Medical Billing Careers, Medical Coding Careers

The other day, traffic on one of my other blogs exceeded that of the hallowed Dot Matrix.  I'm happy to provide a link to Surgical Pathology Coder for anyone interested in what occupies my time during the mornings.  I warn you: it is dull, technical, hair-splitting stuff.  If you have an interest in starting a career in medical billing and coding, consider this a peek behind the curtain.

I am forever seeing ads touting my profession as a hot, growing field.  Most of these ads are directed to potential students to specialize in medical billing by enrolling in a private school.  I enjoy what I do, I've been doing it a long time, but to describe it as exciting and dynamic is to misstate the facts.  The above link demonstrates the kinds of issues that dominate a coders and billers brain power.  Competent medical billers and coders are in demand, more so now than ever before.  New Orleans seems to have too many at the moment with so many hospitals closed and the population down post-Katrina, but good, reliable help is always hard to find.

It is tedious and exacting work, much of it spent typing and much of it dominated by government regulations and contractual obligations.  In it's way it's quite fascinating and stimulating despite being repetitive much of the time.  As my other blog demonstrates, many coders and billers specialize in a particular field of medicine.  If you work in primary care, you code thousands of flu shots every late autumn, for instance.  I've worked in a variety of medical specialties and each of them has their own nuances to master, but once that's done it is pretty much the same thing day after day.  If you are happy with that, and I usually am, then medical billing and coding may be for you.

Don't think I'm downplaying the value of my profession.  It is vitally important to keep the healthcare system running.  Medical billers ensure that appropriate payment is made for medically necessary services.  Medical coders ensure that medical information is accurately reported according to a standardized methodology.  This isn't just for reimbursement purposes.  The reported information is collected by outside agencies like the Center for Disease Control and Prevention for research and to track trends in national health.

A medical biller is not the person who sends you bills after you receive medical care.  He or she is the person who gets your bills paid by insurance or government programs like Medicare and Medicaid.  It is an intricate system with many rules and regulations beyond those governing coding.  If you like solving problems, no matter how ethereal they may seem, it is a good and rewarding career.  It isn't for everyone though.

WK

Dot Confucius

"In a country well governed, poverty is something to be ashamed of. In a country badly governed, wealth is something to be ashamed of." - Confucius.

The same can be said of a city.

As a magnet of opportunity, a great metropolis draws immigrants from all walks of life. It used to be that the wealthy as well as the poor lived cheek by jowl in our cities. This is still somewhat the case in Boston. While many of the wealthy have emigrated to the suburbs, Beacon Hill is still a fashionable address for the upper crust. Their are new, luxury condominiums high above the rest of the older city skyline around the waterfront and the Common. The same can't be said about the other neighborhoods though.

Roxbury Heights for instance, was once quite prosperous. You can tell by the architecture that remains. I drove through the neighborhood this afternoon and nowadays it is more ghost town than prosperous. Ashmont Hill isn't in such an abandoned state, but it has seen more glamorous days. Some of the streets are the most picturesque in Boston and, in fact, my favorite house in the city is located on Melville Avenue. Tell someone in Tory Row that you live in Ashmont and they'll say, "How can you? The Red Line smells like urine after Savin Hill!" Not true, the breeze off Dorchester Bay sprinkles the atmosphere with the aroma of April freshness. Even in August.

While no one should be begrudged having a little extra pocket change or a nest egg socked away for retirement, these things seem to be the exception rather than the norm in many parts of Dorchester. What does that say about Dorchester in particular and Boston as a whole? While extreme poverty may be negligible, so is extreme wealth in the Dot. To say the neighborhood is middle class is accurate and there is no shame in that. To say it is upper middle class is a stretch of the imagination even this daydream believer cannot swallow.

When a city is governed well, poverty, while not something to ashamed of per se, is symptomatic of a broken system. When a city is mismanaged, the means of achieving comfortable wealth are distasteful. The same is true of influence, reputation, and perquisites. What is the source of access? Character and ability, or connections and the ability to make 'donations'? Would you tell your mother how you earned them?

I'm no insider. The only time I've been inside City Hall was to get my Dorchester parking sticker, a plain slug of a design for motorcycles on which the clerk writes Dorchester and the expiration date with indelible magic marker (and not with the best penmanship, I might add). Is the city mismanaged? We have an experienced urban mechanic keeping the gears well-greased. I have little interaction with the local government aside from dodging or paying parking tickets and dealing with what seems to be an regular stream of excise tax bills.

I am not insinuating any corruption in the current administration. Plenty of innuendo surrounds it, but it just that: nothing proven and certainly nothing egregious. It could be an interesting election. Or it might not. As Tuesday's editorial below was entitled, The More Things Change, the More They Stay the Same.

Sharing wealth

Dorchester is a warren of streets, a labyrinth, a maze in which rats seek cheese and innocent pedestrians lose thier way. The tangled streets of Dorchester, Mass. lead out into the rest of greater Boston in one direction and into a horn of plenty in the other. Dorchester is shaped like a tortured gall bladder but its stones are not calcifications cemented with hardened bile. They are not pyrite either. They are the real thing, nuggets of pocket change to be spread around willy-nilly, for good cause.

I was at the Fields Corner Shopping Center this afternoon, picking up carrots and a bottle of hot sauce. A well dressed man approached me in the parking lot. "Excuse me sir, I have a flat tire and Auto Zone up the road charges $13.95 for a plug kit. My son is sleeping in the car, you can see him, can you help me out?"

I am usually dubious of such things, but this was a well dressed man, one gentleman to another, with a plausible story. I was admiring his outfit of light pants, navy jacket, woven leather loafers, crisp, white shirt and red tie sporting a tasteful green seahorse motif, as he walked from Dot Ave to my position. I thought it was a little early in the season for such an ensemble but he wore it well. As a person who travels on two wheels and doesn't carry a spare, I felt his pain. He said, "I work for Verizon, across from South Station. I pass people every day asking for money and now I'm one of them. I guess sometimes bad things happen to good people." I wasn't about to pass judgement on his goodness but I was inclined to help someone with a flat tire, having been in the same straits more than once.

The man had a Carribean accent. When I handed him fourteen dollars he said, "I'm sorry. You misheard me. A plug kit costs $30.95. That sounded more believable since the plug kit for my motorcyle cost $45. I emptied my wallet. He said, "You can take my cell phone number. I work for Verizon." I said I didn't want to be bothered with a lot of follow-up. I gave him my address and told him to mail me what he owed me. "I will," he said, "You'll have faith that there are honest people in the world,"

Perhaps I will. I'm out thirty-five bucks and while I'll miss them, I won't miss them overly much. It is better to waste money with good intentions on a confidence scheme than to squander it on loose women and booze.

I don't go to church. If I did, I would be making donations to give help the needy. I figure I'm cutting out the middleman by giving it to those who have the nerve and need to ask directly. I won't be fishing in my mailbox for reimbursement, but I will be contentedly surprised to find my trust in humankind rewarded with a payback plus an extra five-spot tacked on for my troubles.

Matta-pannus

This story is bizarre beyond being believable, but here we go anyway. Someone has to tell it and I was present and accounted for.

I received an email recently from an agent of the Massachusetts Executive Office of Health and Human Services. It read, "Mr. King, We understand you are familiar with events occurring in Dorchester that may not be followed by the usual news media or government agencies. We request a meeting to discuss some unusual, medical occurrences that have taken place in Dorchester and would like to learn your insight on developments concerning a demonstrable uptick in back alley surgical procedures. [italics mine]." This certainly seemed like my bread and butter so I agreed to an interview on the eleventh floor of One Ashburton Place downtown.

The agent and I sat at an empty conference table while nibbling catered sandwiches delivered from rebecca's cafe (lower case for proper nouns dictated by rebecca's corporate HQ). The agent asked me what I knew about illicit, unlicensed surgeries being performed in Dorchester. I admitted that this development hasn't registered on my radar.

A little back story: Over the past few years Mass Medicaid has been approving and paying for gastric bypass surgery for beneficiaries whose overall health is threatened by morbid obesity. As one would expect, rerouting a person's esophagus more directly to the small intestine is an expensive affair, even at government rates. The surgery is generally successful in alleviating the condition it is supposed to cure. Patients on average lose between 65% to 80% of excess body fat very quickly. This rapid weight loss often results in the patient acquiring a pannus about the patient's midsection.

Pannus is the Latin word for cloth though in this case it may be more properly translated as 'apron.' The patient's skin cannot contract as quickly as the excess fat being lost and hence an apron of empty skin develops that, in some cases without the underlying support, can hang almost to the knees. The Health and Human Services agent informed me that rumor on the street is that Mass Medicaid considers removal of this pannus after gastric bypass surgery isn't covered by the program since it is considered cosmetic surgery rather than therapeutic. I could see the reasoning. After all, I don't see any supermodels with an apron of excess belly skin strutting the catwalk, not even at Boston fashion shows.

The agent explained that some panniculectomies, as the surgical removal of this apron is called, are medically necessary. The underside of the pannus is often subject to dermatitis either of the fungal kind because of difficulties in keeping these deep folds clean and dry, or of the mechanical kind due to excessive rubbing against other surfaces. She emphasized that when medically justified the surgical removal of excess belly skin is a covered service under Mass Medicaid guidelines. This sounded reasonable to me.

The agent leaned in so close that her hair was in my egg salad, "Do you know, Mr. King, that we have seen a twenty-seven patients at Boston hospitals who are suffering complications from panniculectomies performed for private payment in unlicensed operating theaters in the Dorchester area?" I admitted that didn't know that. She continued, "Most of these beneficiaries are eligible for coverage under Mass Medicaid rules from contracted providers but they don't go there because they've been told the Commonwealth is cutting back on reimbursement for this procedure. They are going to unlicensed surgeons to correct their deformity and paying out of pocket. Granted, it's a reasonable fee considering the work being done, but it often much more than what Mass Medicaid has determined to be the proper reimbursement rate. Naturally, providers not certified by the Commonwealth don't always adhere to the standards we here at the Executive Office of Health and Human Services beleive to be in people's best interest. The system is starting to see the consequences in post-operative infections and sponges being left in the wounds." It was all news to me.

She said, "Do you know where most of these operations are performed?" I knew the answer already before she said it, "Mattapan."

Of course, Mattapan, that neighborhood where all sorts of trickery hatches without breaking egg shells. Mattapan...Where truth and falsehood exchange hats and every passing face is an enigma that asks. "How do you do?" Mattapan... Where fake IDs are passports. Mattapan... Where every shyster and accountant and hedge fund manager proudly hangs a store-bought diploma behind his desk. Mattapan... Where the best hot dogs are served, where best suits are tailored, and where the most well-attended churches make room to shelter their congregations. Mattapan.... Sweet, trusty, shady, sparkling, sparking Mattapan, the part of Boston that is most a'glow with unbridled opportunity. Mattapan...

The agent asked me if I could shed any light on the department's statistics. I said no and I thanked her for the sandwich. Exiting onto Ashburton Place, I looked at Boston's skyline looming and stretching to the south. I was only a few miles from Mattapan but I was a world away, slender and stylishly dressed in a bespoke suit and a shirt sporting folded-over cuffs. I get my tailoring done in Mattapan by an unlicensed tailor. If I needed a panniculectomy, I might consider the unlicensed neighborhood surgeons headquartered in that part of Boston. It is a place known as much for its bargain quality as for skirting around regulations. The two go hand in hand. Let the buyer beware and do due diligence. Any sawbones with a paring knife and a bottle of rubbing alcohol can hang his or her shingle in Mattapan but so can any respectable surgeon. You roll the dice for relief and the chance to improve your condition. You take your chances but there are worse places than Mattapan. There aren't any statistics for all the successful operations.

Unpaid Bills

A nice place to pay your utility and phone bills is at Honey Plus on State Street. Yes, you could write checks and send them in the mail. Yes, you could make the most of modern technology and use your computer. Given the choice between paying bills from the comfort of home and vistiting Honey Plus, the answer is obvious.

This store opened a few years ago featuring candy barrels overflowing with sweets for sale by the pound. The business has expanded over time. There is now a line of off-brand grocery products, handmade incense, tobacco products, glass smoking pipes, hardware, small tools, household sundries, perfumes, hygeine products, clothing a hot dog machine, and assorted gift items for the person who has everything but an Atlantic City ashtray or plastic snow globe.

You can pay your gas, electric and telephone bills at Honey Plus. Here is how it works. You stand in line while customers buy cigarettes and lottery tickets. When it's your turn, you hand the clerk your bills. He tallies the amount on a calculator and you pay him cash. Then the clerk enters the payment information for each company into a clicking, whirring machine hidden under the counter. He hands you a receipt for each utility printed on a stiff, cardboard stub as big as an airplane boarding pass.

Whalehead King drove through the rain to pay his bills today. The machine is out of order until Sunday. Hooray! He gets to go to Honey Plus again next week.