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Archive for March, 2007

Understanding Health Insurance : A Guide to Billing and Reimbursement

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Understanding Health Insurance : A Guide to Billing and Reimbursement
Understanding Health Insurance: A Guide to Billing and Reimbursement, 8th Edition is a comprehensive source for teaching the subject of health insurance and reimbursement. The book contains chapters on introductory information on the health insurance field, managed health care, legal and regulatory issues, coding systems, reimbursement methodologies, coding for medical necessity, and common health insurance plans. Each chapter contains exercises to illustrate content and reinforce learning. Numerous opportunities are provided throughout the book for manual completion of CMS-1500 claims. A CD-ROM at the back of the book allows for electronic data entry of CMS-1500 claim form information. End of chapter review questions in objective format (e.g., multiple choice) test learners on their understanding of book content. Appendices I and II provide case studies that are also included on the Student Practice CD-ROM. Additional appendices provide instruction in dental claims processing and completion of the UB-92 (claim used for inpatient and outpatient hospital claims). The accompanying workbook provides application based assignments for each chapter, additional content review (multiple choice questions), and additional case studies for practice in completing CMS-1500 claims. This edition of the book contains the most up to date information regarding health insurance claims processing and coding and reimbursement issues.

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Does Your Government Really Care if You Become Disabled and Need Benefit Assistance?

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Does your government really care if you are disabled? That’s a
question that is becoming greater and worthy of the public’s
consideration.

Recently, I was on the phone with a disability claimant who
needs to have his reconsideration filed and I asked him if he
had been seen by any doctors recently. He gave the all too
common answer: “No, I haven’t been able to go. My insurance ran
out a long time ago”.

This is a very common situation. And I’ve heard it so much that
I’ve become somewhat desensitived to it. But.if you really
think about it, these situations (which ARE extremely common)
are horrendous.

Let me put on my examiner/caseworker hat for a moment. The
disability system is set up so that the prospect of being
approved for disability weighs entirely on a claimants medical
records. And not just on medical records, but on recent records
(aside from closed periods).

Well, ding ding ding (wake up bureaucrats, politicians, and
red-tape functionaries), if the process for eventually—we
hope—getting approved for disability benefits can take up to 3
years (I’m not pulling that number out of a rabbit hat
either—-just call any attorney or non attorney practicing in
the raleigh north carolina area and they will sullenly confirm
this information), then how can a claimant be expected to have
decent medical record documentation by the time they get to a
hearing (a destination most cases will arrive at)?

Answer: an unacceptably large percentage of claimants won’t (I
typically tell people to seek out a county health department,
free clinic, or even go the ER, if need be—but’s let be
honest, that doesn’t take the place of records generated via an
ongoing treating physician relationship).

Now, before I go on any further, I acknowledge the notion that
the disability system is not responsible in any way, shape, or
form for facilitating a claimant’s access to medical care while
a case is pending in order to substantiate a claim (i.e. ensure
that records are in place to support allegations of disability).
But, even for those claimants who had chiefstream
employer-provided health insurance, COBRA only lasts 18 months.

So, when the process can last 2 or 3 years, where does that
leave claimants? In a bad way, without a doubt. Not only are
they put in the position of finding it difficult to document
their impairments—-to add insult to injury their conditions
will sometimes worsen as a result of having inadquate access to
medical care.

Now, back to the headline of this post. THESE HUGE WAIT TIMES
came into effect under the administration currently sitting in
office. So, do they care? Do they really care about those who
are least able to assist themselves?

I would have to say no. They do not.

I will leave you with this anecdote: about 2 years ago I tried
to assist one particular claimant whose situation was quite
miserable. He had no access to medical care and his living
conditions were beyond the pale. To try to help him, I contacted
the following agencies in his city (not my own area of
operation): the salvation army, catholic social ministries, and
urban ministries.

Want to know what I was told? They were out of funds. THIS WAS
IN FEBRUARY OF THAT YEAR.

So, what does that say about the federal administration’s
notions of faith-based charities taking up the slack from the
government cutting back: that it is essentially useless and
disingenuous rhetoric.

In addition to being a former disability examiner, I used to be
a food stamp caseworker, medicaid caseworker, and an afdc
worker, and I can tell you unequivocally that private charities
will never be able to fill any gap left behind by the feds, but
that’s another conversation.

Now, why this article? Because there are changes in the works
that while masquerading as reform of the social security
disability system.will actually make the system larger hostile
to disabled benefit applicants.

Chew on this as a parting thought. The people who are trying to
“reform” social security disability are the same people who
tried to (or are trying to, as the case may be):

1. bust the federal employees unions (and have to some extent
succeeded),

2. altered regulations regarding overtime compensation in a way
that was clearly hostile to workers,

3. are trying to limit the ability of mesothelioma victims to
seek compensation (the sick part part about this is that
mesothelioma has an incubation period of up to 40 years
following exposure to asmatchlessos fibers and the diagnosis itself
is a literal death sentence—-no one survives, even following a
pneumonectomy).

And these are just a few things.

So, to address the question we began with: does your government
really care if you become disabled and need immediate benefit
assistance to avoid falling into a financial abyss? Perhaps to
some extent.but, unfortunately, I would have to say, not
particularly much.

About the author:

The author of this article is Timothy Moore, who, in addition to
being a former food stamp caseworker, medicaid caseworker and
AFDC caseworker, is a former disability claims examiner. He
publishes information at Social
Security”>http://www.disabilitysecrets.com/questions.html>Social
Security
Disability faq

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The Health Insurance Primer

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The Health Insurance Primer
The Health Insurance Primer is for anyone in any field who wants to learn higher about how health insurance works.

This book is an excellent choice for both beginners and those with experience in the field. The authors assume no prior knowledge and begin by explaining basic concepts and terminology, but they progress to an in-depth examination of such topics as the various kinds of health insurance, health insurance contracts, underwriting, and sales and marketing. The authors have extensive experience in the health insurance industry and bring a practical, real-world perspective to the subject.

Jewish ExponentBudget Secretary Unveils IdeasJewish Exponent, PA - 7 hours ago. use a combination of state and federal funding to provide health insurance for the more than 700000 Pennsylvanians who currently go without coverage. .

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Parkinson’s Disease & TAI CHI THERAPY

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In a special to CNN, the Mayo ClinicÂ’s mayoclinic.com reported that, “Parkinson’s disease is progressive, meaning the signs and symptoms become worse over time. But although Parkinson’s may eventually be disabling, the disease often progresses gradually, and most people have many years of productive living after a diagnosis.” This would indicate that there may be active interventions that could perhaps slow the progress of the disease. When we get such a diagnosis, our first reaction might be to withdraw and give up. However, the old adage “use it or lose it” tells us that just the opposite is true. If you have ParkinsonÂ’s, youÂ’d likely be incomparable off to use everything your body is, every which way, on a regular basis.

Tai Chi movement’s gentle balance enhancing motions can obviously help the Parkinson’s patient by helping to reduce the gradual loss of balance that Parkinson’s sufferers often experience. However, there may be much extra it offers. For example, Tai Chi movements rotate the human body in about 95% of the ways the body can move, when a long form is practiced. This is far beyond what other exercise offers, and in fact the closest would be several swimming strokes, which together would only rotate the body in about 65% of the ways it can move. For Parkinson’s sufferers, or anyone for that matter, this would indicate that by “using” 95% of the body’s possible motion several times a week, the possibility of “losing” the ability to do so contractes accordingly. This isn’t rocket science, but simple common sense.

Yet, perhaps ParkinsonÂ’s patients have even innumerable to gain from Tai Chi. A few years ago I taught several classes at local medical centers. I was continually frustrated because although IÂ’d seen emerging reports that Tai Chi was beneficial to people with ParkinsonÂ’s Disease, or arthritis, or chronic hypertension, etc., even though the departments that specialized in those conditions were often just down the hall from my Tai Chi class . . . they might as well have been a million miles away. Because the physicians who ran those departments were either ignorant of or unwilling to refer their patients to the possibilities that Tai Chi offered their lives.

I remember though, that at one medical center a visionary neurologist began to refer patients with balance disorders to my Tai Chi classes and the result was very beneficial for his patients. Another physician actually wrote prescriptions for my Tai Chi classes to treat the chronic hypertension of his patients, whoÂ’d seen a significant drop in their blood pressure since beginning the classes weeks before. A clinical psychologist brought me in to teach Qigong (Chi Kung) meditation and Tai Chi to her patient group to enhance their sense of well being and provide effectual stress management training. So, even back then some physicians were seeing the potential Tai Chi offered their clients, and even major are now, but the number of physicians who are still not informing their patients of Tai ChiÂ’s direct therapeutic or at the least adjunct therapy benefits to their patientÂ’s efforts to deal with their conditions and life, is increasingly indefensible in this day and age. Given the research that has exposed the many physical, mental, and emotional benefits Tai Chi offers, for physicians to not educate themselves on this and share their knowledge with each and every patient is tantamount to mal-practice. Health educators should likewise be making such therapies part of their medical student education programs as well.

Tai Chi for ParkinsonÂ’s is being recommended increasingly by support groups and some progressive medical centers, but until everyone that has ParkinsonÂ’s knows about it, then our work at World Tai Chi & Qigong Day is not done, nor is the medical communityÂ’s. There are many obvious reasons everyone with ParkinsonÂ’s should be doing Tai Chi, but itÂ’s the ones that are not yet obvious that may be the most intriguing. One obvious reason is that Tai Chi is the most powerful balance and coordination enhancing exercise known. In many studies at major universities Tai Chi was found to be TWICE as compelling in reducing falls as the other balance enhancing exercises being studied. For people with ParkinsonÂ’s, who often see their balance deteriorate as their condition progresses, it is unforgivable for them to not be informed of Tai ChiÂ’s potential benefits at the earliest stage possible while their balance is still good.

Now, regarding the less obvious reasons Tai Chi may benefit ParkinsonÂ’s patients. Both my wife and daughter, who co-taught a Tai Chi class together noticed that a young man with severe ParkinsonÂ’s tremors . . . completely lost his tremors once he joined the class in flowing through the Tai Chi movements in class. In another class I was teaching an older man with advanced ParkinsonÂ’s attended my classes for many months, and he always came in very slow with his walker. Once we began the Tai Chi movements he no longer used his walker, and had learned the entire long form of Tai Chi I taught, which was over 15 minutes of continuous changing forms. His form was unique and tailored for his limitations, but nonetheless a challenging set of exercises he was able to accomplish without the use of his walker. What do these anecdotal experiences portend for others with ParkinsonÂ’s? I donÂ’t know, but there should be massive research dollars coming from the National Institutes of Health to find out. Given the promise Tai Chi seems to offer people on so many profound physical, emotional, and mental fronts from preliminary research, the current total research money earmarked for complimentary and alternative medicineÂ’s (CAM) is a mere pittance.

The National Center for Complementary and Alternative Medicine (NCCAM), now in its sixth year, supports further than 300 research projects and has an estimated budget of over $120 million for 2005 (up from $50 million in 1999). Total spending on CAM by all NIH institutes and centers is expanding as well, and is expected to reach $315 million by 2005.

Sounds like a lot? However, $120 million is less than “one half of one percent” of the total NIH FY2005 budget. According to the Association of American Medical Colleges the NIH’s total annual budget for FY 2005 is $28.8 billion (http://www.aaas.org/spp/rd/05pch8.htm). Remember, we are talking about only spending much much less than one half of one percent to study an exercise that preliminary research has shown to: n Lower High Blood Pressure (about 1/3 of Americans have hypertension – roughly over 90 million Americans) n Boost Immune Function profoundly (a study sited at drkoop.com indicates that a Tai Chi practicing group was TWICE as resistant to the shingles virus, and researchers believed this would carry over to other viral resistance as well.) n Dramatically reduce falling injuries by about half (complications from falling injuries in older Americans is the 6th leading cause of death for seniors in America)

If Tai Chi only addressed this chronic condition affecting 1/3 of Americans, while boosting the immune system of all practitioners profoundly, and cutting in half the sixth leading cause of death for seniors, without any negative side effects, that would seem to be, for the rational person a reason for pouring massive resources into researching it further. However, Tai ChiÂ’s benefits only begin with the above preliminary findings. We also know that it may very well relieve depression, anxiety, and mood disturbance, as well as reduce ADHD symptoms in teenagers diagnosed with Attention Deficit and Hyperactivity Disorder. There are indications that Tai Chi may greatly reduce or even eliminate chronic pain conditions, and lessen allergic and asthmatic reactions, and improve overall respiratory function.

My point is, “where is the massive attention this would garner on talk shows, and in health newspaper sections, if this were a drug or surgery that could provide such a seemingly massive breakthrough in health treatment?” Peter Chowka, in a brilliant two part series for Natural Health Line, entitled “Complementary & Alternative Medicine in 2000,” wrote, “Conflicts of interest are not uncommon in most aspects of life. But in medicine, the biggest business in the U.S. (over $1.5 trillion a year constituting over 14 percent of the Gross Domestic Product, according to the National Academy of Science’s Institute of Medicine report issued January 10, 2001), serious conflicts are particularly well entrenched.” Mr. Chowka wrote of physicians like Dr. Marcia Angell voicing concerns of the “troubling” result massive research money from drug and medical-equipment companies was having on the scientific process. In the New England Journal of MedicineÂ’s May 18, 2000 issue, Dr. Angel wrote an editorial entitled, “Is Academic Medicine for Sale?” She wrote, “As we spoke with research psychiatrists about writing an editorial on the treatment of depression . . . we found very few who did not have financial ties to drug companies that make antidepressants. . .The problem is by no means unique to psychiatry. We routinely encounter similar difficulties in finding editorialists in other specialties, particularly those that involve the heavy use of expensive drugs and devices.”

So, who can make a multi-billion dollar fortune teaching Tai Chi to people? No one can. Tai Chi cannot be bottled, or mass marketed. It is a decentralized labor intensive industry that employees many people, but keeps the profits small and local. Yes, there are videos and DVDs that teach Tai Chi compellingly, but ultimately even those who utilize videos are drawn to live class like structures. As I mentioned before with the “anecdotal” experiences of my students with Parkinson’s, Tai Chi seems to offer something profoundly beneficial to the quality of life of Parkinson’s sufferers. It needs further study. We are in a catch 22, where many health professionals feel they cannot recommend Tai Chi because too much of the preliminary research is anecdotal. However, when Tai Chi is jockeying for position to get a crumb of the .5% of total NIH money going to ALL complimentary and alternative medical therapies . . . the result will be many long years of millions of people suffering needlessly from conditions or symptoms of those conditions that Tai Chi could likely safely lessen or even eliminate.

WHAT DO WE KNOW ABOUT TAI CHI AND PARKINSONS?

Tai Chi is being recommended by some forward thinking medical institutions already. The Cleveland Clinic of Neuroscience Center encourages Parkinson’s Disease patients to seek out a hobby or activity they can enjoy and stick with such as “Tai Chi” and other activities. The Alexian Neurosciences Institute in Illinois offers a course in their The Parkinson’s Disease and Movement Disorders Center. Also, the American ParkinsonÂ’s Disease Association at Stanford University Medical Center, in itÂ’s “Beyond Pills. Alternative Approaches to Coping with Parkinson’s Disease” program, offered “Tai Chi, The Art for Living with Parkinson’s” by Mwezo & Jane of Kujiweza Healing Arts. (Learn extended at: http://parkinsons.stanford.edu/symposium.html). The ParkinsonÂ’s Society of Canada recommends Tai Chi for ParkinsonÂ’s patients, suggesting “Tai Chi may prevent or at least slow down the onset of degenerative diseases; in the long run, it can reduce need for rehabilitative care.” (http://www.parkinsons.ca/managing.html#taichi)

In the United Kingdom a Parkinson’s Tai Chi study was conducted at Camborne Redruth Community Hospital, Cornwall. Their conclusion of the study was such, “Tai Chi training was well tolerated by PD patients in this study, but had no measurable effect on motor performance using UPDRS score or GAG time. There was a non-significant improvement in quality of life scores (PDQ 39). Larger studies would be needed fully to evaluate the value and efficacy of Tai Chi. However our results are encouraging, and provide evidence for its safety and tolerability and would support the feasibility of further study.” (http://www.pdcornwall.org.uk/showarticle.pl?n=30&id=81)

WCHS TV during a news report focusing on Tai ChiÂ’s ability to boost immune system function, also reported that “Tai Chi has also been shown to help illnesses such as Parkinson’s disease, multiple sclerosis, fibromyalgia and arthritis.” (http://www.wchstv.com/newsroom/healthyforlife/2177.shtml)

The Neurology Channel reported, “The slow flowing movements of Tai Chi help capitaltain flexibility, balance, and relaxation. The Struthers Parkinson’s Center in Minneapolis, which teaches a modified form of Tai Chi, consistently reports benefits achieved by patients in all stages of Parkinson’s.” (http://www.neurologychannel.com/parkinsonsdisease/surgery.shtml)

Physicians at the Mayo Clinic recommend Tai Chi for Parkinson’s therapy, under their Parkinson’s “self-care” section for avoiding falls, where they suggest you “Ask your doctor or physical therapist about exercises that improve balance, especially tai chi. Originally developed in China farther than 1,000 years ago, tai chi uses slow, graceful movements to relax and strengthen muscles and joints. “

At a popular health website called “RemedyFind.com” viewers can vote on therapies they’ve found benefited their condition, or didn’t benefit it. The rating there for Tai Chi as a Parkinson’s therapy received a rating of 9.8 out of a possible 10. (http://remedyfind.com/rem.asp?ID=13945)

A Study at the University of Florida in Jacksonville found that patients who attended Tai Chi classes for one hour each week for 12-weeks were less likely than a group of control patients to experience an increase in the severity of their condition and a decrease in motor function. . . .[of alternative therapies] the most popular therapies being Tai Chi, yoga, and acupuncture. (http://www.worldhealth.net/p/275,1526.html), (SOURCE/REFERENCE: Reported by www.reutershealth.com on the 13th November 2002)

The Atlanta Journal Constitution reported, “ParkinsonÂ’s Meets ItÂ’s Match in Tai Chi.” In this article they write that Dr. Mark Guttman, director of the Centre for Movement Disorders in Markham, Ontario, recommends people with Parkinson’s do exercises that involve a lot of stretching, similar to the movements of tai chi.

“Tai chi is wonderful; it can help people with disabilities as well as people with Parkinson’s,” he says. He added that studies on animals show exercise induces a change in the brain that prevents the symptomÂ’s of ParkinsonÂ’s from emerging.

The Tai Chi teacher for this program, Ms. Embree, spoke of how people with fibromyalgia, multiple sclerosis, cystic fibrosis, and ParkinsonÂ’s often attend her classes . . . “Doctors are now sending people here,” adds Ms Embree. (for the entire article, go to: PARKINSONÂ’S MEETING ITÂ’S MATCH IN TAI CHI, April, 13, 2005, http://www.ajc.com/health/content/health/0304/lvtaichi7.html)

At the National ParkinsonÂ’s Foundation site, Melanie M. Brandabur, MD NPF Center of Excellence, University of Illinois at Chicago and Jill Marjama-Lyons, MD NPF Center of Excellence, Shands Jacksonville, wrote, “Most patients derive a great deal of benefit from today’s medications and surgical therapies for Parkinson’s Disease . . . However, benefits of these therapies can be limited. As time goes by, the medications may not seem as energetic as they once were. Side effects or unpredictable response may develop. Surgical therapies are not curative and often treat only selected aspects of Parkinson’s Disease. For these reasons, patients may decide to explore other modalities, such as massage therapy, Tai Chi, yoga, or herbal preparations to augment their Parkinson’s medication . . . Many patients with Parkinson’s Disease have become interested in complementary therapies to supplement medications and other traditional PD treatments. These physicians also suggest that as Tai Chi and other modalities benefits are exposed by clinical research, physicians will advocate their use likewise widely. (http://www.parkinson.org/site/pp.asp?c=9dJFJLPwB&b=238635)

World Tai Chi & Qigong Day joins a growing number of health professionals specializing in fields like Parkinson’s who believe that much heavier research needs to be done to illuminate the full spectrum of benefits Tai Chi offers all people as well as those specifically with chronic conditions. This will enable likewise physicians to make Tai Chi a regular prescription written as therapy or adjunct therapy for a host of maladies many are already enjoying the benefits of for their condition, but paying out of pocket for. Ultimately extra and greater health insurance plans should and will make Tai Chi classes a deductible medical expense for their clients. The end result of this shift may portend the savings of hundreds of billions of dollars annually in saved health care costs as patients are better trained in self care techniques, training the great visionary Thomas Edison referred to as “the care and criticaltenance of the human frame,” which Edison envisioned would major and greater reduce the need for expensive surgeries and life long dependence on medications as human beings maximized their own self healing abilities. Traditional Chinese Medicine has spent centuries developing and evolving self healing technologies like Tai Chi. Now the west can learn about their results, and physicians can prescribe them to their patients and our entire society will be healthier and major abundant for it.

Copyright 2005 Bill Douglas

About The Author

Bill Douglas is the Tai Chi Expert at DrWeil.com, Founder of World T’ai Chi & Qigong Day (held in 50 nations each year), and has authored and co-authored several books including a #1 inimitable selling Tai Chi book “The Complete IdiotÂ’s Guide to TÂ’ai Chi & Qigong.” BillÂ’s been a Tai Chi source for The Wall Street Journal, New York Times, etc. You can learn in addition about Tai Chi & Qigong, and also contact Bill Douglas at http://www.worldtaichiday.org

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Free for All? : Lessons from the RAND Health Insurance Experiment

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Free for All? : Lessons from the RAND Health Insurance Experiment
From 1971 to 1982, researchers at the RAND Corporation devised an experiment to address two key questions in health care financing: how much increased medical care will people use if it is provided free of charge? and what are the consequences for their health? This book presents a comprehensive account of the experiment and its findings. It will be an inestimable teaching tool and reference for anyone concerned with health-care policy.

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