BREAKING INTO THE MEDICAL TECHNICAL WRITING FIELD 10/19/2010 Traci Wilbanks, Senior Technical Writer 2 Introduction How I got in the door My Medical Experience 3 Started as a technical writer for a durable medical equipment (DME) company and transitioned into the role of a business systems analyst in the IT organization. Currently working for a clinical decision support system (CDSS) software company in the Operations organization. Medical Experience is a Must? 4 The requirement for medical experience seems to depend on the organization’s structure and to whom the technical writer role reports. Medical experience seems less important for technical writers in the IT organization. Having basic knowledge of the health care workflow from claim to payment helps as does knowledge of industry jargon and standards organizations. 5 Writing in the Medical Arena Personal experience is still experience As a Patient 6 You know that the healthcare system is complex. Every provider has different rules and processes for submitting claims and getting paid, but the overall process is fairly standard. Your experience with your own health care or the health care of a family member is helpful because it gives you a different perspective which can help you better serve your end users. Major Streams in Healthcare 7 Payers Care and claims management Its customers are members Pharmacies Provide drugs Its customers are patients and providers Providers Physicians, hospitals and other facilities Its customers are patients Suppliers Provide anything prescribed that is not a drug Its customers are patients and providers 8 Knowing the Major Players Big insurance companies are not the only big guys on the playing field As Medicare/Medicaid Goes, So Goes the Nation 9 The Centers for Medicare & Medicaid Services (CMS) is a branch of the U.S. Department of Health and Human Services. CMS is the federal agency that administers the Medicare program and monitors the Medicaid programs offered by each state. http://www.cms.hhs.gov/ CMS dictates the direction and initiatives of medical billing and medical software companies because meeting CMS’s requirements satisfies a large portion of its patient base. The VA 10 The United States Department of Veterans Affairs not only provides its members with health care benefits, but it also administers the care through its facilities. With 1,400 sites of care, the VA operates the largest integrated health care system in the nation. CMS + VA 11 As of August 2010, 25.4% of US adults were insured through a government program such as Medicare, Medicaid, or military/veterans’ benefits. This figure is about 13% higher than the 22.5% of US adults receiving government health insurance in January 2008, one month after what is generally considered to be the December 2007 starting point of the current recession. - Gallup-Healthways Well-Being Index The Joint Commission 12 The Joint Commission is an independent, not-forprofit organization which accredits and certifies more than 18,000 health care organizations and programs in the United States. The mission of the Joint Commission is to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. Guidelines and Compliance 13 In order for providers to get paid, they have to be compliant with established guidelines. Most health care organizations look to the Joint Commission for these guidelines. Guidelines cover a variety of areas based on the type of health care program (i.e. ambulatory care, home care, hospitals, laboratories, etc.). 14 Client Systems & Technology Setting the Pace of Progress User Interfaces & Hardware 15 The technology underpinning most medical billing systems is antiquated (e.g. green screen terminal emulators to view AS400 data). Organizations often have several disparate systems with no interoperability. The hardware in larger institutions (i.e. hospitals, suppliers, etc.) is often a decade behind current levels which limits the innovations proposed by Development. 16 What is Healthcare Reform’s Impact? Paying attention to politics is critical HITECH Act 17 Health Information Technology for Economic and Clinical Health Act The HITECH Act is part of the American Recovery and Reinvestment Act of 2009 in which $19.2 billion is intended to increase the use of Electronic Health Records (EHR) by physicians and hospitals. If physicians and hospitals are “meaningful users” of EHR systems, they are eligible for reimbursements which could cover the costs of implementation. EHR system vendors are clamoring to demonstrate adherence to meaningful use guidelines to become a certified EHR; government money is only available if a certified EHR is purchased. Data Interchanges 18 HL7 – Health Level 7; clinical and administrative data domain; one of several American National Standards Institute (ANSI) accredited Standards Developing Organizations (SDOs) SNOMED CT – Systemized Nomenclature of Medicine Clinical Terms Recommended reading – Principles of Health Interoperability HL7 and SNOMED by Tim Benson Competitive Bidding 19 The Medicare Modernization Act of 2003 established requirements for competitive bidding for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). The intent is to set more appropriate payment amounts for these items which will result in reduced out of pocket expenses for Medicare beneficiaries. This act forced medical suppliers to enhance existing intake and billing systems to establish whether or not the supplier won the bid in a given area and what the fixed price is. Rounds of bidding happen every 18 months requiring the systems to remain flexible. 20 What Should You Know? Getting your foot in the door may require a little research Acronyms 21 HIPAA – Health Insurance Portability and Accountability Act PHI – Protected Health Information HCPCS Codes – Healthcare Common Procedure Coding System ICD-9/ICD-10 Codes – International Statistical Classification of Diseases EMR/EHR – Electronic Medical Record/Electronic Health Record LOINC – Logical Observation Identifiers Names and Codes NDC – National Drug Code NPI/UPIN – National Provider Identification/Unique Provider Identification Number Third Party Organizations 22 Clearing houses – entities which process or aid in the processing of information (e.g. perform billing functions for a supplier, offer consolidated list of guidelines) Drug Database Publishers – provide metadata about drugs including descriptions, pricing, and interactions