Sunday, December 23, 2012

Long Term Care Basics that You Must Know Of

Long term care involves a wide range of services that helps people perform mundane activities of daily living such as bathing, eating, dressing, toileting, transferring and continence. According to the Department of Health and Human Services, long term care will become inevitable to at least 70% of people aged 65 and older. The very high probability of us needing such kind of care makes it important for us to know more about it. Below are some long term care basics that we must be aware of.

Where to Receive Long Term Care

Depending on an individual’s preferences, budget and need, long term care services can be received in the home, community or in long term care facilities such as nursing homes and assisted living. Individuals who need help in performing ADL but do not require round the clock attention can receive care in their homes.

However, when their condition progressed, they must be transferred to facilities which provide a more intensive level of care. Some may continue to receive care in their homes but they must hire a professional caregiver who can provide the level of care they need. Buying assistive devices and modifying the home may also become necessary.

Costs of Long Term Care

One of the most expensive types of services in the healthcare industry is long term care. Its costs can easily wipe out the life savings of an individual who has not planned for it. Long term care expenses also consume at least a third of the entire Medicaid budget. An individual who does not have long term care insurance and do not qualify for government assistance must be prepared to pay close to $100,000 a year if he has to receive care in a nursing home. The table below indicates the average costs of long term care services in America for the year 2012.

2012 Cost of Care Survey by Genworth Financial

$18/hour for homemaker services

$19/hour for home health aides

$61/day for adult day care centers

$3,300/month for assisted living facilities

$200/day for semi-private room accommodation in a nursing home

$222/day for a private room in a nursing home

With these very high costs, we must plan how to pay for it. To plan effectively, try to learn more long term care basics at

People with no private insurance can still receive long term care through government long term care. Through Medicare, Medicaid and other federal programs, people can receive extended care and assistance with their daily living activities.

Thursday, December 20, 2012

Importance of Account Receivable (A/R) Follow-up in Medical Billing Process

Account receivable management is the most important service in medical billing companies. It plays a vital role in medical billing process.

Every day a large number of services are provided by physicians, hospitals and nursing homesto various patients. The patients are given treatment and care as a part of these services and each time they facilitate such services, they owe a certain amount to the physicians and hospitals. The physicians, nursing homes andhospitals then get paid by the patients as well as by the insurance companies in return.

So you can imagine how important the insurance model of every organization is. It is to be noted that the insurance model is very important for small as well as big organizations. This model helps in diligently recovering the over-due payments. The account receivable follow ups (AR follow-ups) help in running the business of such organizations. For example, in hospitals or nursing homes, the AR follow-ups department manages denial from various insurance companies and working on them to get resolved.

In the initial times, account receivable management or Revenue cycle management was merely treated as a departmental activity. But, in the recent times, it has turned into a specialized skill center comprising of professionals. In fact, it has become a crucial part of billing services that are provided by medical billing companies.

The importance of such processes has increased because a lot needs to be done so as to receive a payment in lieu of the medical services provided by physicians. Before the process of AR follow-up starts, the procedure of charge entry, verification and payment posting is done. Charge entry can be defined as a process where charge codes are entered into a healthcare claim form. In the process, there is a need to determine procedure as well as a diagnosis code based on the treatment given by doctors. The insurance companies also prescribe specific rules to determine valid claim. The audit team has to see whether the given claim is based on those specified rules or not. If the answer is in affirmative, then it would approve the claim for submission. The proper specified rules made by the companies lower the risk of claim denials. After the approval, the claim is submitted to the insurance company; which is then processed by the company. However, the claims which insurance companies pay to the provider also include denials. Hence, accounts receivable team is created which does follow up with the insurance company to solve the denials and take appropriate steps.

So you can imagine the amount of work that needs to be done before physicians can claim their money for the services provided by them. This explains why accounts receivable follow-up has become so important in the billing process.

The function of AR team is to analyze the denied claims, partial payments and non- payments. If any claim is submitted incorrectly, then AR team corrects it and submits the claim again. AR team also communicates constantly with the patient, insurance company and the medical office or nursing home. An AR team comprising of AR analytics and AR follow-up, should have qualities like patience, diligence, attention to skill and good analytical skills. The above qualities make the members a valuable asset of the organization.

Thus, we can conclude that account receivable management is the most important service provided by medical billing companies. The effectiveness of this account receivable team will determine the financial health of medical billing companies, physicians, nursing homes and hospitals.

VOCIS has robust and secure infrastructure and processes that help us to provide Revenue Cycle Management, Medical Billing, Medical Coding, Transcription, Website and Application Development, Internet Marketing, and Virtual Staffing services to our clients in a risk free and almost zero downtime mode.

Monday, December 17, 2012

Maternity and Critical Illness Cover: Additional Coverage Offered With Health Insurance Plans

There are different types of health insurance plans available in the market. In order to make it suitable for different sections of society, these plans offer additional coverage that is generally kept optional such that an insured can buy, only if required. It is advisable to opt for such coverage in order to stay protected. Apollo Munich has devised several types of plans in order to help people buy as per their needs.

There is a large variety of health insurance products available in the market. Each and every of these products come with a different set of benefits and coverage limits and with enticing features that draw people’s attention in no time. Many people buy these products, only after looking at these attractive features, but it is not the right means to adopt. An ideal way to buy the right plan is to focus on healthcare needs and then, shortlist plans accordingly. Once the plans are shortlisted, a person should look into all the features and coverage limits in order to know about them better. A comparative study of these products’ quotes can help a person in deciding upon the same.

Many of the products available offer additional coverage along with the plans. One of the most common coverage is maternity expenses. There are many medical insurance plans that offer additional coverage to maternity expenses. Under this coverage, an insured gets cover for maternity expenses after certain time period. It is to ensure that you do not buy plan, right just before you require the coverage, else the health insurance industry would broke down. In fact, these plans offer coverage to future medical expense. This coverage works on the principle of benefit, which offers lump sum payment, as specified in the plan’s terms and conditions.

Generally, health insurance industries have predefined the amount of money to be paid in case of normal or caesarean delivery of an insured. Hence, the compensation depends upon these limits and not upon the medical expenses incurred. When a person opts for such coverage, he or she is supposed to pay a little extra premium.

Another optional coverage that is available with pure health insurance products is Critical Illness Cover. Though this coverage can be purchased in the form of separate plan, but there are many plans that offer it as an additional benefit with healthcare products. As mentioned above, an insured pays a little extra premium on opting for this cover, but it ensures dual protection, if he or she is diagnosed suffering from any serious disorder. Under this coverage, an insurer offers lump sum payment to an insured, on being diagnosed with any enlisted critical disease.

There are certain points to look into in case of critical illness coverage. The most important of all is the number of diseases included under the coverage. More are the disease enlisted, more is the protection offered. Another important point is to carefully read the clauses of the coverage. Each and every of the disease covered has its specific definition, which needs to be fulfilled for an insurer to offer the coverage. These terms and conditions should be carefully read to avoid the troubles later.

Likewise, there are different other types of additional coverage offered by an insurer with different products. One can opt for them to ensure that he or she has more protection against future medical contingencies of life.

In addition to it, there are certain types of plans that are called top-up plans that offer cover to additional expenses or higher inpatient expenses. These plans are designed to help people enjoy life to a greater extent. There is daily cash hospital benefit plan that offer insured daily cash on being hospitalized. The amount of compensation made is directly proportional to the number of days an insured is hospitalized and the amount of daily cash chosen.

The coverage offered by this plan takes care of miscellaneous expense that an insured has to pay. It includes transportation expense, laundry charges, food and other related costs. Another type of top-up plans that are available in the market is those that offer coverage to higher inpatient treatment expenditure. These plans take care of inpatient expenses, after certain amount. Every notable insurer, like Apollo Munich, has brought in all types of plan to cater to medical needs of people. Few of its plans are also available in different variants to help people choose the one that suits the best.

Saturday, December 8, 2012

Individual Health Insurance Plans - Planning Individuals For Future Needs

If insurance is all about planning for uncertainty, then a health insurance plan must be on top of your checklist.

You make plans for your future. You save up to buy a new car, a new house, or go on a vacation. Then suddenly you fall sick or have an injury and are in need of hospitalisation. The medical bills burn a hole in your pocket and your savings are diminished. It is common knowledge that medical expenses are constantly on the rise. In times like this it is important that we have an insurance plan to safeguard our savings and our plans.

Injury and illness is unpredictable, one minute you may be the picture of health and the next you may need medication or hospitalisation. The rise in expenses - health and otherwise is definite and constant. With the constant rise of inflation, medical expenses are also on the rise. Having a health plan that will rise with the times and keep you at par for medical expenditure is a smart move.

When an individual gets a health insurance plan he is assured that his health will be taken care of. Most hospitals are covered by health insurance companies so the person can be sure to get the best treatment for his illness. Health insurance works in two ways - a person has to pay the bills himself and the get refunded by the insurance company on presenting the bills or a person can avail cashless facility. Most hospitals are covered with cashless facility meaning the person has a card to show his insurance details and he can be treated at the hospital with paying anything from his pocket and the insurance company will cover his bill.

A health insurance plan also works as an investment as an individual can also get tax deduction of up to Rs. 15000 according to the Income Tax Act of 1961 under section 80D.

The cost of an individual health insurance policy depends upon various factors like, the age of the person covered by policy, individual or family floater, medical history of the individual, number members covered, average age of the family protected as well as past claims created by the person covered by insurance.

While taking an individual health insurance, it would be better if you are aware of all the inclusions and exclusions of the insurance plan. A handy list of network hospitals and good knowledge of the claim settlement process will help you take the optimum benefit from your health insurance policy in testing times.

Tuesday, December 4, 2012

Why Outsource Medical Billing and Coding To A Company Instead of Hiring Full Time In-house Employees.......?

Now a days health care industries are hiring medical billing companies instead of in-house employees. There are many reason behind this.

People in the medical and the healthcare industry such as physicians, nursinghomes and hospitalsoutsource their Medical Billing and Medical Codingservices to other companies as it is very cost effective for them. Because of this, various physicians, nursing homes and hospitalshave started to look for alternative options and are trying to outsource their Medical Billing and Medical Codingprocesses.

Because the health care services need greater efficiency at all times, the role of a Medical Billingcompany becomes all the more important. Physicians, nursing homes and hospitalsare constantly outsourcing these services to other companies so as to reduce their Medical Codingand Billingexpenses. They no longer have to maintain any infrastructure nor incur manpower costs required to maintain these services. This further enhances their revenue and helps them in providing better services to their clients.

Not only these outsourcing firms help physicians, nursing homes and hospitalsin reducing their bills, but they are also specialists in doing this job. Medical Billingerrors such as error in coding, data entry mistakes, delay in claim submissions, and missed charges are very common. But if you have outsourced your billing work to other companies then you can be assured of the quality of the work they will offer you.

The physicians, nursing homes and hospitals can outsource processes like insurance collections, insurance verification and handling insurance appeals, record of patient’s charges, payment posting, claim submission and many similar processes.

If you outsource your medical codingand billingprocesses then these outsourced firm customize the processes for you as per your requirements and combine various strategies so as to deliver desired results to you. The outsourced firm also keeps itself updated on the latest trends and regulations in the insurance industry so that they offer results in compliance with them.

The outsourced firms also offer a complete package of solutions and handle your claims properly. They employ the most experienced professionals who have a sound knowledge about the medical industry. They train their employees from time to time so as to keep them updated with the latest changes in medicaland insurance regulations.If you were to do this in the house then it can cost you a huge amount of money. So the outsourced firm not only provides efficient services at all times but also helps you in cutting your operating costs and offers better administration of your processes.

When should you outsource your Medical Billing process?

You must outsource your Medical Billingprocess when you think it has become expensive for you to maintain it in-house and you are finding it difficult to manage it too. Here are some of the other reasons why you must outsource it:

When you need access to experts and better resources

When you wish to reduce your operating expenses.

To increase efficiency of your billing process

Improve your core business processes

Increase productivity

Increase revenue

Overall we can say that outsourcing your billing processes can help in more than one way and increase your productivity. So enroll for one today and see your efficiency grow.

Vocis has extensive experience in providing comprehensive billing services for just about every specialty. We provide end-to-end medical billing services, including following-up of pending claims, initiating collections, finding out reasons for denials of claims, and tracking outstanding receivable balances