Posts Tagged ‘patient’
Health Insurance Exchanges Under the Patient Protection and Affordable Care Act (ACA)
The fundamental purpose of a health insurance exchange is to provide a structured marketplace for the sale and purchase of health insurance. The authority and responsibilities of an exchange may vary, depending on statutory or other requirements for its establishment and structure. The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) requires health insurance exchanges to be established in every state by January 1, 2014. ACA provides certain requirements for the establishment of exchanges, while leaving other choices to be made by the states.
Qualified individuals and small businesses will be able to purchase private health insurance through exchanges. Issuers selling health insurance plans through an exchange will have to follow certain rules, such as meeting the private market reform requirements in ACA. While the fundamental purpose of the exchanges will be to facilitate the offer and purchase of health insurance, nothing in the law prohibits qualified individuals, qualified employers, and insurance carriers from participating in the health insurance market outside of exchanges. Moreover, ACA explicitly states that enrollment in exchanges is voluntary and no individual may be compelled to enroll in exchange coverage.
Exchanges may be established either by the state itself as a “state exchange” or by the Secretary of Health and Human Services (HHS) as a “federally-facilitated exchange.” A federally-facilitated exchange may be operated solely by the federal government, or it may be operated by the federal government in conjunction with the state, as a “partnership” exchange. All exchanges are required to carry out many of the same functions and adhere to many of the same standards, although there are important differences between the types of exchanges. States had to declare their intentions to establish their own exchange no later than December 14, 2012; to date, 17 states and D.C. have received conditional approval from HHS to operate a state exchange. States interested in pursuing a partnership exchange must declare their intentions no later than February 15, 2013.
ACA and regulations require exchanges to carry out a number of different functions. The primary functions relate to determining eligibility and enrolling individuals in appropriate plans, plan management, consumer assistance and accountability, and financial management. ACA gives various federal agencies, primarily HHS, responsibilities relating to the general operation of exchanges. Federal agencies are generally responsible for promulgating regulations, creating criteria and systems, and awarding grants to states to help them create and implement exchanges.
A state that is approved to operate its own exchange has a number of operational decisions to make, including decisions related to organizational structure (governmental agency or a nonprofit entity); types of exchanges (separate individual and Small Business Health Options Program (SHOP) exchanges, or a merged exchange); collaboration (a state may independently operate an exchange or enter into contracts with other states); service area (a state may establish one or more subsidiary exchanges in the state if each exchange serves a geographically distinct area and meets certain size requirements); contracted services (an exchange may contract with certain entities to carry out one or more responsibilities of the exchange); and governance (governing board and standards of conduct).
In general, health plans offered through exchanges will provide comprehensive coverage and meet all applicable private market reforms specified in ACA. Most exchange plans will provide coverage for “essential health benefits,” at minimum; be subject to certain limits on cost-sharing, including out-of-pocket costs; and meet one of four levels of plan generosity based on actuarial value. To make exchange coverage more affordable, certain individuals will receive premium assistance [...]
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Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (ACA)
New federal tax credits were authorized in the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended), to help certain individuals pay for health insurance coverage, beginning in 2014.
ACA requires “American Health Benefit Exchanges” to be established in every state by January 1, 2014, either by the state itself or by the Secretary of Health and Human Services (HHS). Exchanges will not be insurers, but will provide eligible individuals and small businesses with access to private health insurance plans. Generally, the plans offered through the exchanges will provide comprehensive coverage and meet all ACA market reforms, as applicable. One of the requirements that most exchange plans must meet is to provide a certain level of coverage generosity based on actuarial value. Each level of coverage generosity is designated according to a precious metal and corresponds to a specific actuarial value: Bronze (actuarial value of 60%), Silver (70%), Gold (80%), and Platinum (90%).
To make exchange coverage more affordable, certain individuals will receive premium assistance in the form of federal tax credits. The premium credit will be an advanceable, refundable tax credit, meaning taxpayers need not wait until the end of the tax year in order to benefit from the credit, and may claim the full credit amount even if they have little or no federal income tax liability. Although the premium credits will not be available until 2014, the illustrations provided in this report are based on current federal poverty levels, to reflect how the estimated premium credit amounts compare to current income levels.
Under ACA, the amount received in premium credits is based on income tax returns. These amounts are reconciled in the next year and can result in overpayment of premium credits if income increases, which must be repaid to the federal government. ACA limited the amount of required repayments. Since the enactment of ACA, these limits have been increased in order to raise revenues for other legislative initiatives (e.g., P.L. 111-309 and P.L. 112-9). Most recently, on June 7, 2012, the House passed H.R. 436, the Health Care Cost Reduction Act of 2012, which includes a measure that would remove all limits on repayment, making individuals fully liable for the full amount of any premium credit overpayment.
Relative affordability of health insurance premiums individuals and families might face within health insurance exchanges will likely vary from exchange to exchange based on a host of factors, including enrollees’ age, the varying prices paid by plans for medical goods and services, the breadth of the provider network, the provisions regarding how out-of-network care is paid for (or not), and the use of tools by the plan to reduce health care utilization (e.g., prior authorization for certain tests). Examples provided in the Appendix of this report depict a range by which premiums might reasonably be expected to vary based on enrollees’ age, and variation in medical costs across geographic areas, for purposes of illustration only. Actual premiums will likely vary among health insurance exchanges based on a wide range of factors other than those depicted in this report.
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Tucson, Ariz. (PRWEB) September 27, 2012
SynCardia Systems, Inc., manufacturer of the worlds first and only FDA, Health Canada and CE (Europe) approved Total Artificial Heart, announced today that Advocate Christ Medical Center in Oak Lawn, Illinois, has discharged its first patient to receive the SynCardia temporary Total Artificial Heart. Leroy Haynes, 64, left the hospital using the Freedom
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BEAUTY FROM AFAR AFFORDABLE & QUALITY COSMETIC CARE OUTSIDE US BOOK MEDICAL NEW
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Woburn, MA (PRWEB) September 05, 2012
What do hospital infections, sinusitis, periodontal disease, middle ear infections, tonsillitis, COPD, diabetic foot wounds, osteomyelitis and cystic fibrosis have in common? The persistence of these chronic conditions originate from slimy bacterial biofilms that encase bacteria and microbes of many types, exploit the immune system and resist antibiotic treatment.
While the existence of bacterial biofilm was first documented in 1683 and rediscovered in the late 1970s, molecular diagnostics have demonstrated the omnipresence of biofilms in medical conditions affecting more than 17,000,000 people annually. The film Why Am I Still Sick? identifies the multifaceted roles of biofilms in causing persistent disease and offers startling revelations through interviews with medical experts and patients:
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Get The BEST Medical Care-YOU Can Navigate The Medical Maze: A Patient Guide
Consider this, “If you live in Fort Myers FL., you’re two or three times more likely to get your knee replaced than if you live in Miami…” the reason has nothing to do with knees. The healthcare consumer in the USA has a “43% chance of undergoing an unnecessary test” How do you prevent that? How does this happen that “more people now die from the misuse of prescription drugs purchased legally in pharmacies than from illicit drugs bought on the street.” All of this can be reduced by one person; you. You need to know how to get the best out of one of the costliest and most fragmented medical systems in the developed world. This book is a must read for anyone who wants to be a more informed and smarter consumer. Everything you need, facts, statistics, the questions to ask your doctors, the resources on the Internet, and the law to back you up.
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Geriatrics and the Law: Understanding Patient Rights and Professional Responsibilities, Third Edition (Springer Series on Ethics, Law and Aging)
“The updated Third Edition of Geriatrics and the Law by the leading scholar in law and old age belongs on the desk of every hospital and long-term care administrator, Director of Nursing, and Medical Director. It is the most comprehensive volume available on the topic. The book provides clearly written legal and ethical principles and their implications and applications.”–Elias S. Cohen, JD, Executive Director, Community Services Systems, Inc.
Significant changes in the law are affecting patients’ rights and professionals’ responsibilities in providing clinical services to the elderly. This edition of Kapp’s successful text continues to inform and sensitize health care professionals about the legal issues, and offers practical advice and guidance to practitioners in a variety of disciplines.
The text has been thoroughly updated and, where appropriate, expanded. Topics woven into each chapter include: implications of the relevant statutes, regulations, judicial opinions, private guidelines, and discussion of new laws. This practical book is a valuable and useful resource for practitioners, health care students, and educators. It contains extensive references and a helpful Appendix of Resources.
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Denville, NJ (PRWEB) July 05, 2012
EMRs provide therapists with a one-stop resource for managing all aspects of patient care, said Chhoda. Theyre efficient, cost effective and integrate easily with office workflow.
Patient portal
EMRs offer patient portals that clients can use to send messages to the office, schedule an appointment or request information. Physical therapy documentation software provides therapists with the means to engage patients in the care and management of their health for better treatment results. Therapists can share documents with the patient, and a physical therapy EMR offers a secure means for patients to provide their personal information, symptoms and concerns. Chhoda noted that patient portals require little training for staff, freeing them to devote more time to patient care.
Reminders
Cancellations, no shows and self-termination of treatment are inevitable in any practice. An EMR enables practices to remind patients automatically of their appointments through text messaging and email, and many systems feature automatic phone reminders.
Insurance verification
Patient insurance coverage runs the gamut from a full range of services to minimal intervention. When clients schedule an appointment, their insurance provider, coverage and eligibility for physical therapy services can be verified. Systems allow for verification on a single client or can be set for automatic batch verifications at the end of each day, all accomplished in real time.
Complete records
A physical therapy EMR provides a complete record for each patient, without the need to rely on patient memory, faxes or the Postal Service to deliver essential information. Therapists have access to a patients complete medical file, along with notes, for more efficient and effective treatments. An EMR can provide labor savings within the practice of up to 30 percent on tasks that require information gathering.
Chhoda is an expert in the implementation of office systems that increase the level of patient care and enhance practice profitability. His new ways of utilizing an electronic medical record for physical therapy services offer therapists valuable insight into additional ways an EMR can benefit the financial health of their clinics, while providing a significantly enhanced level of patient care.
Chhodas office can be reached by phone at 201-535-4475. For more information, visit the website at http://www.emrnews.com.
ABOUT NITIN CHHODA
Nitin Chhoda PT, DPT is a licensed physical therapist, a certified strength and conditioning specialist and an entrepreneur. He is the author of “Physical Therapy Marketing For The New Economy” and Marketing for Physical Therapy Clinics and is a prolific speaker, writer and creator of products and systems to streamline medical billing and coding, electronic medical records, health care practice management and marketing to increase referrals. He has been featured in numerous industry magazines, major radio and broadcast media, and is the founder of Referral Ignition training systems and the annual Private Practice Summit. Chhoda speaks extensively throughout the U.S., Canada and Asia. He is also the creator of the Therapy Newsletter and Clinical Contact, both web-based services to help private practices improve communication with patients, delivery better quality of care and boost patient retention.
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Belleville, IL (PRWEB) June 22, 2012
A new national survey finds that 71 percent of U.S. physicians spend 20 minutes or less with each patient during an office visit. That can be a challenge for patients seeking Social Security Disability Insurance(SSDI) benefits who need to work closely with their doctors when preparing their claims, according to Allsup, which provides SSDI and Medicare plan selection services.
The study of physician workload and compensation was published this spring by Medscape, WebMDs medical professionals website, which analyzed data gathered from 24,000 U.S. physicians. The largest number of physicians, 26 percent, reported spending 13-16 minutes with a patient. But the good news for individuals applying for Social Security Disability Insurance is that critical care specialists spend an average of 25 minutes or more with each patient.
SSDI is a medically based program, therefore it requires considerable input from healthcare professionals, said Ed Swierczek, Allsup senior claimant representative. The clinical findings and medical opinions of healthcare professionals can be given significant weight by the SSDI adjudicatorbe it a disability examiner or an administrative law judge.
In fact, a Social Security Ruling (SSR 96-2p) applicable to the disability program states a treating physicians medical opinion is given controlling weight as long as the opinion is supported by the medical evidence. With that in mind, a treating physicians medical opinion can be vital to any disability claim, Swierczek said.
SSDI is a federally mandated disability insurance program overseen by the Social Security Administration (SSA), and it operates separately from the retirement and Supplemental Security Income (SSI) programs. SSDI provides monthly benefits to individuals who are under full retirement age (age 65 or older) and who can no longer work because of a severe disability. Individuals and their employers pay for the federal insurance program through FICA taxes.
If an individual can no longer work because of a mental or physical impairment, seeing a physician or mental healthcare provider to document the impairment is paramount, Swierczek said. He shared the following tips for working with healthcare professionals during the Social Security Disability Insurance application process.
See a doctor trained in assessing the respective impairment. For example, if a persons primary problem is mental, seeing only a primary care physician will not have as much weight as seeing a qualified mental healthcare professional, such as a psychiatrist, psychologist or licensed clinical social worker, Swierczek said.
Determine if the doctor will support a disability claim. Its advisable to address this issue with the doctor right away, Swierczek said. If the doctor feels the individual can work, it is highly unlikely that he or she will be supportive of the claim and therefore will not be an advocate for the patient during this process.
Make sure the doctor documents all findings. If the physician supports the claim, its important that he or she documents the individuals chart with all physical and mental findings, Swierczek said. That includes complaints, such as being unable to stand for long periods of time or stay focused on a task, as well as symptoms, such as pain, fatigue and shortness of breath.
Prepare the doctor for requests. The Social Security Disability Insurance process requires comprehensive paperwork, Swierczek said. Let the doctor know that he or she may be asked to complete assessments on the individuals behalf, citing the functional limitations secondary to the impairments. For example, questions might include how much a person can lift or carry, how long the individual can sit, stand and walk, and if the person is able to use his or her hands effectively.
Encourage timely responses. Because applying for SSDI can be a lengthy process, its important to ask the doctor to respond to any request for information on the disability claim as soon as possible, Swierczek added. Nearly two-thirds of initial applications are denied, many because of technical or medical reasons, which leaves applicants wondering what to do next. A smarter move is to find expert representation before filing with Social Security.
To determine if you are eligible for Social Security disability benefits, call the Allsup Disability Evaluation Center at (800) 678-3276.
ABOUT ALLSUP
Allsup is a nationwide provider of Social Security disability, Medicare and Medicare Secondary Payer compliance services for individuals, employers and insurance carriers. Founded in 1984, Allsup employs more than 800 professionals who deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. The company is based in Belleville, Ill., near St. Louis. For more information, go to http://www.Allsup.com or visit Allsup on Facebook at http://www.facebook.com/Allsupinc.
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Right Care, Right Now: How To Be A Powerful Patient Advocate For A Loved One
“What makes this book different? There isn’t a lot of fluff. Just solid, useful information and tools that will help you make good decisions for a loved one.”
-IJH, San Francisco, California
“RIGHT CARE, RIGHT NOW” is a practical no-nonsense guide written for people short on time who need information about representing a patient in today’s U.S. health care system.
Included are powerful strategies and techniques to plan and process health care decisions for a patient.
This is an easy to read reference that is to the point and heavily linked to essential research, physician, hospital, drug and government insurance websites.
Features:
- How to avoid the top ten mistakes made by most health advocates.
- How to research medical treatment options (and why you shouldn’t rely on Google).
- How to find the best doctors, surgeons and hospitals, and which questions you should ask before you hire them.
- How to do background checks on doctors and hospitals.
- Learn when teaching hospitals tend to make the most mistakes.
- When and how to fire a doctor.
- Why second and third opinions matter.
- How to get get the best second and third medical opinions, and why it is often best NOT to get them from colleagues of the primary care physician.
- How to research and source the best and most economical medications.
- How to work with Medicare and private insurance companies, and deal with excessive charges and billings.
- How to appeal insurance denials of insurance coverage.
- How to establish your legal and practical role as a patient advocate, or outsource to a professional or volunteer advocate.
And much more…
This is the book for non-medical people who must deal with one of the most complex medical bureaucracies on the planet, and who don’t have a lot of time to learn how to do it.
EXCERPTS
FROM CHAPTER 1:
“Your role as a health advocate can mean the difference between life and death for someone you love.”
Every year more than 200,000 deaths in the United States result from hospital errors that could have been prevented. They happen because of distractions, shift changes, miscommunication, or natural human error. Every day there are thousands of examples of misdiagnosis, mistakes with prescriptions and dosages, procedural errors in hospitals, and other problems, nearly all of which could be prevented with quality and procedural control measures.
FROM CHAPTER 9:
“It’s not good enough that Aunt Gertrude likes the doctor and the hospital. Do background checks.”
You don’t have to be at the mercy of a website or a referral. You can find the answers about a doctor’s license for yourself…
Useful Websites:
DocFinder
www.docboard.org
This remains the only combined database of all licensing jurisdictions that has its direct source of data from state licensing boards.
Federation of State Medical Boards
www.fsmb.org/directory_smb.html
This website has links to state medical and osteopathic boards.
Public Access to Court Electronic Records (PACER)
www.pacer.gov
This electronic public access service allows users to obtain case and docket information from federal appellate, district and bankruptcy courts, and the PACER Case Locator via the Internet. PACER is provided by the federal judiciary in keeping with its commitment to providing public access to court information via a centralized service. The cost is very reasonable.
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