ICD-10-CM – The New Medical Coding Challenge Arriving October 1, 2013

On October 1, 2013, the medical coding world as we know it, will awaken to a new and exciting challenge. The 14,000 ICD-9 medical codes that millions of physicians, medical facilities, and hospitals use, will increase to approximately 64,000 codes. With the extra 50,000 codes will come very specified disease diagnoses and the medical coding world will need to brush up on their coding guidelines, their medical terminology and their anatomy and physiology.

January 1, 2012, is the compliance date for the HIPAA 5010 (HIPAA X12 formats version 5010), which is a new format designed to regulate electronic transmissions of specific healthcare transactions. Any medical facility not in compliance will not be able to receive their reimbursements.

Are you ready for ICD-10? Good quality classes in medical terminology and anatomy and physiology will be worth the time and funds spent when you are able to find the new codes with ease.

What medical coding certification are you seeking? Have you made up your mind to seek the certification from the AHIMA (CCS) or from the AAPC (CPC)? Whichever one you choose, make sure you use the study guides for general information, but also, and most importantly, study the coding books depending on what test you are taking and what specialty you decide on. Know the different surgeries in each of the chapters of the CPT book. You can order some instructional coding books that give you an opportunity to practice coding with the answers in the back of the book. In-patient hospital and physician offices will need to know the E & M codes forward and backward. Learn how to find ICD codes quickly and learn where modifiers are needed. Familiarize yourself with the HCPCS codes. Check with coding associations and take practice tests to help you get ready to be tested. Get a good nights rest, eat a nourishing breakfast and go into the testing room with a positive attitude in becoming the next coding specialist.

Many medical coders are fortunate in finding medical coding jobs where they can work from home. What a dream to be able to work from home and not have to leave the house. After years of experience working in a facility, it is possible to find a medical coding job opportunity and work from home.

Medical coding is a very challenging profession. To succeed in medical coding, one must study medical terminology and anatomy and physiology. Being successful is not only knowing the medical language and where all of the body parts are, it is also important to know the government guidelines and to know how to match the medical necessity codes correctly to the procedure codes. The reward will not only be the provider reimbursement from submitting clean claims, but also the satisfaction of knowing that the challenges were met!

Muddle Through Towards Better Web Design

Since the arrival of Pope Benedict XIV at the Twitter scene, I’ve been wondering how many people who don’t know how to use the Internet are still out there in the Western world. But an even more intriguing question is this: how come so many people are proficient at using it? Have they been taught web browsing at school? Did they have to read “Internet For Beginners”? Have they taken any special courses?

The answer of course is that they learnt things on the fly. Our cognitive abilities allow us to instinctively absorb new information, recognize new patterns and adapt to new environments and routines. We don’t need special instructions or conscious decision-making regarding the best approach to knowledge accumulation. We want to do something and we try to do it. We “muddle through”.

I borrow here the language of the web usability guru Steve Krug, and in particular his “Don’t Make me Think” book, considered by many the “bible” of user experience. Muddling through is Krug’s third “fact of life” of real-world Web use, just after scanning and “satisficing”. Below I’m going to prove that muddling through is not just an effective and time-saving approach to information discovery that humans simply opt for but rather it’s the way we live in general. Our minds are conditioned to muddle through. Better web designs are impossible without proper recognition of this fundamental human nature.

How Do We Really Use Websites?

So how many of you read the user guide booklet that came with your new iPhone? What about the “Convention Used in This Book” page in your latest educational book? Mu guess is: not many. The same is true for the way we use websites. Everyone’s busy, everyone’s just trying to figure out how to get to a particular place and doing anything else seems like a waste of time. Now the funny thing is that everyone’s got their own way of doing things. Even when it comes to a standard process such as navigating a website, some people will follow the links in the main navigation, while others will use the search button or start scanning paragraphs for clues.

One important implication of this tendency to muddle through is that people will often use websites in unexpected ways. Designers sometime envisage a perfect way of completing a particular process, e.g. you click on this link, you fill the form, you browse the available options and choose one as indicated in the instructions displayed to you left, you click the big “submit” button, etc. But in practice there are many ways to browse a website, use a web application, or even fill a contact form (“should I put my phone in the specially designated field or attach it in the body of the message like I always do?”). As a result, when offered a detailed record of how websites are actually used, some designers might think “who on Earth would let those monkeys anywhere near a computer?” Such attitude ignores of course that web users are not trying to figure out what the brilliant designer had in mind when creating the interface. They just want to get what they came for. If they have muddled through something and it worked, why shouldn’t they try the same approach next time?

A well quoted example of such interface misconception is Steve Krug’s anecdote about some users typing full URLs (including www.) into the Yahoo search box every time they want to go to a particular website. Krug explains:

If you ask them about it, it becomes clear that some of them think that Yahoo is the Internet, and that this is the way you use it.

Muddling through, being a rather crude approach to cognition, is clearly prone to errors. But many errors, like the one above, don’t have a great impact on the end result. If a website is used on a regular basis, an incomplete understating might slow things down a notch or make the user miss out on alternative options. But if you compare this to a structured approach to web browsing that involves careful review of published instructions and analysis of all potential routes and uses of the interface, then muddling through certainly sounds attractive. As Jeffrey Veen puts it:

[..] we’re much more like motorists behind the wheel of a car in an unfamiliar city. We have a clear destination in mind, and are making split-second decisions while negotiating a confusing new place. And we are doing a task that demands our attention at the same time. No wonder we don’t read. We’re just trying to get done with this nonsense as quickly as possible.

I believe this to be a well accepted proposition in the realm of user experience. However, besides this need for time-optimization there is also an alternative perspective for understanding the muddling through process where the explanation is found in the depths of the human psyche. In such view, we don’t simply choose to muddle through. Muddling through is what makes us who we are.

Psychology of Muddling Through – the Doing Mode

In the field of Psychology, the process of muddling through is recognized as part of the “Doing mode”. Doing mode is the function of the mind that allows rational critical thinking. Doing mode is what allows us to build bridges, send men to space, or write our thesis. It also governs the process of learning from repetition, a crucial ingredient to the success of the muddling through approach.

According to Prof. Mark Williams from Oxford University, Doing mode usually begins with recognition of a gap between our perceived current state and some alternative state that we would prefer to be in. In the context of the Web, this could be as simple as “I sit here bored to death; I would rather be watching a video of a skateboarder hurting himself”. This perceived gap triggers an automatic pattern of mind activity, which sole aim to bring us closer the desired state.

Doing mode is responsible for analysing, planning, comparing, judging, discriminating, etc. What might be less obvious to some readers (especially those who never practiced meditation) is that these processes are usually instantaneous and unconscious. In the West, thinking is often considered a domain of consciousness. This is not true, however. Many people would be ready to claim thoughts as their own. But when asked where their thoughts came from, most would be left bemused. Thoughts arise spontaneously. In a state of concentration the trend of thought can generally be directed towards a specific subject but the arising of thoughts seems as if mental phenomena had a life of their own.

What I’m getting at is that Doing mode, and hence muddling through, is like an automatic pilot. We don’t choose to do it, we just do it. In some sense Doing mode can be thought of as an elaborate survival mechanism. The existence of a desired state usually leaves us little room for considering why such state is desired or what the optimal way of achieving it is. Doing mode forces us to strive towards the goal, regardless of whether it was chosen in a sober, conscious state of mind or not. In fact, the goal does not even have to be “real”. It can be based on an ephemeral emotion that develops into a mood (interestingly this is how stress arises – the mind considers a negative feeling to be a problem, a gap that must be overcome, triggering an array of memories, thoughts, and impulses that have a similar emotional hue in order to find a “solution”). This helps explain why when feeling a little down or lonely we can end up spending hours surfing for pictures of cats playing piano without even noticing.

Intuitive Web Design

Doing mode is not something designers need to fight against (although see “Conclusion” below for a brief mention of an alternative mode). Instead, designers need to try capture this somewhat primitive mind activity by allowing it to freely channel towards a positive outcome (finding information, buying products online, leaving a feedback, etc.).

If we compare web design to building a house, it is often too tempting for an architect to assume the house being used by a perfect gentlemen, who will always politely knock on the door, wipe his shoes on the “Welcome” mat, take of his hat and put it on the designated coat rack, and head to the dining room, never stepping outside the corridor carpet. The real user of the house, however, turns out to be a caveman who breaks the kitchen window with his club to get in, and rummages through the garbage bin in search for food.

The role of the architect is not to discriminate between the gentleman and the caveman and label one as “right” and the other as “wrong” or “crazy”. The architect should instead recognize the nature of the house’s users. If putting a gate in the kitchen will benefit the users, then that’s what needs to be done. Decorating the dining room is not the priority.

In web design the importance of muddling through is most commonly recognized in navigation, although the approach can be observed in a much wider range of web interactions. The first step is of course to recognize that navigating a website is very different from navigating a physical space, such as a building. When we’re online, it’s not immediately clear where we are and where we are heading towards. We cannot even tell how big the website is!

When building websites, our first task should be to mitigate those obvious shortcomings of the Web, which might otherwise hinder the user’s instinctive drive. Faced with a Doing mode, long, written instructions usually become redundant. A better solution is to follow conventions, which can come from other websites and computer applications (e.g. an arrow next to drop down menus or putting a “careers” link in the footer) or the real world (e.g. 3D-looking buttons). Anything that aids scanning and immediate recognition of the information structure is also a huge plus. In general, to create an intuitive design we need to stop thinking about writing paragraphs to fill empty space and focus instead on building a proper infrastructure, putting up traffic signs, etc.

Operating in a very dynamic environment, websites often try to introduce new ideas and new ways of interacting with the user. These ideas might require a new perspective in order to be used effectively, and thus the error-prone muddling through process can lead to confusion and misuse of the service. This does not, however, imply that we should build barricades to prevent people from experimentally figuring things out. We just need to make sure that the user is most likely to muddle through along a path that maximizes the benefits from learning-by-doing, encourages further exploration, and enhances the user’s understanding of the new service, its functionality, and scope.

There is a whole arsenal of potential solutions out there that could be leveraged to channel user’s instincts. A more recent idea in web usability, progressive reduction, is a great example of just how much intelligence interfaces can acquire. Of course, every website faces its own set of challenges, and the point of this article is merely to emphasise the importance of the muddling through process. It may not be the way we would like people to use the web but it is the way they really use it. We must face this fact.


Muddling through is not a niche approach to using the Web. It is the human way of using the Web and is true even for the most web-savvy people (or especially for web-savvy people). The reason why the process often doesn’t receive the recognition it deserves is because we are not aware of it. The fact that it’s subconscious does not mean it cannot be harnessed. It does, however, require thorough analysis of our emotional and behavioural tendencies in order for it to be helpful in building smarter web interfaces.

As most things in nature, Doing mode has its opposing force. In addition to the Doing mode, human mind can also operate in a state of awareness and directed attention that is devoid of judgment, allowing us to directly experience the present moment. Psychologists have labelled this state “Being mode”. Though not ideal for navigation, we might prefer users to be in a Being mode when faced with a new idea that would be discarded in the Doing mode due to biased views. In such a scenario, we might want to shake the user out of his day-dreaming mode and become awake and alert, seeing things with a clearly comprehensive mind and inviting the user to re-examine his own condition.

Those of you familiar with Buddhism or a similar philosophy might already know what I’m talking about. This is certainly not the sort of idea that would be regularly echoed in mainstream discussions. For the sake of brevity I’ll leave the Reader with just this enigmatic introduction to the Being mode (the state of awareness). In the near feature I will write an article explaining this alternative way of engaging audience with deserving depth and detail. In the meantime stay tuned for the upcoming article publications on our blog.

Home Improvement Tips: Ways to Increase the Value of Your Home

Reasons for A RedoHome improvement projects often begin with someone saying, “Wouldn’t it be nice if… ?” usually followed by a wish for a remodelled kitchen or a room addition for space to accommodate every family member’s needs. More often than not, reality and dreams don’t coincide, due to limited funds for realizing the dream, or limits on the available space. The trick: turning your dreams into reality. Begin with a realistic evaluation of your needs. Homeowners usually consider home improvements for one of the following reasons.You may feel the need to update something that is out-of-date. If your kitchen colour scheme was perfect a few decades ago but no longer works, now may a good time to update it.Some home improvement projects grow out of an immediate need to replace broken or inefficient fixtures. If a sink, tub, or toilet needs to be replaced, consider taking advantage of the opportunity to do a makeover on the entire bathroom.If you’re preparing to sell your home, you’ll want to be sure to get top dollar from the sale. That’s great motivation for some home improvement projects.You have decided that staying put and improving your home is a better option than moving.Your family has grown and you need more space.Improving to Move? or Improving to Stay?Evaluate your plans carefully if you’re improving your home to list it for sale. Cutting corners may hurt your prospects rather than helping them. But don’t go overboard either. Potential buyers may prefer not to pay for some of the extras, such as a hot tub or pool. You’re better off keeping the changes simple.And remember that buyers who view your home may not share your tastes and may not appreciate the care you took to find just the right shade of green paint for the walls.You’ll find that improving to sell is easier if you can think about it from the prospective buyer’s point of view: What is important to the home buyer? Here are a few remodelling projects buyers are likely to find valuable:Adding or remodelling a bathImproving the kitchenAdding a new roomLandscapingAdding a bedroomAdding or enclosing a garage.If you’re remodelling because you want to stay in your home, you should still avoid over-improving it. You’ll probably want to sell it someday, and even if your house is the best on the block, it may be difficult to convince potential buyers to pay for the things you considered important. And when you consider making improvements, keep in mind the value of other homes in the area. Your home’s value should not be more than 20% above the average, which means that a $10,000 kitchen improvement project well could be a better investment than a $10,000 hot tub, especially if yours will be the only home in the area with a hot tub.Home Maintenance versus Home ImprovementsIt’s unfortunate that some home improvement projects are undertaken because something has broken. Replacing a leaky bathtub may be the first step to a major bath remodeling: since the tub has to be replaced anyway, why not do the whole room?While that might be a legitimate reason to remodel, avoid basing your home improvement projects on immediate needs. You’ll be better off if you minimize problems with proper maintenance. Examine every part of your home at least once a year. Check the roof, the plumbing, electrical wiring, etc. As soon as become aware of a problem, fix it. Making repairs when you’re first aware of them will help you avoid larger expenses later on. Keep in mind that maintenance does not add to the value of your home. Usually repairs are not improvements; they are necessities.Hiring Professionals May Save You Time and MoneyIt should go without saying that home projects can be expensive, so you may be tempted to tackle them yourself as a way to save money. That may be a smart move for small projects. You won’t have to wait for someone to fit your house into their busy schedule, and you can boast about having done the work yourself.But unless you’re very versatile, major home improvements are better left to professionals. If you decide to remodel the kitchen and plan to do the work yourself, will you be able to handle the plumbing, electrical, and carpentry work on your own?. And don’t forget that you’ll need to finish it quickly, because you won’t have a kitchen as long as it’s a “work in process” and eating three meals a day in restaurants could get expensive. Keep in mind, do-it-yourself jobs generally take more time. And you’ll be responsible for getting all the necessary permits and inspections.Hiring people who have the required experience can save you money and time, too. For example, these professionals can help you get a custom look using stock products, and that can be a significant savings. Getting something done right the first time will give you value that lasts for years.To find qualified and dependable home improvement specialists, check with friends, business associates, and neighbours for recommendations. Always get at least three references, and check them out thoroughly. Also check with the local chapter of the Better Business Bureau or Chamber of Commerce. Their numbers can be found in the community services section of your telephone book.Once you’ve located the necessary home improvement specialists, make sure everyone is in agreement about the design, the schedule, and the budget, and get the details down in writing in a signed contract.It’s also wise to check on professional certifications and licenses, where required, and be certain that the contractors you hire are fully insured and bonded. Your town or city Building Department can provide that information. And it’s very important that you make sure contractors carry workers’ compensation insurance: if workers are injured on the job, you won’t be liable if the contractor is covered. Request copies of their insurance certificates. And make sure that either you or your contractor have gotten any necessary permits before the work begins. Contact your local Planning and Zoning Commission for information.Here’s a quick overview of some of the professionals you may need to work with when you remodel your home:Architect: Architects design homes or additions from the foundation to the roof. If your project will require structural changes such as adding or removing walls, or if the design is complex, you will probably need an architect. Since architects may charge an hourly or a flat fee, make sure you get an estimate of the total cost: drawing up the plans for a major remodeling project can take 80 hours or more.Contractor: The contractor oversees the home improvement project, including hiring and supervising workers, getting the necessary permits, making sure inspections are done as needed, and providing insurance for work crews. It’s always a good idea to get proposals from one or more reputable contractors, based on the specific details of your project.Be sure each contractor bids on exactly the same plan so that you can compare their bids more easily. When you’ve chosen a contractor, make sure the contract specifies that you will pay in stages. You’ll usually pay one third when the contract is signed so that the contractor can buy supplies. The number and timing for making the remaining payments will depend on the size of the project. Do not make the final payment until all the work is successfully completed, inspected, and approved.Interior Designers: Interior designers are specialists who will provide advice on furnishings, wall coverings, colors, styles, and more. They help save you time by narrowing your selection, and save money because they usually receive professional discounts from their suppliers. When meeting with an interior designer, be sure to tell them about your personal style and preferences. Expect to pay anywhere from $50 to $150 per hour, or you may be able to negotiate a flat fee of approximately 25% of the total project cost.