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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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by John Stossel

        Sen. Bernie Sanders' presidential campaign was just disrupted by campaign workers demanding the same $15 per hour Sanders demands government force all employers to pay.
        It serves him right.
        Years ago, the activist group ACORN faced the same problem. After fighting for a higher minimum wage, they tried to convince a judge they should be granted an exception when paying their own workers, since they were involved in such important and productive work.
        Government telling employers what to pay people creates nasty side effects.
        Five years ago, Seattle won fame by becoming the first American city to mandate a $15 per hour minimum.
        "Fifteen in Seattle is just a beginning. We have an entire world to win! Solidarity!" vowed City Councilmember Kshama Sawant.
        New York state and many cities followed in Seattle's footsteps.
        But now the results from Seattle are in:
        Some people who already had jobs are being paid more. They're the winners under the new law.
        But the losers are needier people: people who are looking for jobs.
        After Seattle raised its minimum wage to $15, entry-level job growth stalled. Job growth continued in the rest of Washington state but not in Seattle.
        The $15 minimum helped some people while hurting even poorer people.
        "It's presented by minimum wage advocates as a win-win ... no negatives," complains a skeptical Erin Shannon of the Washington Policy Center in my latest video.
        Shannon points out the negatives. For example, stores that once hired inexperienced kids and trained them, giving them valuable starter experience, stopped doing so once Seattle raised its minimum wage.
        "Politicians," one store owner told my video producer, "have no sense whatsoever about what it means to small businesses like us."
        Today, for companies with more than 500 workers, Seattle's minimum wage is $16 per hour.
        It's as if the politicians never learned about supply and demand. They think prices can be set wherever government decrees, with no consequences.
        But there are many bad consequences.
        Twenty-year-old Dillon Hodes understands that. He's a winner of the video-making contest run by my charity, Stossel in the Classroom. Hodes saw what happened to his friend when the Kroger she worked at raised its minimum wage to $12 an hour.
        "She was getting paid $12 an hour, but slowly, they started cutting her days, her hours. She was (eventually) regulated to only working on Sundays. That's because she was young and inexperienced," explains Hodes. "She's worth the world to me, but she wasn't worth $12 to Kroger."
        The $12 minimum wage took away her job. How much more damage will a $15 minimum do?
        Rigel Nobel-Kosa, another sitc.org video contest winner, pointed out that many high employment "countries such as Iceland, Norway, Sweden and Switzerland" have no minimum wage laws.
        They do not end up with impoverished workers making a penny an hour. Wages, like all prices, are a function of supply and demand. Switzerland has much less unemployment than the U.S.
        Esther Rhodes won our high school essay contest, pointing out that America's first minimum wage laws were racist. At the time they were passed, blacks were more likely to be employed than whites. Blacks were paid less -- but they had jobs.
        Congressman Miles Clayton Allgood, D-Ala., then said he hoped a minimum wage law would stop "cheap colored labor in competition with white labor."
        So, explains Rhodes, although Americans now think a minimum wage was meant to help the neediest people, "it was meant for the opposite: to keep the poor and the minorities from getting jobs!"
        She also understands that the law now makes it harder for her to get a job.
        "I'm 14," says Rhodes. "My labor wouldn't be worth $15 an hour!"
        All government's workplace rules have nasty unintended consequences.
        If only the politicians were as smart as the sitc.org kids.
        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 John Stossel

    Recording events from public land shouldn't be a crime.

    Yet when a woman in Utah, standing by a public road, filmed farmworkers pushing a cow with a bulldozer, the farmer drove up to her and said, "You cannot videotape my property."

    Soon the police came and local prosecutors charged her with "agricultural operation interference."

    They dropped the charges several months later since she was on public land.

    But what if she'd posed as a farmworker, got a job on the farm and then secretly recorded what she saw?

    Increasingly, activists do that. More than a hundred such undercover investigations have been done.

    They then distribute video that sometimes shows animals being cruelly abused. In my video this week, we see calves being hit, kicked and thrown.

    Farmers, upset about such recordings, are now asking politicians to outlaw them, and several state legislatures have obliged. They've passed "ag-gag" laws -- bans on sneaking onto farms to secretly record what they see.

    Kay Johnson Smith of the Animal Agriculture Alliance supports such laws, though she doesn't use the term "ag-gag."

    "We call it 'farm protection,'" she told me. "Activists stalk farms to try to capture something that the public doesn't understand. The agricultural community is the only business where this sort of tactic is really being used."

    Smith says the activists' real agenda is not just preventing cruelty to animals: "These activist groups want to eliminate all of animal agriculture."

    I believe her. Many activists are animal rights extremists.

    But I also worry that laws like ag-gag rules will stop people from revealing abuses. I'm an investigative reporter. I can't do my job well if laws prevent me from showing the abuse. Audiences often won't believe what I report if they can't see it for themselves.

    Videos made by the group Mercy for Animals have led to criminal charges. Some of their investigations led Walmart to create new purchasing policies.

    The Animal Legal Defense Fund claims ag-gag laws violate the First Amendment. They've succeeded in getting several states' ag-gag laws struck down.

    When Iowa's law was ruled unconstitutional, legislators simply replaced it with a narrower law that forbids activists to lie to get access to farms.

    The activists argue that because farms lie about their practices, the only way to reveal the truth is to lie to get onto farms.

    Activists simply "want to ensure that the American public knows how these foods are processed, what happens to animals," says Animal Legal Defense Fund lawyer Amanda Howell.

    "You've got tens of thousands of animals in warehouses standing on concrete floors never seeing the light of day. ... If that affects people's purchasing decisions, then there's a reason for it," says Howell.

    "They want to make their movie ... their sensational video," retorts Smith. "If they really cared about animals, they would stop it right then! Instead, they go weeks and months without reporting anything to the farm owners."

    That's often true.

    Activists say long-term investigations are necessary because otherwise "a company can say this is a one-off," says Howell. Long-term investigations "show that's something that happens every day."

    I took that argument to Smith.

    "What they really want is to stop people from eating meat, milk and eggs," she said. "There are bad apples in every industry, (but) 99.9% of farmers in America, they do the right thing every single day. Farming isn't always pretty."

    I asked Howell if she and her group do want to end all consumption of meat and eggs. It's funny watching her response on the video. She never gives a straight answer.

    But her evasions bother me less than corporations using politicians to censor their critics.

    Whatever you think of the activists -- and I have problems with many of them -- government shouldn't pass special laws that prevent people from revealing what's true.

    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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