Scary Things Doctors Do: New Investigative Tool for Patients

Scary Things Doctors Do: New Investigative Tool for Patients

 

Most doctors do wonderful things. They take care of their patients and work very hard. I’m married to a fantastic doctor, so I know they exist.  However, having spent 15 years as a pharmaceutical representative, I saw some scary things out there.  It’s important to keep in mind that someone had to graduate last in their class.  Here is a list of things that I actually saw occur in doctors’ offices while I was in the field.

  1. Illegal drug use in doctor’s office – There was one office where the receptionist actually had her boyfriend shoot something (I assume heroine) into her arm while I talked to her through the glass partition that separated the waiting room from the doctor’s area.  The reaction she got from the medication made it clear it was some form of illegal substance.  The doctor walked right by and had no reaction.
  2. Doctors popping pills – There was one doctor I called on who would take Prozac while he chatted, bragging, “I take these things to lose weight.”  This same guy was always popping some form of pill, usually for an off-label use.
  3. Doctors committing fraud – Another doctor in my territory was arrested for charging the government for testing blood that he never actually tested.
  4. Doctors not using best medications to save money – I called on a doctor who once told me that he would not prescribe a drug that he thought he was good for his patients because, as he put it, “that comes out of my budget  . . . if they go to the ER, someone else pays for it.”  He had no problem telling me that he didn’t mind if his patients suffered if it meant he could make a few more bucks from the HMO.
  5. Doctors getting paid by pharmaceutical companies – It is not unusual for a doctor to get paid to speak for certain pharmaceutical companies.  I remember calling on a particular doctor who made it very clear that he not only spoke for a particular company but also had a great deal of stock in that company. Because of this relationship, he had no intention of using competitive products even if they were better.

The good news is that the Internet allows for patients investigate issues with their doctors.  According to the article, How To Find Out if Your Doctor and Drugmakers Are In A Relationship, “The nonprofit investigative journalism outfit ProPublica has a tool you can use to see how much money your doctor has received from drug companies.”  To find out if your doctor is profiting from drug companies, click here to go to the ProPublica site.

 

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Doctors’ Time Running Out To Meet HIPAA 5010 Requirements

Effective January 1, 2012 there will be a new HIPAA 5010 version that will be a required for doctors to use for electronic filing.  If physicians don’t use version 5010 for all HIPAA electronic transactions by that date, their claims will be rejected and they won’t be paid.  Doctors are feeling the pressure to get their systems ready for this change.  Many physican practices have not embraced the electronic age as well as other businesses have and are now behind the eight ball, scrambling to meet these new standards.

Medcost.com reported, “The purpose of 5010 is to facilitate the country’s ongoing goal of transitioning to an electronic health care environment by updating the current standards for electronic health care and pharmacy transactions. The updated 5010 versions replace the current versions of the standards and will promote greater use of electronic transactions. This change has been driven by the United States Department of Health and Human Services (HHS).”

There are some helpful resources to show doctors how to prepare for this transition.  GetReady5010 offers free webinars.  The AMA also has some excellent resources. Despite all of these free offerings, many physicians are not prepared for this change. American Med News reported, “Many physicians have not even begun to see if they are compliant with what are known as HIPAA Version 5010 standards. According to a survey released in March by the Medical Group Management Assn., 56% of practices have not scheduled any internal testing for 5010, and 61% have not scheduled any testing with their major health plans. The survey covered 349 practices with 13,290 doctors.”

What’s new in the HIPAA 5010 version? Some of the changes include:

  • Physicians must submit a nine-digit, rather than a five-digit, ZIP code
  • Physicians may distinguish between principal diagnosis, admitting diagnosis, external cause of injury and patient reason for visit codes
  • 5010 set will allow for the inclusion of ICD-10 codes

Nextgen.com listed the following frequently asked questions relate to HIPAA 5010 to help understand requirements.  Click on the links for answers to each of the questions.

  1. What is HIPAA 5010?
  2. Who will need to upgrade to HIPAA 5010?
  3. Why must I upgrade to HIPAA 5010?
  4. How is HIPAA 5010 different from HIPAA 4010?
  5. What are the key dates for HIPAA 5010 and what is the deadline for HIPAA 5010 implementation?
  6. What happens if I’m not ready by the compliance deadline?
  7. Is there a chance for a delay in the compliance date?
  8. What do I need to do to prepare for the upgrade to 5010?
  9. If I finish all of this work before the compliance deadline, can I start to use the 5010 transactions?
  10. What provider transactions are implemented with HIPAA 5010?
  11. Where can you obtain the X12 Technical Reports?
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