Medical billing is a leading business related to the health care industry. Medical billing business plans help you achieve your goals in the new business sector of medical billing. Like any other businesses, proper planning leads to a winning situation. To start a medical billing service, either in a small office or a cooperative business with other medical services, you should do a plenty of research to create a detailed business plan. Medical billing business plans guide you throughout the billing business to evaluate the medical practices that fall within your target market segment.

The demand for health services is on the increase these days. Medical billing business plans describe all the objectives and the nature of services. To help the medical community, first you have to set up a medical reimbursement consultancy, and which is equipped with all infrastructure facilities to handle diverse medical administrative functions.

Medical billing business plans help you get an overview of the entire medical billing business. They assist you in selecting the best course of action for the success of your business. Medical billing business plans also enable you to set priorities and choose the best alternatives out of a situation.

A lot of sample medical billing business plans with financial forecasting ideas required by lenders, investors, and banks are available on the Internet. These sample ready-made plans can be used to effectively set up and monitor medical billing businesses. You can also make use of the medical billing business plans software that is available on the Internet.

Continuing with our series on medical billing claims via electronic means, we’re going to cover the EA0 record, picking up with field number 10, which provides more information to the payer about the accident, if there was one, in relation to the claim and the condition of the patient.

EA0 field 10, positions 40 - 41, is the accident state. This is a two character state code that tells the payer in which state the accident occurred. This is important because each state has different laws regulating accident cases pertaining to medical billing of claims.

EA0 field 11, positions 42 - 43 is the accident hour. This is a two digit time that must be reported in military time. In words, 9 AM would be reported as 09 and 9 PM would be reported as 21 for 21 hundred hours. Minutes are not reported. If the accident took place before the half hour, round down. If after the half hour, round up.

EA0 field 12, position 44, is the abuse indicator. This is an indicator that tells the payer if the condition was caused by abuse such as spousal abuse or parental abuse. This is needed for legal reasons in case the claim has to go to court.

EA0 field 13, position 45, is the release of information indicator. This is an indicator that tells the payer that information is allowed to be released to other people. This is important because of the privacy laws regarding patient files. Unless this is marked off, no records can be given to anyone outside of the attending physician.

EA0 field 14, positions 46 - 53, is the release of information date. This is the actual date that the patient or guardian signed off that information can be shared. If any information was shared prior to this date, it could be grounds for legal action.

EA0 field 15, position 54, is the same of similar condition indicator. This tells the payer that the condition that the patient is suffering from is the same or a similar condition to a pre-existing one. This is also important in case of lawsuits when trying to prove that a condition was caused by an accident.

EA0 field 16, positions 55 - 62, is the same of similar condition date. This is the date when the original condition was first diagnosed. This is to show how long it has been that the patient has been suffering with this condition, again, in case there are legal issues involved.

EA0 field 17, position 63, is the disability indicator. This tells the payer if the patient is disabled. There are only three things that can go here. Either T for total, P for partial or blank for no disability.

EA0 fields 18 and 19, positions 64 - 79. These are the disability date fields, from and to respectively. The to field is only filled in if the disability was temporary. If the disability is permanent or is still in effect, then this field is left blank.

In our next installment in this series on medical billing of claims electronically, we’re going to pick up with EA0 record field number 20.

Major medical insurance is a health insurance plan that covers most serious medical expenses up to a maximum limit, normally after a deductible and co-insurance provision. This is a moderately cheaper form of health insurance with an element of speculation to it. Major medical insurance plan is intended to provide financial protection for extraordinary medical bills beyond the limits of one’s current medical insurance plan.

The term deductible refers to the amount the individual pays out of his purse for medical expenses before the insurance company pays the balance. For example, if the deductible is $6,000 and the hospital expense is $14,000, the insurer will pay only $8,000. The higher the deductible, the lower the premium. Young people in their twenties (who are confident of their health condition) and older men between fifty and sixty-five (who are still waiting for Medicare acceptance) are two groups who generally apply for major medical insurance.

Major medical insurance policy is available as an individual plan or as part of a group plan. An individual plan provides many of the valuable features seen in-group plans such as dental coverage, prescription drug cards, and family and child-only benefits. A self-employed person not covered by a group plan, an early retiree, a part-time employee, an unemployed person, or one actively seeking employment qualify for the major medical insurance policy.

Major medical insurance coverage is for protection against major hospital charges and not routine medical bills. The policy provides benefits for sickness or injury, regardless of whether the care is provided at a doctor’s office, clinic or hospital. Pre-existing medical conditions and cases, such as mental health and substance abuse, are normally barred from its coverage.

Rates of major medical insurance policy differ with the state one a person lives in and his age. In certain states in the United States, the saving on premiums could be two-thirds. Before making a decision, it is wise to look for professional guidance from insurance companies and/or agents, and compare major medical insurance quotes.

… CMS has updated the Program Integrity Manual to clarify that contractors must consider all documentation during a medical review, to include information such as physical and occupational therapy evaluations, physicians’ letters, other written physician evaluations, or any document that provides relevant information about a patient’s clinical condition. When documentation does not support information in physician progress notes, the physician’s notes will be the determining factor during the review. However, if documentation is provided in place of physician progress notes, contractors will determine whether the documentation is sufficient to justify coverage. If it is not, the claim will be denied, CMS said. To read CMS’s clarification of the Program Integrity Manual, go to www.cms.hhs.gov/manuals/pm_trans/R100PI.pdf.

… CMS has published a final rule (Federal Register, Dec. 8, 2006) regarding the Patients’ Rights Condition of Participation, which is applicable to all Medicare- and Medicaid-participating hospitals and contains standards that ensure minimum protections of each patient’s physical and emotional health and safety. It responds to comments on the following standards presented in the July 2, 1999, interim final rule: notice of rights; exercise of rights; privacy and safety; confidentiality of patient records; restraint for acute medical and surgical care; and seclusion and restraints for behavior management. As a result of comments it received, CMS has revised the standards regarding restraint and seclusion and set forth standards regarding staff training and death reporting. Effective date: Jan. 8, 2007.

Almost all accredited North American universities and Continuing Education organizations offer a wide range of Nursing Continuing Education Courses as part of their Certificate, Diploma and Degree [Associate to Doctorate level] Programs. These Continuing Education Courses are so designed that any nursing aspirant can join the course of his/her choice by following any one of the programs below.

Undergraduate Registered Nurse [RN] to Bachelor’s Degree [such as BSN]:

This program allows any registered nurse to work for and acquire a Bachelor’s Degree.

RN-BSN-MSN program: This is a bachelor’s degree completion program in which the aspirant can earn credits towards a Master’s Degree while completing upper-level BSN coursework.

RN-MSN Bridge Program: This program prepares RNs who already have a BA/BS degree in a non-nursing subject area to work for an MSN Degree course.

BSN, MSN and PhD Programs: These courses allow nurses to work for one particular degree program.

Program Nomenclature and subject combinations are determined by the Continuing Education Organization or the University that runs the program. Some offer courses such as Master of Hospital studies [MHS], EdD in Nursing [Doctor of Education in Nursing] etc. The program routes mentioned above are illustrative and not comprehensive.

Getting back to Continuing Education Courses, they are usually short and very affordable. For instance, Wild Iris Medical Education, a Continuing Education organization for nurses, seems to offer, according to its website www.nursingceu.com, courses such as `Herbal Medicine,’ a one-hour course costing $10.00; `Chest Pain’, 1.5 hours, $15.00; `Endoscope Cleaning’, 1 hour, $10.00; and `Post Anesthesia Care Complications’, 5 hours, $35.00.

According to a recent release by the U.S. Census Bureau, a Bachelor’s degree holder earns approximately $1 million more than a high school graduate, and a Master’s degree holder earns nearly $1.5 million more than a Bachelor’s degree holder in his/her lifetime.

Millions of persons suffer from a number of harmful medical conditions, which can include cardiovascular problems, diabetes, asthma, neurological disorders, allergies, fainting, epilepsy, memory loss or blindness, to name a few. People are not safe in their homes, for the fear of an attack occurring when they are home alone. Also, they may fear to venture out of their homes freely. The situation becomes all the more serious when a person lives alone. Also, financial constraints may compel him to work, even if he suffers from some serious debilitating ailment.

Medical Alert necklaces are very helpful for such persons. These necklaces and the pendants with them can be engraved with brief but vital medical bio data and the ID of the patient—for example, his or her name, telephone number, name of the doctor and a brief description of the person’s illness. They can be made in beautiful designs in steel, sterling silver or gold.

In addition to the above information, such necklaces can also be fitted with very small, lightweight and non-intrusive electronic medical alarm transmitter buttons designed to alert emergency services in the event of a medical problem. For example, if you slip and fall in your bathroom and fracture your hip, all you need to do is to press the button on your necklace and you can get help in a short time. This system can connect to your home telephone line and place a call for help. Your family members, friends and physician receive the alert, and the doctor reaches you with the help you need. These gadgets may be expensive, but a little search may enable you to find you inexpensive medical alarm systems also. These devices are fitted with batteries, which have a pretty long life.

It is important, before buying such alarms or alert systems, that you make a thorough enquiry about the services of the monitoring agency- whether it is doing the monitoring itself, or contracted out the job. The monitoring should be professional and efficient, since lives are at stake. Efforts, therefore, should be made to buy the gadgets and services of a certified monitoring agency.

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Medical Alert devices are electronic gadgets worn on your body to alert your family, friends and doctor in case of a medical emergency. They are normally meant for senior citizens, but they are equally crucial for all those who suffer from serious and debilitating diseases like cardiovascular conditions, asthma, allergies, neurological problems, epilepsy, fainting, blindness and numerous other medical conditions.

Medical Alert devices come in many shapes and designs. They may be in the form of buttons, necklaces, bracelets, pendants or wristwatches. They may have designer shapes. They may be made of precious metals like silver or gold, or come in practical shapes without any attention to their aesthetic appearance. Image-conscious wearers usually go in for these devices in form of fashionable (medical) jewelry, which is less likely to advertise their medical problems to others.

Since wearing these devices is often a medical necessity, one has to be careful before deciding which device is best suited to their type of disease. The simplest form of these devices are manufactured as jewelry items with the medical history of the patient, along with telephone numbers of his family and doctor, engraved on them. But far more useful than these are the jewelry items fitted with sensors and electronic mechanisms that activate the transmission system installed within, and connect to telephone lines or radio frequencies to contact the patient’s family, friends, and doctor, and also summon medical assistance. These devices contain the medical identity of the patient and the history of his disease so the critical time in diagnosing is not wasted.

Considering the millions of people the world over suffering from different medical problems, the market is awash with fashionable designer medical jewelry meant for these persons. Therefore, one must be cautious before spending money on them. It would be better to seek the advice of one’s doctor before deciding which device suits your medical condition. These devices are sophisticated, and likely to be costly and beyond the reach of ordinary persons. But if a thorough search is made through the Internet, Yellow Pages or other sources, cheaper but equally useful accessories can be bought. Care should also be taken about the reputation of the manufacturing company with regard to the product quality, guarantee of its effectiveness and after-sales service.

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Fashionable medical identification jewelry is a perfect solution for those who suffer from critical medical conditions like epilepsy, stroke, diabetes, heart transplant, fainting fits, asthma, memory impairment or blindness, and need to wear Medical Alerts or health monitoring systems, but are also image-conscious and hence do not want to wear matter crude gadgets or bands around their wrists.

If you personally survey the market, by surfing the Internet or by wading through the Yellow Pages or newspapers, you find a baffling variety of Medical Alert bracelets, if a bracelet is what your doctor has recommended. In a critical medical emergency, when you become helpless and cannot explain your condition, it is the medical information embedded in the bracelet that identifies you, along with the medical problem that is afflicting you. While the symptoms appearing at that critical moment baffle those around you, the medical description engraved on your bracelet may facilitate an early diagnosis, and an appropriate and timely treatment may save your life. The information legibly engraved on the front and backside of the bracelet also mentions the contact numbers of your family members and your doctor.

These bracelets come in a variety of attractive designs and price ranges. You can choose one that suits your pocket. They are made of sterling silver, gold or high-quality non-allergenic stainless steel polished to give a jewelry finish. Medical ID bracelets are available in all sizes for adults and children. The bracelet chains are fitted with a clasp that cannot open accidentally.

You should consult your doctor concerning what medical description about your problem should be engraved upon your bracelet. These bracelets can also be artistically fitted with transmitter buttons; pressing them activates some radio frequencies that raise an alarm in the base stations of the monitoring agency, which in turn alerts your family members and the doctor about the occurrence of the problem. The monitoring system talks directly to you in a very loud voice so that everyone can hear. In this way, medical aid or your relatives and friends can be summoned.

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Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health says that 250,000 deaths are caused each year by “Iatrogenic” causes – Iatrogenic is defined as induced in a patient by a physician’s activity, manner or therapy. Dr. Starfield cautions that these estimates are for deaths only and do not include negative effects that are associated with disability or discomfort. These numbers do not reflect non-fatal injures. Those figures must be staggering. And what is the cost to the health care delivery system? Millions to billions of dollars per year.

If you are not able to tell an emergency room physician about your medical conditions, your medications, allergies and past surgeries, you may become one of the statistics.

Get a copy of your medical records. Have them available in case of an emergency. Know what medications you are taking along with the dosage. Always ask for copies of your test results. It’s always a good idea to keep your records on you so get something like MyMedicalCD . Especially if you travel a lot. Update it frequently, for it could very well save your life.

Remember - You are in charge of your life. Help doctors give you the best treatments possible. Take charge today!

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