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by John Stossel

    "Fake news!" shouts the president. His supporters cheer.
    That drives my colleagues into a frenzy of self-absorbed handwringing: "Threats to press freedom ... press persecution!"
    It's silly. American reporters are hardly less safe because of President Donald Trump's hyperbole.
    (Trump is reckless when he uses the term in other countries. Authoritarians in Russia, China, the Philippines, Saudi Arabia, etc., now cite "fake news" while they jail or kill reporters. He should shut up about "fake news" when he's overseas.)
    But I smiled when I first heard him use the phrase, not because news stories are "fake"-- they typically aren't (reporters who make things up are usually caught and fired) -- but because so much of what people call "news" is press releases and breathless exaggerations of isolated problems.
    It's stupid news.
    This spring, I attended my 50th college reunion. Alumni officials asked me to join a panel titled "Free Speech and Fake News."
    It made me ask myself, "What were the biggest life-changing events in the 50 years since I graduated?"
    My selections:
    --Invention of the personal computer and cellphone.
    --Google and Facebook.
    --The fall of the Soviet Union.
    --Pollution-control rules.
    --The women's movement.
    --Changing attitudes about sex and gender.
    --A drastic reduction in poverty around the world.
    Only one of those giant changes (the fall of the Soviet Union) led the news!
    Instead, "big" headlines of my previous reunion years (five-year periods when I might show up for the celebration) were topics like:
    --Patty Hearst robbing a bank.
    --Serial killer Ted Bundy.
    --The accident at the Three Mile Island nuclear plant.
    --The "Band-Aid" concert for famine relief.
    --The Exxon Valdez oil spill.
    --The O.J. Simpson trial.
    --Columbine.
    --Michael Jackson's death.
    --Ebola.
    --And this year: the Ethiopian Airlines plane crash.
    (I chose those stories from "biggest stories of the year!" reports in mainstream media like MSN and ABC News.)
    Those events were worth covering, but why do media mostly ignore more important events like the creation of cellphones and Google or how millions have lifted themselves out of poverty?
    One reason is because they happen gradually. When Facebook was being invented, few reporters noticed.
    Another is because the big stories happen in more than one place. We reporters are good at covering plane crashes and murder. We can easily interview the official in charge.
    But the biggest news, like changing attitudes about gender, happens all over the place.
    When I graduated, 60% of the world's population lived in extreme poverty. Now, fewer than 9% do. Globally, that's probably the most life-changing event over the past 50 years -- a great victory, made possible by freer markets.
    But most reporters don't like free markets, and politicians rarely talk about change they don't control.
    The "Band-Aid" concert meant well, but journalists hardly covered the big cause of famine in Ethiopia. It wasn't African drought; it was Marxist governments that were happy to starve their enemies.
    In 1989, the Berlin Wall coming down was too beautiful an image to ignore, but it would have been nice if journalists had spent time analyzing how wrong they'd been to call capitalism unjust and communism sustainable.
    Instead, images of the Exxon Valdez oil spill dominated the news that year, helping spark a decade of exaggerated environmental fears.
    In 1994, the Rwandan genocide did get news coverage, as it should have, but Americans heard much more about O.J. Simpson.
    In 2004, coverage of the Iraq and Afghan wars was plentiful, which was good. But now that the Afghanistan War is America's longest war, it gets very little coverage. It's harder to report on long-term political problems that aren't solved by U.S. military intervention.
    During my previous reunion, in 2014, one of the biggest stories was hysteria about an Ebola virus outbreak. But only one American died from Ebola that year.
    My fellow Princeton panelists sneered at me when I said that. They said that thousands died in Africa. That was true, but if that's the measure of a news story, why aren't millions of deaths from malaria and diarrhea in Africa front-page news? Because "Ebola!" scares reporters and makes for better clickbait headlines.
    The news is stupid and shallow.
    John Stossel is author of "No They Can't! Why Government Fails -- But Individuals Succeed." For other Creators Syndicate writers and cartoonists, visit www.creators.com.
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by Walter E. Williams

    Years ago, it was hard to be a racist. You had to be fitted for and spend money on a white gown and don a pointy hat. You celebrated racism by getting some burlap, wrapping it around a cross, setting it ablaze and dancing around it carrying torches. Sometimes, as did Lester Maddox, you had to buy axe handles for yourself and your supporters to wield to forcibly turn away black customers from your restaurant. Or, as in the case of Theophilus "Bull" Connor, you had to learn to direct fire hoses and vicious police attack dogs against civil rights demonstrators.
    Younger racists, along with their parents, had to memorize poems for whenever a black student showed up for admission to their high school or college. For example, "Two, four, six, eight, we don't want to integrate!" Of course, there were a host of racial slurs and epithets that could be hurled, with impunity, at any black person in your presence. In earlier times, you didn't have to be sophisticated, but it took a bit of work, to be a racist.
    Today, all that has changed. To be a racist today takes little effort. For example, one can sit back in his easy chair and declare that he's for across-the-board tax cuts. That makes you a racist. If you don't believe me, think back to 1994 when the Republican-led Congress pushed for a tax-cut measure. Former U.S. House of Representatives member Charles Rangel, D-N.Y., denouncing the Republicans' plan before a Manhattan audience as a form of modern-day racism said: "It's not 'spic' or 'n-----' anymore. (Instead,) they say, 'Let's cut taxes.'" A few months later, he compared the GOP's "Contract with America" to measures in Nazi Germany saying, "Hitler wasn't even talking about doing these things."
    One can be labeled a racist through a set of "microaggressions" listed in "Diversity in the Classroom, UCLA Diversity & Faculty Development" from 2014.
    Here are a few statements one should avoid: "You are a credit to your race." "Wow! How did you become so good in math?" "There is only one race, the human race." "I'm not racist. I have several Black friends." "As a woman, I know what you go through as a racial minority."
    But most instances of microaggressions are less overt. There are college microaggressions such as a male student rolling his eyes when a female student speaks, or people not wanting to be in study groups with those of different races.
    Perhaps the easiest way to be labeled a racist is to suggest that a wall be built on our border with Mexico in order to keep people from Mexico and points south from entering our nation illegally. Also, a slam-dunk charge of racism is to say that the standard practice of separating children from parents is Nazi-like. But imagine you are stopped with your child in the car and charged with a DUI in any of our 50 states. You're going to be arrested and your child taken to protective child services. The identical practice on our southern border becomes racism.
    As veteran journalist Brit Hume said about the uproar over President Donald Trump's latest bomb-throwing: "Trump's 'go back' comments were nativist, xenophobic, counterfactual and politically stupid. But they simply do not meet the standard definition of racist, a word so recklessly flung around these days that its actual meaning is being lost." The president cleaned up his remarks a few days later saying: "These are people that hate our country. If you're not happy in the U.S., if you're complaining all the time, very simply, you can leave." By the way, leaving isn't Trump's idea. Many leftists pledged to flee America altogether if Trump were elected president.
    The bottom line is that when leftists have no other winning argument, they falsely accuse others of racism. Republicans cower at the charge and often give the leftists what they want. Black Americans who are octogenarians, or nearly so, need to explain what true racism is, not to correct white liberals but to inform young black people.
    Walter E. Williams is a professor of economics at George Mason University. To find out more about Walter E. Williams and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate webpage at www.creators.com.
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by John Stossel

    Never before have presidential candidates offered voters so much "free" stuff.
    Kamala Harris wants you to "collect up to $500 a month."
    Elizabeth Warren says, "We need to go tenfold in our research and development in green energy."
    No one has tracked the cost of all of the promises. So my video team did!
    Who will spend the most?
    Here are the new spending proposals from the five most popular (according to ElectionBettingOdds.com) candidates.
    In my latest video, we break it down by category, education spending first:
    Joe Biden wants to "triple the amount of money we spend for Title I schools" ($32 billion) create "universal pre-K" ($26 billion), provide "free community college" ($6 billion per year) and double the number of psychologists and social workers in schools ($14 billion) -- $78 billion total.
    That's a lot, but much less than what Kamala Harris would spend.
    She too wants to "make community college free" ($6 billion), but she'd add debt-free "four-year public college" ($80.1 billion), "increase government's investment in child care" dramatically ($60 billion) and "give the average public school teacher a $13,000 raise" ($31.5 billion) for a total of $177 billion.
    Pete Buttigieg rarely says what his proposals would cost, but he at least seems to want to spend less than Harris.
    He touts "free college for low- and middle-income students" and would give teachers more money. Assuming his plan is like Harris', that brings his education total to $87 billion.
    Elizabeth Warren would spend much more.
    "You'll be debt-free!" she tells students. Taxpayers, unfortunately, will be deeper in debt, since she would "forgive" most existing student debt and make public college tuition free ($125 billion).
    She also wants a "Universal Child Care and Early Learning Act" ($70 billion).
    These big-ticket items put her in first place so far.
    But wait! Bernie Sanders would spend even more.
    He'd completely "eliminate student debt," "make public colleges and universities tuition-free" and provide universal day care and pre-K. That totals $280 billion, so Sanders "wins" in education spending.
    I assumed the self-described socialist would be the biggest spender, but he's got lots of competition! Let's look at health care spending.
    Harris, Sanders and Warren all propose "Medicare for All," including for people here illegally.
    Sanders goes further, saying, "Under our plan, people go to any doctor they want." He admits it will cost between $3 trillion and $4 trillion per year, about what the government now spends on everything. How will he pay for that? Well, somehow the rich will pay. Or Martians. Somebody.
    Sanders, Harris and Warren all said they'd ban private health insurance -- although Harris now says she'd let private companies sell "Medicare plans" that "adhere to strict Medicare requirements on costs and benefits." She also claims her "Medicare for All" will be cheaper than Sanders' version, but as of now there is no independently calculated cost.
    When it comes to the environment, all Democratic candidates but Biden say they support the Green New Deal, which Republicans say would cost $93 trillion. For our ranking, I went with the lowest estimate we could find: An economist who likes the idea says it will cost around $500 billion a year.
    Welfare? Harris would increase benefits and have the government pay your rent if it's over 30% of your income ($94 billion), and Friday she offered $75 billion to black colleges and minority entrepreneurs.
    Warren wants to spend more ($50 billion) on housing.
    Sanders would increase food stamps for kids ($10.8 billion), boost Social Security benefits ($19 billion) and guarantee everyone a government job ($158 billion), for a total of $187.8 billion.
    President Donald Trump, who says America will never be a socialist country, hasn't been a responsible spender either.
    Since he took office, spending increased about $500 billion per year. Trump did propose some cuts, but when Congress ignored his cuts and increased spending, he signed the bills anyway.
    Now he says he'd spend even more: $200 billion a year for infrastructure, $8.6 billion for the border wall construction, $1.6 billion for more NASA funding and on and on, for a total of $267 billion.
    We can't afford it! The federal government is already $22 trillion in debt -- $150,000 per taxpayer.
    While Trump's $267 billion is bad, the Democrats' plans are worse. We counted $297 billion proposed by Biden, $690 billion from Buttigieg, $3.8 trillion from Warren, $4 trillion from Sanders and $4.3 trillion from Harris. That would double what the entire federal government spends now.
    Senator Harris "wins" the free stuff contest.
    Taxpayers lose.
    John Stossel is author of "No They Can't! Why Government Fails -- But Individuals Succeed." For other Creators Syndicate writers and cartoonists, visit www.creators.com.
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By Trinity Albertson, MBA, CPC, CRC

Making money in healthcare is a far different process than in any other business model and revenue is the pipeline of any business. Without reimbursement for services rendered, any healthcare organization can be in serious trouble. Knowledge of the healthcare revenue cycle will allow you to identify the gaps in your practice.

Earning money in healthcare starts and ends with the patient encounter. Everything revolves around the visit; from the quality of the initial intake, to the clinical documentation and code selection, and billing and collection efforts. Here, we will briefly discuss the 7 deadly mistakes in healthcare revenue cycle and how to avoid them. Let’s get started!

1. Inaccurate Verification of Eligibility and Benefits with No Cost Estimation
Today, patients are shoppers, for both their insurance plan and their medical care. With laws now requiring citizens to have medical coverage, there has been a rise in high deductible plans and payer requirements for coverage of services.
 
“Nearly 25 percent of medical practices do not verify patient eligibility upfront, according to a report by Caparo. (Murphy, 2016)”
Accurate verification of coverage and benefits is crucial for proper payment, not only from the payer but also from the patient. 
Why do we verify insurance eligibility and benefits? Well, to answer these questions:

a.    Is the patient’s coverage active and are they on the policy?
b.    Is a pre-certification/authorization required?
c.    Do they meet medical necessity per the payer’s requirements?
d.    What is the patient responsibility portion?

Real-time eligibility is key. There are plenty of tools now that automate this process and provide real-time benefit details for any patient, payer, and plan. When in doubt, call!

Cost estimation tools are the second part of this process. Not only should these basic above questions be answered, before rendering services, but costs for the services the patient will receive should be calculated and transparent. High deductible plans mean less coverage for the patient initially and patients are involved more than ever.

“Rapid HSA (health savings account) adoption increase; approximately $775 billion in 2020 invested into HSA’s.”

Patients want to know what their bill will be upfront. Patients will compare your prices to your competition and without an estimate at all, they likely will go elsewhere.

2. Lack of Point of Service Collections and Payment Options
Once the patient walks out the door, regardless of ability, propensity to pay changes significantly. Collection efforts before services being rendered only guarantee payment.
Statistics show, “68% of patients failed to fully pay off medical bill balances in 2016, up from 53 percent in 2015, and 49 percent in 2014. This number is expected to climb to 95% by 2020. (TransUnion, 2017)”
Giving patients convenient payment options will significantly increase collections as well. Patient’s want access to digital tools and online bill pay. Without means of collecting numerous payment methods in office, your collections will decrease. Cash, check, and all major credit cards are the standard. Your billing statements should be easy to read and understand. Get rid of all the technical jargon and make the balance owed stand out visually. (Healthcare, 2019)

3. Poor Clinical Documentation Integrity
Everything revolves around the note. Are your clinicians exercising good clinical documentation integrity? Comprehensive documentation can be simple.
The note indicates everything that happened in the encounter. Proper documentation and coding support the clinical judgment of the treating provider. Without the proper details, it is likely that your claims will not be supported and may result in the recoupment of payment. All diagnosis and procedural codes should be 100% supported in the note. The note should be completed within 48 hours of the encounter, signed, and submitted for audit and billing. An audit is the only way to truly tell if your clinicians are missing the mark in their documentation. Complete and accurate clinical documentation will maximize your reimbursement potential.
How to document clinical documentation appropriately is not taught in medical school, and the importance may not be obvious to the provider. There are several ways to increase the effectiveness of a CDI (clinical documentation integrity) program in your organization.
“The main message to physicians should be that CDI is a quality initiative. (Towers, 2013)”

4. No Denial Prevention
Did you know? One (1) out of every five (5) claims are denied or rejected (Alpha II, 2019)

•    15-20% of all claims filed
•    60% of lost/denied claims are never resubmitted
•    18% of denials are never collected

Appeals and Rejections are Costly! Approximately 2/3’s of appeals and rejections are recoverable (Alpha II). The average price for reworking a claim is approximately $25.20 each (Alpha II).
Are you tracking First Pass Claims Rate (acceptance of a claim) in your practice?

Here are some of the Top Denial and Rejection Reasons noted by CMS:

•    Mismatched CPT/ICD-10 code
•    Incorrect Coding
•    Lack of Medical Necessity
•    Upcoding/Unbundling
•    Missing/Incorrect Modifiers
•    No Physician Signature

There are many tools available to help you with denial prevention and management. Consult in an expert today!

5. Little payer management
Effectively managing and modeling payer contracts is crucial as the terms of these contracts have a significant impact on a healthcare organization's financial performance and each payer contract is different.

“Managing contracts successfully starts with clearly understanding all aspects of your contracting landscape. That can be allowing others in the organization to leverage the contracting material to perform their functions better. (Gooch, 2017)”

Effective payer management means having a good relationship with great communication. The goal is prospective payments. Measuring and monitoring the performance of your payers will indicate if you are being paid appropriately. If you are not getting paid correctly, this is a battle you should be fighting.

Have you negotiated your reimbursement rates recently?
Four Critical Components to Payer Contracting and Negotiation (Alpha II, 2019):

•    Composition: What are you starting with?
•    Performance: How well is the payer performing?
•    Expectation: How should they be performing?
•    Strategy: Steps to reach the expected performance

Note: a negotiation can be initiated anytime, regardless of what the contract says, yet should occur upon regular renewals, approximately every 2-3 years.

6. Not Having Quality Data and Key Performance Indicator Management
Data doesn’t lie! Without good analytics, it is almost impossible to identify the true gaps in your practice and the bottom line for your organization will be negatively impacted. Changes in healthcare IT (information technology) have made it easier to monitor the performance of your revenue cycle.
How do you know what should be measured? The right revenue cycle consultant has the right solutions for you. Don’t wait!

7. Inadequate staffing
We’re not recommending throwing warm bodies at the problem!

“We know how challenging it is to find the right people with the right skills to keep your revenue cycle humming. There always seems to be a shortage in the marketplace, not to mention budget restraints. Because of this, most healthcare organizations are trying to ‘make-do’ with existing staff. It’s a classic case of continually trying to do more with less. We’re all guilty of this, but in truth, we’re only hurting ourselves in the end. (Smith, 2016)”

•    Start with calculating workload (task x time x frequency = workload)
•    Implement a robust training program

With the right staffing and training, your revenue cycle will outperform your expectations!

submitted by Trinity Albertson, Healthcare business consultant and coach, Colorado Springs

For more information visit TFALLC.net

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by Walter E. Williams

     Let's think about priorities. Say that you live in one of the dangerous high crime and poor schooling neighborhoods of cities like Chicago, Baltimore, Detroit or St. Louis. Which is most important to you: doing something about public safety and raising the quality of education or, as most black politicians do, focusing energies upon President Donald Trump and who among the 20 presidential contenders will lead the Democratic Party? The average American has no inkling about the horrible conditions in which many blacks live. Moreover, they wouldn't begin to tolerate living under those conditions themselves.
        In Chicago, one person is shot every four hours and murdered every 18 hours. Similar crime statistics can be found in many predominantly black neighborhoods in Baltimore, Detroit, St. Louis and many other large cities. It's not just an issue of public safety, for high crime has other devastating consequences.
        Crime lowers the value of property. We can see some of this when housing prices skyrocket in formerly high crime areas when large numbers of middle- and upper-income people purchase formerly run-down properties and fix them up. This is called gentrification -- wealthier, predominantly white, people move in to renovate and restore slum housing in inner cities, causing higher rental prices and forcing low-income residents out. Also, as a result of gentrification, crime falls and neighborhood amenities increase.
        The high crime rates in many black neighborhoods have the full effect of outlawing economic growth and opportunities. Here's a tiny example of the impact of crime on businesses. In low crime communities, supermarket managers may leave plants, fertilizer and other home and garden items outdoors, unattended and often overnight. If one even finds a supermarket in a high crime neighborhood, then that store must hire guards, and the manager cannot place items outside unguarded or near exits. They cannot use all the space that they lease, and hence they are less profitable. Who bears the ultimate cost of crime? If you said black people, you're right. Black people must bear the expense to go to suburban shopping malls if they are to avoid the higher prices charged by mom and pop shops.
        In low crime neighborhoods, FedEx, UPS and other delivery companies routinely leave packages that contain valuable merchandise on a doorstep if no one is at home. That saves the expense of redelivery and saves recipients the expense of having to go pick up the packages. In high crime neighborhoods, delivery companies leaving packages at the door and supermarkets leaving goods outside unattended would be equivalent to economic suicide.
        Today's level of lawlessness and insecurity in many black communities is a relatively new phenomenon. In the 1950s, '40s, '30s and earlier times, people didn't bar their windows. Doors were often left unlocked. People didn't go to bed to the sounds of gunshots. And black people didn't experience anything like what's experienced in Chicago and other cities such as one person being shot every four hours and murdered every 18 hours. The uninformed blame today's chaos on discrimination and poverty. That doesn't even pass the smell test, unless one wants to argue that historically there was less racial discrimination and poverty than today.
        Politicians who call for law and order are often viewed negatively, but poor people are more dependent on law and order than anyone else. In the face of high crime or social disorder, wealthier people can afford to purchase alarm systems, buy guard dogs, hire guards and, if things get completely out of hand, move to a gated community. These options are not available to poor people. The only protection poor people have is an orderly society.
        Ultimately, the solution to high crime rests with black people. Given the current political environment, it doesn't benefit a black or white politician to take those steps necessary to crack down on lawlessness in black communities. That means black people must become intolerant of criminals making their lives living hell, even if it requires taking the law into their own hands.
        Walter E. Williams is a professor of economics at George Mason University. To find out more about Walter E. Williams and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate webpage at www.creators.com.
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