is Fun

Coding Question Websites

 

Coder Resources "My Passion" - http://www.justmypassion.com

AAFP Answers

Just Coding

MediSoft Demo Software Download

Click here - NOTE: this is a software vendor and they will attempt to sell you the full version software

PowerPoint Presentation Viewer (free!)


PDF Document Reader (free!)


Wordprocessing Software (free!)


Superbill (Encounter Form/Charge Slip)

Free Superbill Templates


Medical Office Forms and Supplies

Bibbero (1500 forms, Rx Pads, Charts, Superbills, Registration forms, etc.)

HIPAA HOT Topic

Helpful HIPAA Explanations Click here

HIPAA Forms Samples Click here

HIPAA Requests Click here

HIPAA Powerpoint Presentation Click here

HIPAA Violations and Social Media Click here

GREAT HIPAA FAQ (UCSF) Click here

HIPAA-Related California Laws:
California Medical Information Act (CMIA) www.privacyrights.org
Senate and Assembly Bills (including Health and Safety 123100) www.legingo.ca.gov  
State Agencies (including Title 22) www.calregs.com

Bush-Mandated Health Information Infrastructure: ONC

HIPAA Authorization Checklist Click here

CLAIM FORMS

The New Claim Form 1500 CMS Click here    Download the claim form pdf to save changes.

The Old Claim Form 1500 CMS Click here

The Claim Form UB-04  Click here

EDI - Electronic billing 1500 form to X12 ANSI format Click here

Powerpoints for special Quizzes

INSURANCE

INSURANCE Terms Powerpoint Click here

MEDICARE Powerpoint Click here

Medicare Hot Topics

Noridian Medicare MAC Site Click Here

POSTING RA Payments Powerpoint Click here


Ventura County (Area 17) Medicare Fee Schedule 2014 Click here

CMS HOMEPAGE

Medicare Online Interactive Courses - Claim Form, ICD-9-CM, etc.

General Information About Medicare

CCI Edits FAQ

Download CCI Edits

Medicare Eligibility (SSA Site)

Centers for Medicare and Medicaid Services

Medicare CLIA Waived Lab Tests List

Medicare DMERC (DME) Carrier

Medicare Brochure on DME

Medicare Beneficiary Site

New Medicare Administrative Carrier (MAC - includes parts A&B)

Medicare Fee Schedule

Reading Medicare's Remittance Advice (Explanation of Medicare Benefits sent to provider)

Payment, Reduction or Denial Reason Codes on Medicare's EOB (the EOMB or Remittance Advice)

Medicare's UB04 Facility Billing Form Instructions

Medicare Choice HMO Option

Clean Claim Interest Calculation

Medicare Provider Education Seminars

Home Health Prospective Payment System Explained

Social Security Information

Medi-Cal

California Medi-Cal Fee Schedule (Includes Level III HCPCS) Click here

California Medi-Cal Fee Conversion Factors Click here

California Medi-Cal AEVS phone verification (SAMPLE) Click here

Medi-Cal Program

Medi-Cal Fee Schedule

Medi-Cal Claim Submission Delay Reason Codes

Medi-Cal HMO Capitation Agreement (sample)

California Children's Services (CCS)

MILITARY: TRICARE and CHAMPVA

(Obamacare, Affordable Care Act) Click here

California Insurance Exchange Benefits Click here

Exchanges in more detail Click here

Insurance Mandate Flow Chart (Kaiser Family Foundation) Click here

Affordable Care Act ("Obama Care") Information Click here

Simple Timeline of Affordable Care Act ("Obama Care") Changes Click here

ACO - Accountable Care Organizations Click here

AMA Summary of Healthcare Reform Click here

 AMA's Detailed Articles on Healthcare Reform Click here

Advocacy: Health Insurance Finder Click here

Electronic Health Records Hot Topic

Electronic Health Records Software Demos Click here

Electronic Health Records Click here

EHR - Computers Change Bedside Manner Cick here

EHR - Additional Documentation May Lead to Fraud Accusations Click here


ICD-10-CM Hot Topic - News Update, courtesy AAPC.com 

    ICD-10 Delayed Until 10-01-2015

The United States Senate just passed HR 4302, the Protecting Access to Medicare Act. If signed into law by President Obama, then this bill will delay ICD-10 and shift required implementation from October 1, 2014 to as early as October 1, 2015. The act also extends the “doc fix” for Medicare’s Sustainable Growth Rate (SGR) payments for a year.

The bill was rapidly introduced to the House of Representatives on Thursday, March 27th, for vote. After a voice vote passage, it moved to the Senate for today’s vote. Primary arguments cited for delaying the ICD-10 implementation included lack of readiness surrounding clinical documentation, vendor solutions, and systems testing.

We encourage you to keep calm and code on. 

If you are ready for implementation, then we know this delay may be difficult; we will support you with both access extensions and refresher courses. If you need another year, then this change offers an opportunity to increase your readiness through proactive education, practice, and testing. The postponement allows improvement of anatomical knowledge, review and adjustment of documentation quality and clinician education, and adjustment of coding and billing procedures.

AAPC remains committed to serving you with the highest quality training and support to help you adapt to the ever-changing healthcare environment.

Please watch for subsequent emails and other communications from AAPC with more information as this situation develops.

ICD-10 Physician Resources Click here

ICD-9-CM to ICD-10-CM Differences Click here

ICD-9-CM to ICD-10-CM Converter (AAPC) Click here

CMS Video on ICD-10-CM Click here

ICD-9-CM to ICD-10-CM Code Equivalences Click here

ICD-10-CM Powerpoint Presentation Click here

ICD-10 World Health Org Website Click here

ICD-10-CM and ICD-10 PCS Website Click here

ICD-10 Tutorial Click here

Evaluation and Management Hot Topic

Evaluation/Management Summary Click here

Evaluation/Management Presentation #1 Click here

Evaluation/Management Presentation #2 Click here

Evaluation/Management Reports to code Click here

E/M Computer/Calculator 1995 Rules Click here

E/M Calculation Form 1995 Rules Click here

E/M Calculation Form 1997 Rules Click here


Global Surgery, Bundling, NCCI Hot Topic

Modifier Tips  Click here

New Medicare Modifiers "distinct procedures"  Click here

NCCI Edits and How to Use Them Click here


MEDICARE NCCI Edits Click here


Direct Link To NCCI Files Click here

More on NCCI Click Here

Claims Compliance - CCI and Fee Schedules Click here

CPT Surgery Global Periods Click here

CPT Modifier -59 instructions Click here


Endoscopy Coding Presentation Click here

Sample OP Report Click here

Abstracting and Coding from and Operative Report Click here


Miscellaneous Hot Topics

Insurance Payments - RAs/EOBs Click here

Patient Billing and Collections Click here

Hospital Billing Overview Click here

Hospital Care Terms and Regulations Click here

The Joint Commission's DO NOT USE Abbreviation List Click here

Patient and Insurance Information and Balance Billing Click here


Computer-Information Technology for Healthcare Click here


Demo Electronic Health Record System from the VA Click here

CODING - MISC TOPICS

SCAN HCC University and Ask A Coder FAQ

Free Download of 2009 ICD-9-CM Codebook and Indexes

Official Center for Disease Control (CDC) ICD-9-CM Instructions

*ICD-9 Coding Notes

Online ICD-9-CM Coder

ICD-9-CM Codes List

HCPCS I - CPT Online

HCPCS II Multiple Years, Codes and Index

HCPCS II - Online Codes with Modifiers and Fees

Yahoo Groups - Medical Billing Forums (free)

American Medical Association (AMA) CPT Page

E/M University's E/M Coding Page

Billing for Twin Births - both vaginal, both C-section or one of each

When to Use E/M Code 99211

ICD-10 Draft Info

SNOMED CT - Systematic Nomenclature of Medicine-Clinical Terms (English-Language Equivalent of ICD)


HOSPITAL BILLING - UB04

UB04 Facility Claim Form Instructions

Revenue (Rev)Codes used on the UB04 Facility Claim Form

Revenue (Rev) Code Cheat Sheet

Other UB Codes Cheat Sheet (includes "bill type")

Hospital Billing (UB04) Resources

The UB04 Facility Claim Form

UHDDS Flash Cards

Free Online DRG Grouper

3M Encoder Site

Sample of 2007 ASC (Ambulatory Surgical Center) Grouper/Pricer

When Insurance Companies Violate the Laws

It seems like billers and providers have a maze of laws and regulations, but it is very important to understand that insurance payors also have legal obligations, and there are various governing agencies and governing laws to be aware of.

Summary of AB1455 (know your rights!  great for starters!) 


Overview of AB 1455 (California Assembly Bill "Fair Payment Practices Law")
Regulates the timiliness of insurance payments and appeals and the payment of interest on delinquent claims.

AB 1455 Documents
Library of documents and forms relating to AB1455.

Department of Insurance (DOI)
Regulates Indemnity plans, Automobile Liability and Slip and Fall and other non-Managed Care plans.

Department of Managed Health Care (DMHC)
Regulates PPO, HMO and all other types of Managed Care health plans.


Collections Laws


Truth In Lending



 
 Internet Job Search

*Samples of Job Interview Questions and Suggested Types of Answers

*Videos on Job Interview Questions and Stretegies

Job Search Sites - from AAPC Chapter Webpage Click here

Job Postings - from AAPC National Webpage Click here


Remember! Avoid giving your Social Security Number on the internet! Instead, put XXX-XX-XXXX in fields demanding it. Employers don't need your SSN unless they are actually hiring you, so give the Social Security Number only in the face-to-face interview process.  Be very cautious of anonymous employers and blind ads on anonymous sites like Craigslist.org.

 
*WARNING : Please beware of phishing scams that promote work-at-home opportunities and may also pose as legitimate companies. Please be advised that a recruiter will never ask you for a credit card or any type of payment as part of consideration for a legitimate job. 

Privacy Advice

For your privacy and protection, when applying for a job online, DO NOT:

  • Provide your social security number to a prospective employer,
  • Provide credit card or bank account information or
  • Perform any sort of monetary transaction.

_________________________________________________________________________________________________________________________

PRE-EMPLOYMENT TESTING

Some employers will require you take various kinds of skills tests for filing, typing, written English, coding, business math, etc. Be sure you are not caught off-guard when you go to an interview, do whatever study-review you would do before such tests just in case they surprise you with a test!

Some employers give "personality tests" as well. These can be simple tests of business ethics (is it ok to bring home pens from work for personal use? If you saw a co-worker stealing, would you report it?) or they can be pseudo-psychological tests like the MMPI (Minnesota Mult-phasic Personality Inventory). Be cautious when answering questions on these types of tests. They are testing for whether you are a "team player" whether you like to work, whether you are an optimist or a pessimist, what your self-image may be and how you interact with others. Obviously, you don't want to take this kind of test on a "bad day." Or at least, you should answer based on how you answer on a "good day." It is illegal in California for employers to request pre-employment lie-detector tests.

Many employers require a background check (credit, convictions, etc.) and drug screening. These may only be done with your consent, but not consenting amounts to withdrawing your application for most of these companies. If you are taking prescription narcotics, be sure to disclose the medication on the laboratory's forms (not the forms that go to the employer)when you give your sample, and give the doctor's phone number and name so that the prescription can be verified. Use of narcotics with a valid prescription is not illegal or illicit and shouldn't affect a person's ability to be employed unless the medication actually affects the person's activities and performance. Additionally, the Americans With Disabilities Act (ADA) requires employers to accommodate disabilities when they are able, but disclosire prior to employment may invite intentional or unintentional discrimination.


THINGS YOU MAY ENCOUNTER WHEN STEPING INTO THAT BILLING JOB! 
 
Often, when you apply for billing positions, be prepared to see lots of surprises.  California does not regulate what kind of license or qualifications a medical biller or a billing service should have, and there is a big range out there as far as competence and quality.  Also, doctors usually do not understand the billing process and expect their billers to handle the most of the process without involving the doctor.  Be prepared to be very tactful when you need to explain something to the doctor and follow my adage of "blame the insurance company" rather than admonish the doctor.  The doctor has a great deal of knowledge, education and intelligence, and can be quite easily annoyed by the red tape of the insurance and billing process when he's there to heal people. 
 
When you step into a jobsite, you are very likely to step into a messy situation left behind by a previous biller.  This is especially true with smaller practices as the biller often doesn't have a lot of supervision.  Another common complication is that the doctor may have a wife, mother, daughter or other relative managing the office for him, and this person may be nominally be in charge of billing without any idea of what insurance billing entails.  Patience is a virtue in these situations.  I find that even as a consultant I sometimes need to bite my tongue to keep from stepping on toes when things are being done in ways that seem incorrect or inneficient. 
 
However, if things appear to be unethical or illegal, it's better not to just bite your tongue... you need to cover yourself against being accused of somebody else's errors or even somebody else's fraud.  Always document what you do and try to make it clear what work you did as opposed to what others worked on.  Do not let anybody, even your supervisor, use your computer password.  If you see something that looks highly questionable, you may want to email your supervisor or the doctor and send a "blind copy" of the email to your home email as proof that you raised the issue.  Do not ever accuse anyone of fraud or illegal activity.  Bring unusual items to someone's attention for an explanation and make sure you document these are not items you worked on.


California Employment Development Dept (EDD) Scam Warnings (Includes "Medical Billing" scams)

Be On The Lookout For Job Scams

Disclaimer to CalJOBs Job Seekers: "The Employment Development Department (EDD) does not regularly review job listings with Uniform Resource Locators (URLs) for content or accessibility. On occasion, job listings with URLs may require job seekers to register with the site or to pay a fee. The EDD does not require job seekers to register with or use any site that charges a fee."


Common Employment Related Scams

  1. CHECK CASHING SCAMS
    1. Check cashing scams frequently begin with email correspondence offering a job either as (1) a secret shopper or (2) someone who transfers funds internationally. The scam artists often attempt to reassure the victim of the legitimacy of the position by offering documents which actually have no value, such as invalid contracts, forged or false documents bearing company letterhead, false letters of credit, payment schedules and bank drafts. After obtaining the trust of the victim, the scammer continues. Checks, money orders or wire deposits will be sent to the victim for "processing" or for use as a deposit while "secret shopping" a local bank. The victim will be asked to cash the check or money order (wire deposits will send the money directly to the victim’s account) and send a percentage of the funds back to the scammers. The need for the "middle man" is often explained as being a way around international fees or taxes, and sometimes the need to obtain payments from PayPal or another online payment system. Once the funds are sent back to the scammers (usually the victim is told to keep a percentage for themselves, as payment for their services) the victim’s bank or financial institution learns that the check/money order/wire transfer was fraudulent. The funds are then subtracted from the victim’s account and they are made liable for the lost money.


  2. RESHIPPING
    1. Reshipping scams are often targeted at work-at-home moms or other people trying to supplement their income. These scams begin with an employment offer, usually via email, to the victim. As with check cashing scams, these "employers" offer legitimate looking contracts and other documentation to make them appear legitimate. Once the victim's trust has been obtained, packages are shipped to the victim's residence with instructions to reship the packages to another address. (Often the victim is asked to repackage the goods.) Once the package has been shipped from the victim's residence (or by using a service such as DHL, FedEx or UPS) the victim is "guilty" of receiving and shipping stolen property. This can result in police involvement, as the return address or shipping receipts lead back to the victim.


  3. WORK AT HOME SCAMS
    1. Work at home scams are varied and can be more difficult to detect than the other scams described here. They come in many different forms and change regularly. The following are some of the most common:
      1. Envelope Stuffing Scams - These scams usually incorporate a "registration fee" to be paid before work can begin. Once this fee has been paid, the "employee" is asked to post an ad in a local newspaper or other media, using their own contact information. This ad is often the exact same ad that the "employee" responded to. Once the "employee" receives a response to the ad, he or she will fill an envelope with information/instructions on how to start and mail it to the new applicant. The scammer claims that your fees will be calculated based upon how many responses you get for the ad you placed.
      2. Medical Billing - Advertisements for these pre-packaged businesses always contain an initial financial investment. The advertisement or solicitations will falsely state that only a small percentage of medical claims are transmitted electronically and that the market for medical billing is wide open. In reality, however, the market is well established. You should therefore be cautious of these advertisements.
      3. List of Work-At-Home Jobs - These are offers to purchase a list of companies that are purportedly hiring for work-at-home positions. You should exercise caution before purchasing such lists because they are often inaccurate.


  4. MULTI-LEVEL MARKETING (MLM)
    1. Also referred to as Pyramid Schemes, these marketing ploys involve recruiting new members to earn money. Although there are legitimate MLM businesses, also called "Network Marketing," these are based on selling products or a service. When the business focuses primarily on finding new recruits, the business and its employees may be in danger of participating in an illegal pyramid scheme.

Steps to Better Protect Yourself

  • Keep your email address private
  • Be cautious of any employer offering employment without an interview (either in person or by phone).
  • Be cautious of any employer who charges a fee to either employ or find placement for you.
  • Please investigate thoroughly any employer requesting that you transfer funds or receive packages for reshipment, especially if they are located overseas. Most of these employment offers are check-cashing or shipping scams!
  • Do not provide your social security number or any other sensitive information to an employer unless you are confident that the employer is legitimate.
  • Avoid vague offers as these are often scams. If the employer is not willing to specifically describe the position they are offering, you should exercise caution.
  • Be wary of inflated claims of product effectiveness.
  • Be cautious of exaggerated claims of possible earnings or profits.
  • Beware when money is required up front for instructions or products.
  • Be leery when the job posting claims "no experience necessary."
  • Be cautious when dealing with individuals outside of your own country.
  • Be wary when replying to unsolicited emails for work-at-home employment.
  • Research the company to ensure it is authentic.
  • Contact the Better Business Bureau to determine the legitimacy of the company.
  • Be cautious of employers who conduct their interviews in a home setting or in motel rooms.


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