Eligibility Checking Part 1: Determining Patient Financial Responsibility

The healthcare landscape has changed, and one of the biggest changes is the growing financial responsibility of patients with high deductibles that require them to pay physician practices for services. This is an area where practices are struggling to collect the revenue they are entitled.
In fact, practices are generating up to 30 to 40 percent of their revenue from patients who have high-deductible insurance coverage. Failing to check patient eligibility and deductibles can increase denials, negatively impact cash flow and profitability.
One solution is to improve eligibility checking using the following best practices:
-Check patient eligibility 48 to 72 hours in advance of scheduled visit using one of these three methods:
1. Business-to-business (B2B) verification, which enables practices to electronically check patient eligibility using electronic data interchange (EDI) via their electronic health record (EHR) and practice management solutions.
2. Look up patient eligibility on payer websites.
3. Call payers to determine eligibility for more complex scenarios, such as coverage of particular procedures and services, determining calendar year maximum coverage, or if services are covered if they take place in an office or diagnostic centre. Clearinghouses do not provide these details, so calling the payer is necessary for these scenarios.
-Determine patient financial responsibilities – high deductibles, out-of-pocket limits, then counsel patients about their financial responsibilities before service delivery, educating them on how much they’ll need to pay and when.
-Determine co-pays and collect before service delivery.
Yet, even when doing this, there are still potential pitfalls, such as changes in eligibility due to employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.
If all of this sounds like a lot of work, it’s because it is. This isn’t to say that practice managers/administrators are unable to do their jobs. It’s just that sometimes they need some help and better tools. However, not performing these tasks can increase denials, as well as impact cash flow and profitability.
In our next post we will examine ways to overcome these challenges.
ELIGIBILITY VERIFICATION WITH PAYERS
$6.5 per hour* onwards or $2.50 per Benefit Verification based on workflow plan
Eligibility checking is the single most effective way of preventing insurance claim denials. Our service begins with retrieving a list of scheduled appointments and verifying insurance coverage for the patients. Once the verification is done the coverage details are put directly into the appointment scheduler for the office staff’s notification.
There are three methods for checking eligibility:
Online – Using various Insurance company websites and internet payer portals we check patient coverage.
Automated Voice system (IVR) – By calling Insurance companies directly an interactive voice response system will give the eligibility status.
Insurance Company Representative Call- If necessary calling an Insurance company representative will give us a more detailed benefits summary for certain payers when not available from either websites or Automated phone systems.
Clinicspectrum is a healthcare services company providing outsourcing and back office solutions for medical billing companies, medical offices, hospital billing departments, and hospital medical records departments.

Freedom of Press, the Misinterpretations in India

The right to expression and freedom of speech is very essential in a democratic nation. Intellectuals have backed it for a long time as a gateway to other liberties, conjecturing that curtailment of freedom of expression inexorably leads to restrictions on other rights such as the right to be informed. The Right to Freedom of Speech is guaranteed by Article 19 (1) (a) of the Constitution of the Republic of India.
From the other end, Article 19(1) (g) of the Constitution of India is critical in determining the standards applicable to the conduct of the many news-providing outlets i.e. the media institutions in India.
Nevertheless, the right to freedom of speech is confused and equated with the need to overlook the media as a business (dealt by Article 19(1) (g) of the Constitution of the Republic of India), which is fundamentally blemished. The rights of a citizen and the rights of a media business owner fall under different creels and outlines, and cannot be considered both are the same.
It is very essential to understand that freedom of speech and expression includes freedom of circulation, to the extent that the ability to propagate one’s expression is inherent in that freedom. Also, it is equally essential to understand that a recipient of news and a publisher of news belong to fundamentally different interest groups. This is in particular why expressing an opinion per se and the business of publishing/circulating news have been so clearly distinguished by our law makers. Both, therefore, need different levels of misunderstanding to ensure that a later right preserved in Article 19(1) (g) does not abrogate or limit the rights enshrined in Article 19(1) (a).
Press freedom under Article 19(1) (g) has to be secured as such to allow the public to be well informed. Also, the self-governing testimonial of a state is judged by how mindful the press is to ensure that the ordinary citizen actually gets the right to free speech and expression-to enable an effective democracy-and that such a right is not denied to them for commercial ends.
The Constitution, the supreme law of the land, guarantees freedom of speech and expression under Article 19 that deals with protection of certain rights regarding freedom of speech. While Article 19 (1) (a) states that all citizens shall have the right to freedom of speech and expression, from the other end Article 19 (1) (g) allows every individual to practise any profession, or to carry on any occupation, trade or business.
Further, fundamental rights form a part of the basic structure of the Indian Constitution and cannot be amended. There are certain restrictions imposed on the freedom of speech and expression by Article 19(2), constitutional protection is the greatest guarantee of freedom of speech in India. Also, according to Indian law, the freedom of speech and of the press does not confer an absolute right to express one’s thoughts freely. Article 19 (2) of the Indian constitution enables the legislature to impose certain restrictions as follows:
Security of the State,
Friendly relations with foreign States,
Public order,
Decency and morality,
Contempt of court,
Defamation,
Incitement to an offence, and
Sovereignty and integrity of India.
In the purview of the above mentioned restrictions, every individual and media organization needs to understand whether there is any violation of the above restrictions, while they quote Freedom of Speech as the authority. In fact, there is a very thin line that separates the right to freedom of speech from the restrictions associated with the same. So, there is a need to understand the right thoroughly.
Articles from http://www.sumankasturi.com have been very popular among the masses as they are well written and balanced. The author himself writes various articles at his personal blog http://sumankasturi.wordpress.com in order to get connected with the masses who are looking for the good content in the allied fields of communication.

Hate Against Women

It is something that rages world-wide and every society has problems with it as the hate against women grows deeper rather than declines. It is perpetuated by men of all persuasions and no matter whether gentle in their nature or dogmatic and bullish most of them are caught at some stage trashing or laughing at the fairer sex. The result is that women are easy to blame for things that go wrong and they are held to account in marriage when men lose interest in them.
Some who fear Sharia law might look again at how they treat women in their families and societies. After my reincarnation the thing that bothered me the most was that my new body was female, as I had been a man in my last life. Hovering above it as the body lay on the seat in front of a dray in a paddock the scene was sunny, bright, and it was about 45 years of age. In fact, I can verify it.
Between lives a vision was given to me of my life ahead and that the age of 45 would be something extraordinary. Knowing there was a job waiting for me it was also important to remain quiet until the authority to speak out was given. During my life, therefore, I lived to reach that age with full expectation that the Spirit would deliver me.
What Spirit, you might ask? Others might already have made up their mind that evil spirits have got hold of me. Still others will know that I speak of the Great Spirit of the Universe, the one and only God.
So why did it send me back as a woman? This bothered me for a long time as I struggled with the prejudice and lack of opportunities given to females even in Australia. Nonetheless I battled on and took the knocks, the ridicule, and the things thrown against me as all I could learn was taken on board and more besides.
At 45 years and just as shown to me between lives the Spirit came and commissioned me to the job on my mind at my last death. It is nothing that could be imagined as it involves undoing the work of 666 and exposing his identity.
The Old Testament prophecies predict it (Jeremiah 31:22) and in other places foretell of the woman who will remove the wall of deceit (Lamentations 2:18) and restore the children of Israel to their inheritance. Men, who are aware of these things, were determined to stop her (Isaiah 62:11) because they dream of being equal to God and women are nothing but instruments for child-bearing.
Religions support the view that women are not able to serve God and many believe they are incapable of spirituality. This is the reason behind the hate and why women are blamed for the sins of the world.
Norma Holt has memory of her reincarnation and knows that reincarnation is fact and that everyone who has lived is back. The discrimination and hatred against women is a male dominated belief in dreams from sun-worship. Many are turning to the Mountain of God which is the Internet (Micah 4:1) for answers.

Don’t Give Up

We’ve all heard it, the stories of people who persevered despite numerous rejections and failures to ultimately become famous in their field and achieve some amazing results but do we take this lesson to heart? Do we see failure as a reason to quit or as a stepping stone towards success? If it doesn’t work out once do we think it never will? I am here to tell you that if you have a dream then don’t you dare give up! Yes you may fail, you may fail numerous times but so long as you keep getting back up then failure is not the end and may still turn into success.
Decide What You Really Want
It’s no good saying ‘don’t give up’ if it’s something you don’t really want. If you don’t really want it then by all means quit, we can’t all do everything but decide what it is that you really want in life and then never, ever give up on that thing that you are passionate about.
Failure Teaches You How Not to Do It
Each time you fail at something you really want to do just see it as a lesson in how not to do it. ‘OK, so doing it that way didn’t work, what other method can I try?’ Consider life an experiment. There may be many ways that don’t work but if you keep trying you will eventually find the one way that does work. Just keep a note of what hasn’t worked and don’t keep trying to do things the same way because if you keep on trying to do things in the same way that you failed before then you will not succeed but try to do it a different way and you will learn from your mistakes.
Be Patient
Sometimes it’s not so much the process we are following to achieve the results as it is the timing. Some things are not going to happen immediately. Unfortunately we live in an age where we have gotten used to almost instantaneous results and when things don’t work out like that we tend to get impatient and give up. The best things in life however will take time so learn to be patient and realize that everything doesn’t have to happen overnight.
Be Teachable
Be teachable and willing to learn. If there are people who have gone through this process before then ask them how they did it and why they think they eventually got it right. Take notes of the lessons they learned along the way and try to avoid the same mistakes they have already made. As Isaac Newton said, “if I have seen further, it is by standing on the shoulders of giants”, learn to stand on the shoulders of those who have gone before and learn the lessons they have learnt so that you can reach further because you won’t need to go through the same mistakes. You don’t have to do it alone and mentorship is one of the best success principles.
Plenty of people have failed again and again but have gone on to achieve great things with their lives because they didn’t give up; they showed patience, persistence and learnt from others. Learn to do the same if you have something you really want to achieve and see failure as your stepping stone to greater things.
This article was written by Mandy Buchanan, owner of My Success Factory. To learn more success tips and get our free eBook visit our blog at http://www.mysuccessfactory.net/blog/

The Mob Justice Mentality

How does mob justice happen? You may question yourself. You are in a busy street going about your daily activity. You hear a shrilly sound from most probably a lady and a heavy commotion follows shortly. There is tension in the air. You turn back to see what is happening only to find a group of three or more roughing up a young man. Your curiosity makes you to get closer to witness the scene. By the time you arrive the number of people have increased, the young man is already drowning into his pool of blood and the people around him are using any available objects to hit him. You come across a young lady and panic is written all over her face and she can’t force back her tears. The atmosphere forces you to ask her what is going on. She struggles to speak but after gaining composure she tells you that the young man being beaten thoroughly had tried to snatch her mobile phone and after screaming people came from nowhere and cornered the man who was trying to run for his life.
It’s always a messy scene where the mob has dispensed its justice. But is mob justice a form of justice? They always believe they are right. They often draw their power in their huge numbers. They are almost unstoppable when they begin to execute their justice. They are outrageous, easily provoked and they don’t allow any form of opposition. The suspect or the victim always suffers their wrath. They always tie their actions to the assumption that once they are done with the suspect, it’s always a learning point for others who may be having the criminal mind to change. They are not always concerned whether the victim who was being robbed will get back their property. No! They want it to be a learning lesson to the other upcoming thugs. In most of the times, the suspect ends up being torched, hanged up or left to die after severe beating.
The mob justice mentality makes them the law enforcer, the prosecutor and judge at a go. The suspect always has no time to be heard which is a violation against his right. The law of being innocent till proven guilty is always contravened and yet it’s called justice. Cases of mistaken identity are always rampant when the mob justice takes its cause. Innocent lives are lost and this leads to a bitter pain amongst the relatives of the victim. The mob psychology presumes that once they are done with their barbaric act the other criminals will be put on notice and part ways with their criminal nature. That is not always the case since as a matter of fact, crime increases as the accomplices of their victim seeks to revenge. Also research has shown that the people who always involve their selves in the act of mob justice are always the people with lewd characters coupled with idle minds seeking a place to vent out their anger and frustrations. In other circumstances, the participants in mob justice were once the victims of violent robbery.
There is always amicable ways of conflict resolutions and mob justice does not make it one. A state is governed by its laws enshrined under a constitution and therefore taking laws into ones hand is purely injustice. Justice cannot be achieved when one party is not heard and his or her own rights are infringed. The mob justice mentality is the worst disease that needs to be cured and it can only be achieved when you and I get together and not involve ourselves with the act.