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How To Get Started With Outsourcing Medical Billing

By Ashly Williams, freelance writer, Billing Solutions.

For owners and managers of treatment centers, outsourcing your billing process makes perfect sense. The process of managing your billing process requires time and resources. Additionally, it’s a bit complicated having to balance coordinating patient care and handling the billing collection process. Having your in-house staff managing the billing process adds to their tasks and requires accountability. Any errors in the ICD coding will lead to penalties for your practice. To protect you from such problems, here’s how to get started with outsourcing medical billing.

Why outsource revenue collection management

With outsourcing, the burden of managing the collection process goes to third-party staff. Luckily, these have enough industry experience and expertise in managing the process. You will significantly benefit from their professional touch to your billing process. This obvious outstrips relying on the capabilities of in-house staff. You will enjoy peace of mind that your collection process is in the hands of professional. Outsourcing medical billing also offers your staff the chance to devote more energy to engaging with patients more.

Apart from costs becoming easier to control in your practice, you will benefit from industry specialty services to suit your needs.  As your practice grows and your patients become more, it requires a balance in the number of people attending to them. To keep up with the staffing level might lead to a hike in management costs. Luckily, you can outsource and save a significant amount.

There’s more

Health services handle various patients and this makes their work to become complicated. Therefore, it’s very important to get billing for treatment facilities  that meets the needs of your practice. Your staff will not have to work beyond their normal capacity anymore. Outsourcing your collections process to specialty RCM service comes with other benefits including:

How to find the best service provider

It’s very important to evaluate potential service providers before outsourcing your billing services. A good service should offer specialty services to meet your requirements. Understanding complexities in your practice’s billing process eliminate unnecessary delays. The provider should keep up with industry trends to ensure that you benefit from the latest RCM practices  and technology. Additionally, the agency should have trained and experienced staff to lessen the chances of making errors. These significantly slow down the revenue flow.

The most important quality of a good medical billing service provider is the ability to keep communication lines open. The company should promptly contact you in case any issues are detected while handling your billing. Additionally, the billers should respond quickly to inquiries regarding billing and reimbursements. This will ensure that the billing process goes on smoothly with no chance of errors  and disagreements.

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3 Healthcare Technology Advances Transforming the Industry

By Kristin Savage writes regularly on the Pick Writers blog and occasionally contributes to other educational platforms.

Technology has become an inseparable part of our lives. No matter how you look at it, from smartphones to computers, we need technology to function in our everyday routines. The exact same thing came to apply in the medical field.

As technology continues to advance, there are more and more ways in which those creations can be applied in the medical field and revolutionize the way the healthcare industry works. Here are 3 of the most important current technological advances which have played a very important role in the industry.

Artificial intelligence in hospitals

One of the most important things that are happening in our hospitals now is the incorporation of AI technologies in the healthcare system. By including innovative technologies in the care of all patients, a number of benefits have been created as a result.

The most important thing that has been put to use have to be robot-assisted surgeries. In traditional medicine in order to perform an operation, the doctor has to have very steady hands, be able to be very precise and also manage to stay standing for hours, especially when an operation is very difficult and high-risk. On top of that, the doctors can stay in a much more comfortable position during the operation.

Surgery-assisting robots have really changed the way a plethora of operations are being done. From gastric bypass surgeries to heart ones, these AI robots can really change the way the medical practitioners operate. Not only do they have a much clearer view of the area they are operating on, they are also a lot more precise thanks to the robotic tools.

In addition to these perks, some operations can now be completely done by robots working remotely.  This can be a great help to the medical personnel and it can also create more open spots for patients in urgent care who really need to be operated on.

These elements truly help reduce the risk of surgeries, make them more accessible to patients. Along with that, they can also drastically reduce the healing time after the operation and make the overall experience a lot more pleasant for the patient.

Along with that, there are also new systems and devices installed in the hospitals which aid the medical practitioners when it comes to making a diagnosis. They are much simpler to use and monitor the patients in a much more effective way. From new scanning devices to tools which help with drug administration, the hospital experience had become a lot more pleasant for both the personnel and the patients involved.

Digital records and databases

A common problem in the hospitals is how long it takes for medical practitioners and nurses to create appropriate and complete files for their patients. This can lead to long waiting times and a lot of effort from the medical personnel’s perspective in order to keep everything under control and collect the correct data.

Up until the last century, every document in the medical field was collected in a paper-based system. In our day and time, technology has given the healthcare industry a way of storing everything into an electronic format. This has changed the field in many different ways.

First of all, it has truly simplified the way medical histories are being created. There are certain AI tools similar to Alexa and Siri, which can listen in to the patient-doctor conversation and automatically turn everything that had been mentioned in a complete file. This truly helps save a lot of time for the doctor as they won’t have to take noted of everything that is being said anymore. On top of that, the visits will be shorter and therefore the waiting time will be reduced drastically.

Along with that, the saved information can very easily be added to the patient’s medical history as it is now easily accessible for the doctor online. This is very helpful when it comes to connecting the dots and finding our exactly what could be wrong with a patient’s health.

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The Future of Digital Health, According To Accenture’s Sumit Kimar Nagpal

Sumit Kumar Nagpal
Sumit Kumar Nagpal

In his keynote session at the DreamIt conference in Tampa, November 6, 2018, Sumit Kimar Nagpal, global lead of digital health strategy at Accenture, says the future of healthcare is about a few simple things: Keeping people safe, providing for their well-being and improving care via information and technology.

Sounds simple, but guess what? Traditional players in healthcare are simply not ready, he said. Before explaining why, he painted a portrait of the current landscape and what he expects to come.

First, the current marketplace is all about cost then “innovation,” “agility,” “convenience,” and even the supposed “patient experience.” Cost, however, is likely the single most important issue in healthcare, he said, citing its 18 percent of the US GDP. There a lot of talk about convenience and collaboration, but what’s the outcomes? he asked.

Cost is the biggest driver. It’s a “cost takeout” marketplace, which is dominated by back office optimization. In other words, reduce costs through back office efficiency controls and strategies to save health systems money.

However, there are three important mega trends in healthcare related to the individual consumer. We are aging as a population; we are living longer; and we are facing more long-term conditions. All of this is surrounded by consumerism or the consumer experience and what that means to their health.

Another major transformation is that care is shifting in its location. There is a shift of care to the retail setting, for example, out of the four walls traditionally known in healthcare, for earlier engagement of care in the areas where people live, work and play. This even means that experiences are moving online, into the home and into the community setting.

Those who give us care is changing, too, he said. We’re used to seeing a doctor or a family care provider in an office at a practice, but that is quickly shifting. Care teams are extending well beyond the doctor into retail pharmacists, friends and family, teleconsultations, visiting nurses and social workers and “Dr. AI” and “Dr. Google.

“We’re building a very different relationship with technology to help us decide what’s next and what we have as a condition. This is all about taking down the silos and the four walls, and includes deep, mass personalization,” he said.

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Startups: Success, Failure and Solving Health System’s Problems

Some of the biggest problems that investors, entrepreneurs and startup leaders need to solve was the point of a discussion during an opening session of an innovation summit hosted by DreamIt in Tampa in November. According to member of the panel — Daniel Vukmer, senior associate VP of network integration, USF Health; Todd Dunn, director of innovation, Intermountain Healthcare; and Ashley Simmons, director, design integration, Adventist Health System – some of the current top priorities for health systems continue to include patient access to care, better experiences when care is required and, of course, improving outcomes.

Those are the priorities that healthcare startups should be addressing.

For most health systems, the panelists said, moving healthcare to a much more consumer-centric business model is their most pressing issue – other than providing care itself. Because of this, the seemingly ever-allusive value-based outcomes will likely follow.

Simmons said Adventist Health System’s main priority is improving the consumer experience; the consumer is at the end of every decision point. “It’s consumers at the end of the day that we are engaging,” she said.

For startup leaders, they can look to Amazon for tips on how to create an overall experience, but they must truly understand the problems they solve or can solve as part of the charter, how they can help health systems solve these problems and who they need to align within the organization to bring about change between the health system and the startup.

Innovation is a collaborative effort, Dunn said. Health startup leaders must work with clinicians to understand the most pressing problem that needs solving or the one the health system is struggling with most. Also, instead of brain storming solutions that the startup may think exist, consider “pain storming,” Dunn added. When pains can be identified, solutions can be offered.

For Vulkmer, innovation requires a problem to solve, as well as must include a quality value proposition. How will a startup help a system address cost, quality and service – the triple aim? Startups also must align with the needs of health systems to help them make a move and change, Simmons added.

“There’s not an area in healthcare that’s not going to need to be served in the next five to 10 years,” said Dunn, meaning there are plenty of opportunities for innovators who wish to take on the challenges.

What works, what fails

When young, lean and new IT organizations want to succeed, perhaps the best approach – as it is in any business – is knowing the landscape being served, understanding the marketplace and being well aware of competitors. Some startups fail simply because they don’t understand the marketplace they are trying to serve, as well as the most pressing problems they need to solve.

Some startups are overly confident, too, said Simmons. “A few startups we’ve worked with that have failed because they don’t understand their marketplace and competitors, and have made claims that were untrue,” she said. “Nine times out of 10 you’re probably not the only one doing something and you’re probably not the best one doing it.”

Finally, failure for startups can come because they think they can change healthcare at a macro level when their solution is granular at best.

Another setback for entrepreneurs and innovators is being verbally critical of a provider or even saying that “healthcare is broken” during an initial engagement, Dunn said. “It’s deeply personal to us and we’re trying to fix it. This is not a system, it’s people making up a system.”

Getting beyond the pilot

To ensure success, startup leaders might consider some best practices. These include engaging someone inside the health system who is championing the effort. Additionally, these leaders may want to time-bind a return time for the system. Also, consider putting a project manager on the plan to keep the project or relationship moving.

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Revolutionizing Medicine with Artificial Intelligence

By Claire Whittaker, CEO, Artificially Intelligent Claire.

In today’s world, we have access to more data than ever before. Analysis of big data is allowing us to solve ever more complicated problems at scale in a way that was not previously possible.

It’s a revolution.

Now it’s time to use the revolution of artificial intelligence in medicine. But what does this mean for the way we diagnose and develop new treatments?

Giving researchers access to pools of big data and equipping them with the tool of machine learning allows then a great opportunity to speed up processes that would have previously taken years. The typical timeline for new drug development from concept to market-ready product can range between 12 and 30 years. A significant portion of this time is devoted to research and development.

Patient diagnosis and treatment also experience, in particular for more acute diseases and ailments, a substantial amount of study to perfect. How can we leverage artificial intelligence in medicine, and its application in machine learning to help speed up this process?

We are starting to see the power of this technology to support medical diagnosis and treatment in several recent papers published by medical research institutes. These papers show the breadth at which the technology can be applied to increase the efficiency of the processes of diagnosis and treatment significantly. Thus allowing doctors to spend more time working directly with patients and saving institutions money.

Here we look at how artificial intelligence in medicine is driving forward our understanding of a variety of conditions. From drug development, through to improving the testing process and finally onto diagnosis — it is clear that there are multiple benefits of partnering with the technology.

Step 1: Drug Development

A recent article published in Nature highlighted several companies using machine learning to improve the drug development process. One company highlighted is Berg.

Berg is using machine learning to better understand and map human biology in far greater details. In their own words, “instead of hypothesizing the mechanism of a disease and focusing on only a few related compounds, we profile the entire disease by analyzing various patient biofluids (OMICS) and cell models (bio systems) as well as clinical information (EHRs).” This knowledge is then fed into Berg’s data analysis systems to be applied to drug development. The use of this artificial intelligence in medicine helps us to develop drugs more quickly and efficiently.

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Consumer Demand for Provider Data in the Digital Age

By Erin Jospe, MD, Chief Medical Officer, Kyruus.

Erin Jospe, M.D.
Erin Jospe, M.D.

We live in the digital age, a time of unprecedented information generation and information consumption. Consumers have grown facile in their navigation of the information industry landscape, and have developed expectations of ready access to the data they need to make better, more satisfying decisions for themselves as to where their time and money is most rewardingly spent.

Health decisions are no exception to this new paradigm. Just like the ratings, the cost, and the availability data people use to consider what shoes to buy or restaurants to patronize, more and more patients are seeking a similar level of information to guide their decisions for where and with whom to pursue their care. This is not to equate the more superficial decisions we all make with little consequence to the decisions we make when considering where to receive safe and clinically sound healthcare.

Finding a care team with the clinical expertise to navigate a person safely through their new cancer diagnosis is clearly a vastly different premise than deciding on a pair of boots to buy. That said, it would be naive to think that patients don’t behave like consumers when they can, or that the information they want to make those care decisions remains optional in the competitive market of attracting and retaining patients.

Indeed, studies of consumer behavior bear that out. Consumers want to make informed decisions, and more than half will go online to research providers before selecting one, typically starting with a general internet search. This desire for due diligence with additional research is true even when they have a specific provider recommendation in hand.

To meet patient expectations in the successful selection and scheduling of a provider, we need to acknowledge the importance of being able to readily access the desired information – information that makes it easier for patients to determine if a provider aligns with their clinical needs, logistical requirements, and personal preferences. Savvy health systems embrace the need to surface this provider data, and in so doing, attract and retain a broad customer base.

The start of the patient’s experience with a health system’s providers begins with an ability to discover and leverage the information they want to make decisions about their care providers. While every potential patient will be motivated differently, most commonly seek information on accepted insurance, clinical expertise, and availability.

Certainly locations, cost, languages, gender, publications and education are among the other types of data that influence a patient’s selection of a provider. And this is to say nothing of how a picture of the provider, their professional statement, or their reputation as captured in online ratings and reviews can further assist in the conversion of a consumer’s interest into a booked appointment.

With so many different factors influencing a patient’s decision, the numerous online sources of that data, and the varied accuracy of the data that is available, satisfying customer demand for data can seem daunting to say the least. But health systems need to take action to consolidate, curate, and make this information available to attract and keep customers effectively.

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ICD-10-CM Official Guidelines: What’s New for Circulatory System Coding Rules in 2019

By Deborah Marsh, JD, MA, CPC, CHONC, senior content specialist, SuperCoder.com.

Have you reviewed the changes to the Circulatory System section in the ICD-10-CM 2019 Official Guidelines for coding and reporting? To support medical necessity and payment for your cardiology CPT codes and cardiology HCPCS codes, your ICD-10-CM coding needs to be spot-on. And that doesn’t mean just checking the ICD-10-CM index in your manual or cardiology coding tool. You’ve got to have the Official Guidelines down cold, or at least know where to find them when you need them. As you use the ICD-10-CM code set for 2019 cardiology coding, make sure you’re aware of these revisions to the Official Guidelines (OGs) so your coding complies with the rules.

Check for 2 Changes When Coding Hypertension with Heart Disease

In 2018, section I.C.9.a.1 of the OGs (Hypertension with Heart Disease) stated that “Hypertension with heart conditions classified to I50.- or I51.4-I51.9, are assigned to a code from category I11, Hypertensive heart disease.”

Watch out: In the 2019 OGs, the code listing changes to “I50.- or I51.4-I51.7, I51.89, I51.9.” You’ll continue to use additional code(s) from category I50.- (Heart failure), to identify the heart failure type, when applicable. What’s different? The change removes I51.81 (Takotsubo syndrome) from the guideline.

Clarity on when to code separately: The Hypertension with Heart Disease subsection gets an additional clarification for the instruction about when to code those heart conditions separately from the hypertension. The 2018 wording was “if the provider has specifically documented a different cause.” The 2019 wording is “if the provider has documented they are unrelated to the hypertension.”

See a Similar Documentation Clarification for Hypertensive CKD

 The Hypertensive Chronic Kidney Disease subsection sees an update like the one above for separate coding of hypertension and heart disease. Here’s the exact wording in section I.C.9.a.2:

Know Proper Sequencing for Pulmonary Hypertension

The 2018 OGs had incorporated changes for Pulmonary Hypertension (I27.-) in section I.C.9.a.11. A clarification in 2019 assists by better defining sequencing rules.

The 2018 OGs said that for secondary pulmonary hypertension, you should “code also” associated conditions or adverse effects of drugs or toxins and base the sequencing on the reason for the encounter.

The 2019 OGs revise the instruction to base sequencing on the reason for the encounter “except for adverse effects of drugs (section I.C.19.e).” The section referenced covers coding for Adverse Effects, Poisoning, Underdosing, and Toxic Effects.

Steer Clear of Subsequent AMI Coding Mistakes

Codes and OGs for myocardial infarction got a facelift in 2018, and the 2019 OGs continue to add clarification about how to code properly.

The new instruction added to section I.C.9.e.4 states, “If a subsequent myocardial infarction of one type occurs within 4 weeks of a myocardial infarction of a different type, assign the appropriate codes from category I21 [Acute myocardial infarction] to identify each type. Do not assign a code from I22 [Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction].”

The new instruction goes on to state, “Codes from category I22 should only be assigned if both the initial and subsequent myocardial infarctions are type 1 or unspecified.”

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Artificial Intelligence Is the New Operating System In Healthcare

By Pauline Farris, who speaks Portuguese, English, Spanish and Italian. She is a voting member of the American Translators Association and an active participant of the Leadership Council of its Portuguese Language Division.

Pauline Ferris

Technological advancements always happen so our lives can become a lot easier. We have incorporated technology into every aspect of our lives, from housework to teaching and now even in the health sector. Artificial intelligence has had a great effect on how healthcare works and has helped us take great steps towards making it more efficient and approachable.

Not only does it offer a way to save a lot of time when it comes to treating patients but in general it can help make everyday tasks a lot easier for medical practitioners. There are so many different ways to incorporate AI technology in health and here are some of the reasons why it is so important and useful.

Eliminate waiting time by virtual nursing assistants

One of the biggest complaints in most hospitals and clinics is the fact that patients have to wait so long in order to get checked by a doctor. In the UK, college hospitals in London are starting to introduce AI technologies which will help with taking notes of the patients’ symptoms and prioritizing them based on the severity of their conditions.

A great technology that can truly cut down the wait time for all the patients and make the doctor’s job a lot easier is a new tool called scribes. This great tool works similarly to other tools we already have inside our homes, for example Alexa. If you have ever paid a visit to the doctor, you probably have notices how much time it takes for the doctor to write down all your information and create a record.

This tool simply listens in to your conversation and records everything that is being discussed. At the end of the appointment, the doctor can make it automatically create a record of what has been mentioned in the visit. This can help save a lot of time for both the patient and the doctor.

Another problem is that people who want to book an appointment have to wait a big amount of time in order to actually meet with the doctor. Artificial intelligence can provide the patients with a way to get a better understanding of their condition as well as write down and understand their symptoms and help them cope with their health issue until they can visit the right practitioner.

Making patents’ diagnosis a lot easier

The good thing about AI technologies is that they can store and recall a very large amount of data without any effort. Most doctors work for an extreme amount of hours every week and while they are always prepared to handle any case, some external help could really help them with diagnosing a patient.

The main focus of AI technology in these situations is to provide hospitals with tools which will help make consultations a lot quicker and diagnoses more accurate. These tools will remind the doctors to ask additional questions depending on the patient’s symptoms, order additional tests and even suggest fitted treatment plans which can decrease the healing time and make treatment a lot easier for both the patient and the doctor.

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Sharing Too Much? A Tale of Privacy, Big Data and Sleep Technologies

By Brooke Faulkner, freelance writer, @faulknercreek.

The proliferation of wearable mobile-connected devices has done a lot of good for people trying to lead healthier lives. People are able to gather data about their sleep to help them get better rest, track insomnia, stress, and exercise, and keep up to date on their own daily routines and health.

Many of the devices exist not just as trackers but as ways for people to motivate themselves to exercise more, go to bed at more regular times, and other little things that slip by in the daily grind.

Healthcare Data in the Modern Age

Sleep is absolutely related to health. Many health issues affect our sleep or are caused by issues with sleeping. A number of medical professionals are interested in how, when, and for how long we sleep. These days, that information is stored in digital medical records, which have a number of advantages. Specialists can access information far more quickly and easily to help us with medical problems.

There are, however, disadvantages to medical records being easily accessible and easily updatable. Privacy and security have become major concerns for healthcare providers, as the records contain our most sensitive information, which proves highly valuable to hackers.

Official medical records, however, are just the tip of the iceberg. We use the internet not only as a go-to for advice about medical conditions, but as a method to voluntarily record all sorts of data about us. Recording, storing, and tracking sleep data on our personal devices gives us a lot of power to “do it yourself” when it comes to preventative health and tracking changes in our sleep patterns. This ease of use, however, comes with a cost. It’s not all about sinister hackers, either; that data can be used in all sorts of ways that are, while not outright damaging, at least partially invasive.

Wearables, Bluetooth and Data

Tech companies are working on more advanced ways to use high-tech devices to track our sleep. These include wearables and even devices that don’t need to be attached to the body. The amount of information gathered, and its accuracy, varies greatly by device. The Bluetooth connectivity and the ability to store, track, and share the data the devices collect are parts of their appeal.

The number and type of people who benefit from this information is vast. Sleep disorders are a common side effect of other medical disorders, and managing sleep is an important part of living a healthy lifestyle, especially for people who are at greater risk for certain conditions.

You don’t need to have or be at risk for medical complications to make use of sleep data, however. There are plenty of careers in the U.S. which require people to work long or unconventional hours. Night shifts and long shifts, such as those worked by nurses, can cause havoc with the circadian rhythms that regulate our sleep. This can create complications for otherwise completely healthy people. Being able to self-regulate with the help of wearable devices is a great advantage.

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Harnessing Innovation to Serve and Create Value for Patients

By Georgia Mitsi, PhD, MBA, senior director and head of digital healthcare initiatives, Sunovion Pharmaceuticals Inc.

Georgia Mitsi
Georgia Mitsi

Innovation is not a choice but rather a growth mindset, which creates an environment for building a sustainable business. This mindset allows for objectivity and contributions towards a bigger shared purpose. Innovation is about challenging the status quo with processes that do not work and trying new ways. Innovation is driven by positivity and optimism. Innovation offers options and it should be pursued relentlessly because it provides new opportunities for employees to grow and become even more engaged and productive.

Ultimately, innovation can help to ensure a company’s future. But, harnessing innovation does not need to be daunting, and can be done in small steps.

Many types of companies within the healthcare ecosystem have been leveraging technology to harness innovation, and the pharmaceutical industry in particular is exploring new ways to do so, which is changing the established business model. Technology offers opportunities to redefine the future of the pharmaceutical industry and to contribute towards innovation. Technology though is not a panacea and while it is still rapidly evolving, the focus should be on the “how” and not necessarily the “what” of technology. With regard to digital health care, there are three “hows” that should be considered:

  1. Prevention: How can we protect people from getting sick?
  2. Diagnosis: How can we improve people’s healthcare experience?
  3. Monitoring: How can we better support people and their families during the most challenging periods of their lives?

The new category of digital therapeutics has the potential for creating easy-to-use solutions for all three areas—prevention, diagnosis and monitoring.

Finding Sweet Spots, Enabling Cross-sector Partnerships

It is important to think for a moment how life has changed to understand how the pharmaceutical business can take advantage of the changing dynamics.

Let’s imagine Jenny. Jenny has a place that she calls home; a place that feels secure, relaxed and happy. She has a family, pets and friends. She shops to cover her basic needs and creates opportunities for entertainment. When she gets sick, she goes to the doctor, to the pharmacy and from time to time she may end up at a hospital for additional tests. But Jenny has also a demanding job and a long commute. Her life is busy and time is the most precious commodity. Technology has provided Jenny with the opportunity to make her life more convenient because a lot of her basic needs can be met online. She can easily order groceries, buy clothes, connect with her family and friends, make restaurant reservations, plan her next vacation, work online, read books, complete financial transactions and even receive medical services and medications. Therefore, technology contributes to Jenny’s well-being by making her life more convenient.

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