#Physical Therapy Medical Billing Services

[inficareservices]

Streamline your practice with expert Physical Therapy Medical Billing Services. Our specialized team ensures accurate claims, maximizes reimbursements and reduces administrative burden. Focus on patient care while we handle your billing needs with efficiency and precision. Get in touch today!

[medicalbillingblogs]

Key Insights into Medical Billing for Physical Therapy Clinics

In the dynamic healthcare landscape, physical therapy clinics play a critical role in restoring and improving patients' mobility and function. However, the success of these clinics depends not only on their clinical experience but also on their ability to navigate the complex field of medical billing. Maximizing reimbursement is essential to sustaining operations, investing in technology, and providing high-quality care.

Understanding the medical billing process

Medical billing is the process of submitting and tracking claims with health insurance companies to receive payment for services provided to patients. For physical therapy clinics, this process involves documenting patient encounters, assigning accurate medical codes, and submitting claims to insurance providers. Effective billing requires in-depth knowledge of coding guidelines, payer policies, and regulatory requirements.

1. CPT and HCPCS codes

At the heart of medical billing is the accurate use of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. These codes define the services provided and serve as the basis for reimbursement from insurance companies.

2. Modifiers

Modifiers provide additional information about the services provided, which affects reimbursement rates. Become familiar with modifiers commonly used in physical therapy, such as G0252 (initial assessment) and 97110 (therapeutic exercise).

3. Insurance Billing Guidelines

Each insurance company has its own physical therapy billing guidelines and requirements. Understanding the specific requirements of your contracted payers is critical to ensuring claims are submitted correctly and processed efficiently.

Key Insights to Maximize Refunds

Accurate Documentation

Accurate documentation is the cornerstone of successful medical billing. Clinicians must meticulously record patient assessments, treatment plans, progress notes, and outcomes.

Detailed documentation not only supports the medical necessity of services but also ensures compliance with billing regulations. Additionally, it provides a complete record of insurance claims, reducing the risk of denials or audits.

Proper Coding

Coding errors can lead to claim denials or underpayments, resulting in lost revenue for physical therapy clinics. Therefore, it is essential to assign appropriate medical codes for diagnoses, procedures, and services provided.

Physical therapists must stay up to date on the latest coding guidelines, such as Current Procedural Terminology (CPT) codes and International Classification of Diseases (ICD) codes, to accurately represent the care provided.

Understand Payer Policies

Different insurance payers may have different reimbursement policies and coverage criteria for physical therapy services. It is essential that clinics become familiar with each payer's specific requirements, including prior authorization procedures, documentation guidelines, and reimbursement rates. By understanding payer policies, clinics can optimize their billing practices to maximize reimbursements and minimize claim denials.

Timely Submission of Claims

Timely filing of claims is critical to ensuring prompt reimbursement. Delays in submitting claims can result in cash flow disruptions and a potential loss of revenue. Physical therapy coding and billing should establish efficient processes for generating, reviewing, and submitting claims to minimize response times. Using electronic health records (EHR) systems and billing software can streamline billing workflows and speed up claim processing.

Comprehensive Revenue Cycle Management

Effective revenue cycle management (RCM) is essential to optimizing reimbursement throughout the billing process. From patient registration and insurance verification to claim processing and payment posting, every step of the revenue cycle must be managed efficiently.

By implementing robust RCM strategies, such as automated eligibility checks, claims purging, and denial management, physical therapy clinics can improve cash flow and revenue performance.

Patient Education and Participation

Patient education plays a crucial role in maximizing reimbursement for physical therapy services. Clinics should educate patients about their insurance coverage, co-pays, deductibles, and financial responsibilities in advance.

Clear communication about billing policies, payment options, and potential out-of-pocket expenses can help prevent billing disputes and facilitate timely payment. Additionally, engaging patients in their care plans and treatment goals can improve adherence and outcomes and ultimately improve reimbursement.

Compliance with Regulatory Requirements

Compliance with regulatory requirements is paramount in medical billing to avoid penalties and legal repercussions. Physical therapy clinics must comply with federal and state regulations, such as the Health Insurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), and Centers for Medicare and Medicaid Services (CMS) guidelines.

By maintaining strict compliance standards in documentation, billing practices, and privacy protocols, clinics can mitigate compliance risks and safeguard their revenue.

Training and Continuing Education

The field of medical billing is constantly evolving with changes in healthcare policies, coding guidelines, and technological advances. Continuing training and education are essential for physical therapy clinic staff to stay abreast of industry updates and best practices in billing and reimbursement.

Investing in ongoing training programs, attending workshops, and obtaining professional certifications can empower staff members to effectively navigate the complexities of medical billing and optimize reimbursement results.

Conclusion

Maximizing reimbursement is a multifaceted task that requires strategic planning, meticulous execution, and ongoing diligence. By implementing the key insights outlined in this article, physical therapy clinics can improve their billing practices, optimize revenue cycle management, and ultimately improve their financial performance.

By prioritizing accurate documentation, proper coding, payer understanding, timely claims submission, end-to-end revenue cycle management, patient education, compliance and staff training, clinics can optimize reimbursement and sustainably provide high-quality patient care.

[medical-billing-service-0]

Optimizing Financial Management with Chiropractic Billing Services

In the healthcare sector, chiropractic care plays a vital role in managing musculoskeletal conditions, improving mobility, and enhancing patients' overall quality of life. However, managing the financial aspects of a chiropractic practice can be challenging due to the unique nature of treatments, frequent patient visits, and varying insurance policies. This is where medical billing services come into play, ensuring that chiropractic practices can focus on providing care while their financial operations run smoothly. These services streamline the billing process, minimize errors, and enhance reimbursement rates, which ultimately leads to better revenue management for chiropractic practices.

What Are Chiropractic Billing Services?

Chiropractic billing services are specialized financial solutions designed to meet the unique needs of chiropractic practices. These services are a critical component of Revenue Cycle Management (RCM) services, which oversee the entire process of patient billing, from claim submission to final payment. Chiropractic billing services handle everything from insurance verification and coding of chiropractic adjustments to following up on claims and managing denials. Since chiropractic care often involves ongoing treatments and multiple patient visits, these billing services ensure that claims are submitted accurately and promptly, reducing delays and maximizing revenue.

The Importance of Medical Billing and Coding in Chiropractic Care

Accurate medical billing and coding is essential for chiropractic practices to ensure that they are compensated for the services they provide. Chiropractic care involves various treatments, such as spinal adjustments, physical therapy, and other therapeutic services, each of which requires precise coding to avoid errors. Incorrect or incomplete coding can lead to claim denials or underpayments, which can negatively affect a practice’s cash flow. By partnering with experienced billing professionals who specialize in medical billing and coding, chiropractic practices can ensure that their claims are submitted correctly and in compliance with industry standards, leading to improved financial outcomes.

Benefits of Healthcare IT in Chiropractic Billing

In the digital age, Healthcare IT has transformed the way billing services are managed, offering numerous benefits for chiropractic practices. Advanced billing software and electronic health record (EHR) systems streamline the billing process by automating tasks such as claim submission, coding, and patient record management. Healthcare IT reduces human error, speeds up payment cycles, and allows for better communication between chiropractic providers and insurance companies. Additionally, real-time tracking and reporting features enable chiropractic practices to monitor the status of claims and payments, ensuring that revenue is managed efficiently. Healthcare IT enhances both the accuracy and efficiency of chiropractic billing, leading to improved practice operations.

Chiropractic Billing Services at Mediclaim Management

Mediclaim Management offers specialized Chiropractic Billing Services designed to meet the needs of chiropractic practices. With a deep understanding of the unique challenges that chiropractors face, their team of billing experts ensures that all aspects of the billing process are handled with precision and care. Mediclaim Management’s Chiropractic Billing Services help providers reduce billing errors, increase claim approval rates, and expedite reimbursements. By partnering with Mediclaim Management, chiropractic practices can focus on delivering high-quality care to their patients while ensuring that their financial operations run smoothly in the background.

With Mediclaim Management’s Chiropractic Billing Services, chiropractic providers can optimize their revenue cycle, reduce financial stress, and ensure that their practice remains financially healthy. This allows chiropractors to focus on what truly matters—improving the health and well-being of their patients.

[mososimos]

Physical Therapy Medical Billing Services | OSI

OSI a medical billing company providing physical therapy medical billing services and physical therapy outsourcing services. Call (800) 670-2809.

[eminencercm]

Eminence RCM offers top-quality physical therapy billing services designed to streamline revenue cycle management for physical therapy practices. With expertise in the unique billing requirements of physical therapy, Eminence RCM ensures accurate coding, efficient claims submission, and maximum reimbursement for physical therapy services.

[ensurembs]

Scaling New Heights: 7 Persuasive Reasons to Choose Outsourced Physical Therapy Medical Billing

Outsourced physical therapy medical billing now has become common in the healthcare industry. Several healthcare providers prefer to outsource medical billing services processes from specialized medical billing companies. It offers healthcare staff to offer more focus on health, patient care, and related medical complexities rather than consuming their time with medical billing. There are experts in physical therapy medical billing who can perform the complex task of medical billing. A healthcare professional will gain lots of benefits from outsourcing physical therapy medical billing services. The reasons why healthcare experts choose outsourced physical therapy medical billing are the reasons.

Benefits of outsourcing physical billing experts

There are several advantages of outsourcing medical billing��experts. Outsourcing medical billing enables healthcare experts to streamline their processes, improve efficiency and reduce costs. Healthcare providers reduce the cost overhead of training and hiring in-house staff. In addition to it, expenses related to salaries, office equipment, space, and software also reduce. Outsourcing physical therapy medical billing allows medical experts to pay for the services they need which is a cost-effective solution. Read More…

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[naamahdarling]

Maybe it isn't that I actually hate medical professionals? They just suck and are weird sometimes, and a lot of them shouldn't be practicing, but I don't hate them as a group, like, personally.

What I hate is their ability to make my life harder in ways that are often completely opaque to me, and a lot of the crap things they do are not really possible to challenge. And I hate the fact that holding them responsible fort dogshit behavior in any way that will actually benefit me is almost always impossible.

And I also hate the fact that they have to do stupid things sometimes because that's how the system is set up, and those things sometimes mean patients actually get harmed. They aren't fond of that part either! They don't want the system to be the way it is! But they don't have a choice, so sometimes people like me get forced by bureaucracy into doing things that are re-traumatizing. And I can't imagine that feels good for them at all, knowing that their patients are sometimes only "consenting" because that bureaucracy will not let them be helped in any other way. Which isn't consent at all. I imagine that must be pretty traumatizing for them, too, sometimes.

If it were easier to actually access medical care without tremendous delays in this country right now I would have much less trouble finding providers who are good at what they do and are not horrible people, and who have clinic staff who can do their fucking job.

Oh and I also don't appreciate how evasive and unwilling to commit they are out of fear of being held to an answer that turns out to be inaccurate, but I can't make an informed decision about my own care unless they give me at least some information about probabilities and trajectories and typicalities. Genuinely, how the fuck am I supposed to navigate that shit. I get that some patients are really fucking difficult, but I should be able to get a special stamp on my file or something that says I understand that sometimes medicine isn't an exact science and the best answers that my doctors can give may not always prove to be accurate in the long term. I know they don't like being in that situation either.

A lot of medical professionals are fucking assholes, and unfortunately the ones who are not are still hamstrung by a system set up to actively prevent people from getting care.

I miss my old doctor. He gave no shits about anything that wasn't the patient. He prescribed scheduled meds based on what the patient needed and not based on fear of consequences potentially being imposed on him by the punitive patient-hostile drugs-are-bad moral panic machine developed to force suffering people into buying more dangerous drugs off the street in order to prevent far fewer people from maybe getting high off of drugs that at least weren't laced with lethal substances. (The purpose of a system is what it does.) Did he get sanctioned and become locally unhireable? Unfortunately yes he did. Does he now provide concierge care to rich people? Yes he does. He found a way to make it work, God bless him.

Everything about the medical system in this country is fucked. Hospitals, doctors, nurses, pharmacies, pharmacists, pharmacy techs, phlebotomists, clinic administrative staff, insurance companies, medical schools and schooling, licensing boards, drug advertising to both providers and patients, pharmaceutical reps, researchers, research, publishing, medical trials, pharmaceutical companies, manufacturers and distributors, medical equipment, charting software, billing and billing codes, diagnostic criteria, charity and low income services, accessible transportation, home care, the lack of independent individual patient advocates, dietitians and nutritionists, access to physical and occupational therapy and physical and occupational therapists, the massive bigotry of every kind rampant in every corner of the medical field, social work, senior care and assisted living, deprioritization of informed consent and harm reduction, disability applications, inaccessibility of medical records, especially psychiatric notes which are specifically allowed to be withheld from patients, lack of continuity of care for disadvantaged people, care that is equitably accessible to disabled people, telemedicine, patient portals, phone systems, clinic hours, every single aspect of inpatient and outpatient psychiatry, facility security, all sorts of things going on with therapists who are nevertheless probably the least malicious group of people in this entire charade, aaaaaand patients themselves.

Also hospital toilets that are too tall and make it literally physically impossible for me to poop while I'm there waiting for somebody to come out of surgery. I just needed to take a crap, guys. You didn't need to make the toilets so tall that my feet didn't even touch the floor. It is very clean but there is no shitting for short people at St Francis.

[kaladinsspear]

Self indulgent fluffy modern Shakadolin AU. Because I love them.

* Kaladin is ex army. One of those people who was special forces and therefore “officially” sat on his butt and did nothing for all 6 years of his service. He didn’t of course, but his entire file is redacted so he gets nothing. No disability (how could he have ptsd? He was “never deployed”) no VA support, no GI bill, nothing.

* He is now working for Amazon as a delivery driver while he goes to school. He started premed, but ended up switching to psychology. He’s especially interested in the body/mind connection. Not necessarily medication (though, he does support its use when needed) but more things like diet, sleep, exercise, and how your physical health affects your mental/emotional health.

* He volunteers at the local animal shelter where he takes dogs on hikes each week. This is how he met Syl.

* Syl is a Veterinarian. She volunteers at the local animal shelter as well, and the two quickly became close friends. They currently share an apartment.

* They tried dating for about a week (heteronormativity ya know?) but decided that it wasn’t for them. They love each other deeply and would consider each other life partners, but they don’t love each other romantically.

* Shallan works at one of those “paint with me” art studios. She has a degree in….drawing? (Sorry! I don’t know what the specializations are in art school!) and takes commissions for technical illustrations on the side.

* She loves the Wheel of Time series and has a thriving fan art instagram and tumblr.

* She met Jasna when she was in school. Jasna was her history professor and quickly became her mentor. Somewhere between a mother and older sister with a little bit of a crush thrown in. Not that Shallan would ever actually want to be in a romantic relationship with Jasna, but she so pretty, and smart, and opinionated, and bold, and…… ya know?

* Jasna is the one who introduced her to Adolin, and he and Shallan hit it off right away.

* They dated for about 3 years before getting married. They are sickeningly adorable.

* Adolin served in the military as well because it was family tradition, but didn’t make the career out of it that was expected of him.

* Adolin was a Marine, and his service is on record. He gets a nice GI bill which he is using to study physical therapy.

* Turns out, Adolin and Kaladin go to the same school.

* At first they are kind of indifferent to each other, but soon bond over shared military experience and an interest in whole body health.

* Adolin introduces Kaladin to Shallan and the two hit it off super well.

* Fortunately, they are all adults who know how to talk to each other and Shallan and Adolin have discussed polyamory before, all be it in hypothetical terms.

* Adolin is actually the one to bring it up to Kaladin, just to make sure Kaladin doesn’t feel pressured or sneaky. All 3 of them have a conversation about what a relationship might look like, and they decide to try it out.

* Turns out, it works great for them. Kaladin and Adolin have a delightful bromance thing going on. They probably wouldn’t have gotten together without Shallan, but they love each other deeply and enjoy their relationship.

* Shallan and Syl are super close as well, and they enjoy drawing together and discussing the Wheel of Time.

* Syl and Adolin get super into cosplay and make fantastic creations together.

[inficareservices]

Physical Therapy Medical Billing

Efficient physical therapy medical billing ensures accurate claims, timely reimbursements & reduced denials. Streamline your practice with expert billing services to focus on patient care, not paperwork.

[medicalbillingblogs]

Addressing Billing Fraud and Abuse in Physical Therapy Practices

Billing fraud and abuse in physical therapy practices present significant challenges within the healthcare sector. These unethical practices not only inflate healthcare costs, but also undermine the integrity of the healthcare system, decrease patient trust, and can have serious legal repercussions for professionals. Addressing fraud and abuse in billing requires a multifaceted approach that includes education, strong internal controls, compliance with ethical guidelines, and strict enforcement of legal frameworks.

Understanding Billing Fraud and Abuse

Billing fraud involves intentional deception or misrepresentation that results in unauthorized benefits or payments. In physical therapy, common fraudulent activities include coding, which involves billing for a more expensive service than what was actually provided, unbundling, which involves separating a single service into multiple parts and billing each part separately to increase reimbursement, and ghost billing, which is charging for services that were never provided.

Billing abuse, although not necessarily intentional, involves practices that are inconsistent with accepted medical or business practices, resulting in unnecessary costs. This may include excessive utilization or provision of services that are not medically necessary and misrepresentation, which misrepresents the nature of the services provided or their necessity.

Causes of Billing Fraud and Abuse

Several factors contribute to billing fraud and abuse in physical therapy billing services. Financial pressures can lead professionals to maximize revenue through fraudulent billing practices. The complexity of insurance billing systems often creates opportunities for these unethical practices.

Additionally, inadequate oversight and internal controls can allow fraudulent activities to go undetected. Finally, a lack of adequate training and awareness among staff on proper billing practices and compliance requirements can inadvertently lead to abuse.

Impacts of Billing Fraud and Abuse

The impacts of billing fraud and abuse are far-reaching. Fraudulent billing practices result in higher healthcare costs for insurers, which can translate into higher premiums and out-of-pocket costs for patients. The legal consequences for healthcare providers involved in fraudulent activity can be serious, including fines, imprisonment, and loss of license.

These practices also erode patients' trust in healthcare providers and the healthcare system as a whole. Additionally, resources that could be used for patient care are diverted toward fraudulent activities, leading to resource misallocation.

Education and Training

Education and training are crucial to preventing billing fraud and abuse. Effective programs should target all levels of staff within a physical therapy practice, from administrative staff to therapists. Regular training sessions on proper billing procedures, regulatory compliance, and ethical practices are essential.

Certification programs from recognized bodies, such as the American Physical Therapy Association (APTA), which offers certification in billing and coding, can further reinforce proper practices. Awareness campaigns can also play an important role in educating staff about the consequences of billing fraud and abuse.

Implementation of Strong Internal Controls

Strong internal controls can significantly reduce the risk of billing fraud and abuse. These controls should include segregation of duties to ensure that different people handle billing, coding, and payments, reducing the risk of fraudulent activity.

Regular internal and external audits are vital to detect and prevent fraudulent practices. Additionally, using automated billing systems with built-in checks and balances can help prevent errors and fraudulent activity.

Taking Advantage of Technological Solutions

Leveraging technology can help detect and prevent billing fraud and abuse. Electronic health records (EHR) can ensure accurate documentation of patient visits and services provided. Data analysis can be used to identify unusual billing patterns and potential fraudulent activity. Fraud detection software that can automatically detect suspicious billing activities for further investigation may also be beneficial.

Real World Examples

Real-world examples highlight the importance of addressing fraud and abuse in billing. In one case, a physical therapy practice was found to consistently bill high-level assessment codes, even for routine assessments.

An audit revealed that the practice involved upgrading services to receive higher reimbursements from insurance companies, resulting in significant fines and refunds of overcharged amounts. Another practice was to unbundle services by billing each component of a therapy session separately rather than as a single combined service.

This resulted in higher costs for insurers and patients, prompting corrective action and additional training on proper billing practices. In a third example, a physical therapist submitted claims for services that were never provided, including billing for patients who were not seen and treatments that were not administered.

The fraudulent activities were discovered through an internal audit and patient complaints, resulting in criminal charges and the loss of the therapist's license.

Precautionary Measures

Preventative measures are crucial to mitigating billing fraud and abuse. It is essential to establish clear policies and procedures for billing and coding and ensure that all staff comply with these policies. It is also important to conduct regular audits of billing practices to identify and address potential problems.

Evaluating and monitoring employees for signs of unethical practices can help maintain integrity. Encouraging whistleblowing by establishing a confidentiality policy that protects whistleblowers from retaliation fosters a safe reporting environment. Continuing education and training are essential to keep staff up to date on the latest billing and coding requirements and to reinforce proper practices.

Legal and Ethical Frameworks

Understanding and respecting legal and ethical frameworks is critical to addressing billing fraud and abuse. Regulatory agencies such as the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) provide guidelines that professionals should familiarize themselves with. Compliance with the Health Insurance Portability and Accountability Act (HIPAA) and other relevant regulations is required.

Professional associations such as APTA establish ethical guidelines and standards that must be followed. Participating in continuing education and professional development programs offered by these associations can further improve compliance. It is crucial to be aware of the legal consequences of billing fraud and abuse, including fines, jail time, and loss of license. It is advisable to consult with legal experts to ensure compliance with all relevant laws and regulations.

Conclusion

Addressing billing fraud and abuse in physical therapy billing practices requires a comprehensive and proactive approach. Implementing strong internal controls, fostering a culture of integrity, adhering to ethical and legal guidelines, and leveraging technology are essential strategies. Ongoing education and training, along with periodic audits and monitoring, are necessary to maintain compliance and protect the integrity of the healthcare system. Ultimately, addressing billing fraud and abuse benefits the healthcare system financially, improves patient confidence, and ensures the delivery of high-quality care.

[mososimos]

2024 ICD-10 code and guidelines update

Here is an overview of the FY 2024 ICD-10 code additions, revisions, and other changes that will impact medical coding and billing practices. In reliable medical billing companies, the medical coding team carefully examines annual code updates to ensure accurate reporting of patient conditions and encounters. By staying up-to-date with these updates, billing companies guarantee that the codes utilized for medical procedures, diagnoses, and services adhere to the latest guidelines, thus preventing billing errors and reducing claim denials. https://www.outsourcestrategies.com/blog/2024-icd-10-codes-guidelines/

[thevoidscreamer]

Hey all! Transgender military spouse (and parent to a transgender kid and friend of several transgender service members, transgender former service members, and transgender family members) here with some news.

The NDAA, the defense bill, is headed to President Biden's desk to be signed. I do not expect him to veto this bill. What's wrong with it? A lot of things, but today we're going to talk about how this will impact my family's ability to access lifesaving care. Let's get into it.

The bill bans the military health program, TRICARE, from covering some gender-affirming care for the transgender children of service members "if it could risk sterilization." This is vague terminology. Science-wise, many things could risk sterilization. We know from literal decades of research and practical application that puberty blockers alone and HRT alone do not cause sterilization, but is that enough of a buffer to warrant its coverage by TRICARE? Seeing as TRICARE doesn't cover gender affirming surgeries or vocal training for grown adult dependents (hi, that's me), I'm going to bet not.

The anti-science and pseudoscience spewed by non-experts (and an even smaller percentage of the already small 1% of people who regret transitioning) has been effective in radicalizing politicians and right-wingers against HRT for pre-teens and teens. Words like "mutilation" and over generalizations "you send your son to school one morning and he comes home a girl," are used to monger fear among those unable or unwilling to sit down and crack open a bonafide research study. Some people in my current audience fall into that category.

So let's clear the air with a few facts.

Puberty blockers are usually prescribed to adolescents 10-13 years old and are meant to be used for about two years while the kid figures out which puberty they want to go through. They undergo regular checkups with a pediatric endocrinologist on hormone levels, blood biomarkers, and bone density during this time, while also attending therapy sessions with one or more mental health doctors. Aside from the therapy sessions, this is all the same treatment received by kids with precocious puberty, who are between the ages of 6 and 9 years old with early pubertal presentation.

This has been the treatment for those kids for decades, which is why doctors and scientists are pretty dang solid on the side effects, optimal length of treatment, and general wellbeing outcomes for patients.

According to the Mayo clinic: "GnRH analogues don't cause permanent physical changes. Instead, they pause puberty. That offers a chance to explore gender identity. It also gives youth and their families time to plan for the psychological, medical, developmental, social and legal issues that may lie ahead. When a person stops taking GnRH analogues, puberty starts again."

According to UCLA Health: "If the pubertal blockers are started in the later stages of puberty, you may already be making fertile sperm or eggs. Some people choose to preserve their sperm or eggs before starting pubertal blockers, to keep options open about how to build a family in the future. If you later wish to have genetic children, you would likely have to stop the pubertal blockers and proceed through most of your own biological puberty in order to achieve effective fertility; this may take several years. This would mean you would develop some features of puberty associated with your sex assigned at birth; for some people, this could be distressing."

What about full HRT (testosterone or estrogen)? Test and E are generally not accessible to people younger than the age of 16. If received right on the heels of hormone blockers, THIS may result in infertility. However, those patients who are ONLY seeking full HRT without having done puberty blockers, which is most patients receiving full HRT, are typically able to come off of that HRT and achieve full biological puberty and even procreate.

You've heard of men getting pregnant, right? Those are transgender men who have gone off their testosterone specifically to have biological children. There are, however, other options, for transmascs who don't wish to carry their own child. Namely, egg harvesting, wherein the man goes off of testosterone and receives a hormone injection to stimulate the overproduction of eggs to be harvested and frozen for use at a later date. Both of these methods do require the person to have developed and retained their gonads (testes and ovaries), which is achievable by allowing the body to go through biological puberty (which may be assisted in some cases by additional HRT).

Testosterone and Estrogen are both present in the human body regardless of sex. These hormones do not permanently sterilize a person. So, no, HRT does not generally result in infertility. Gender affirming (lower) surgery, however, can.

Gender affirming surgeries are not available to transgender minors except in extreme cases, and in those extreme cases, it is top surgery, not lower surgery. Gender affirming cosmetic surgery is available to (and undertaken by) cisgender minors starting at 15 or 16 years old (in the form of augmentations, reductions, body shaping, rhinoplasty, and face shaping), and should also be available to transgender minors in the same age bracket.

Lower surgeries are not accessible to minors, and most people under the age of 25 cannot get approval to receive them due to providers not wanting to undertake the liability of possible regret -- even though the regret rate for transitioners is 1%, whereas the overall surgical regret rate average for ALL procedures is 14%. Even in adulthood, transgender men are less likely to be able to access gender affirming lower surgery (hysterectomy, metoidioplasty, phalloplasty) than transgender women, due to doctors' collective reluctance around medical care for people designated female at birth.

No children are receiving gender affirming care that would permanently sterilize them. So why? Why this provision in the NDAA about gender affirming care that "may" sterilize minors? Because of successful fear-mongering and the anti-science movement. Because of the relentless onslaught of anti-trans advertisements during the 2024 campaign season. Because of the unwillingness of self-proclaimed allies in our current institutions to stand by marginalized groups.

I do not expect this policy to remain at a military level. I fully expect that, come 2025, we will see a massive stripping of the protections and supports painstakingly put into place over the past decades, aided and abetted by the democratic party, then glossed over as not being that bad by people who claimed to be our friends. In the next four years, I foresee my gender affirming care, which is covered by TRICARE, suddenly needing to come out of my own pocket. My kid's already will, come the new year.

Ultimately, though, I think that it will be about more than gender affirming care, but queerness in general as a concept -- I foresee transgender service members either erased or forcibly separated. I foresee emboldened discrimination against queer workers and queer students and queer families seeking housing or other support. I foresee bathroom bills and sports bills, and all these things that do not require scientific support, though they may falsely claim it.

Right now, federal and state laws prohibit discrimination against transgender individuals by most public and private insurance health plans. This means insurance companies must cover transition-related care that's medically necessary and it is illegal for them to deny coverage, in most cases. TRICARE seems exempt from this rule. Ultimately, I think over the next four years, those laws will change in an anti-progress fashion.

One of the provisions proposed by Republicans for the NDAA bill was not only to prevent coverage of gender affirming care for minors (which is already shitty) but to prevent that same coverage for adults. While the adult provision did not make it into the bill, the minor provision did, and it passed with overwhelming bipartisan support.

Yes, wages increased for service members across the board, at rates never seen before. But while some of my friends may be celebrating that fact, please keep in mind that while transgender people aren't incredibly visible in your circles, we're literally all over. There are so many of us on and around base (service members and family) and the fact that a removal of access gender affirming care for adults was even legitimately considered is a HUGE warning flag for all of us, as is the removal of access to gender affirming care for minors.

I don't know how to close this out, other than to say that I will never stop being relentlessly visibly queer, regardless of what's to come. I'm considering setting up a meeting group for queer military dependents and service members, though I'm unsure how I want to go about that. Let me know what you think in the comments.

Yours in grief and resistance,

B

Link to Reuter's article: https://www.reuters.com/world/us/majority-us-senate-backs-massive-defense-bill-voting-continues-2024-12-18/

[someone-will-remember-us]

Female inmates are terrified that transgender prisoners will still be allowed into women’s jails, according to policy reviews that have been secret until now.

Women prisoners are concerned that some trans offenders have manipulated the system by ditching hormone therapy used to help them transition as soon as they enter a female jail.

Vulnerable women have told researchers that they fear being sexually abused by male offenders who claim to be transitioning.

The reviews were conducted by the Scottish Prison Service (SPS) after public outrage over the case of Isla Bryson, a double rapist previously known as Adam Graham who was initially remanded to Cornton Vale women’s prison in January last year. Only after political condemnation of the decision was Bryson switched to a male prison.

New guidelines for the SPS will still allow transitioning male prisoners to be admitted to female jails if they have no record of violence against women.

Single-sex campaign groups said the new policy was “shocking”. They said trans prisoners should not be put in women’s jails where most inmates have suffered lives of physical, sexual and domestic abuse.

Kate Coleman, director of Keep Prisons Single Sex said: “At its heart is not the safety of women, rather it is the principle of maximising the opportunities for transgender prisoners to be allocated to the estate corresponding to their expressed gender.”

The aim, she said, was to increase the opportunity for male prisoners identifying as women to have access to women in prison so that they could “practise” being female.

The SPS drew up its policy after a series of unpublished reviews asking female prisoners and officers about their concerns.

The Sunday Post said it had gained access to several papers that contain claims of trans prisoners “manipulating the system” and refusing, as soon as they get into a women’s jail, to take the female hormones that prevent their male genitalia “working”.

One female prisoner said of a trans fellow inmate: “If I was to have an argument with them then I would feel at risk because that’s the strength of a man.” Another said: “The last one to get out [of jail] is now back living as a man. The one before that got out — back living as a man. When he was in our hall he was telling people ‘I’m stopping taking my medication because I can’t get [an erection]’.”

Rhona Hotchkiss, the former governor of a number of Scotland’s prisons, including Cornton Vale, expressed an “increasing concern” for the wellbeing of female prisoners as well as staff. “Why was this research never issued by the SPS?” Hotchkiss asked. “Possibly because it would increase the pressure on them and the SNP government?”

She added: “It is abundantly clear that women in prison — not all of them and not all of the time — are by turns distressed, frightened, annoyed or irritated by the presence of men who identify as women in women’s prisons.”

The SPS said its new policy supported the health, safety and wellbeing of all people living and working in Scotland’s prisons. The reviews had not been published to protect personal information.

“No transgender women with a history of violence against women and girls, who present a risk to women, will be placed in the female estate,” the SPS said.

Separately, Patrick Harvie, the Scottish Greens co-leader, has been criticised for a “dangerous” attack on critics of Nicola Sturgeon’s gender self-identification bill after comparing them with bigots who hate Muslims.

In a podcast the Scottish government minister said that people who express concerns about changes to transgender laws are no different from the far-right trying to ‘“demonise and stigmatise the Muslim community”.

Meghan Gallacher, deputy leader of the Scottish Conservatives, said: “Patrick Harvie typically dismisses legitimate concerns people had about how the bill threatened the safety of women and girls because he is so wedded to his dogmatic views.”

(archive)

[marta-bee]

The online reaction to the United Healthcare exec's murder are getting a bit under my skin. I work in medical billing and previously in medical bill auditing (in an administrative role). So this all hits a bit close to home.

I know it's not a popular position, but I actually do think prior authorization and bill review have a role to play in making health care more affordable for everyone, in the current health care system and when done right. And even if we flipped to something like Medicaid for all (where doctors are still getting paid for specific services rendered), you still have to work out how to map treatment onto specific payment codes and pay for those at a fair and sustainable rate.

And insurance collectives (commercial or otherwise) can play a big role in recognizing when doctors are overcharging in one way or another, or even seeing when doctors are rushing into surgeries before (say) the patient's had enough physical therapy to know if the surgery's really necessary. "It's complicated" is sometimes underselling it.

I'll even admit that in some contexts, some profit should be acceptable if insurance collectives are doing their job. If they're actually balancing cost vs. treatment in a way that helps people afford healthcare. I mean, yes, I'd prefer a system where people like me aren't necessary, but until we get there, I don't think it's obscene for these companies (even when they are companies and not, say, self-funded non-profit insurance collectives; I worked with several) to be for-profit. The real question is how much is too much.

On the flip side... Mr. Thompson was the CEO of a major for-profit insurance, well paid beyond what's reasonable and on his way to a conference with his company's investors. It's really hard to square all that with "playing their part well." The investors aspect is particularly hard to swallow. I mean: what?

And even in an ideal world... look, I've generated those EOB's, which means I've also read them. I may not be a nurse or doctor but I work with them and have had years to educate myself in that world, and they were often hard for me to understand. Even when a denial or modification was necessary, even when the decision is justified for whatever reason, the way it's communicated and the way things that should be between the doctor and the insurance are foisted off on the patient can lead to frustration and anger all around.

I don't know. I see the purpose for insurance and medical audits and all that. I think even in a better system than our current one, you'd still need a way to make medical care affordable and the system economically sustainable. On the other hand: even as I'll never say killing him was acceptable, I can't defend the work that man was doing. All I do know is it's not a particularly comfortable place to be just now.

[havegaysex]

Oh nooooo, $25 for your HRT. Nevermind that some of us who are diabetic, epileptic, or have cancer while also being trans pay out of pocket for medication that actually keeps us alive, plus our HRT. Can't relate to able bodies people bitching about this shit. Go buy a week of insulin for someone on an insulin pump and then call me.

im literally disabled

I'm on SSI as my sole income because I cannot work

I mostly leave my house to commute for healthcare and I finally got a compatent PT who is helping me get a wheelchair evaluation. In the coming year bc my primary insurance changed their plan I will now only get 30 visits for the whole year for physical therapy which is my main pain management, as I would rather not have to be reliant once again on medications that have physical damage with long-term use not to mention making me unable to perform cognitively.

Im well aware disabilities bankrup people .

I'm aware that I'm lucky to even be on SSI and Medicaid and food stamps and have a primary health insurance that isn't Medicaid.

But that doesn't make me suddenly abled and not reliant on a mobility aid. Or able to stand and work enough that I'm not reliant on the government for basic necessities.

I'm so sorry you are waking with so many disabilities and such a difficult diagnosis with the cancer. But please leave me alone bc I cannot help you. I am currently spending all of my limited money on gas and medical bills for my retired service dog.

We are all suffering under capitalism and ableism.