Billing, coding, and practice management: a primer for today's reproductive medicine professional.

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.

Legal requirements for optimal haemophilia treatment in Germany.

The clinical benefits of early prophylaxis in the treatment of haemophilia have been unquestioned since publication of the results of the first randomized study. The question of whether or not prophylaxis is cost-effective remains to be proven. For European physicians treating haemophilia patients, and for German clinicians in particular, the law largely supports the use of prophylaxis in haemophilia, but many doctors are unaware of this. The aim of this review was therefore to describe the German legal framework and outline how it can be used to support appropriate clinical decision-making in the treatment of haemophilia and justify the use of prophylaxis to health insurers and third-party payers. The German Disability Equalisation Law and German Social Law Books V and IX outline legal requirements to prevent or ameliorate disability, and support the argument that all haemophilia patients, including adults, have the right to receive appropriate, adequate, and cost-effective treatment. "Appropriate" treatment means that it must be in accordance with state-of-the-art medical knowledge taking into account medical progress. "Adequate" treatment must be conducive to the goals of haemophilia management, which are to prevent bleeds, treat bleeding episodes, maintain and/or restore joint function, and integrate patients into a normal social life. This can only be achieved when long-term treatment is adequately dosed and regularly administered for as long as it is required. Thankfully, with the availability of virus-safe factor concentrates, the introduction of home treatment programmes, and the law on our side, we are in a very strong position to achieve these goals.

The emergence of diagnostic imaging technologies in breast cancer: discovery, regulatory approval, reimbursement, and adoption in clinical guidelines.

In this article, we trace the chronology of developments in breast imaging technologies that are used for diagnosis and staging of breast cancer, including mammography, ultrasonography, magnetic resonance imaging, computed tomography, and positron emission tomography. We explore factors that affected clinical acceptance and utilization of these technologies from discovery to clinical use, including milestones in peer-reviewed publication, US Food and Drug Administration approval, reimbursement by payers, and adoption into clinical guidelines. The factors driving utilization of new imaging technologies are mainly driven by regulatory approval and reimbursement by payers rather than evidence that they provide benefits to patients. Comparative effectiveness research can serve as a useful tool to investigate whether these imaging modalities provide information that improves patient outcomes in real-world settings.

Ira P. Gunn: educator, advocate, legend.

This column examines the contributions of nurse anesthetist Ira P. Gunn, CRNA, MLN, FAAN (1927-2011), widely recognized as a visionary and tireless advocate for the profession of nurse anesthesia. Her contributions to nurse anesthesia practice, research, education, publication, consultation, credentialing, and government relations have significantly contributed to the preservation and advancement of nursing and nurse anesthesia.

A tribute to George F. Sheldon's vision, versatility, and leadership by example.

To honor Dr. Sheldon's service to the Department of Surgery, the School of Medicine, and the University and to recognize his national and international leadership in the surgical discipline, the University of North Carolina at Chapel Hill hosted a Festschrift in his honor on April 20, 2002, in conjunction with the 50th Anniversary of the UNC School of Medicine.

Finance issue brief: emergency care.

Under what circumstances is an enrollee in a managed care plan eligible to exercise judgment as a "prudent layperson" in determining that an emergency medical condition exists? Does his or her condition justify immediate attention without prior authorization, even if it means an emergency room visit or dialing 911?

Finance issue brief: prompt payment.

Although under standard business laws withholding prompt payment is considered an unfair trade practice, a number of states are enacting new laws or clarifying existing language to ensure that health plans are paying providers in a timely fashion.

Chronic pulmonary disease in South Wales coal mines: an eye-witness account of the MRC surveys (1937-1942).

In the mid-1930s reports were accumulating from the British coalfields, particularly from the anthracite area of South Wales, that coal face workers suffered a disabling lung condition that was not recognized as the (compensatable) silicosis of rock workers. The Second World War was threatening and discontent was rife. Government, through the Medical Research Council, initiated a medical and environmental investigation of chronic pulmonary disease in South Wales coalminers to make a systematic survey. The medical surveys, 1936-1942, were undertaken by a member of MRC staff, Dr Philip D'Arcy Hart assisted by Dr Edward Aslett of the Welsh National Memorial Association. One colliery (Ammanford) was intensively investigated; fifteen others less so; coal trimmers at the docks were added. The main observations were to confirm and describe radiographically the frequency of serious lung lesions apparently due to coal dust, and distinguishable from classical silicosis. Among recommendations accepted by Government, the lung condition became recognized for compensations, and the generic term pneumoconiosis of Coal Workers' was substituted for silicosis.

The role of Medicare reimbursement in contemporary hospital finance.

A hospital, while performing its major function of providing health care, is also viewed as a business. It needs capital from a wide variety of sources, many of which are government regulated. Over the past few years, federal expenditures for Medicare have increased dramatically, as has regulation of hospital revenue sources. Congress enacted the Medicare Prospective Payment System (PPS) to curb hospital cost inflation. This Note examines historical trends in health care financing and analyzes the Medicare reimbursement system, with emphasis on PPS and its impact on hospital revenues. The Note suggests that hospitals, due to the effects of PPS, will be forced to reduce their levels of financial leverage and will have to look for corporate financial alternatives. PPS may signal a new era in hospital finance. Survival mandates an increased focus on efficient corporate, financial and managerial policies.