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The Eighth edition of Medical Insurance: A Revenue Cycle Process Approach emphasizes the revenue cycle—ten steps that clearly identify all the components needed to successfully manage the medical insurance claims process . The cycle shows how administrative medical professionals “follow the money .” Medical insurance specialists must be familiar with the rules and guidelines of each health plan in order to submit proper documentation, which then ensures that offices receive maximum, appropriate reimbursement for services provided . Learn the skills you need for your health professions career using multiple digital resources . Read and study the content more effectively—spending more time on topics you don’t know and less time on the topics you do by using SmartBook®, McGraw-Hill Education’s revolutionary adaptive learning technology
Roughly 40 million Americans have no health insurance, private or public, and the number has grown steadily over the past 25 years. Who are these children, women, and men, and why do they lack coverage for essential health care services? How does the system of insurance coverage in the U.S. operate, and where does it fail? The first of six Institute of Medicine reports that will examine in detail the consequences of having a large uninsured population, Coverage Matters: Insurance and Health Care, explores the myths and realities of who is uninsured, identifies social, economic, and policy factors that contribute to the situation, and describes the likelihood faced by members of various population groups of being uninsured. It serves as a guide to a broad range of issues related to the lack of insurance coverage in America and provides background data of use to policy makers and health services researchers.
Business intelligence supports managers in enterprises to make informed business decisions in various levels and domains such as in healthcare. These technologies can handle large structured and unstructured data (big data) in the healthcare industry. Because of the complex nature of healthcare data and the significant impact of healthcare data analysis, it is important to understand both the theories and practices of business intelligence in healthcare. Theory and Practice of Business Intelligence in Healthcare is a collection of innovative research that introduces data mining, modeling, and analytic techniques to health and healthcare data; articulates the value of big volumes of data to health and healthcare; evaluates business intelligence tools; and explores business intelligence use and applications in healthcare. While highlighting topics including digital health, operations intelligence, and patient empowerment, this book is ideally designed for healthcare professionals, IT consultants, hospital directors, data management staff, data analysts, hospital administrators, executives, managers, academicians, students, and researchers seeking current research on the digitization of health records and health systems integration.
Resource added for the Health Care Business Services program 101601.
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
This text provides physicians with the basic business skills in order for them to become involved in the financial aspect of their practices. The text will help the physician decide what kind of practice they would like to join (i.e. private practice, small group practice, solo practice, hospital employment, large group practice, academic medicine, or institutional\government practice) as well as understand the basics of contracting, restrictive covenants and how to navigate the road to partnership. Additional topics covered include, monthly balance sheets, productivity, overhead costs and profits, trend analysis and benchmarking. Finally, the book provides advice on advisors that doctors will need to help with the business of their professional and personal lives. These include accountants, bankers, lawyers, insurance agents and other financial advisors. The Complete Business Guide for a Successful Medical Practice provides a roadmap for physicians to be not only good clinical doctors but also good businessmen and businesswomen. It will help doctors make a difference in the lives of their patients as well as sound financial decisions for their practice.
CPT(R) 2022 Professional Edition is the definitive AMA-authored resource to help healthcare professionals correctly report and bill medical procedures and services.
Improving our nation's healthcare system is a challenge which, because of its scale and complexity, requires a creative approach and input from many different fields of expertise. Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system-one that increasingly is more effective, more efficient, safer, and higher quality-is rooted in continuous improvement principles that medicine shares with engineering. As part of its Learning Health System series of workshops, the Institute of Medicine's Roundtable on Value and Science-Driven Health Care and the National Academy of Engineering, hosted a workshop on lessons from systems and operations engineering that could be applied to health care. Building on previous work done in this area the workshop convened leading engineering practitioners, health professionals, and scholars to explore how the field might learn from and apply systems engineering principles in the design of a learning healthcare system. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary focuses on current major healthcare system challenges and what the field of engineering has to offer in the redesign of the system toward a learning healthcare system.
Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means. Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.