Healthcare Consumerism

Posted on February 24, 2020

What is healthcare consumerism?

Consumerism is defined by Merriam Webster dictionary as the promotion of the consumer’s interests.  Healthcare consumerism empowers the patient, who is a consumer, to be a more active participant in his/her healthcare.  It is a fundamental shift in patients’ preferences, behaviors, and demands around healthcare services.  Patients are now able to shop for providers who are a good fit in both quality and affordability.  Healthcare consumers are also paying close attention to their insurance plans and medical coverage.  According to a survey, 62% of patients indicated that advance knowledge of their out-of-pocket expenses impacted their decision to have that service.  As much as it is possible, patients are looking to better control and manage their healthcare costs.  This includes the desire for pricing transparency, as well as not receiving surprise medical bills.  

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Preclusion List

Posted on January 17, 2020

                                         What is a Preclusion List?                                                                                                                         

It is a listing that is generated by Centers for Medicare & Medicaid Services (CMS).  It contains a list of providers and prescribers who are precluded from receiving payment for Medicare Advantage items and services of Part D drugs furnished or prescribed to Medicare beneficiaries.  The list was created to ensure patient protections and safety and to protect the governmental funds from providers and prescribers that have been identified as wrongdoers.  The list was also created to replace the Medicare Advantage and prescriber enrollment requirements.  Although this list has some overlap to the Office of Inspector General’s (OIG) Exclusion List, the Preclusion List is not the same as the Exclusion List.

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Exclusion Screenings

Posted on December 13, 2019

                                                                 OIG Exclusion                                                                                                                           

It is the mission of the Department of Health and Human Services (HHS) to enhance and protect the health and well-being of Americans.  As a part of their authority, HHS determines who will receive the benefits from these programs, as well as who will be allowed to provide services to these individuals.  HHS has delegated the authority to exclude individuals from participating in any federal of state healthcare programs to the Office of the Inspector General (OIG).  The OIG’s mission is to protect the integrity of HHS programs, and the health and welfare of program beneficiaries.  The OIG has been tasked with fighting waste, fraud, and abuse in HHS programs, such as Medicare and Medicaid.  Consequently, the OIG has the authority to impose sanctions to individuals or entities that have been found to be unacceptable risks to patient safety and/or program fraud.  Being excluded means that you will not be paid for any item or service you have directly or indirectly furnished or performed for beneficiaries of federal or state healthcare programs.

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Medical Records

Posted on November 12, 2019


Recently, the medical records of hundreds of patients were trashed outside of a medical office building in New York City.  The records belonged to patients of two gastroenterologists.  The Protected Health Information (PHI) that were exposed included names and social security numbers of these patients.  The gastroenterologists were moving to a new nearby office.  They had left the patient charts at their old office to be retrieved by a shredding company.  They had placed the blame on their cleaning people for throwing the records out.  The doctors adamantly deny that they had improperly disposed the records.  They also said that they have “policies and procedures in place regarding the safeguarding and/or disposal of their patients’ protected health information.”  An effective policy and procedure could have prevented such a breach from happening. 

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Customer Service

Posted on October 9, 2019

“Happy customers are your biggest advocates and can become your most successful sales team.”

                                                                                                                                                                                   Lisa Masiello

What is Good Customer Service?

 Customer service is the entire experience (from initial contact to final sale and beyond), that a customer or potential customer may have with your company.  The experience can either be face-to-face, on a telephone call or online.  According to Salesforce, great customer service is: (1) service that is fast; (2) service that is personalized; (3) service that provides a connected experience; (4) service that is proactive (offering a resolution before an issue or disruption occurs).


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Volunteer Work

Posted on August 27, 2019

“What is the essence of life?  To serve others and to do good.”  Aristotle

Why is Volunteer Work Good for Us?

With our busy lives, it can be difficult to find time to volunteer.  We all know that doing volunteer work benefits those that are in need, but did you know that volunteer work is good for us as well?  Volunteering can make us feel happier and healthier.  Here are some of benefits that we receive by giving.


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Posted on July 30, 2019

“Great things in business are never done by one person, they’re done by a team of people.”  Steve Jobs

What is teamwork?

The business dictionary defines teamwork as a process of working collaboratively with a group of people in order to achieve a goal.  Teamwork is essential to accomplishing the objectives and goals of an organization.  And the ability to perform both as an individual and as an effective teammate is the key to professional growth and success.

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Vendor Partners

Posted on June 26, 2019

Are your vendors also your business partners?

While having customers/clients is vital to your business or practice, vendor partner relationships play an important role in efficiency and how smoothly your company or practice operates.  Therefore, having the right vendor partners can make it easier for you to succeed and grow your business or practice.

A vendor provides products and/or services to businesses/practices.  A vendor partnership goes beyond the scope of just their products and services.  When a partnership exists between your business/practice and the vendor, there is a cooperative effort to succeed together.  Vendor partners want you to succeed.  They do not just sell you a product and then walk away.  They continue to be responsive to your needs even after the sale.  It means that your phone calls and emails are returned in a timely manner.  Good vendor partners understand that communication is key to a successful relationship.  Vendor partners also respects your time, which means that scheduled meetings are on time and the necessary individuals are present on conference calls.  Your vendor partner should be experts in their field and can help you resolve any issues you run into.

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Posted on May 31, 2019

What is pre-authorization and why is it important? 

Pre-authorization is the insurance company’s permission that is given to the provider to perform a service.  If permission is not obtained, the provider will not properly get paid for the service.  The prior approval process allows the insurance company to (1) verify that the patient’s account has enough benefit dollars for the insurance company to pay the provider for that upcoming service; (2) ensure that the particular service is an eligible service under the patient’s insurance plan; (3) determine if the procedure is medically necessary.

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Clean Claims

Posted on May 2, 2019

What is a clean claim? 

A clean claim is a claim that was accurately processed and paid the first time it was submitted to the insurance payer; it is the ultimate goal in medical billing.

Why do you want clean claims?

When a claim is rejected, it delays your payment, inflates your accounts receivable, and increase your operational costs because the whole claim cycle must begin again.  Your staff or billing company will have to identify/review the denials and perform any necessary corrections, in order to resubmit these claims to the payers.  Thus, it is in your best interest to ensure that you have a high percentage of clean claims.

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