Loosing Faith in Healthcare Innovation

The third quarter earnings reporting period starts next week and the usual updates of the state of public and commercial medical progress are now guaranteed to be overshadowed. Companies that report prior to the debt ceiling deadline on the 17th include Johnson & Johnson , Abbott Laboratories, and Baxter International. These companies will all have to deal with questions of how their franchises are being affected by current events. With major pharmaceutical players such as Merck & Co having recently announced both additional layoffs and cutbacks we now face the questions of who is next and what steps CEOs may have to demonstrate performance. This however is not the worst of it.


When capital market confidence deteriorates because of political-gridlock no amount of legislation can undo the damage done. Witness the current debate on whether the tax on products developed and sold by medical device industry leaders like Medtronic Inc. (MDT) should remain or be eliminated. A valid question for policy advocates, but secondary in importance when the confidence of all share owners and ultimately future investors rethink options beyond the single equity. As the shutdown continues, investors in all healthcare segments are likely to re-evaluate their portfolios due to delays in basic agency oversight and other suspended activities.

Bill To Kill Obamacare

The House of Representatives on Friday passed legislation to fund federal agencies from October 1 to December 15 while also derailing the healthcare law known as "Obamacare," ignoring warnings from Democrats that they will kill the Republican initiative.

In a partisan vote of 230-189, the Republican-controlled House sent the measure to the Senate where Democrats hold a majority. They will try to delete the Obamacare provision and send the spending bill back to the House for passage by September 30 in order to prevent government shutdowns the following day.

The Senate is expected to debate the bill next week, which would maintain strict, across-the-board spending cuts that were laid out as part of a 2011 deficit-reduction law.

Besides the need to quickly approve the spending measure, Congress also is fighting over separate legislation to raise the limit on US borrowing authority.

Lawmakers are staring down a floating deadline of sometime in October or early November to either pass a measure or hurl the US government into its first credit default

Healthcare Reform in form of ICD 10 in Healthcare insurnace

Healthcare industry in US brings one more change as most innovative of itself. We all know about ICD codes. From past decades US healthcare Industry was  working of ICD 9 codes. Now to drill down more appropriate coding as per disease and increase in various health issues Healthcare industry in world had taken steps and introduced new range of coding and named them as ICD 10. Different parts of world have already started using ICD 10 in their healthcare insurance but US being one of the vast and biggest contributor in this industry is now changing to ICD 10.

ICD 10 is equivalent to learning another language and this will require proper training and education.
In US the pace at which hospital administrators , health professionals and compliance employees are moving toward this ICD 10 transition has raised concern among Healthcare industry leaders. As per Latest survey about 20 percent of small and mid sized hospital have yet to begin any education or training for what's been billed as once the biggest of US healthcare industry of World healthcare industry shifts to ICD 10.
The surveys says that nearly half are lagging behind on the centers for Medicare and Medicaid services timelines for ICD 10 preparation  Surveys results shows that 40 percents of have not begun ICD 10 CM Training for coding staff , 55 percents have not begun ICD 10 PCS training for coding staff , 47 percent have not begun document improvement education for medical staff and about 31 percent do not plan to dual code prior to Oct 1 ,2014.
It is clear that the industry is not making the amount of progress that is needed for a smooth transition  Factors that are contributing to this slow progress includes the change of compliance dates , completing internal priorities and other regulatory mandates. Also despite they know they have to change to ICD 10 respondents are planning to submit ICD 10 coded claims to payers for testing prior to the transition.

State Healthcare

US is covered with medical healthcare healthcare insurance. Medical Healthcare insurance is divided in different states and benefits sometimes differ between states.

States having medical healthcare healthcare insurance.


• Connecticut (CT)
• Delaware (DE)
• District of Columbia (DC)
• Florida (FL)
• Georgia (GA)
• Hawaii (HI)
• Idaho (ID)
• Illinois (IL)
• Indiana (IN)
• Iowa (IA)
• Kansas (KS)
• Kentucky (KY)
• Louisiana (LA)
• Maine (ME)
• Maryland (MD)
• Massachusetts (MA)
• Michigan (MI)
• Minnesota (MN)
• Mississippi (MS)
• Missouri (MO)
• Montana (MT)
• Nebraska (NE)
• Nevada (NV)
• New Hampshire (NH)
• New Jersey (NJ)
• New Mexico (NM)
• New York (NY)
• North Carolina (NC)
• North Dakota (ND)
• Ohio (OH)
• Oklahoma (OK)
• Oregon (OR)
• Pennsylvania (PA)
• Rhode Island (RI)
• South Carolina (SC)
• South Dakota (SD)
• Tennessee (TN)
• Texas (TX)
• Utah (UT)
• Vermont (VT)
• Virginia (VA)
• Washington (WA)
• West Virginia (WV)
• Wisconsin (WI)
• Wyoming (WY)
• American Samoa (AS)
• Federated States of Micronesia (FM)
• Guam (GU)
• Marshall Islands (MH)
• Northern Mariana Islands (MP)
• Palau (PW)
• Puerto Rico (PR)
• Virgin Islands (VI)

HIPAA - Healthcare Health Insurance

The Health Insurance Portability and Accountability Act of 1996  was enacted by the United States Congress and signed by President Bill Clinton in 1996. It was sponsored by Sen. Nancy Kassebaum .

Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs.
Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.

A major goal of the Privacy Rule is to assure that individuals’ health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public's health and well being. The Rule strikes a balance that permits important uses of information, while protecting the privacy of people who seek care and healing. Given that the health care marketplace is diverse, the Rule is designed to be flexible and comprehensive to cover the variety of uses and disclosures that need to be addressed.

HIPAA required the Secretary to issue privacy regulations governing individually identifiable health information, if Congress did not enact privacy legislation within three years of the passage of HIPAA. Because Congress did not enact privacy legislation, HHS developed a proposed rule and released it for public comment on November 3, 1999. The Department received over 52,000 public comments. The final regulation, the Privacy Rule, was published December 28, 2000.2

In March 2002, the Department proposed and released for public comment modifications to the Privacy Rule. The Department received over 11,000 comments.The final modifications were published in final form on August 14, 2002.

How can you get Health Insurance Medical Insurance?

Before Buying Health Insurance Medical Healthcare Insurance one must prepare a questioner in his/her mind or should have at least some questions in their mind about why to choose this plan? What is the difference between these two plans ? What benefit I am going to get by opting this plan ? What special is in this plan ? like ways .
I had prepared a list which you may ask to your agent or to health insurance medical insurance company before opting any plan .
We basically know we have plans like Fee for Service Healthcare Insurance Plan, HMO Medical Healthcare Insurance Plan, PPO Health Plan.

 Before opting Fee-for-Service Health Insurance Plans

• How much is the monthly health insurance premium? 
• What will your total cost be each year? There are individual rates and family rates.
• What does the health insurance policy cover? Does it cover prescription drugs, out-of-hospital care, or home care? 
• Are there limits on the amount or the number of days the health insurance provider will pay for these services? The best fee-for-service health insurance plans cover a broad range of health care services.
• Are you currently being treated for a medical condition that may not be covered under your new health insurance plan? Are there limitations or a waiting period involved in the health insurance coverage?
• What is the health insurance deductible? Often, you can lower your monthly health insurance premium by buying a health insurance policy with a higher yearly deductible amount.
• What is the coinsurance rate? What percent of your bills for allowable services will you have to pay
• What is the maximum you would pay out-of-pocket per year? How much would it cost you directly before the health insurance company would pay everything else?
• Is there a lifetime maximum cap the health insurance provider will pay? The cap is an amount after which the health insurance company will not pay anymore. This is important to know if you or someone in your family has an illness that requires expensive treatments. 

Before opting HMO Health Plans

• Are there many doctors to choose from in the HMO plan? Do you select from a list of contract physicians or from the available staff of a group practice? Which doctors are accepting new patients? How hard is it to change doctors if you decide you want someone else?
• How are referrals to specialists handled?
• Is it easy to get appointments? How far in advance must routine visits be scheduled? 
• What arrangements does the HMO have for handling emergency care?
• Does the HMO offer the health care services you want? What preventive services are provided? Are there limits on medical tests, surgery, mental health care, home care, or other support offered? 
• What if you need a special service not provided by the HMO?
• What is the service area of the HMO? 
• Where are the facilities located in your community that serve HMO members? 
• How convenient to your home and workplace are the doctors, hospitals, and emergency care centers that make up the HMO network? 
• What happens if you or a family member are out of town and need medical treatment?
• What will the HMO health insurance plan cost? What is the yearly total for monthly fees? In addition, are there co-payments for office visits, emergency care, prescribed drugs, or other services? How much are they? 

Before opting  PPO Health Plans

• Are there many doctors to choose from in the PPO health insurance plan? Who are the doctors in the PPO network? Where are they located? Which ones are accepting new patients? How are referrals to specialists handled?
• What hospitals are available through the PPO? Where is the nearest hospital in the PPO network? What arrangements does the PPO have for handling emergency care?
• What health care services are covered by the PPO plan? What preventive services are offered? Are there limits on medical tests, out-of-hospital care, mental health care, prescription drugs, or other services that are important to you?
• What will the PPO health insurance plan cost? How much is the premium? 
• Is there a per-visit cost for seeing PPO doctors or other types of co-payments for services? 
• What is the difference in cost between using doctors in the PPO network and those outside it? 
• What is the deductible and coinsurance rate for care outside of the PPO? 
• Is there a limit to the maximum you would pay out of pocket?

Above mentioned questions are some questions which one must definitely ask or get to know before opting any plan . Now comes the question you have opted best available option . Now still you are not sure that you will get maximum benefit from your Medical Healthcare Insurance plan. Below is the thing which we always think after paying for something in this case maximum benefit after opting Health Insurance Plan.


How to Get the Most from Your Health Insurance Plan?

Medical terminology - Healthcare / Medical Healthcare Insurace

There are number of Medical terms that are used by doctors, nurses and any other healthcare practitioners when we come across and we don't know what are they . These words have long list and they are very important that you must understand .Medical terminology is the collection of words and phrases used to describe medical procedures and diagnoses. If your medical provider uses a word you don't understand, make sure to get the answers you need. Because these are the services that may your Medical Healthcare insurance may cover or may not cover or may require pre-authorization or have limited benefits . In case you forget ask your medical provider what that word means you all can search on web or refer below as almost all the different word or medical terminology used by Medical Healthcare Practitioners are described below alphabetically. As everyone know in this scientific world everyday there is lot more inventions and discoveries happening medical terminology are also changing and keep on updating . There may be chance that some medical terminology may be missing but pages are kept under track review so that if any changes any updation comes soon they can be updated under the section which they belong to .


                                                Medical Terminology List 
                               

       

Medical Healthcare and Medical/Health Insurance

Now come big picture in Healthcare industry and this is Health Insurance . Many of us know something about Health Insurance but almost everyone has something that they may not know.

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement.


A Health Insurance policy is:

1. A contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (e.g. an employer or a community organization). The contract can be renewable (e.g. annually, monthly) or lifelong in the case of private insurance. The type and amount of health care costs that will be covered by the health insurance provider are specified in writing, in a member contract or "Evidence of Coverage" booklet for private insurance, or in a national health policy for public insurance.
2. Insurance coverage is provided by an employer-sponsored self-funded ERISA(Employee Retirement Income Security Act) plan. The company generally advertises that they have one of the big insurance companies. However, in an ERISA case, that insurance company "doesn't engage in the act of insurance", they just administer it. Therefore ERISA plans are not subject to state laws. ERISA plans are governed by federal law under the jurisdiction of the US Department of Labor. The specific benefits or coverage details are found in the Summary Plan Description. An appeal must go through the insurance company, then to the Employer's Plan Fiduciary. If still required, the Fiduciary’s decision can be brought to the US Department of Labor to review for ERISA compliance, and then file a lawsuit in federal court.

The individual insured person's obligations may take several forms:

Premium: The amount the policy-holder or his sponsor (e.g. an employer) pays to the health plan to purchase health coverage.

Deductible: The amount that the insured must pay out-of-pocket before the health insurer pays its share.

Co-payment: The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service.  A co-payment must be paid each time a particular service is obtained.

Coinsurance: Instead of, or in addition to, paying a fixed amount a co-payment, the co-insurance is a percentage of the total cost that insured person may also pay.

Exclusions: Not all services are covered. The insured are generally expected to pay the full cost of non-covered services out of their own pockets.

Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.

Out-of-pocket maximums: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and health insurance pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.

Capitation: An amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.

In-Network Provider:  A health care provider on a list of providers pre-selected by the insurer. The insurer will offer discounted coinsurance or co-payments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers.

Authorization: A certification or authorization that an insurer provides prior to medical service occurring. Obtaining an authorization means that the insurer is obligated to pay for the service, assuming it matches what was authorized. Many smaller, routine services do not require authorization.

Explanation of Benefits: A document that may be sent by an insurer to a patient explaining what was covered for a medical service, and how payment amount and patient responsibility amount were determined.

Foot and Public Healthcare - Medical Healthcare

Foot care practitioners

Care and treatment for the foot, ankle, and lower leg may be delivered by podiatrists, pedorthists, foot health practitioners, podiatric medical assistants, podiatric nurse and others.

Podiatry or podiatric medicine is a branch  devoted to the study of, diagnosis, and medical treatment of disorders of the foot, ankle, and lower extremity.  A Doctor of Podiatric Medicine (DPM), is a specialist qualified by their education and training to diagnose and treat conditions affecting the foot, ankle, and structures of the leg. Podiatric physicians have extensive background knowledge in human anatomy, physiology, pathophysiology, sociological and psychological perspectives, general medicine, surgery and pharmacology. Specialist podiatric physicians are podiatrists who are qualified by additional postgraduate training or fellowship training and experience in the specialized field.

Pedorthist is the title of a healthcare professional who specializes in the use of footwear and supportive devices to address conditions which affect the feet and lower limbs. They are trained in the assessment of lower limb anatomy and bio mechanics  and the appropriate use of corrective footwear – including shoes, shoe modifications, foot orthoses and other pedorthic devises. “Certified Pedorthist” is a title used by both the College of Pedorthics of Canada as well as the American Board for Certification in Orthotics, Prosthetics and Pedorthics . However, in many jurisdictions the practice of pedorthists is self-regulated; professional certification is voluntary.


Public Healthcare practitioners

A public health practitioner focuses on improving health among individuals, families and communities through the prevention and treatment of diseases and injuries,  and promotion of healthy behaviors. This category includes community and preventive medicine specialists, public health nurses, dietitians, environmental health officers, paramedics, epidemiologists, health inspectors, and others.


Dietitians are experts in food and nutrition. They advise people on what to eat in order to lead a healthy lifestyle or achieve a specific health-related goal. Dietitians work in various different capacities in the field of healthcare, food service, corporate setting, and educational arenas.

Environmental Health Officers (also known as Public Health Inspectors) are responsible for carrying out measures for protecting public health, including administering and enforcing legislation related to environmental health and providing support to minimize health and safety hazards. They are involved in a variety of activities, for example inspecting food facilities, investigating public health nuisances, and implementing disease control. Environmental health officers are focused on prevention, consultation, investigation, and education of the community regarding health risks and maintaining a safe environment.

Environmental health is a graduate career in most countries. The minimum requirements in most countries include an approved university degree program, field training and professional certification & registration.

For more information about other healthcare providers please read page Healthcare Providers.

Medical Facility - Hospital/Care Center

What is Medical facility ?

A medical facility is, in general, any location at which medicine is practiced regularly. Medical facilities range from small clinics and doctor's offices to urgent care centers and large hospitals with elaborate emergency rooms and trauma centers. The number and quality of medical facilities in a country or region is one common measure of that area's prosperity and quality of life. In many countries, medical facilities are regulated to some extent by law; licensing by a regulatory agency is often required before a facility may open for business. Medical facilities may be owned and operated by for-profit businesses, non-profit organizations, governments, and in some cases by individuals, with proportions varying by country. An individual having Medical Healthcare insurance can visit these facilities if charges are high still they can avail services as Health insurance pays amount on behalf of them and only a small portion of money is to bear by individuals.

Types of Medical Facility.

Hospital:- 

Almost everyone know about what Hospital is . A Hospital is an institution for healthcare typically providing specialized treatment for overnight stays or in medical terms for inpatient. Some hospitals admit patients suffering from a specific disease or infection or are reserved for specific diagnosis or treatment or for specific age group . Now a days hospital are either run by Government or State or health organizations either profit or non profit or health insurance or by charities or by donations. Hospitals nowadays staffed by professional trained doctors , nurses , paramedical clinics . 

Health care centre:-

This is another important type of Medical facility which includes clinics, doctors office, which serve as first point of contact and normally they provide outpatient medical , nursing , dental and other type of care services.

Nursing home :-

Although almost everyone can have some idea about Nursing and if we add home in that you may get rough idea about what is this type of facility . This facility includes residential treatment centres i,e they have accomodation facilities and engage in providing short term or long term medical treatment of a general or specific nature which is not performed by hospital to inpatients with any of a wide variety of medical conditions.

Drug store :-

They are engaged in retailing prescription or non prescription drugs and medicines and other thype of medical and orthopaedic items . Normally these stores are regualted or based ib hospitals or clinics. But they can even you can see running privately and are usually staffed by pharmacist , pharmacy technicians and pharmacy aides. There even you can go and get you first aid in case of any emergency .

Medical Healthcare Insurance - Healthcare Provider

Healthcare can form significant part of countries economy . Healthcare is conventionally regarded as an important determinant in promoting the general health awareness of people around the world. Take example of this worldwide eradication of Smallpox in 1980 - declared by the WHO as the first disease in human history to be completely eliminated by deliberate health care interventions.

So in order to deliver modern Healthcare depends on group of trained professionals. This includes professionals in medicine, dentistry , nursing , allied health along with public health practitioners and community health workers who systematically provide personnel and population based preventive , curative and rehabilitative care services.

What is Healthcare providers and what they do?

A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities.

An individual health care provider (also known as a health worker) may be a health care professional within medicine, nursing, or a field of allied health. Health care providers may also be a public/community health professional. Institutions (also known as health facilities) include hospitals, clinics,primary care centres, and other service delivery points. The practice of health professionals and operation of health care institutions is typically regulated by national or state/provincial authorities through appropriate regulatory bodies for purposes of quality assurance. Together, they form part of an overall health care system.

These healthcare providers are linked under Medical Healthcare Insurance . When an individual or family or Group or a company takes Medical Healthcare Insurance they will get list of providers and their contact details and location . By this means Healthcare providers can be easily located and contacted . Which in turn very much helpful to one who is in really need .

Please read page Healthcare Providers for deep information about Health care Providers in Medical Insurance or Health Insurance

Medical Healthcare Insurance

Whenever we listen or read term Healthcare or Medical Healthcare or Medical Healthcare insurance we usually come up with thing some kind of health insurance which is of no use for us . The basic reason behind is that we in a year fall ill or prone to disease once or twice that can be treated only by our nearest physician or chemist shop or by taking some pills that also in cheap . So why to pay in this why to take Medical Healthcare Insurance which is costly and starts payment after some time.

But this wrong perception which we had in our mind . The terms Healthcare in Medical Healthcare Insurance  means:-
The prevention, treatment and management of illness and the preservation of mental and physical well being through the services offered by the medical and allied health professionals.

But still these things can be done if we assign local doctor living nearby to our house. Basic definition of Healthcare will not explain you why to take Medical Healthcare Insurance . The word Care in Medical Healthcare Insurance means a lot in our daily life .

Care is the one that mother do for a child, father do for family, government do for citizens, a good friend do to his/her friend and so on . Still care means a lot like services rendered by members of the health professionals for the benefit of a patient .

Admission care in the nursing interventions defined as facilitating entry of a patient into a healthcare facility.
Adult day care a Medical Healthcare services provided for adults with a disability or illness who need partial care and companionship during the day when family members are working or otherwise unable to stay at home with disabled persons.
Ambulatory care healthcare services that are provider on an outpatient basis.
Cesarean section care in the nursing interventions classification defined as the preparation and support of a patient delivering baby by cesarean section.
Emergency care defined as life saving measures in life threatening situations

Now the idea comes up in our mind why to take Medical Healthcare Insurance . This just like that visiting to dentist , you know you should do it but you avoid it till your last breath . Health insurance is an absolute necessity for every individual - young or old .

A Medical Healthcare Insurance is a way of ensuring you and your family against any financial contingency arising due to an unforeseen medical emergency. The average life span of an individual has increased owing to improved medical facilities and increased awareness about one's well being . However at the same time

healthcare and medical costs have also moved like rocket. Also there has been an increase in incidence of medical problems due to lifestyle like stress and eating habits.

You may also like to read Why you need Medical Healthcare Insurance? Please read