ViSwiss – A Personal Review

Viswiss is a male enhancement product that promotes long term, and short-term effects. The main concern with these pills is erectile dysfunction. By taking this supplement, you should expect longer lasting, harder erections, enhances your libido, and also can increase your stamina. With all three of these things being fixed, this can result in a major boost in confidence, and your overall mental health. Men that suffer from erectile dysfunction are very prone to things like depression, which is why there are so many products for men to choose from to help them with erectile dysfunction.

After taking this pill, results should be expected to start being noticeable after 20 minutes. This makes this solution a very fast acting one. On top of being very fast acting when you initially take ViSwiss, it also claims to last up to 72 hours. Products that last this long are a very good thing, so men don’t have to preplan and schedule something like a sexual encounter, when it should just be natural. To make this pill even more convenient, it can also be taken with alcohol, which many natural male enhancement pills recommend not to do if you want to see full results.

All the ingredients in ViSwiss are naturally found, and mostly come from different herbs. This makes the product safe. This also means the product can easily be bought online or in stores, and you do not need to go through the hassle of a doctor and pharmacy just to get the pills. The herbs in this formula work to do many different things can be helpful to your sex life. It aims to increase testosterone, promote proper blood circulation, and it also has a lot of beneficial vitamin like qualities to promote general health. You can easily view the full ingredient list to see what herbs are in it, and what effective ingredients are in use with this formula.

You can buy this product very discreetly from their main page, and billing process is also discreet. Sexual health is a private matter, so ViSwiss respects that. The price for the pills is comparable to many other products on the market, and is not too high or too low. A full money back, satisfaction guarantee, also backs these pills. Taking in to account the guarantee, and the relatively fair price, this product may not be a bad choice for you to try and boost your sexual health, and overall day-to-day health.

Health Care Careers – 8 Among the Hottest Professions in Health Care

Several people hold the mistaken belief that occupations inside the health care business are restricted to primary patient caregiving. The truth is, you will find a wide variety of full-time options for skilled job seekers.

In fact, as the U.S. population continues to get older, health care employment opportunities are some of quickest growing within the nation and around the globe.

The following is a range of eight among the hottest occupations in healthcare at this time:

1. Mental Health Counselor

Mental health counselors help men and women to take care of emotional problems and also to maximize mental well-being using a variety of treatments. Registered consultants ordinarily require a Master’s education to be able to qualify.

2. Pharmacists

Pharmacists disperse medicines prescribed by doctors. These people moreover help to inform people concerning the drugs they fill and their best usage, which includes recommended specifics about dosage, uncomfortable side effects and contraindications. A diploma from a college of pharmacy is necessary for this role.

3. Medical Researchers

Healthcare researchers conduct study on human illnesses to help create practical remedies to human health diseases. These successes include vaccines and drugs. Professional medical scientists are able to furthermore execute medical research, transcribing, drug evaluation and specialized writing. A successful applicant will need to have a doctorate diploma in the field of biology or a related field.

4. Medical Transcriptionists

Medical transcriptionists encode dictated recordings produced by physicians and some other medical workers. The particulars incorporate reports, observations and correspondence that may well in the end become part of the patient’s medical archives. A healthcare transcriptionist may be educated in a specialized university or a business facility to attain a certificate.

5. Medical Records Technicians

Professional medical records technicians own the primary responsibility of maintaining and checking the accuracy of the patient’s health-related records such as exam results, medical background, lab reports, diagnoses, etc. An associate degree from a school is essential coupled with a broad degree of knowledge in scientific disciplines and medical science.

6. Lab Technicians

Laboratory technicians do tests that can lead to the diagnosis or recognition of the person’s disorder. They might furthermore analyze and report it to the the person’s personal medical doctor. A bachelor’s degree in professional medical technology and wide-ranging foundational experience will assist to position an individual to be an appealing applicant.

7. Physical Therapists

Physical therapists offer services meant to restore a person’s bodily functionality, increase range of motion, decrease suffering and prevent permanent harm to people with physical disabilities. A bachelor’s diploma in physical therapy is recommended to qualify.

8. Medical and Health Service Managers

Health service managers develop, manage and organize health care functions. A Master’s degree in public health or health sciences will go a long way in readying a person for this kind of position. However, for a few openings, a college degree will suffice.

For information on job and employment hunting ideas, please visit – a preferred website providing great insights on job & career choices, along the lines of Traveling Nurse Employment or Medical Career Training and many further suggestions!

The Mental Health Medication Preauthorization

Dr. Durruthy, does your patient need this medication? Life reminds me to adapt to change and remain flexible in order to be less stressed by the daily challenges in my profession. Nonetheless, the medication preauthorization has been a continuously harrowing adventure including ongoing changes. I am routinely asked to preauthorize medications for my patients. It may seem like a harmless request, especially to those who are naive to the process. Simply call into a toll free 800 number and verify that you ordered the medication.

If you analyze the situation, it becomes a big problem. If a prescription is rendered, a documented paper trail exists. Yet I have to find time to call into a pharmacy benefit plan for a growing number of patients. Of course cost is an issue for most companies; therefore, making the process convenient by hiring a full complement of customer service representatives is not a priority. Thus, I usually hear the customary announcement that we will be with you shortly because we are experiencing a high call volume. This can make my blood boil during a busy day. Time is valuable and this waiting exercise will cause me to be late with other patients who have established appointments. When a live person finally answers my call, additional time is required for them to locate the patient records in their data base. This exercise is predictably a total disaster for a new hire or if the patient is a spouse or child with a different last name than the insured subscriber. The process requires me to verify and update the name, address and telephone number of the subscriber. After the demographic information is given or verified, more time is lost waiting for the pharmacist to come on the line.

Depending upon the employer’s insurance medication benefit arrangement, the pharmacist may be given a golden opportunity in which to change my mind. I am asked about the patient’s diagnosis, whether I’ll be following the patient for potential side effects, and if other medication choices have been considered. I frequently think about how this preauthorization routine has become the essence of my existence as a psychiatrist.

Playing the game of preferred medication can be complex. The little known historical fact that the pharmaceutical benefit manager is often influenced by the drug manufacturer is often forgotten. In other words, a pharmaceutical company that manufactures drug X often owns the respective benefit manager. In this capacity, a pharmaceutical company can dictate that their drug X becomes the preferred medication offered to the plan’s beneficiaries for that defined illness. Other medications will be non-preferred and cost the subscriber more.

In my opinion, the future relationship between health care and technology is uncharted and bleak. As the population ages, so do the body organs including the brain. No new medications for mood disorders such as depression are on the horizon. Those of us seasoned in pharmacology have started to enter new frontiers with antidepressant medications needed to sustain those with chronic severe illnesses. Along the way, I have had the experience of computers rejecting prescribed pill counts, especially when they are indicated for those with severe illness. My patients are frequently stabilized by dosages outside of the standard amount as prescribed by those with less skill. Evidence based medicine works well if your illness is a common one which responds to agents that those with less training feel comfortable prescribing. However, what happens when your brain does not respond to the standard low dose of an SSRI (selective serotonin reuptake inhibitor)?

This preauthorization requirement combined with technology can easily track your medication and limit your choices. I have no answers for this dilemma but I do encourage you to become active and understand health reform issues, especially if your illness is chronic and challenging to stabilize.

Medicare and Medicaid Audits of Psychologists and Other Mental Health Professionals

Over the past year I have observed an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals.

I have recently seen a number of audits initiated against psychologists and mental health professionals who treat assisted living facility (ALF) and skilled nursing facility (SNF) residents. Most often these are audits by the Medicare Administrative Contractor (MAC), because this area of medical practice has been identified as one fraught with fraud and abuse. Sometimes these are only “probe” audits, initial audits requesting one (1) to five (5) medical records. Other times the MAC has been requesting anywhere from 120 to 375 records.

Zone Program Integrity Contractors (ZPICs).

Zone Program Integrity Contracts (ZPICs), are the primary Medicare fraud detection contractors. If a probe audit, MAC audit or other investigation of audit suspected fraudulent billing, the ZPIC may come in. The ZPIC also identifies and target various CPT codes, areas of medical practice, services and equipment that are highly susceptible to fraud. It will then initiate a ZPIC audit on its own. ZPICs receive bonuses based on amounts they recover for the Medicare program.

OIG Annual Work Plan.

The Office of Inspector General (OIG) publishes a work plan each year which discusses the areas, types of medical services, CPT codes, equipment and tests it considers to be most susceptible to fraud and abuse. The new plan is usually published in the fall for the work year. It is available online.

Psychiatrists, psychologists and mental health counselors, as well as facility administrators, compliance officers, attorneys and billing and coding experts should review this work plan each year to learn what the OIG considers to be fraud and abuse and why. Measures should be immediately implemented to remedy any problems in your practice or facility that are identified.

Qui Tam or Whistle Blower Cases.

In many cases an audit or investigation may be convened against a facility, individual or group, based on the filing of a qui tam or whistle blower’s case. You won’t know this, however, because these cases are filed under seal and stay sealed, often for years. These suits are based on false claims that have been filed for Medicare, Medicaid, Tricare, Veterans Administration (VA) or any other federal or state program. They are usually filed by disgruntled, former employees. These may cause the initiation of any of the types of audits discussed above.

If you suspect that this has happened, you should immediately retain legal counsel to represent you or your organization. If OIG special agents (S/As) or Federal Bureau of Investigation (FBI) agents are involved, it would be foolish not to retain an experience health law attorney before you speak to anyone.

Medicaid Audits.

I have also seen an increase in Medicaid audits by state agencies, as well.

Ordinarily, Medicaid audits are initiated by the program integrity section or division of the state agency that administers the Medicaid program, or one of the agency’s contractors. The states are under increasing pressure from the federal government to be much more aggressive in identifying Medicaid fraud and recovering the overpayments.

If Medicare or any of its contractors recover an overpayment from a provider, they will also notify the state Medicaid program and Tricare program. These will them initiate audits and collection actions.

State ZPICs.

States are now contracting with ZPICs to help detect fraud and make recoveries of large overpayments from Medicaid providers. Additionally, the Medicare ZPICs may also detect and recover Medicaid overpayments, as well.

Areas Being Targeted.

In state Medicaid audits, I have recently seen increased scrutiny in the following areas:

1. Pediatric care
2. Therapy (speech therapy, physical therapy, occupational therapy) especially to pediatric patients and developmentally disabled patients.

3. Small assisted living facilities (ALFs), group homes, homes for the developmentally disabled (DD) and other small facilities.

4. Home health agencies.

5. Pediatric dentistry.

6. Optometry care, especially if delivered in a nursing home or assisted living facility (ALF).

7. Ambulance and medical transportation services, especially of nursing homes.

8. Psychiatric psychological and mental health.

Use of Statistical Sampling and Extrapolation Formulas to Multiply Repayment Amounts.

In both state Medicaid audits and in Medicare audits, I have experience increased reliance by the auditing agency on use of mathematical extrapolation formulas to estimate the amount that should be repaid. The formula used usually takes the overpayment that has actually been found and, based on several factors, multiplies it out to many times the actual overpayment amount. Thus, a found overpayment of $2,800 may become a demand for repayment of $280,000, based on the statistical extrapolation.

Things you should know about this are as follows.

1. Neither the Medicare program nor the state Medicaid programs should use an extrapolation formula, unless:

a. There is a “high” error rate in the claims that have been submitted; or

b. There have been prior educational efforts or prior audits of the provider, and the provider

has failed to correct the problems in claims submission previously found.
2. The states each have different guidelines, rules or regulations on when they will apply the statistical formula. Some do not use it. Some use a higher percentage error rate to prompt use of the formula and some lower. North Carolina is one of the lowest we have encountered; an error rate of more than five percent (5%) will prompt its Medicaid agency to apply the statistical extrapolation to the recovery amount.

Problems Psychologists and Mental Health Professionals May Encounter Producing Records for Audits.

Many psychologists, therapists and health professionals are being audited because they are treating patients in a nursing facility or assisted living facility.

In most cases, a history, physical, comprehensive assessment, physician orders, diagnosis, medication list, medication administration records, consultations, social service notes and other medial documents being relied upon by the therapist are reviewed and assessed in connection with treatment of the patient. The big problem here is that these usually stay in the facility. When an audit occurs, these may not all be available.

The biggest issue that Medicare and Medicaid seem to be targeting is lack of documented “medical necessity.” The auditors take the position that the audited therapist must produce copies of the documents listed above, in part, to show “medical necessity” for the services provided.

Additionally, most physicians who treat patients in nursing facilities place their own assessments, plans and notes into the facility’s chart and do not retain a copy themselves. When the audit comes, they may not be able to produce copies of their own notes and evaluations.

I recommend that any provider treating residents of nursing homes and assisted living facilities (ALFs):

1. Review the local coverage decision (LCD) applicable to the code(s) you bill so you know what requirements must be met and what documentation is required.
2. Review the Medicaid provider handbook or state regulations for the services you provide if you are a Medicaid provider.

3. Obtain and keep copies of all applicable histories, physicals, care plans, physician orders, physician consults, etc. This is best done by obtaining and using a portable scanner. You can then keep the copies electronically in a properly secured, protected server in your office (backed-up, off site, of course).

4. Sign all of your evaluations, prepare your reports, evaluations progress notes and consultations on your laptop or other computer and sign it electronically before you print it out. Alternatively, if you still use paper, scan the paper copy (after signed) and maintain it electronically.

5. Do not use unusual or non-standard terms and abbreviations. If you do, you must keep an “abbreviations and definitions” list and produce it with your records in any audit response.

6. In your reports, evaluations and notes, use the terminology from the LCD and Medicaid provider handbook. Also, always include the start time, stop time and total time spent with any resident in your report, evaluation and notes.

7. Be sure the patient, patient’s next of kin/surrogate, patient’s physician or nursing home administrator signs off as having received the services each time. The patient’s signature is preferred.

Contact Health Law Attorneys Experienced in Handling Medicaid or Medicare Audits.

Medicaid and Medicare fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid and Medicare fraud criminal charges arise out of routine Medicaid and Medicare audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

Disclaimer: Please note this article is for general education and information purposes only and does not constitute legal advice or solicitation for clients. Our opinions stated herein are just that, our opinions.