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Implementing a Personal Health Record While Applying For Health Insurance Online

The preparation phase of filing for health insurance is an excellent time to implement a computer-based personal health record   because you can proverbially kill two birds with one stone, i.e. begin the creation of your own all important personal medical record and decrease the likelihood of being denied medical insurance coverage or experiencing gaps in your coverage known as  existing exclusions if your application is approved because of incorrect information entered on your application.                            https://www.detroitescorts.siteThe online health insurance application process from acquisition of health insurance quotes to the final application approval is a streamlined one which is designed to enable you to find the best insurance for you in the least amount of time, but if you do not have the proper information pertaining to your health while going through the process, the efficiency that is intended may be   or negated.

The creation of a personal health record as you prepare to file for health insurance online probably can not only help you more efficiently and accurately go through the application process and find the health insurance that is best for you, but can also be of immense value to you in the future in other settings such as applying for a job, applying for various licenses that require health information, obtaining an airman medical certificate if you are a pilot, and preparing for visits to doctors or other health care providers, only to mention a few.

In applying for health insurance, as is the case in virtually any application proceeding, going through the process without having documents to refer to can be very frustrating and might result in incorrect information being submitted causing your application to be denied, and in the worst case scenario, a conviction for health insurance fraud.

In deciding whether not to grant you medical insurance, insurance companies want to know a number of things about your past and current health such as past illnesses, current illnesses, dates of onset of symptoms pertaining to diagnosed and non-diagnosed medical conditions, surgeries, past and present medications, allergies,   and even some details about the health of family members inasmuch as some conditions have hereditary links. Not all insurance companies use the same application form, but to get a good idea of additional information that you need to focus on entering into your personal health record in preparation for the application process you can download a standard insurance application for your state from a site on the Internet. You may be able to obtain some of the relevant information from paper records you already have such as copies of  from doctor visits, a health diary, prescription receipts, prescription bottle labels or notes you have taken during actual doctor visits. As you gather this information prior to applying for health insurance online is a good idea to   it for quick and easy reference during the health insurance online application process by entering it into the appropriate sections of you .

It is unlikely that you will have all the information you need at your fingertips, thus it might be necessary to obtain some of that information from your health care provider(s). While it would not be practical or reasonable to expect your healthcare provider to review your office medical record and answer all your questions during a sick visit or follow up visit, state laws give you access to review your medical records upon request during the office business hours. Because this might be a unique experience for your healthcare provider and staff and could engender some concerns regarding possible litigious intent on your part, it might be a good idea to be forthright early on in expressing exactly what your purpose is for acquiring the information and why you think having a personal health record would be of benefit to you and possibly the health care provider as well.

As you review your office records is a good idea to take notes of what you can understand and perhaps make copies of important x-ray and laboratory reports which can later be incorporated in your  if you have a scanner. If your medical history is rather complicated and/or your office record is not legible or difficult to understand it might be best to speak with your doctor to see if a special appointment can be made to review and discuss the salient features of the record and/or if a summary with dates and copies of the important supporting documents such as laboratory reports and x-rays can be provided. If your doctor has a very busy schedule and would charge you a visit to provide this information you might request assistance from a qualified member of the staff instead of the doctor per  , if appropriate.

It is not necessary that your entire personal health record be finished prior to applying for health insurance online, but once the basic information for used for insurance application has been entered, the remainder of the work can be done at your leisure.

 

 

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Importance of Mental Health Among Youth

Mental health is not merely the absence of mental illness, but it also the ability to cope with the challenges in life. Mental health is as important as physical health to everybody. Youths usually experiment with attitudes, appearances, and    Most of their experiments are harmless, but some experiments may have terrible results. Children and youths experience mental health problem such as stress, anxiety, harassment, family problems, depression, learning disability, etc. Serious mental health problems, such as self-injurious  and suicide, are increasing among youth.          gadgets
A good mental health is essential for leading a good life. Youth cannot succeed in academic and personal life effectively if they are struggling with a mental health problem, such as depression or unsteady feeling due to academic, social or family pressures.

Failure to detect youth’s mental health problem may result in negative consequences such as increased risk for academic failure, social isolation, unsafe sexual  , drug and alcohol abuse, suicide attempt, unemployment, and poor health. A recent report says, The rising rates of mental and emotional problems among U.S. children and youngsters signal a crisis for the country.

Depression, anxiety, attention deficit, conduct disorders, suicidal thinking, and other serious psychological problems are striking more and more children and youths. Conservative estimates say one in every ten children and adolescents now suffers from mental illness severe enough to cause impairment.” Even if detected earlier, unfortunately many children and youth do not receive the help they need. Some reports are there that most children and youth who need a mental health evaluation do not receive services and that the rates of use of mental health services are also low.
Parents and adults must take care of the youth’s mental health. The parents and adults must talk with the youth, be a good role models to them, advice them to choose good friends, and monitor their activities.

There is a growing and unmet need for mental health services for children and youth. Mental health services are important for student’s and youth’s success. Prevention programs help in early identification of mental health problems in youth. These programs provide education on mental health issues, violence prevention, social skills training, harassment prevention, suicide prevention, conflict resolution, and screening for emotional and  problems. The Family Guide Web sites are designed for parents and other adults to   the importance of family, promote mental health, and help prevent underage use of alcohol, tobacco, and illegal drugs.

Good mental health is very important for youth’s success. In order to  the importance of mental health in youth, the following steps can be taken: Create awareness of child and youth mental health issues; provide a comprehensive guide for effective and meaningful youth meetings for   and professionals; and Conduct programs to generate awareness about youth’s mental health in each communities. Awareness about the importance of mental health issues among youth equally important to other physical issues, such as heart disease, AIDS, cancer, etc. Local and state health officials must draw more attention to the importance of mental health treatment of affected children and youths.

Attention to youth’s mental health will more effectively improve their life standard. This also positively impacts their academic and personal life achievements. The families, society and youths benefit only when mental health problems in youths are identified and prevented earlier.

 

 

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Degree in Health Administration Programs

Over the past few years, the health industry is growing at rapid pace and as a result the demand for health management/caring professionals has boomed proportionately. If we look at the present scenario the need for qualified, well trained and dedicated health managing personnel are relatively high in comparison to last year. Consequently, today the ratio of students selecting a health administration course or going for a degree in health administration has grown dramatically. A health care administration degree actually prepares you to manage various issues within the health care industry effectively.    https://bibloteka.com/

Not long ago, the professions liking administering or managing health issues or health-   were just considered to be merely a data management element. But the present picture depicts a different story. Today health administration has steadily become one of the quickest growing sections of health care. In fact, it is predicted that the field will see a steep growth in the need for qualified health-care personnel and administrators in coming next few years. However, a degree in health administration from reputed college can put you in a position to  this demand in just over two years. These days there are numerous health care administration training and nursing colleges that offer programs or courses that not only address this need but give your career a giant push.

Earning a master’s or bachelor’s degree in health administration allows you to widen your career opportunities, as you could find yourself working in different places like Hospitals, Medicaid, Public Health Departments and Rehabilitation  Moreover, you may even earn a lot more money. Besides this, you may even advance your healthcare career and become an administrator, manager, or supervisor. The major highlight about attaining a health administration degree is that the degree incorporates business and healthcare knowledge and in many countries the program is also well accredited by the commissions or bodies on Accreditation of Healthcare Education. At the end of doing your health administration degree, you will also gain a thorough understanding of critical health care issues and how to evaluate the deficiencies within the system.

Once you complete the course, you can acquire a responsible possible like health administrator, where you won’t be just responsible for   or interpreting healthcare service but as an invaluable member of health network you will be the supporter for insuring that the quality of service is uphold. As a graduate, you will have the learn tools to improve the systems within healthcare  like Hospitals, Medicaid, so that patient needs are served more efficiently. In addition, the course also provides you with opportunity to enhance your management/administrative backgrounds through a curriculum that primarily focus on theories and contemporary practice applications.

This health administration degree help you achieve expertise in health care service leading to other high positions in health care. Alternately, it is important that you choose the program that is accredited and affiliated to a well-ranked institution or university. Practical and clinical training is also essential for health administration program. So you should have a clear knowledge about the kind of practical lessons that institute plans to provide you.

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Health Care Fraud – The Perfect Storm

Today, health care fraud is all over the news. There undoubtedly is fraud in health care. The same is true for every business or  touched by human hands, e.g. banking, credit, insurance, politics, etc. There is no question that health care providers who abuse their position and our trust to steal are a problem. So are those from other professions who do the same.JAMB Subject combination

Why does health care fraud appear to get the ‘lions-share’ of attention? Could it be that it is the perfect vehicle to drive agendas for divergent groups where taxpayers, health care consumers and health care providers are dupes in a health care fraud shell-game operated with ‘sleight-of-hand’ precision?

Take a closer look and one finds this is no game-of-chance. Taxpayers, consumers and providers always lose because the problem with health care fraud is not just the fraud, but it is that our government and insurers use the fraud problem to further agendas while at the same time fail to be accountable and take responsibility for a fraud problem they facilitate and allow to flourish.

1. Astronomical Cost Estimates

What better way to report on fraud then to tout fraud cost estimates, e.g.

– “Fraud perpetrated against both public and private health plans costs between $72 and $220 billion annually, increasing the cost of medical care and health insurance and undermining public trust in our health care system… It is no longer a secret that fraud represents one of the fastest growing and most costly forms of crime in America today… We pay these costs as taxpayers and through higher health insurance premiums… We must be proactive in combating health care fraud and abuse… We must also ensure that law enforcement has the tools that it needs to deter, detect, and punish health care fraud.” [Senator Ted Kaufman (D-DE), 10/28/09 press release]

– The General Accounting Office (GAO) estimates that fraud in healthcare ranges from $60 billion to $600 billion per year – or anywhere between 3% and 10% of the $2 trillion health care budget. [Health Care Finance News reports, 10/2/09] The GAO is the investigative arm of Congress.

– The National Health Care Anti-Fraud Association   reports over $54 billion is stolen every year in scams designed to stick us and our insurance companies with fraudulent and illegal medical charges. web-site]  was created and is funded by health insurance companies.

Unfortunately, the reliability of the purported estimates is dubious at best. Insurers, state and federal agencies, and others may gather fraud data related to their own missions, where the kind, quality and volume of data compiled varies widely. David  professor of Law, University of Maryland, tells us that the widely-disseminated estimates of the incidence of health care fraud and abuse (assumed to be 10% of total spending) lacks any empirical foundation at all, the little we do know about health care fraud and abuse is dwarfed by what we don’t know and what we know that is not so. [The Cato Journal, 3/22/02]

2. Health Care Standards

The laws & rules governing health care – vary from state to state and from   and others to understand as they are written in legalese and not plain speak.

for services rendered to patients. Although created to universally apply to facilitate accurate reporting to reflect providers’ services, many insurers instruct providers to report codes based on what the insurer’s computer editing programs   – not on what the provider rendered. Further, practice building consultants instruct providers on what codes to report to get paid – in some cases codes that do not accurately reflect the provider’s service.

Consumers know what services they receive from their doctor or other provider but may not have a clue as to what those billing codes or service descriptors mean on explanation of benefits received from insurers. This lack of understanding may result in consumers moving on without gaining clarification of what the codes mean, or may result in some believing they were improperly billed. The multitude of insurance plans available today, with varying levels of coverage, ad a wild card to the equation when services are denied for non-coverage – especially if it is Medicare that denotes non-covered services as not medically necessary.

3. Proactively addressing the health care fraud problem

The government and insurers do very little to proactively address the problem with tangible activities that will result in detecting inappropriate claims before they are paid. Indeed,  of health care claims proclaim to operate a payment system based on trust that providers bill accurately for services rendered, as they can not review every claim before payment is made because the reimbursement system would shut down.

They claim to use sophisticated computer programs to look for errors and patterns in claims, have increased   and post-payment audits of selected providers to detect fraud, and have created   and task forces consisting of law enforcers and insurance investigators to study the problem and share fraud information. However, this activity, for the most part, is dealing with activity after the claim is paid and has little bearing on the proactive detection of fraud.

4. Exorcise health care fraud with the creation of new laws

The government’s reports on the fraud problem are published in earnest in conjunction with efforts to reform our health care system, and our experience shows us that it ultimately results in the government introducing and enacting new laws – presuming new laws will result in more fraud detected, investigated and prosecuted – without establishing how new laws will accomplish this more effectively than existing laws that were not used to their full potential.

 

 

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A Psychologist’s Suggestions For Improving Your Health Insurance

Health            https://spynaija.com                insurance company earnings were released, showing billion dollar profits by the major insurance companies. Despite these earnings, all of the insurance companies continue to increase their premiums on an annual basis. I am writing as a small business owner, health care provider, and health care consumer to describe my concerns about health insurance abuses.

As a small business owner, the annual 15% to 45% health insurance premium rate increases are   Each year, as our employees age, we reduce benefits to afford minimal health coverage. As health consumers, our care is inferior and restricted by insurance company bureaucracy, and we have additional increased out of pocket costs. Just this past week, it was reported on how health insurers have posted billion dollar profits, at the cost of reduced care for the insured. How is this fair? It is time to remove the anti-trust exemption that protect insurance companies, and permits them to abuse the public.

As a health care provider, my income has systematically been reduced, as insurance companies increasingly dictate the care I provide, the fees I receive etc. Additionally, we have been forced to spend more time and money on hiring administrative staff to deal with insurance company errors, obfuscation, and refusal to pay for things that they must. Thus, health insurance companies increase health care costs tremendously simply through their administrative harassment of health care providers. As an example, I counted more than 200 claim errors from one insurance company in one year. This meant that over 200 hours were spent rectifying insurance company errors! Resolution of the problem only occurred after I sought assistance through Congressman  office (for which I am immensely grateful). It is no surprise that private insurance administrative costs of 35 to 40% are way higher than those of Medicare, which are 3 to 5%. This high rate of administrative costs is unacceptable, and insurance accountability must be implemented.

In my quest to resolve the high rate of insurance company errors, I learned that insurance companies routinely employ personnel to deal with bad publicity. They employ entire departments to deal with legislators and the public. They spend unknown amounts of money on advertising and lobbying. In this time of economic distress, and with so many problems funding proper health care, what are insurance companies doing spending so much money on advertising and public relations? Who is looking into the huge burden they add to rising health care costs through all of their administrative errors, public relations gambits, advertising, etc?

In the early  I joined several health insurance panels as a participating provider. Initially, the insurers offered reasonable fees, I signed up, hoping to be part of the solution to the country’s health care woes. Within two years, our fees were slashed dramatically. I maintained provider participation with a few panels whose rates were acceptable. Although I dropped out of the lower paying plans (whose compensation would have left me with an income that is similar to the starting salary of a teacher), it was amazing how my name remained in their list of participating providers (a phenomenon known as the “phantom panel”). In all of these years, the fee has never been raised in the few panels in which I remained. In contrast, my medical health insurance rates have risen dramatically, as have my rents, taxes, utilities, malpractice insurance, etc.

There is something wrong in a society when the healers, who require great educational training, are paid at far lower rates than those that deny health care, as is the case with the insurance company executives. Their compensation packages are in the millions of dollars each year, while the health care providers struggle to maintain a middle class standard of living. Health insurance companies contribute to the  out of control health care crisis.

In my opinion, any successful health care reform must include:

1. Limits on the compensation of insurance executives (in the same way that incomes of all medical health providers have been reduced).

2. Financial limits on insurance company expenditures on lobbying, advertising and public relations efforts. Those funds need to be re-directed towards actual health care.

3. Insurance companies exemption from anti-trust regulations must be eliminated.

4. Insurance company accountability and reduction of their claims processing errors and administrative costs must be reduced so that they fall in line with that of Medicare (3 to 5%). Stringent penalties need to be assessed upon insurance companies that fail to follow this ruling.

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The Development of Multi-Professional Occupational Health Services

During the                https://www.monalise.dk/                     last fifty years a need to reduce the rate of occupational accidents and diseases, and to address the economic burden that arises from workplace accidents and diseases onto the tax payer through the   of costs, has forced the   of the national infrastructure to support employers to   their legal obligation in health and safety at work. This was to a large extent guided by the International Labour   conventions. The  Occupational Safety and Health Convention, No 155 (13) and its Recommendation, No 164 (14), provide for the adoption of a national occupational safety and health policy and prescribe the actions needed at the national and at the individual company levels to promote occupational safety and health and to improve the working environment. The   OH Services Convention, No. 161 and its Recommendation, No. 171 (33), provide for the establishment of occupational health services, which will contribute to the implementation of the occupational safety and health policy and will perform their functions at the company level.

EU legislation on the introduction of measures to encourage improvement in the safety and health of workers at work defines the employer’s responsibilities for providing all of the necessary information concerning safety and health risks, and the protective and preventive measures required, obligation for consultation with and the participation of workers in health and safety, the employer’s responsibility for providing training and health surveillance. The framework Directive also states that the employer shall enlist competent external services or persons if appropriate services cannot be   for lack of competent personnel within the company.

Therefore, the framework Directive greatly strengthens the concept of addressing the issue of health and safety at work by using multi-professional occupational health services, and in encouraging the active participation of employers and employees in improving working conditions and environments.

The  and scope of occupational health (OH) is constantly changing to meet new demands from industry and society, therefore the infrastructures which have been created for occupational health are also undergoing continuous improvement. OH is primarily a prevention-orientated activity, involved in risk assessment, risk management and pro-active strategies aimed at promoting the health of the working population. Therefore the range of skills needed to identify, accurately assess and devise strategies to control workplace hazards, including physical, chemical, biological or  hazards, and promote the health of the working population is enormous. No one professional group has all of the necessary skills to achieve this goal and so co-operation between professionals is required. OH is not simply about identifying and treating individuals who have become ill, it is about taking all of the steps which can be taken to prevent cases of work related ill-health occurring. In some cases the work of the occupational hygienist, engineer and safety consultant may be more effective in tackling a workplace health problem than the occupational health nurse or physician.

The multi-professional OH team can draw on a wide range of professional experience and areas of expertise when developing strategies, which are effective in protecting and promoting the health of the working population. Because ‘OH largely evolved out of what was industrial medicine there is often confusion between the terms ‘OH and ‘Occupational Medicine’. The distinction between the two has recently been clarified in the WHO publication Occupational Medicine in Europe: Scope and Competencies.

In this document it states that “Occupational medicine is a   of physicians; occupational health covers a broader spectrum of different health protective and promotional activities.” It is clear that the medical examination, diagnosis and treatment of occupational disease are the sole preserve of the occupational physician. It is only the physicians who have the necessary skills and clinical experience to perform this function in the being paid to the prevention of hazardous exposure and improved risk management there should be less need for extensive routine medical examinations and hopefully fewer occupational diseases to diagnose in the future. Therefore, it is likely that more occupational physicians will want to move into the broader modern field of preventative occupational health than in the past.

However, at this point, where the physician stops using the skills learnt in medical school and starts to enter the workplace to examine working conditions, there is a much greater overlap between the core areas of knowledge and competence between occupational physicians, now  OH, and other OH experts, such as occupational hygienists, safety engineers and an increasing number of occupational health nurses.

The occupational physicians, in their scope and competencies acknowledge that there is no longer any requirement for the physician to be automatically chosen to manage the occupational health team. The person, from whatever discipline, with the best management skills should manage the multi-professional occupational health team in order to ensure that the skills of all of the professionals are valued and fully

 

 

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California Health Insurance – Independent Health Life Agent Verses Insurance Company In House Agent

You have just              https://trevonbranch.tech/                         completed an online form requesting a free health insurance quote and moments later you are being inundated with phone calls from insurance agents hoping to get your business. Try not to become overwhelmed or annoyed by these “pesky sales people” because they are really not telemarketers. Most of them are well-trained state licensed professionals who can really help you make a good decision regarding which health plan is best and most affordable for your individual or group coverage needs.

You may be under the misconception that if you buy your health plan directly from the insurance company, and cut out the “middle person”, you will save money. This is absolutely not the case. In fact, insurance companies rely on agents for most of their business and that’s why they pay them commissions for bringing in customers. It does not cost a consumer one penny more to use a licensed California health insurance agent to obtain their insurance coverage.

There are many differences between California health insurance and other states including how it is applied for.

For example, while Blue Cross and Blue Shield are one company in other states, here in California, each is separate and applied to individually as Anthem Blue Cross of California and Blue Shield of California.

California health insurance law AB 1672 is an improvement over the federal  law that covers all states in that it includes the following with regard to California group coverage:

1. Individuals with  -existing medical conditions may change over to a new group health plan without an exclusionary period.

2. It allows small businesses and professional   to have access to health plans providing they have between 2 and 50 full time employees.

3. It keeps insurance rates from climbing after a claim is filed.

4. Employees who have health problems may change jobs or health plans without being rated higher for having  -existing conditions.

That said, the very best health insurance agent for your individual and business needs is an “Independent Agent.” Why? Because they represent multiple insurance carriers, not just one. An independent agent can help you select the most appropriate cost-effective plan offering the most benefits for your dollar as available from the major carriers, rather than feeding you just one company’s line of health plans which may not suit your particular needs. Many people are too complacent and settle for what their current insurance company has to offer. They could use a good independent agent to sort through the many plans available from multiple insurance carriers to find and provide the best choice of options.

Another misunderstanding you may have is that insurance agents set the premium rates for the health insurance plans they sell. Thinking if you shop around you may get a better price for the same plan. Premium rates are based on your age, zip code or county in which you reside and are controlled completely by the insurance companies. Every agent uses the exact same rate guides set by the insurance companies. The condition of your health may affect your premium, which may be rated up after the insurance company’s underwriting department has reviewed your medical records. Again, the insurance company, not the agent, determines that outcome.

Now, let’s talk about the benefits of having a good insurance agent representing you. Most consumers neither know nor understand the benefits of a health plan being offered and need the expertise of an agent to explain the benefits to them in full. For example, do you know what the difference is between an “out-of-pocket maximum” and an “annual deductible?”

An out of pocket maximum is the most you will have to pay in a given year for deductible and coinsurance for covered benefits before your insurance starts to pay 100% of most expenses until the year ends.

An annual deductible is usually the amount you pay each year before your health plan starts paying anything for covered services. Generally, the higher the deductible, the lower the premium. Certain services such as prescription drugs carry separate deductibles. Plans may vary and sometimes benefits will kick in before you have to meet the deductible.

A knowledgeable health insurance agent can be a guide through the maze and help you choose the right plan to meet your needs and budget while obtaining the most benefits for your dollars spent. An agent will also make clear how the benefits for a generic prescription may differ from the benefits for a brand prescription on a particular plan.

After you have a health plan in place, a good, caring agent will remind you to pay your premium on time so the insurance company doesn’t cancel you. Your agent can also be an enormous resource for assistance if you run into a problem with a health insurance claim. Instead of waiting on hold at the insurance company’s 800 number for thirty to forty- five minutes, call your agent and explain your problem and if you have chosen the right agent, you will get help and may save yourself lots of time and frustration, maybe even some money by having an expert in your corner where your best interests come first.

So next time you or someone you know, fills out one of those on-line forms for a health insurance quote and you get several phone calls from health insurance agents wanting your business, be grateful that a professional wants to help you for free to choose the right plan and you’ll have an important friend for life.

My name is Diane Le your California Health Insurance Specialist with more than 25 years experience. I am an   Independent Agent for the major California health insurance companies including Anthem Blue Cross, Blue Shield of California, Health Net, and Kaiser.

Let me guide you through the maze of obtaining proper health insurance coverage for you, your family or business, with an individual or group plan based upon your specific needs. I will find the best coverage for your insurance dollar by  the various plans of the major insurance companies I represent.

 

 

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Health Care Fraud – The Perfect Storm

Today, health                https://trevonbranch.tech/                 care fraud is all over the news. There undoubtedly is fraud in health care. The same is true for every business or   touched by human hands, e.g. banking, credit, insurance, politics, etc. There is no question that health care providers who abuse their position and our trust to steal are a problem. So are those from other professions who do the same.

Why does health care fraud appear to get the ‘lions-share’ of attention? Could it be that it is the perfect vehicle to drive agendas for divergent groups where taxpayers, health care consumers and health care providers are dupes in a health care fraud shell-game operated with ‘sleight-of-hand’ precision?

Take a closer look and one finds this is no game-of-chance. Taxpayers, consumers and providers always lose because the problem with health care fraud is not just the fraud, but it is that our government and insurers use the fraud problem to further agendas while at the same time fail to be accountable and take responsibility for a fraud problem they facilitate and allow to flourish.

1. Astronomical Cost Estimates

What better way to report on fraud then to tout fraud cost estimates, e.g.

– “Fraud perpetrated against both public and private health plans costs between $72 and $220 billion annually, increasing the cost of medical care and health insurance and undermining public trust in our health care system… It is no longer a secret that fraud represents one of the fastest growing and most costly forms of crime in America today… We pay these costs as taxpayers and through higher health insurance premiums… We must be proactive in combating health care fraud and abuse… We must also ensure that law enforcement has the tools that it needs to deter, detect, and punish health care fraud.” [Senator Ted Kaufman (D-DE), 10/28/09 press release]

– The General Accounting Office (GAO) estimates that fraud in healthcare ranges from $60 billion to $600 billion per year – or anywhere between 3% and 10% of the $2 trillion health care budget. [Health Care Finance News reports, 10/2/09] The GAO is the investigative arm of Congress.

– The National Health Care Anti-Fraud Association   reports over $54 billion is stolen every year in scams designed to stick us and our insurance companies with fraudulent and illegal medical charges.  web-site]  was created and is funded by health insurance companies.

Unfortunately, the reliability of the purported estimates is dubious at best. Insurers, state and federal agencies, and others may gather fraud data related to their own missions, where the kind, quality and volume of data compiled varies widely. David  , professor of Law, University of Maryland, tells us that the widely-disseminated estimates of the incidence of health care fraud and abuse (assumed to be 10% of total spending) lacks any empirical foundation at all, the little we do know about health care fraud and abuse is dwarfed by what we don’t know and what we know that is not so. [The Cato Journal, 3/22/02]

2. Health Care Standards

The laws & rules governing health care – vary from state to state and from   – are extensive and very confusing for providers and others to understand as they are written in legalese and not plain speak.

Providers use specific codes to report conditions treated    and services rendered  . These codes are used when seeking compensation from   for services rendered to patients. Although created to universally apply to facilitate accurate reporting to reflect providers’ services, many insurers instruct providers to report codes based on what the insurer’s computer editing programs   not on what the provider rendered. Further, practice building consultants instruct providers on what codes to report to get paid – in some cases codes that do not accurately reflect the provider’s service.

Consumers know what services they receive from their doctor or other provider but may not have a clue as to what those billing codes or service descriptors mean on explanation of benefits received from insurers. This lack of understanding may result in consumers moving on without gaining clarification of what the codes mean, or may result in some believing they were improperly billed. The multitude of insurance plans available today, with varying levels of coverage, ad a wild card to the equation when services are denied for non-coverage – especially if it is Medicare that denotes non-covered services as not medically necessary.

3. Proactively addressing the health care fraud problem

The government and insurers do very little to proactively address the problem with tangible activities that will result in detecting inappropriate claims before they are paid. Indeed,   of health care claims proclaim to operate a payment system based on trust that providers bill accurately for services rendered, as they can not review every claim before payment is made because the reimbursement system would shut down.

They claim to use sophisticated computer programs to look for errors and patterns in claims, have increased   and post-payment audits of selected providers to detect fraud, and have created  and task forces consisting of law enforcers and insurance investigators to study the problem and share fraud information. However, this activity, for the most part, is dealing with activity after the claim is paid and has little bearing on the proactive detection of fraud.

4. Exorcise health care fraud with the creation of new laws

The government’s reports on the fraud problem are published in earnest in conjunction with efforts to reform our health care system, and our experience shows us that it ultimately results in the government introducing and enacting new laws – presuming new laws will result in more fraud detected, investigated and prosecuted – without establishing how new laws will accomplish this more effectively than existing laws that were not used to their full potential.

With such efforts in 1996, we got the Health Insurance Portability and Accountability Act   . It was enacted by Congress to address insurance portability and accountability for patient privacy and health care fraud and abuse.  purportedly was to equip federal law enforcers and prosecutors with the tools to attack fraud, and resulted in the creation of a number of new health care fraud statutes, including: Health Care Fraud, Theft or Embezzlement in Health Care, Obstructing Criminal Investigation of Health Care, and False Statements Relating to Health Care Fraud Matters.

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Physician Retention – Get a Plan!

Physician recruitment          https://psychedelichomes.com/               and retention is becoming increasingly difficult each year. More hospitals, group practices, and managed care work harder to recruit and retain the best and brightest physicians. As competition continues to grow, we are seeing more aggressive physician relations programs to strengthen relations with physicians. With 84% of the hospitals and thousands of group practices and most managed care companies in America recruiting, many feel it has become a recruitment war. (In 1999, with 6000 physicians graduating from Residency programs, there were over 18,000 practice opportunities available.)

Direct recruitment costs average $30,000 per physician (This does not include relocation expenses). Additionally, the following costs associated with physician turnover should be considered:

Patient Access
Patient Turnover
Gross Billings Lost
Inpatient Revenue Lost
Referrals Lost
Average annual turnover was 6.4% for all medical groups responding to the survey conducted by the American Medial Group Association – 5.2% for medical groups with more than 500 physicians and 6.9% for those with less than 500 physicians.
Causes of Provider Turnover

It is rare for a provider to have experienced one catastrophic event that causes them to seek other employment. Most typically, it is a combination of several things that build over time.

Typical causes of turnover:

Lack of or “bad” chemistry with the partners (#1 reason nationwide)
The practice didn’t    their professional needs (i.e. multi vs. single   group, group too big or too small, etc.)
The practice was different than expected (i.e. longer hours, weekend hours, evening hours, outreach expected, in-patient duties expected, number of patients seen per day, etc.)
Absence of feedback during the critical time of the honeymoon
Desire to be closer to family
The physician and family never become a part of the community
The physician and/or spouse never became comfortable with the environment
Lack of control over their practice (i.e. Scheduling, referral   being excluded from the decision making process, etc.)
Lack of two-way communication
Lack of appreciation
The feeling of abandonment.
Physician Retention Begins During Recruitment
Physician retention really begins early in the recruitment process. Retention efforts that should be included during the recruitment/interview process include:

Screening candidates for the best all around “fit”
Establishing mutual expectations during the interview & reiterating these before an offer is made (i.e. Patient load, call schedule, committee time,  to a full practice, etc.)
Ensuring that candidates know exactly what to expect
Screening the Spouse for career objectives or requirements
Integrating “retention” into the interview process. Communicating to candidates upon interview that one of the primary goals of the recruitment process is retention
Justification for a Three Year Plan
The highest turnover is during the first three years on the job among well-paid professionals in all industries, including medicine, and is especially high during the first year. To retain the highest percentage of new physicians,   should plan to work with them for three years.

Continue to build relationships with the physicians
Help them adjust professionally & develop their practices
Help them adjust personally to their new environment
The key to physician retention is to maintain regular contact with physicians and their spouses to stay abreast of how they are adjusting, and to anticipate any problems that may develop. The most critical element in any retention plan is a mechanism to “check in” on the physician’s expectations.
Recruiting cannot be considered completely successful until the physician is on staff and productive to the point of providing a service to the community and producing enough revenue to pay back recruitment. Therefore, the recruitment function should include responsibility for seeing that the physician and his or her family are not only recruited, but are successfully acclimated to their new location.

At all times you should keep in mind the needs of the physicians’ spouses and families because frequently physicians’ satisfaction depends on their families’ adjustment.

 

 

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When Should I See a Family Care Doctor?

It is very            https://wecarefamilyphysicians.com/                  beneficial to develop a continuing relationship with primary care physicians, because they get to know you over the years. Therefore, they are more likely to notice changes in your health status.

Family care doctors can treat minor acute problems such as a cold or a flu as well help you manage chronic conditions. They can answer any questions you might have and refer you to a specialist, if needed. If take medications on an ongoing basis, they will write and renew your prescriptions.

You should start seeing a primary care physician before you actually need them. Schedule a check-up every year. At many institutions, you will have to schedule an appointment weeks or months in advance. Don’t wait to schedule an appointment, even if you don’t urgently need one at the moment.

On your first visit, your doctor will ask you about your and your family’s health history, especially major illnesses such as cancer, and about any medications you are currently taking and if you are experiencing any symptoms.

Prepare for your visit by writing down all major illnesses and conditions that you have had in the past or that you are still dealing with, all medications that you are taking (including their dosage), any questions that you might have about current or recent symptoms, what they are, what brings them on and what relieves them. Bring along any test results that you might have, for example if you recently went to an urgent care facility, and the results of regular screenings, such as mammograms.

Your doctor might schedule tests to investigate your symptoms. A blood test is usually ordered, even if you don’t have any concerns, in order to check your cholesterol and blood sugar levels. You will get the results a few days later and your doctor or a nurse will call you, if there are any concerns.

If your doctor comes to the conclusion that you need further evaluation or more testing, they will refer you to a specialist. Many insurance plans and also many specialists require that you see a primary care physician first to avoid unnecessary costs.

A good family doctor will also counsel you on the prevention of disease, such as diabetes, heart disease and high blood pressure, which are often caused by weight problems due to a lack of exercise, alcohol consumption and an unhealthy diet.