Business Startup Ideas – Start a Medical Coding/Transcription Business

You’re no doubt reading this because you want to work from home and are looking for a few business startup ideas. You may want to escape prairie-dog-town, home-school your children, or finally do something on your own. Whatever your reason, you can start and grow your medical coder or transcription business by leveraging your past work experience and high level of motivation, and professionalism. There are lots of folks who can empower and enable you.

Medical Coding: When you go to the Doctor for medical help, your diagnosis along with the clinical procedure used to treat your illness or condition is given a code. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) set the standards for the classification systems that healthcare providers must use. Under HIPAA certain codes must be used to identify specific diagnosis and clinical procedures on claims, encounter forms and other electronic transactions. That’s where the Medical Coder comes in. These professionals are responsible for translating healthcare providers’ diagnostic and procedural phrases into coded form. They do this by reviewing and analyzing health records to identify relevant diagnoses and procedures so the appropriate code can be applied.

Codes are published by the U.S. government as a multi-volume set. These codes are being continually updated as new diseases are discovered and identified and new technologies emerge. Coding is performed through a review of the health record on each patient. The coder transforms the documented medical descriptions of patient diagnosis and procedures into numerical codes. Accurate and timely coding does a number of things:
1) provides information useful in the management of diseases and improving the quality of health care,
2) provides data to assure that the appropriate services are being performed,
3) assures the health care facility is promptly and appropriately reimbursed and
4) provides information about the diagnosis and procedure to the people paying for the services.

Although certification in Medical coding is voluntary in the USA, most medical professionals do every bit they can to minimize risk. Coding is a key element in the billing function and compliance with regulatory and other requirements. Therefore, some customers may specifically ask for documented proof of your experience, qualifications, skills, and certification. Remember, the coding must be done right the first time. The doctor has to pay for each code on the bill. Insurance companies will usually pay claims in a timely fashion when the correct codes are used. The doctor has to pay again for each wrong code. Therefore accuracy is vital.

You can augment what you lack in coding experience by showcasing your work experience, high level of professionalism and motivation, your passion for excellence and your dedication to continual learning. Remember you are contracting for services as an independent business owner. You may be able to negotiate with a provider to perform work in their office, gain their trust and later move the work to your home.

If you’re not familiar with Coding and are uncomfortable pursuing this line of work just yet, you may want to take a look at Medical Transcription as a way to gain some background and experience

Medical Transcription: The core of performing the job of Medical Transcription is listening and writing. You will also see this important work referred to as healthcare documentation specialist. You are in effect a medical language specialist who interprets and transcribes dictation by medical professionals. You are a trusted professional who accurately and confidentially captures patient care information by converting voice-recorded reports into text format. You are entrusted with private and personal information to ensure that the information captured is an accurate record of what is dictated. Performing this work requires the ability to interpret dictation correctly and to protect patient records. You must possess the people skills necessary to work directly with medical doctors, surgeons, and other specialists and health care professionals. You do not have to have a certification for this line of work. However, you will have more credibility and probably make more money if you do.

You will have to learn the voice of the person you are transcribing; that may take some time. You will be expected to understand and accurately transcribe medical terminology, anatomy and physiology, diagnostic procedures, pharmacology and treatment assessments. The dictation can range anywhere from ten seconds to ten minutes. Your job is to get this dictation converted into a text file as soon as possible. You then format the reports; edit them for mistakes in translation, punctuation, or grammar; and check for consistency and any wording that doesn’t make sense medically.

So how do you set a reasonable expectation? Let’s say your customer (doctor) sees a patient every 15 minutes and he works a ten hour day. Let’s also assume that your deadline for submitting transcriptions is 24 hours. That is forty transcriptions due in 24 hours. Procrastination is not a trait that works well in this profession. The point here is to negotiate a turn-around time that makes you successful and pleases your customer. If you are not very fast at transcription, you may want to start out by quoting a rate by the page. This also provides your customer a tangible audit of the amount of work you have completed. Discover what a nominal turnaround time is. If it is 24 hours, then comply with that requirement. You may be able to fit in a few more customers and still make your commitments. Be sure to factor in the interruptions for taking children to school, their doctor, and the occasional emergency. Pace yourself and set reasonable expectations for you and your customer. Remind them that you are only a phone call or email away.

If you have little or no experience as a medical transcriber, you may want to land a part-time gig and build your skills and your credibility. Meanwhile, you can set aside some time to train at home and earn your certification.

If you are an experienced medical transcriber – get your business card and brochure in the hands of healthcare professionals. Ask for a trial run and at least a referral.

Bottom line: You’ll never know unless you try.

How to Save Money by Eliminating Overwork at Your Health Care Site

One of the seven wastes identified in John Black’s book The Toyota Way to Healthcare Excellence is overproduction. In manufacturing this type of waste is easily identified as producing too much of an item, more than the customer ordered, or having too large an inventory of materials to be used in a product, inventory that goes unused. In service industries recognizing overproduction is not as easy. I consider overproduction in healthcare to be doing too much work to accomplish a desired health outcome, such as ordering duplicate medical tests, or having unused medication or other medical product. No matter what the setting, overproduction is costly, both to the consumer and to the producer.

In his book John Black gives two examples of overproduction. At Virginia Mason Medical Center before its application of the methodology of the Toyota Production System (TPS) it was quite common to ask patients the same questions at different points along the “value stream” of medical service. For instance, a nurse might ask a patient after surgery about the patient’s pain level and soon thereafter a physician would ask the same thing. This would lead to exasperation on the part of the patient and a waste of time for the caregivers. This is not to say that all duplicate questioning is not useful. For instance, it is a good practice for several different staff to ask a patient his or her name and what medical procedure is to be performed before surgery. This helps avoid wrong site surgery.

In the other example in John Black’s book Park Nicollet Health Services used to take many steps to send out test results to an ambulatory care location. Several copies of the test were made at the original site. Then the test being sent to the site went through several stages of being handled. Now, Park Nicollet sends a copy of a test result to the required site electronically as soon as the result is available. This way, the results are not “lost” and delays are eliminated.

A commonly recognized source of overwork or overproduction is production of duplicate medical tests when one would have been sufficient. In 2007 the Commonwealth Fund, a nonprofit agency working towards a highly effective health care system, reported that 14% of patients it researched stated that physicians requested the same medical test within a two year span. Of course, some of these duplicate tests may have been necessary, but many were not. It seems that lack of effective communication is the cause of many of these duplicate tests. For instance, a patient may have blood work done by his or her primary care physician and then this same work is repeated when the primary care physician refers the patient to a specialist for a problem identified in the first blood work. The tests often are reordered because the second physician in the line of treatment does not have access to the first set of results.

Something similar to this happened to me at my last physical. I told my primary care physician that I would visit my urologist to go over my PSA from the blood tests done for the physical (I have an HMO plan). I do this as I had a high PSA result once. I had the appointment made from my primary care site and then, as usual, I had my blood work done immediately after the physical. When I went to the appointment with my urologists, I found that he did not have my PSA results. We found out that my primary care physician had failed to order the PSA test as part of the blood work. My urologist performed as much of the exam as he could and had another round of blood work ordered so that my PSA level could be determined. The failure of a PSA being ordered initially resulted in extra time being spent by the urologist and myself in getting the results and discussing them as well as incurring unnecessary costs.

Another source of overproduction in the annual physical is due to the fact that many times blood work or other tests are performed after the physical. Doing the tests after the physical requires that the physician or a staff person contact the patient to discuss any unusual results or may even result in another appointment. If the standard tests are performed in advance of the physical, then the results can be discussed during the physical. Obviously, this way there is better discussion between patient and physician of the results and there is a great savings of time and money.

Dr. Ted Epperly of the American Academy of Family Physicians stated in the February 8, 2009 Wall Street Journal that much of duplicate testing could be eliminated with the use of electronic medical records. The effectiveness of electronic medical records to accomplish this requires that most of the providers of medical care-physician offices, hospitals, medical labs, pharmacies, nursing homes, etc.-be connected through their EMR’s. In West Michigan, where I live, the initiative to connect EMR’s is being led by the local hospitals. This task is far from complete. I believe that few communities are interconnected to this extent. Until most regions are electronically communicating patient test results to one another, I believe that duplicate tests will continue to be common.

Another source of overproduction is the ordering of tests by physicians to avoid lawsuits. Physicians report that they believe that the use of defensive medicine and malpractice insurance raise the costs of medical care 10% or more, depending on the state in which the medical service is being performed. This was reported on MSNBC on November 4, 2009. In this same report Dr. James Wang of Boston reported that after being sued for allegedly failing to diagnose a case of appendicitis, he says he turned to what’s known as “defensive medicine,” ordering extra tests, scans, consultations and even hospitalization to protect against malpractice suits.

As you can see, there are many ways that overproduction occurs in healthcare. Some of the ways are unavoidable, such as the excessive amount of paperwork required by insurers to document charges for care provided. Some will continue until technology catches up. Yet, much can be eliminated at healthcare sites by the use of quality improvement tools. For instance, providers can work in teams and use process maps to identify what work in a process is “value added” and eliminate that work which is not as far as possible. The process of eliminating overproduction in this way must be done over and over as it is rare that all overproduction can be eliminated. However, with continual process improvement much can be eliminated. The results will be an improvement of the bottom line, improved patient outcomes and satisfaction, as well as increased satisfaction on the part of the providers.

Your Health as Related to Your Complex Environment

Article 5 of 7

The first segment of this article deals with the vulnerability, through the lack of knowledge, of the individual in dealing with his or her health. The second segment discusses some of the special means available, through the use of technology, to far better deal with the environment as it relates to human health.

If you would, please refer to handout “B” (the Health Chart) The B handout can be viewed also by clicking on a link at the end of this article. The handout is also an essential part of this discussion.

Let’s say the sloping line in handout B represents our health in general. From the normal-plus level down to the potential disease level area. Although this chart is oversimplified, it does give us a better picture of what we are all presently dealing with on a day to day basis in our lives, and also, in general, what we are trying to accomplish here. It’s very sad but true, that we have no idea where we are at on any such line of wellness, up in the healthy areas or down in the disease area, nor do we have the ability to exercise any organized degree of control over our position on any such line.

The disease area is where our present health care system primarily operates. In fact, the present health care system is often referred to as a disease-oriented medical system. We hear a lot about this area, because this is where most research and other medical activities take place, not up in this pre-disease stage area, or for sure not up in the normal-plus area.
(Although I am using only one line here (in handout A) for discussion, and simplification, purposes, the use of a number of lines, possibly representing major body systems, may in fact provide a more realistic representation).

We are told that major diseases such as most cancer, heart problems and the like usually take years to materialize, yet how often is someone given a complete physical examination and a clean bill of health, only to come down with the symptoms of one of these diseases within weeks? Obviously, the person was not likely in good health at the time of the examination; he or she was in reality down in this disease area, or pre-disease stage area, not up here, and for sure not up here in the normal plus area. The hundreds of health level conditions from the disease level up through the normal plus level would be fully established by this system. Currently you are diagnosed to have some level of diseased, or with the absence of that diagnosis, considered to be normal and sent home. What about the hundreds of subtle conditions in between–for example such as your system being slightly out of balance with minor corrections required?

Unfortunately, at this time, the way we usually become aware that we are not normal is when we develop the physical symptoms of a disease or from the results of a lab test. Instead of being up in the normal area, we are sadly down in the disease area or close to it. We often go from what we consider to be a condition of good health to abruptly finding out we have a disease, sometimes a very serious one, often causing a major change in our life, to often with no warning or opportunity for any form of intervention to prevent it. We then can only hope that the disease is curable or at least treatable.

For all practical purposes, basically we are left completely in the dark to struggle with where we are really at on our own. Most of the time we have no idea of how close we are to the potential disease levels. Operating under these conditions most of us just do the best we can, hoping to help ourselves with our level of health, whether it’s through what we eat, an exercise program, what we try to avoid, etc. This is a very weak and vulnerable position to continually be in, but it’s currently a fact of life. Unfortunately, it’s about all we can do. That is very sad indeed with the technology available to provide us far far more.

The proposed system, would not only provide you far more knowledge about your true level of health, but in addition, and just as critical, usually how you could have far more control over that level of wellness. The contrast between the current health care situation and what the system being proposed here could provide in terms of preventive and wellness knowledge might be compared to someone just feeling around in the dark, and then having someone come along and turn on the lights.

This article discusses a core element of the proposed national research center and how the supercomputers can relate vital data to disease and prevention and wellness. It also discusses a system that has the means of not only closely monitoring your health in great detail but far more control over it as well.

Now let’s take a look at the environmental factors:

In order to exert control over our level of wellness, we clearly also need to take into account external elements that affect our health, and of course that includes our personal environment.

In discussing our environment, we will use the word “environment” in its broadest sense, to include foods, nutrition, and exercise programs so on. However, bringing the environment into the health picture vastly complicates setting up any simple electronic processing system. It requires a far more powerful and sophisticated medical information system, but it’s absolutely essential. Any system that does not include the environment cannot be effective. The current high levels of disease and medical expense would only continue. This system does include the environmental elements.

So, how do we go about bringing in such large and diverse amounts of data into some type of format or system so that they can be evaluated as to their affect on our health?

Please refer to handout “C” Labeled Environment.

These are just a few examples of the many environmental factors that we are exposed to that can affect our health.

If we look at the upper left side of the page we see typical foods such as tomatoes broccoli and grapefruit, and directly across the page are listed some of the potential concerns for contamination, such as insecticides and herbicides, both widely used in this type of farming now days.

Just below that on the left are meats, poultry, dairy products, and eggs. Here we have additional potential contaminants we need to be especially concerned about–antibiotics and hormones–which are used very extensively by the farmers providing these products. (There are details in the book on the excessive use of chemicals by farmers).

We also have water. Well water is usually inspected by the county for bacteria only, not chemicals.

Then, last, but for sure not least, we have medicines, which could well be some of our most dangerous exposures. There definitely needs to be a far more reliable means of testing the typical pharmaceutical drug. In addition, there is a great need for more effective, friendlier and less expensive medicines. Extensive testing of natural elements is part of this system, which will be discussed later.

Sadly, we don’t even really know which chemicals we are ingesting or inhaling let alone the quantity. Also, what about the synergistic effects of these chemical combinations? At this time none of this is known!

Because this involves precious human health, and even life itself, this haphazard method of controlling food and water supply contamination, in this day and age of technology, is very sad indeed, and in my opinion absolutely unnecessary!

Capturing the environmental information for each individual at first seems almost insurmountable, but if we look into it further and with the help of some of the latest technology it is not as difficult as it first appears. For example, one use of technology, that would be very effective and easily applied, is to convert the checkout counter at supermarkets to easily transfer your supermarket orders to a special home computer, by merely having the credit card reader converted over to also read a plastic card you could carry with you. You could pass the card through the card reader the same as a credit card. The reader would recognize it for the type of card it is, read the telephone number on it and transfer details of the total order to a special home computer. This information could be easily downloaded later for use in a health report. Not only would that provide a total list of what you purchased, and avoid detail work on your part, but it would also provide the critical brand names. This would be very valuable in terms of research, in monitoring the quality of food. When significant health problems arose with a particular product, the research and diagnostic computers would be able to actually identify the brand.

This system would be very practical because the supermarkets already have all that store product information on their store computer systems, and such a system would require primarily the conversion of the credit card readers.

Also an environmental staff person would be mandatory in each medical office operation to help input, all environmental data for the patient or individual. This expert’s wages would likely be reimbursed by the government, at least initially, from the huge savings in health care expenses provided by the new system–savings in the hundreds of billions of dollars (there is a small chapter on the economics involved). It should be noted that the environmental data input would be used for research purposes only for the first two or three years, but could likely be used for diagnostic purposes later (there are details in the book on how and why this is so).

We discussed the limited options available to preserve human health within the limitations of the present health care system. We also discussed both the limitations of knowledge, and the ability to control, one’s personal environment as to its effect on human health.