Medical Claims Processing Software, Apex EDI Clearinghouse, claim processing in healthcare.#Claim #processing #in #healthcare
Apex EDI s Medical Claims Processing Software Is Simple Efficient
Medical practices of the 21st century need cutting edge software to adhere to current healthcare legislation, as well as maintain a profitable business. Apex EDI makes filing medical claims simple and efficient. Regardless of which practice management software or electronic claims processing you may currently use, Apex EDI integrates seamlessly to ensure efficient and ethical medical claims processing.
Apex EDI is a national clearinghouse focused on your local medical practice! Our medical claim service is leading technology efforts in thousands of practices nationwide. Physicians and office managers view Apex as the best resource for revenue cycle management. Our clearinghouse services allow you to send your medical claims from your software directly to payers. Additionally we provide you with advanced Claim Status reporting and web based claims management functions to streamline your billing process and to get you paid faster; allowing you to focus on patient welfare.
We are a proud partner of numerous medical practitioners to provide the following:
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We have a proprietary process of focusing on what matters most — “Getting you Paid!” We offer several distinct ways to improve your claims processing experience!
- Connect to your medical office software with our simple desktop app — Apex OneTouch®. This allows us to capture the claim file from most software and complete your medical claims processing in less than two minutes.
- Apex API — complete integration. This product allows your existing software to “plug and Play” your claims/statements/patient eligibility information to the patient ledger and billing sections of your software. This allows you to manage medical claim reimbursement from within your software. (Ask us for details)
Additional Transactions Include:
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- Ask your software to incorporate Apex EDI integrated claims
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WE ARE A POST GRADUATE
The Clinical Nutrition Certification Board (CNCB) is a 501(c)(3) non-profit tax-exempt certification agency which provides professional training, examination and certification for health care practitioners.
The discipline of Human Clinical Nutrition applies principles derived from current biochemical and physiological scientific knowledge for the purpose of promoting optimal health while recognizing biochemical individuality. The Certified Clinical Nutritionist assesses a person s nutritional needs to achieve normal physiological function. Assessment includes the use of appropriate test and observations such as case history, anthropomorphic measurements, physical signs, laboratory tests, and nutrition/lifestyle analysis to determine an educational nutrition program. Assessment also provides the basis for referral to a licensed physician, or other health care professional.
The educational protocol may include, among other information, nutrition / lifestyle modification, nutritive supplementation, understanding of physiological/biochemical pathways, and evoking of regenerative processes.
The Purpose of Certification
The Certified Clinical Nutritionist (CCN) Examination establishes reputable standards of excellence.
Creation of a quality examination, based on a validated scope of practice which appropriately represents the field of clinical nutrition.
Candidate access to the broad scope of clinical nutrition training and a mechanism for recertification every five years, recognizing continued competency in the field.
The CCN Examination Candidate must:
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The CCN Examination processes and the examination data bank are reviewed and revised annually, in accordance with the specifications of the Role Delineation Study. The CNCB utilizes a criterion referenced passing point for each section of the certification examination.
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Healthcare Dives Into Big Data
With the mandated adoption of electronic health records (EHRs), many healthcare professionals for the first time got centralized access to patient records. Now they’re figuring out how to use all this information. Although the healthcare industry has been slow to delve into big data, that might be about to change. At stake: not only money saved from more efficient use of information, but also new research and treatments — and that’s just the beginning.
For instance, data from wireless, wearable devices such as FitBits is expected to eventually flood providers and insurers; by 2019, spending on wearables-data collection will reach $52 million, according to ABI Research. Another source of health data waiting to be analyzed: social media. Monitoring what people post can help fight insurance fraud and improve customer service.
These are just two ways big data can be used to improve care while cutting costs, experts say.
“We, as a society, need to start creating our own metrics for how healthcare quality is defined. In the sense of looking at costs, we know where there’s avoidable cost in healthcare. We just need to get folks the data they need to avoid those pitfalls,” said Dr. Anil Jain, senior VP and chief medical officer at Explorys. in an interview. Explorys, which is an innovation spinoff from Cleveland Clinic, is powering Accenture’s Predictive Health Intelligence in a collaboration intended to help life sciences companies determine the combination of treatments and services that can lead to better patient, provider, and economic outcomes for diabetics.
Hosted analytics, partnerships and collaborations, and lower-cost internal applications open the door for smaller organizations to use big data, too.
“Earlier, data warehousing and analytics was restricted to larger organizations because it was cost prohibitive. What big data has done has brought it down to smaller orgs. But the biggest challenge with these smaller markets and mid-tier organizations is resources,” Manmeet Singh, co-founder and CEO of Dataguise. told us. “Cloud is becoming very prevalent. They’re going to store a lot of data in the cloud. They’ll outsource a lot of that data to the cloud. Automation of compliance is important.”
Having witnessed the impact that big data and analytics have on other markets — and perhaps on competing healthcare organizations — healthcare CEOs want to know how their organizations can use these tools. In a PwC study, 95% of healthcare CEOs said they were exploring better ways to harness and manage big data.
Increasingly, CIOs can find similar organizations with pilot or full-blown projects. Forest Laboratories, for example, is collaborating with ConvergeHealth by Deloitte and Intermountain Healthcare on research to benefit patients with respiratory diseases. Using the collaborative, rapid-learning system developed by Intermountain and ConvergeHealth. Forest’s researchers use OutcomesMiner analytics software to develop new treatments and therapeutic products and improve patient outcomes.
The move to value-based payments means healthcare providers are taking on more risk, says Jeff Elton, managing director of Life Sciences for Accenture. To manage risk and treat patients most appropriately, providers need data — accurate data from a range of sources, he tells us.
Expanding use of big data across healthcare organizations should sound some alarms within C-level suites, Singh cautions. “From my perspective, security and compliance should be discussed from the get go. It should be part of their overall strategy.”
In the meantime, some healthcare organizations already have plunged into big-data analytics, with impressive results. Click through our slideshow to see some innovative uses of analytics in healthcare.
How are you using big data in healthcare projects? Let us know in the comments section.
Alison Diana has written about technology and business for more than 20 years. She was editor, contributors, at Internet Evolution; editor-in-chief of 21st Century IT; and managing editor, sections, at CRN. She has also written for eWeek, Baseline Magazine, Redmond Channel. View Full Bio
6 Big Data Analytics Use Cases for Healthcare IT
BOSTON—The increasing digitization of healthcare data means that organizations often add terabytes’ worth of patient records to data centers annually.
At the moment, much of that unstructured data sits unused, having been retained largely (if not solely) for regulatory purposes. However, as speakers at the inaugural Medical Informatics World conference suggest, a little bit of data analytics know-how can go a long way.
It isn’t easy, namely because the demand for healthcare IT skills far outpaces the supply of workers able to fill job openings, but a better grasp of that data means knowing more about individual patients as well as large groups of them and knowing how to use that information to provide better, more efficient and less expensive care.
Here are six real-world examples of how healthcare can use big data analytics.
1. Ditch the Cookbook, Move to Evidence-Based Medicine
Cookbook medicine refers to the practice of applying the same battery of tests to all patients who come into the emergency department with similar symptoms. This is efficient, but it’s rarely effective. As Dr. Leana Wan, an ED physician and co-author of When Doctors Don’t Listen. puts it, “Having our patient be ‘ruled out’ for a heart attack while he has gallstone pain doesn’t help anyone.”
Dr. John Halamka. CIO at Boston’s Beth Israel Deaconess Medical Center, says access to patient data—even from competing institutions—helps caregivers take an evidence-based approach to medicine. To that end, Beth Israel is rolling out a smartphone app that uses a Web-based- drag-and-drop UI to give caregivers self-service access to 200 million data points about 2 million patients.
Admittedly, the health information exchange process necessary for getting that patient data isn’t easy, Halamka says. Even when data’s in hand, analytics can be complicated; what one electronic health record (EHR) system calls “high blood pressure” a second may call “elevated blood pressure” and a third “hypertension.” To combat this, Beth Israel is encoding physician notes using the SNOMED CT standard. In addition to the benefit of standardization, using SNOMED CT makes data more searchable, which aids the research query process.
2. Give Everyone a Chance to Participate
The practice of medicine cannot succeed without research, but the research process itself is flawed, says Leonard D’Avolio, associate center director of biomedical informatics for MAVERIC within the U.S. Department of Veterans Affairs. Randomized controlled trials can last many years and cost millions of dollars, he says, while observational studies can suffer from inherent bias.
The VA’s remedy has been the Million Veteran Program. a voluntary research program that’s using blood samples and other health information from U.S. military veterans to study how genes affect one’s health. So far, more than 150,000 veterans have enrolled, D’Avolio says.
All data is available to the VA’s 3,300 researchers and its hospital academic affiliates. The idea, he says, is to embed the clinical trial within VistA, the VA EHR system, with the data then used to augment clinical decision support.
3. Build Apps That Make EHR ‘Smart’
A data warehouse is great, says John D’Amore, founder of clinical analytics software vendor Clinfometrics. but it’s the healthcare equivalent of a battleship that’s big and powerful but comes with a hefty price tag and isn’t suitable for many types of battles. It’s better to use lightweight drones—in this case, applications—which are easy to build in order to accomplish a specific task.
To accomplish this, you’ll need records that adhere to the Continuity of Care Document (CCD) standard. A certified EHR must be able to generate a CCD file, and this is often done in the form of a patient care summary. In addition, D’Amore says, you’ll need to use SNOMED CT as well as LOINC to standardize your terminology.
Echoing Halamka, co-presenter Dean Sittig. professor in the School of Biomedical Informatics at the University of Texas Health Science Center at Houston, acknowledges that this isn’t easy. Stage 1 of meaningful use. the government incentive program that encourages EHR use, only makes the testing of care summary exchange optional, and at the moment fewer than 25 percent of hospitals are doing so.
The inability or EHR, health and wellness apps to communicate among themselves is a “significant limitation,” Sittig says. This is something providers will learn the hard way when stage 2 of meaningful use begins in 2014, D’Amore adds.
That said, the data that’s available in CCD files can be put to use in several ways, D’Amore says, ranging from predictive analytics that can reduce hospital readmissions to data mining rules that look at patient charts from previous visits to fill gaps in current charts. The latter scenario has been proven to nearly double the number of problems that get documented in the patient record, he adds.
4. ‘Domesticate’ Data for Better Public Health Reporting, Research
Stage 2 of meaningful use requires organizations to submit syndromic surveillance data, immunization registries and other information to public health agencies. This, says Brian Dixon, assistant professor of health informatics at Indiana University and research scientist with the Regenstrief Institute. offers a great opportunity to “normalize” raw patient data by mapping it to LOINC and SNOMED CT, as well as by performing real-time natural language processing and using tools such as the Notifiable Condition Detector to determine which conditions are worth reporting.
Dixon compares this process to the Neolithic Revolution that refers to the shift from hunter-gatherer to agrarian society approximately 12,000 years ago. Healthcare organizations no longer need to hunt for and gather data; now, he says, the challenge is to domesticate and tame the data for an informaticist’s provision and control.
The benefits of this process—in addition to meeting regulatory requirements—include research that takes into account demographic information as well as corollary tests related to specific treatments. This eliminates gaps in records that public health agencies often must fill with phone calls to already burdened healthcare organizations, Dixon notes. In return, the community data that physicians receive from public health agencies will be robust enough to offer what Dixon dubs “population health decision support.”
5. Make Healthcare IT Vendors Articulate SOA Strategy
Dr. Mark Dente, managing director and chief medical officer for MBS Services, recommends that healthcare organizations “aggregate clinical data at whatever level you can afford to do it,” then normalize that data (as others explain above). This capability to normalize data sets in part explains the growth and success of providers such as Kaiser Permanente and Intermountain Healthcare, he says.
To do this, you need to create modules and apps such as the ones D’Amore describes. This often requires linking contemporary data sets to legacy IT architecture. The MUMPS programming language, originally designed in 1966, has served healthcare’s data processing needs well, but data extraction is difficult, Dente says.
Service oriented architecture is the answer, Dente says, because it can be built to host today’s data sets—as well as tomorrow’s, from sources that organizations don’t even know they need yet. (This could range from personal medical devices to a patient’s grocery store rewards card.) Challenge vendors on their SOA strategy, Dente says, and be wary of those who don’t have one.
6. Use Free Public Health Data For Informed Strategic Planning
Strategic plans for healthcare organizations often resort to reactive responses to the competitive market and a “built it and they will come” mentality, says Les Jebson, director of the Diabetes Center of Excellence within the University of Florida Academic Health System. Taking a more proactive approach requires little more than a some programming know-how.
Using Google Maps and free public health data, the University of Florida created heat maps for municipalities based on numerous factors, from population growth to chronic disease rates, and compared those factors to the availability of medical services in those areas. When merged with internal data, strategic planning becomes both visually compelling (critical for C-level executives) and objective (critical for population health management), Jebson says.
With this mapping, for example, the university found three Florida counties that were underserved for breast cancer screening and thus redirected its mobile care units accordingly.
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Tenet selling 8 more hospitals as investors debate company breakup
Outgoing Tenet Healthcare CEO Trevor Fetter said investors should debate whether to break up Tenet around its three main business lines hospitals, ambulatory surgery centers and revenue-cycle software or leave the company whole.
Lawmakers look for compromise to stabilize health insurance markets
The chairman of the Senate health committee says he’s looking for short-term fixes that Republicans and Democrats can agree on in the next 10 days so Congress can influence ACA insurance rates for 2018.
Kaiser donates $500,000 to Harvey mental health relief effort
Kaiser Permanente is targeting mental health in its disaster-relief funding efforts, a first that may encourage other health systems to follow suit.
Best Places to Work in Healthcare – 2017 (alphabetical list)
Modern Healthcare is proud to present the 150 companies and organizations that have been named to its Best Places to Work in Healthcare for 2017. An alphabetical list of the companies and organizations is presented here.
Data Points: Hurricane Katrina’s lasting legacy
Growing providers skirt antitrust scrutiny with small physician acquisitions
Providers across the country have been snapping up physician groups primarily through piecemeal acquisitions of small group practices and hiring handfuls of new doctors. While individual purchases don’t significantly change a market, 1 in 5 physician markets is considered highly concentrated.
Maryland insurance co-op Evergreen Health to be liquidated
With Evergreen Health’s liquidation, just four of the initial 23 ACA health insurance co-ops will sell individual coverage in 2018.
Senate budget committee rejects Trump’s $15 billion cut to HHS
An appropriations subcommittee rejected a proposed multibillion-dollar cut to HHS funding over concerns that it could stymie medical innovation.
Truveris raises $25 million in new funding
The $25 million influx will allow data analytics company Truveris to expand its platform across the prescription benefits industry.
Fidelity National Financial to acquire T-System
In its first healthcare technology investment, the real estate and mortgage insurance and services company will pay $200 million for T-System, which makes emergency department documentation technology.
Making use of chronic condition data
Health information is meaningful only when observed and interpreted. Chronic condition monitoring data would reveal a whole lot more if someone else was keeping an eye on them too, looking for anomalies and trends and keeping people healthy during all the time they’re not directly observed by.
Safety & Quality
Novo Nordisk pays $59M to settle allegations it downplayed drug’s cancer risk
Novo’s settlement sets the precedent that the False Claims Act can be used to punish drug companies that use marketing tactics to avoid drug safety warnings as required by law, experts say.
Jeanne Lillig-Patterson, co-founder of First Hand Foundation, dies at 59
Lillig-Patterson, the seventh employee at EHR vendor Cerner, co-founded the foundation in 1995.
This week’s poll: The federal government allocated $254 million to the Hospital Emergency Preparedness Program in 2017. Should funding increase, decrease or stay the same?
Share your opinion in the latest edition of our bi-weekly poll. The federal government allocated $254 million to the Hospital Emergency Preparedness Program in 2017. Should funding increase, decrease or stay the same?
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In this day and age more and more people are finding out that having a Bachelor s degree is essential for their survival. There are hundreds of college degree programs that available throughout the United States. One degree program that has gained popularity amongst potential students that want to advance their education and career prospects is Healthcare Management.
Almost all colleges and universities in the United States offer Healthcare Management programs. These types of programs are accessible at many brick and mortar campuses and through reputable and accredited online degree programs. Those that are in Healthcare Management will be responsible for all aspect of healthcare and hospital management, including: creating work schedules, keeping up to date records of events in the facility in which they are working in, collaborating with supervisors and hospital administrators, improving the quality of services in the healthcare setting in which they work and managing patient finances and billing. While this type of degree, especially on the bachelors level, will not guarantee c-level responsibilities, it does open up the individual to tasks and roles that include the management of people and resources.
Before applying for admission to a Healthcare Management degree program a person must have earned a high school diploma or a GED. Those interested in enrolling in a Healthcare Management program will need to have experience using basic addition, multiplication, division, subtraction, English and algebra. Students that are enrolled in an online Healthcare Management curriculum will be able to study the fundamentals of business while also learning about the essential parts of the United States healthcare system.
As the US healthcare system continues to evolve, rules and regulations around healthcare continue to change. This means that an individual who is looking for a health management program must complete a thorough analysis on the university and programs in which they are interested. It is highly recommended that an individual only enroll in programs in which it s faculty regularly participate in both the private and public sector or healthcare.
There are a variety of courses that will be required for successful completion in order to earn a degree in Healthcare Management. Some classes that are mandatory for earning a degree in Healthcare Management are Community Health, Project Management, Healthcare Financial Management, Healthcare Terminology, The Legal Aspects of Healthcare Management and Healthcare Informatics. The courses in this curriculum help students learn and gain a better understanding about public health policies, regulations in healthcare that are sanctioned by the United States government, HIPPA legislation, healthcare promotion, coding, quality management and healthcare information systems. A student that is enrolled in a Healthcare Management program will also learn and develop important skills in managing finances for healthcare settings and recognizing medical errors.
Like any other career choice there are certain personality types that may fair better than others in this kind of field. Most people that pursue a career in Healthcare Management are those with type A personalities that pay attention to detail, have well developed interpersonal skills, compassion for others, problem solving skills and analytical skills. Pursuing a Bachelors in Healthcare Management online has a lot of benefits. One of the benefits is you can earn a degree in the comfort of your own home. Another benefit of earning a degree online is the amazing amount of flexibility that online classes offer to students. On average, it will take a student four years to earn a Bachelors degree in Healthcare Management. Depending upon the individual it could take only two years or five years for successful completion of courses to earn their degree.
For those that have earned a Bachelors in Healthcare Management there are an assortment of career opportunities that will be available. Some career opportunities that may be open to those with a Healthcare Management Bachelors degree are positions as a healthcare consultant and hospital service manager. For those that have earned a Bachelors in Healthcare Management they will have the chance to work for healthcare associations, the United States military, nursing homes, health insurance organizations and research institutions.
The environment in which a person in this field works is usually a well-lit, clean office. The typical hours that are required weekly in this career field are 40 hours per week with the possibility of working weekends, nights and holidays. According to BLS.gov, careers in Healthcare Management are slated to increase by over 20% throughout 2013 until 2020. For people in this type of career field the salary vary significantly. The usual starting salary for people in this career path is $51,000 and can increase to over $100,000 annually depending on experience. While there are an array of different health related career opportunities out there, health care management degree programs can open up the door to a non-clinical career in the field.