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Medical Necessity
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Book Synopsis Essential Health Benefits by : Institute of Medicine
Download or read book Essential Health Benefits written by Institute of Medicine and published by National Academies Press. This book was released on 2012-01-17 with total page 256 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 2010, an estimated 50 million people were uninsured in the United States. A portion of the uninsured reflects unemployment rates; however, this rate is primarily a reflection of the fact that when most health plans meet an individual's needs, most times, those health plans are not affordable. Research shows that people without health insurance are more likely to experience financial burdens associated with the utilization of health care services. But even among the insured, underinsurance has emerged as a barrier to care. The Patient Protection and Affordable Care Act (ACA) has made the most comprehensive changes to the provision of health insurance since the development of Medicare and Medicaid by requiring all Americans to have health insurance by 2016. An estimated 30 million individuals who would otherwise be uninsured are expected to obtain insurance through the private health insurance market or state expansion of Medicaid programs. The success of the ACA depends on the design of the essential health benefits (EHB) package and its affordability. Essential Health Benefits recommends a process for defining, monitoring, and updating the EHB package. The book is of value to Assistant Secretary for Planning and Evaluation (ASPE) and other U.S. Department of Health and Human Services agencies, state insurance agencies, Congress, state governors, health care providers, and consumer advocates.
Book Synopsis Coding for Medical Necessity Reference Guide - First Edition by : AAPC
Download or read book Coding for Medical Necessity Reference Guide - First Edition written by AAPC and published by AAPC. This book was released on 2020-03-18 with total page 17 pages. Available in PDF, EPUB and Kindle. Book excerpt: Master coding concepts related to medical necessity and report compliant codes for your services. Revenue loss, rework, payback demands—how much are medical necessity errors costing your practice? And that’s to say nothing of potential civil penalties. Get medical necessity wrong and it’s considered a “knowingly false” act punishable under the FCA. Stay liability-free and get reimbursed for your services with reliable medical necessity know-how. AAPC’s Coding for Medical Necessity Reference Guide provides you with step-by-step tutorials to remedy the range of documentation and coding issues at the crux of medical necessity claim errors. Learn how to integrate best practices within your clinical processes—including spot-checks and self-audits to identify problems. Benefit from real-world reporting examples, Q&A, and expert guidance across specialties to master coding for medical necessity. Learn how to lock in medical necessity and keep your practice safe and profitable: Avoid Medical Necessity Errors with CERT Smarts Rules to Improve Provider Documentation Denials? Pay Attention to Procedure/Diagnosis Linkage Nail Down the Ins and Outs of Time-based Coding Expert Guidance to Fend Off RAC Audits and Denials Beat E/M Coding Confusion with Payer Advice Improve Your ABN Know How with This FAQ
Book Synopsis Medical Necessity by : Daniel Skinner
Download or read book Medical Necessity written by Daniel Skinner and published by U of Minnesota Press. This book was released on 2019-12-24 with total page 263 pages. Available in PDF, EPUB and Kindle. Book excerpt: How the politics of “medical necessity” complicates American health care The definition of medical necessity has morphed over the years, from a singular physician’s determination to a complex and dynamic political contest involving patients, medical companies, insurance companies, and government agencies. In this book, Daniel Skinner constructs a comprehensive understanding of the politics of defining this concept, arguing that sustained political engagement with medical necessity is essential to developing a health care system that meets basic public health objectives. From medical marijuana to mental health to reproductive politics, the concept of medical necessity underscores many of the most divisive and contentious debates in American health care. Skinner’s close reading of medical necessity’s production illuminates the divides between perceptions of medical need as well as how the gatekeeper concept of medical necessity tends to frame medical objectives. He questions the wisdom of continuing to use medical necessity when thinking critically about vexing health care challenges, exploring the possibility that contracts, rights, and technology may resolve the contentious politics of medical necessity. Skinner ultimately contends that a major shift is needed, one in which health care administrators, doctors, and patients admit that medical necessity is, at its base, a contestable political concept.
Book Synopsis Definition of Serious and Complex Medical Conditions by : Institute of Medicine
Download or read book Definition of Serious and Complex Medical Conditions written by Institute of Medicine and published by National Academies Press. This book was released on 1999-10-19 with total page 127 pages. Available in PDF, EPUB and Kindle. Book excerpt: In response to a request by the Health Care Financing Administration (HCFA), the Institute of Medicine proposed a study to examine definitions of serious or complex medical conditions and related issues. A seven-member committee was appointed to address these issues. Throughout the course of this study, the committee has been aware of the fact that the topic addressed by this report concerns one of the most critical issues confronting HCFA, health care plans and providers, and patients today. The Medicare+Choice regulations focus on the most vulnerable populations in need of medical care and other services-those with serious or complex medical conditions. Caring for these highly vulnerable populations poses a number of challenges. The committee believes, however, that the current state of clinical and research literature does not adequately address all of the challenges and issues relevant to the identification and care of these patients.
Book Synopsis Extending Medicare Coverage for Preventive and Other Services by : Institute of Medicine
Download or read book Extending Medicare Coverage for Preventive and Other Services written by Institute of Medicine and published by National Academies Press. This book was released on 2000-05-07 with total page 410 pages. Available in PDF, EPUB and Kindle. Book excerpt: This report, which was developed by an expert committee of the Institute of Medicine, reviews the first three services listed above. It is intended to assist policymakers by providing syntheses of the best evidence available about the effectiveness of these services and by estimating the cost to Medicare of covering them. For each service or condition examined, the committee commissioned a review of the scientific literature that was presented and discussed at a public workshop. As requested by Congress, this report includes explicit estimates only of costs to Medicare, not costs to beneficiaries, their families, or others. It also does not include cost-effectiveness analyses. That is, the extent of the benefits relative to the costs to Medicareâ€"or to society generallyâ€"is not evaluated for the services examined. The method for estimating Medicare costs follows the generic estimation practices of the Congressional Budget Office (CBO). The objective was to provide Congress with estimates that were based on familiar procedures and could be compared readily with earlier and later CBO estimates. For each condition or service, the estimates are intended to suggest the order of magnitude of the costs to Medicare of extending coverage, but the estimates could be considerably higher or lower than what Medicare might actually spend were coverage policies changed. The estimates cover the five-year period 2000-2004. In addition to the conclusions about specific coverage issues, the report examines some broader concerns about the processes for making coverage decisions and about the research and organizational infrastructure for these decisions. It also briefly examines the limits of coverage as a means of improving health services and outcomes and the limits of evidence as a means of resolving policy and ethical questions.
Download or read book Medical and Dental Expenses written by and published by . This book was released on 1990 with total page 20 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book The Medicare Handbook written by and published by . This book was released on with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author :United States. Congress. Senate. Committee on Health, Education, Labor, and Pensions Publisher : ISBN 13 : Total Pages :106 pages Book Rating :4.F/5 ( download)
Book Synopsis Medical Necessity, from Theory to Practice by : United States. Congress. Senate. Committee on Health, Education, Labor, and Pensions
Download or read book Medical Necessity, from Theory to Practice written by United States. Congress. Senate. Committee on Health, Education, Labor, and Pensions and published by . This book was released on 1999 with total page 106 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis The Future of Disability in America by : Institute of Medicine
Download or read book The Future of Disability in America written by Institute of Medicine and published by National Academies Press. This book was released on 2007-10-24 with total page 619 pages. Available in PDF, EPUB and Kindle. Book excerpt: The future of disability in America will depend on how well the U.S. prepares for and manages the demographic, fiscal, and technological developments that will unfold during the next two to three decades. Building upon two prior studies from the Institute of Medicine (the 1991 Institute of Medicine's report Disability in America and the 1997 report Enabling America), The Future of Disability in America examines both progress and concerns about continuing barriers that limit the independence, productivity, and participation in community life of people with disabilities. This book offers a comprehensive look at a wide range of issues, including the prevalence of disability across the lifespan; disability trends the role of assistive technology; barriers posed by health care and other facilities with inaccessible buildings, equipment, and information formats; the needs of young people moving from pediatric to adult health care and of adults experiencing premature aging and secondary health problems; selected issues in health care financing (e.g., risk adjusting payments to health plans, coverage of assistive technology); and the organizing and financing of disability-related research. The Future of Disability in America is an assessment of both principles and scientific evidence for disability policies and services. This book's recommendations propose steps to eliminate barriers and strengthen the evidence base for future public and private actions to reduce the impact of disability on individuals, families, and society.
Book Synopsis Medical Technology Assessment Directory by : Institute of Medicine
Download or read book Medical Technology Assessment Directory written by Institute of Medicine and published by National Academies Press. This book was released on 1988-02-01 with total page 709 pages. Available in PDF, EPUB and Kindle. Book excerpt: For the first time, a single reference identifies medical technology assessment programs. A valuable guide to the field, this directory contains more than 60 profiles of programs that conduct and report on medical technology assessments. Each profile includes a listing of report citations for that program, and all the reports are indexed under major subject headings. Also included is a cross-listing of technology assessment report citations arranged by type of technology headings, brief descriptions of approximately 70 information sources of potential interest to technology assessors, and addresses and descriptions of 70 organizations with memberships, activities, publications, and other functions relevant to the medical technology assessment community.
Download or read book Medical Necessity written by J. Mitchell and published by . This book was released on 2016-02-13 with total page 294 pages. Available in PDF, EPUB and Kindle. Book excerpt: Dr. Denise DeLuca is in medicine for what she can get out of it, not what she can give. She is enabled by incompetent hospital administrator Royce Wexler, who in turn works for a corporate hospital system with a focus on the bottom line first, and patients second.When an ambulance hits famous Bicentennial first-born baby Flip Jenson in front of the Ascend Medical Center emergency room where he was born 23 years earlier it brings out the worst in Dr. DeLuca. She scrambles to cover her growing trail of dysfunction. A local television reporter who wants to move onto a bigger news market sees Dr. DeLuca as her way out of Charlottesville, VA. That is if she can unravel Dr. DeLuca's intrigue and the actions of the hospital that protects her.Medical Necessity explores the power structure of hospitals and the relationship between medical staffs, administrators and boards of directors. A cast of characters keeps the story lively - from a narcotic pain pill-seeking hustler to a handsome ladies man born without arms. The story is set in the late 1990's. These were the last days of a healthcare era when physicians, insurance companies and hospitals amassed huge fortunes working in a fee-for-service money environment, largely free of any quality-of-care requirements. Medical Necessity tells a story of what happens when institutions and the people in charge are not held accountable.
Book Synopsis Care Without Coverage by : Institute of Medicine
Download or read book Care Without Coverage written by Institute of Medicine and published by National Academies Press. This book was released on 2002-06-20 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
Book Synopsis ICD-10-CM Documentation 2021: Essential Charting Guidance to Support Medical Necessity by : American Medical Association
Download or read book ICD-10-CM Documentation 2021: Essential Charting Guidance to Support Medical Necessity written by American Medical Association and published by . This book was released on 2020-09-16 with total page 525 pages. Available in PDF, EPUB and Kindle. Book excerpt: ICD-10-CM Documentation 2021 brings coders and physicians together to ensure documentation success, identifying all ICD-10-CM documentation requirements using detailed checklists.
Book Synopsis Medical Necessity in Private Health Plans by :
Download or read book Medical Necessity in Private Health Plans written by and published by . This book was released on 2003 with total page 118 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Beyond the HIPAA Privacy Rule by : Institute of Medicine
Download or read book Beyond the HIPAA Privacy Rule written by Institute of Medicine and published by National Academies Press. This book was released on 2009-03-24 with total page 334 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the realm of health care, privacy protections are needed to preserve patients' dignity and prevent possible harms. Ten years ago, to address these concerns as well as set guidelines for ethical health research, Congress called for a set of federal standards now known as the HIPAA Privacy Rule. In its 2009 report, Beyond the HIPAA Privacy Rule: Enhancing Privacy, Improving Health Through Research, the Institute of Medicine's Committee on Health Research and the Privacy of Health Information concludes that the HIPAA Privacy Rule does not protect privacy as well as it should, and that it impedes important health research.
Author :United States. Congress. Senate. Committee on Health, Education, Labor, and Pensions Publisher : ISBN 13 : Total Pages :94 pages Book Rating :4.0/5 ( download)
Book Synopsis Medical Necessity, from Theory to Practice by : United States. Congress. Senate. Committee on Health, Education, Labor, and Pensions
Download or read book Medical Necessity, from Theory to Practice written by United States. Congress. Senate. Committee on Health, Education, Labor, and Pensions and published by . This book was released on 1999 with total page 94 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis OPM Should Promote Medical Necessity Programs for Federal Employees' Health Insurance by : United States. General Accounting Office
Download or read book OPM Should Promote Medical Necessity Programs for Federal Employees' Health Insurance written by United States. General Accounting Office and published by . This book was released on 1980 with total page 82 pages. Available in PDF, EPUB and Kindle. Book excerpt:
