RESUMO
Despite years of recognition that many physicians are woefully unprepared to face challenges regarding the business of medicine, marginal progress has been made. In this piece, we aim to provide the contemporary reproductive medicine physician with an understanding of billing, coding, and, most importantly, cost containment for a typical fertility practice. It is critical for modern practices to not forego hard-earned revenue to insurance companies or not be aware of critical rules and regulations. While running a successful fertility practice requires good medical care, a profitable practice is necessary for overall long-term success. This article provides a brief history of medical insurance and billing, explains the process of updating billing codes, and reviews the revenue cycle, cost containment, and contract negotiations with insurance companies.
Assuntos
Administração Financeira , Reembolso de Seguro de Saúde , Gerenciamento da Prática Profissional/tendências , Medicina Reprodutiva , Codificação Clínica/economia , Codificação Clínica/história , Codificação Clínica/organização & administração , Codificação Clínica/tendências , Administração Financeira/economia , Administração Financeira/história , Administração Financeira/organização & administração , Administração Financeira/tendências , Ocupações em Saúde/história , Ocupações em Saúde/tendências , História do Século XX , História do Século XXI , Humanos , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/história , Reembolso de Seguro de Saúde/tendências , Gerenciamento da Prática Profissional/economia , Gerenciamento da Prática Profissional/história , Gerenciamento da Prática Profissional/organização & administração , Medicina Reprodutiva/economia , Medicina Reprodutiva/história , Medicina Reprodutiva/organização & administração , Medicina Reprodutiva/tendênciasRESUMO
In recent months, organized medicine has been consumed by the anticipated transition to the 10th iteration of the International Classification of Disease system. Implementation has come and gone without the disruptive effects predicted by many. Despite the fundamental role the International Classification of Disease system plays in health care delivery and payment policy, few neuroradiologists are familiar with the history of its implementation and implications beyond coding for diseases.
Assuntos
Codificação Clínica/história , Classificação Internacional de Doenças/história , Neurologia/métodos , Radiologia/métodos , História do Século XX , História do Século XXI , HumanosRESUMO
General practitioner (GP) computing has its origins in the 1970s when the benefits of clinical coding and prescribing were demonstrated. During the early 1980s Dr James Read, working with Abies Informatics Ltd, developed the eponymous Read Codes, which were broader and more comprehensive than other schemes, yet intuitive and easy to use. In 1988 a joint working party of the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) recommended that the Read Codes be adopted nationally. The Read Codes have been used by almost all GPs in the UK since the mid-1990s. Many developments in general practice, including GP fundholding (where GPs held the budgets to commission elective care for their patients), the Quality and Outcomes Framework (QOF - pay for performance for improving chronic disease management) and GP commissioning (the current NHS reform in which primary care leads commissioning of services for their patients) would have been impossible without all GPs using a common clinical coding scheme. Systematized Nomenclature For Medicine - Clinical Terms (SNOMED CT) is a merger of the Read Codes with SNOMED RT - the original SNOMED reference terminology developed by the American College of Pathologists.
