Monday, January 23, 2017

Keep Your Independence Day Safe

Three-quarters of Americans plan to enjoy the outdoor cookout experience to celebrate the Fourth of July Holiday.  With all that fun, come some obvious and not so obvious dangers.  Read on to see tips on keeping everyone happy and healthy in the backyard or at the park.


The smell of BBQ in the air starts your mouth watering.  That sound of meat sizzling on the grill could kill you, or at least give you cancer.

Do this to reduce your risk:

1.Marinade meats for 30 minutes prior to grilling to reduce Hetercyclic Amines (HCA’s)

2.Cook meat properly.  Burnt meat contains HCA’s causes gene damage Consumption of HCA’s can cause damage to genes. This can often be related to increased cancer risk.

3.Eat only 4-6 oz. of red meat per meal (18 oz. per week) or instead eat chicken, fish, fruits and veggies made on the grill.

causes gene damage Red meat increases the risk of colon cancer.

mosquito borne illness

Ants are famous for crashing the picnic, but the mosquito is much more harmful.  Keep everyone comfortable and disease free by reviewing this information on those pesky, flying pests.

causes gene damage Mosquitoes spread dangerous diseases like West Nile Virus, Dengue and Malaria.  Mosquitoes infect nearly 225 million people annually with Malaria resulting in approximately 781,000 deaths.

1.Mosquitoes are attracted by dark colors, body heat and smells from body chemicals like carbon dioxide and lactic acid.  Dress in lightly colored protective clothing and use repellent containing DEET. 

2.Eliminate breeding areas by draining all standing water where they lay their eggs.

3.Avoid peak mosquito hours: early morning and evening.

heat stress

We all wish for a bright sunny day for our holiday activities, but be cautious of the effects that summer time heat can have on your body.

1.Drink plenty of fluids, avoiding sugar sweetened drinks.

2.Protect your skin with sunscreen and wear loose-fitting, lightweight and light colored clothing.

3.Be aware of symptoms of heat-related illnesses like heat stroke and heat exhaustion.   You can go to the CDC website to see a full guide on heat stress illnesses.

causes gene damage Excessive heat above 80 degrees with 40% or more humidity can have even more serious consequences for those people with diabetes.  Diabetics should:

Check medication and test strips packaging and their glucose meter regarding effects of exposure to high temperatures.  Take the necessary precautions to protect them and insulin pumps from the heat.

Keep insulin cool, preferably in a cooler without direct contact with ice or frozen gel packs.

For those on a restricted liquid intake, they should discuss with their doctor how best to adjust to their intake during times of high heat.

National HIV Testing Day

June 27th has been designated by the US Department of Health and Human Services to be National HIV Testing Day.

Since the discovery of the Human Immunodeficiency Virus in the 1980’s, HIV has affected numerous millions of people in the United States alone.   The CDC estimates more than 1.1 million people in the United States are living with HIV infection currently and about 50,000 new cases are diagnosed each year.

The CDC also reports that almost 1 in 5 (18.1%) of infected individuals are unaware of their infection.  As with any disease, the ideal way to fight the spread of HIV is with early detection.  It allows those who are diagnosed to initiate treatment as soon as possible, increasing survival chances and quality of life. This also helps to eliminate the chance of unknowingly spreading the disease to others.  

Healthcare professionals should take this opportunity to encourage high risk individuals to be screened for HIV.  Information on testing that is geared to provider education is provided on the website.

For patients, a screening location finder can be found on the CDC website by clicking here or also at

The table below lists basic on the Medicare coverage for HIV Screening.  Please consult the CMS Preventive Services website for complete detailed information.

Service : Procedure Code(s)
HIV Screening
G0432-Infectious agent by EIS technique
G0433-Infectious agent by ELISA technique
G0435-Infectious agent by rapid antibody test

Any beneficiaries at increased risk for HIV infection or pregnant.
Annually for high risk beneficiaries. 
Three times per pregnancy.

Sunday, January 22, 2017

Well in the realm of medical billing, RA means Remittance Advice.

An RA is the detailed reply sent by a payer in response to a claim for a medical service.  The details in the RA assist the biller in reconciling the payment that is received or provides the explanations for any non-paid items.

Many times it can also be referred to as an Explanation of Benefits (EOB).

An RA can come in two forms:

paper EOB : Standard Paper Remittance (SPR)    

ERA : Electronic Remittance Advice (ERA)

Both contain similar information, but the ERA format has numerous advantages over the paper format.  Most ERA’s are received within days of the claims processing by the payer instead of the weeks in can take for the SPR to arrive via mail.   

Most of the best Medical Billing Software enables ERA data to be directly imported into the billing system where it can be auto-adjudicated.  

This eliminates the time consuming and error prone task of manually keying in all the data from the RA

Iridium Suite Medical Billing Software by Medical Business Systems contains an integrated automated Payment Posting module that seamlessly imports and adjudicates all of your ERA’s.

The explanation of payment on the RA is typically detailed in a “coded” fashion utilizing combinations of alpha and numeric code sets.  Medicare utilizes the most standardized version of these code sets, and they consist of four types:

Group codes: identify the responsible party or category of adjustment and are combined with CARCs

There are five group codes:
  1. CO-Contractual Obligation
  2. CR-Corrections and Reversal
  3. OA-Other Adjustment
  4. PIR-Payer Initiated Reductions
  5. PR-Patient Responsibility

Claim Adjustment Reason Codes (CARCs):  explain the adjustment of the non-paid amount

For a complete list of CARCs, visit Washington Publishing Company's website by clicking here. 

Remittance Advice Remark Codes (RARCs):  provide a more detailed explanation of the adjustment of a service line or claim level payment

For a complete list of RARCs, visit Washington Publishing Company's website by clicking here. 

Provider Level Adjustment Codes: indicate an adjustment that applies to the pay to provider, not a specific service line or a claim
Provider Level Adjustment Codesare specific to Medicare.  For a complete list, see the CMS publication by clicking here.

Follow this link to download an informational white paper on “Understanding Explanation of Benefits Statements.”

The Medicare Learning Network in April 2013 released “Remittance Advice Information: An Overview” Fact Sheet (ICN 908325).  You can access this publication by clicking here.

CMS to Update the Benefit Manual for ESRD PPS

CMS details in a recent publication of the “MLN Matters” an implementation date of September 9, 2013 for the revisions to the "Medicare Benefit Policy Manual”.  The manual will be updated to reflect change request (CR) 8261 providing information on the end-stage renal disease prospective payment system (ESRD PPS).

ESRD PPSThe background and implication of the ESRD PPS, are as follows:

•In August 2012, CMS released an analysis of patient claims in the new ESRD prospective payment system, which showed that this payment system has had no negative effects on patients’ health.

•The ESRD PPS, first implemented in 2011, expands renal dialysis services included in the single bundled payment to the dialysis facilities and provides for patient case-mix adjustments, facility level adjustments, and outlier payments.  It is intended to improve efficiency. 

•CY 2013 will be the third year of a four-year transition to the new payment system.  The overall impact of the CY 2013 changes is projected to be a 3.0 percent increase in payments. 

Hospital-based ESRD facilities have an estimated 3.6 percent increase in payments compared with freestanding facilities with an estimated 2.9 percent increase. Urban facilities are expected to receive an estimated payment increase of 3.0 percent compared to an estimated 2.9 percent increase for rural facilities.

•The ESRD QIP aims to promote continued improvement in the quality of care provided to patients with ESRD. The final rule focuses on clinical measures and has added the following QIP reporting measures to cover a broader range of patients who receive dialysis care:

o To evaluate anemia management

Anemia Management, a reporting measure.

o To evaluate dialysis adequacy

A clinical Kt/V measure for adult hemodialysis patients.
A clinical Kt/V measure for adult peritoneal dialysis patients.
A clinical Kt/V measure for pediatric in-center hemodialysis patients.  

• The overall economic impact of the ESRD QIP is an estimated $24.6 million for PY 2015. The total expected payment reductions will be approximately $12.1 million, and the costs associated with the collection of information requirements for certain measures to be approximately $12.4 million.

• The estimated payment reduction will continue to incentivize facilities to provide higher quality care to beneficiaries. The reporting measures that result in costs associated with the collection of information are critical to better understanding the quality of care beneficiaries receive, particularly a patient's experience of care, and will be used to incentivize improvements in the quality of care provided.

Saturday, January 21, 2017

The Job Description Of A Phlebotomy Technician and Venipuncture Technique

The Job Description Of A Phlebotomy Technician

A phlebotomy technician is a medical professional that draws blood and other fluid samples from a patients body for the purpose of medical diagnosis and assessment or for purpose of blood donation. 

The phlebotomy technician takes these blood samples from the patient using venipuncture, which is the most common method. Venipuncture entails getting the blood directly from median cubital vein, which lies within the anterior of the elbow. 

Blood can also be obtained through a capillary method or from a small pinprick in the finger. A phlebotomy technician is the medical professional that is responsible for drawing blood using all of these methods.

The tasks attributed to a phlebotomy technician include making sure that all of the instruments used in the drawing of the blood is sterilized and safe. 

After the blood draw is complete the phlebotomy technician is required to label the collection container immediately with the patient’s information, the reason for the blood draw and any other identifying information.

All relevant paperwork must be completed immediately in order to have a paper trail to trace the route of the sample, assuring the patient and the doctors that the correct blood sample is being used for the diagnosis and assessment. 

The proper identification of the blood sample and having the appropriate paperwork completed is the most crucial part of the job as even the most minor error can lead to a misdiagnosis or a contamination., which can be detrimental to the patient, the doctor, the facility and everyone concerned.

Phlebotomist are required to keep detailed records about their patient’s blood test results and information within the computer system of the facility where they are employed. Many phlebotomy technicians are also charged with the responsibility of training new technicians in sample collections and analysis.

You must be able to put your patients at ease. Blood draws tend to be painless procedures, however, many patients are still very nervous about having their blood taken. 

A good phlebotomy technician will have a comforting manner and will be able to ease their patients fears. Phlebotomy technicians are employed at almost every type of medical facility, including hospitals, clinics, doctor’s offices, diagnostic laboratories and of course, blood banks.

In order to become a practicing phlebotomy technician one must have a high school diploma or equivalent. A background in science or biology is helpful and a training program from a certified vocational training program must be completed. One must also pass a test from one of the following associations in order to become certified.

The American Society of Clinical Pathologists (ASCP)
The American Association of Medical Personnel (AAMP)
American Medical Technologists (AMT)
The National Credentialing Agency (NCA)

The training programs to become a phlebotomy technician typically take one year to complete. Certification and licensing is generally not required in most states, however, getting your certification will give you a big advantage when it comes to getting a job. Many employers will only hire phlebotomy technicians who are certified with a accredited association.

Venipuncture Technique

If you have ever had your blood drawn for a donation or for a medical test you may have ended up with a huge purple bruise on your arm or you may not have had any bruise at all and the only way you can tell that you gave blood at all is the little tiny mark from where the needle pricked your skin.

Phlebotomy technicians need to become skilled in venipuncture technique or phlebotomy technique as it is often called. Drawing blood should not be a painful experience for the patient either as the blood is being drawn or afterward.

Drawing blood is somewhat of an art, but a good technique is something that can be practiced and learned. If you are planning to be a phlebotomy technician the art of venipuncture is something that you should work on daily.

Preparing for Venipuncture

It is important to properly prepare the patient to prevent possible patient injury and infection. Possible fainting or dizziness can occur in even the healthiest patients so the patient should always be seated before starting. All tight or constricting clothing or jewelry should also be removed.

The phlebotomy technician or nurse will select the most appropriate vein for blood collection. The skin over the vein must then be cleaned thoroughly with a 70% alcohol solution wipe in a spiral motion from the inside out.

The phlebotomy technician should always practice good venipuncture techniques including:

1. Washing hands thoroughly with a hospital recognized antiseptic hand soap. The phlebotomy technician should also always wear examination gloves that are either latex or vinyl.

2. Selecting the most suitable vein. This is the vein that can most easily accommodate the blood draw with just one stick. No patient likes to be poked again and again.

3. Clean the area thoroughly with the hospital or clinic approved swabs, usually either povidone-iodine 1% or an alcohol or CHG prep.

The Vein Puncture

A tourniquet is usually applied about 3 to 4 inches above the collection site on an extremity, such as the arms. This forces the blood to pool inside the vein making it easier for the stick and for the blood collection or for an intravenous catheter insertion. The patient can also make a fist and this will also aid in the pooling of the blood in the vein.

The needle chosen is selected based upon the size of the patient, the patient’s age, the condition of the vein and the reason for the venipuncture. 

The needles are flattened to point on one side. This flat side is called a bevel and it allows the needle to slide easily through the skin and into the vein. 

The needle should be positioned with the bevel facing upward, parallel to the vein at a 15-degree angle so that it can press through the vein in a quick and smooth motion.

The phlebotomy technician should also be confident and have a steady hand when poking the patient. An unsteady hand can be frightening for a patient. 

After the venipuncture is complete it is important to apply pressure to the site in order to stop the blood flow and prevent bruising.

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