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Thursday, 10 April 2014 08:14

ICD-10’s: As Certain as Death and Taxes?

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post 88 picI have been anticipating the advent of ICD-10’s and considering its impact on healthcare and dentistry in particular.

A December post entitled “Physicians Will Experience ICD-10 Anxiety Next Year. Should Dentists?” looked forward to this October, 2014 inevitability.

It was reinforced by Marilyn Tavenner, CMS Administrator, in February while giving a keynote address at the HIMSS conference. Her statement: “Let's face it guys, we've delayed this several times and it's time to move on.”

Well as Benjamin Franklin once said “In this world nothing can be said to be certain, except death and taxes.”

On Tuesday, April 1st the president signed a bill that would postpone the implementation of ICD-10 until 10/1/2015, a one-year reprieve. The language in the bill prohibits CMS from enforcing the 2014 mandate for the new codes.

So do healthcare providers breathe a collective sigh of relief? It depends on where they were at with their ICD-10 preparations.

Thursday, 27 February 2014 10:37

EHR, EDR, PMS, and now certified EHR.

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post 82 picEHR, EDR, PMS, and now certified EHR. Knowing the difference is the key.

The abyss of the acronym language that has become a part of our culture is ever present in both of our professional lives as well as our personal. 

I find that sometimes I have to refer to sites such as just to interpret what my college student is trying to say. 

The understanding of acronyms and what they really stand for is not limited to the culture of our community, for it expands far into our professions as well.  

On occasion I hear a dental professional say “We have been using an EHR for years, so why can’t we use it to qualify for Meaningful Use incentives?”  When I hear this, I am reminded the ever confusing interpretation of what the acronyms EHR, EDR and PMS can be. 

If you look “EHR” up on an acronym finder, “Electronic Health Records” is top of the list, followed by things such as “English Historical Review” and “Explosive Hazards Reduction(s)”.  Electronic Dental Record appears 11th on list for “EDR”, preceded by “Event Data Recorder”.  We won’t even go into “PMS”, although in case you didn’t know, it is for “Practice Management Software”.  

Thursday, 20 February 2014 09:07

Healthcare Dominates Best Jobs for 2014

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post 81 picI love year-end lists:  best movies, richest people, most popular books… 

That’s why when U.S. News and World Report put out “The 100 Best Jobs for 2014”, I was all over it.  I’ll admit to wanting to assure myself that my technology skills would still be in demand, but what surprised me was both the volume and placement of healthcare positions.

While technology jobs hold on to the first and second ranking on the list (#1 software developer, #2 computer systems analyst) the #3 best job for 2014 was a bit of a shock – dentist.  I felt a certain pride in counting nine tech related jobs in the top 100 but this was completely eclipsed by no less than 37 healthcare related occupations.  

The list included all aspects of healthcare with physicians (#8), various nurses (#4, #6, #38, #81), pharmacicsts (#5), various therapists (#7, #14, #21, #27, #32), lab techs, surgical techs, pharmacy techs and radiologic techs.  Dental skills were covered rather thoroughly with #3 being the dentist, #10 being the hygienist and #66 being the dental assistant.

post 80 picWere you one of the 110 million Target customers whose credit or debit card was compromised over the holidays?  No? 

You only shop at high-end stores where this kind of thing would never happen.  That is except for the 1.1 million Neiman Marcus customers who suffered a similar fate. 

Changes are blowing through the U.S. credit and debit card industries with the intent of plugging the holes in this leaky dyke.  These efforts could affect how you handle card payments at your dental practice.

U.S. credit and debit card issuers are going the way of their European and Asian counterparts and embedding a computer chip into the plastic.  In the UK these are called chip and pin cards. 

The credit card industry refers to it as EMV (Europay, Mastercard and Visa).  The chip provides more sophistication and security than presently provided through the magnetic stripe.  

Credit and debit card authorization goes through a 3-step process at the point of sale (POS).

1.    Card Verification – card details are read and authenticated by the POS device.  Currently this happens by the reading of the magnetic stripe.  
2.    Card Holder Verification – this is done through the verification of the signature provided by the card holder with the signature on the back of the card or perhaps with the merchant asking to see a picture ID.  
3.    Transaction Verification – this is an electronic exchange between the POS device and the card issuing bank.  Has the credit limit been reached?  Has the card been reported stolen?

The addition of the embedded chip in the card strengthens the first step and the addition of the pin entry strengthens step 2.  With the embedded chip the card is nearly impossible to duplicate, even if you know the card holder’s account number.

It looks like the U.S. will adopt the chip but not the pin entry and continue to rely on the signature verification to validate the card holder in step 2.  

How might this affect your dental practice? 

post 79 picThe venerable signature pad has been a dental practice companion for years. 

It has been the principal tool to capture an electronic signature on documents needing a higher level of authenticity. 

Are their useful days numbered with the advent of touch screen displays and tablet computers?  The answer is a big NO, and here’s why.

What is an electronic signature?

According to the “Electronic Records and Signatures in Commerce” act the legal definition of an electronic signature is a sound, symbol or process associated with a document that is:

1.    Unique to each user
2.    Under the sole control of the signer
3.    Linked to the document in such a way as to prevent tampering
4.    Capable of being authenticated.

The purpose of these four points is to provide authentication and non-repudiation to the associated document.  

Let’s look at how a traditional pen-on-paper signature stacks up against these measures.


post 77 picOn a non-descript October morning in 2001 Microsoft brought into the world the latest addition to its Windows family of operating systems, Windows XP. 

It became the beloved companion of millions of computers over the years.  A web analytics firm, Net Applications, estimates that it is still being run on over 30% of the world’s 1.5 billion computers. 

But this old friend has reached the end of its life, and late last year Microsoft announced that it would be ending support effective April 8th, 2014.  It will be joined in death by its close friend, Office 2003. 

No services are planned.

Cause of Death

As with any death the immediate question is always “Why?”  Microsoft’s policy is that Windows and its Office products will be supported for a minimum of ten years and XP is in its 13th year.

So what happens on April 8th?  Does it suddenly stop working? 

No.  It means that no new security updates, fixes, or patches will be available.  The longer you have those machines in your office, after the April date, the more vulnerable they become to viruses and hackers. 

Independent software vendors are unlikely to support XP with new versions of their applications and PC hardware manufacturers will stop supporting our late friend.  You should be making plans to replace your XP computers.

post 71 picAs I work through our coding list for DAISY clients and incorporate the changes that the ADA has made to the CDT 2014 code set, I have to work at recalling how the office staff stays informed of the changes that are coming more rapidly to their everyday workflows.

Coding changes are no easy task for any organization, and the impact of the CDT codes impact ADA, HHS, HIPAA standard for use in electronic transactions, insurance companies, clearinghouses, and ultimately the dental practice

When you take a moment to reflect on the many hands that touch the CDT codes on a daily basis, it is immense. 

When you look at the whole picture, the dental practice seems like only a small part of the team. 

However, the dental practice is the one player that begins the entire transaction and can have the most impact on efficient and accurate procedure coding and billing. 

Thus, the accurate posting of the procedure code for that one patient seen this morning can be processed through numerous computers and human processes.  

Thursday, 03 October 2013 10:40

Medical Identity Theft and the Dental Practice

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post 63 picIn last week’s blog I advocated the use of authentication tools such as fingerprint readers to shore up security in the practice or at least the strengthening of password management habits. 

I did this because of the recent rise in medical ID theft and not wanting the dental office to be an enabler of this fraud. 

This week’s post explores medical ID theft a little more closely and attempts to make you aware of the problem’s magnitude and the potential dangers of this crime.

Let me start with a definition.

Medical identity theft is when someone uses another individual’s name and personal ID to fraudulently receive medical services, prescription drugs and/or goods, including attempts to commit fraudulent billing to the insurer.

Numerous articles have been in the press the last few weeks because of the publishing of a paper entitled “2013 Survey on Medical Identity Theft” by the Ponemon Institute.  Most of the content in this post is based on the results of that survey.  

How big is the problem?

This problem is huge. 

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