Medical insurance Books
Wolters Kluwer Health The Health Care Handbook: A Clear and Concise
Book SynopsisDescribed in the New York Times as “an astonishingly clear ‘user’s manual’ that explains our health care system and the policies that will change it,” The Health Care Handbook, by Drs. Elisabeth Askin and Nathan Moore, offers a practical, neutral, and readable overview of the U.S. health care system in a compact, convenient format. The fully revised third edition provides concise coverage on health care delivery, insurance and economics, policy, and reform—all critical components of the system in which health care professionals work. Written in a conversational and accessible tone, this popular, highly regarded handbook serves as a “one stop shop” for essential facts, systems, concepts, and analysis of the U.S. health care system, providing the tools you need to confidently evaluate current health care policy and controversies. Provides essential introductory coverage while also offering depth and focus gained through the authors’ experience over three editions of this best-selling handbook Features framing questions at the start of each chapter to help spur thought and discussion of the topics Contains a new section that synthesizes how multiple issues throughout the book come together in the example of hospital readmissions reduction policy Includes more data visualization such as maps and infographics for quick comprehension of complex information Offers multiple viewpoints and suggested readings so readers can develop their own opinions on key topics Used as a curricular resource in more than 150 training programs nationwide, including schools of medicine, nursing, physician assistant, pharmacy, physical therapy, occupational therapy, business, sociology, pre-medical, health administration, health law, and health policy; also used for employee training in a variety of organizations within the pharmaceutical, medical device, health care system, health insurance, and health IT fields Enrich Your eBook Reading Experience Read directly on your preferred device(s), such as computer, tablet, or smartphone. Easily convert to audiobook, powering your content with natural language text-to-speech.
£26.99
The University of Chicago Press Economic Dimensions of Personalized and Precision
Book SynopsisThis volume explores the intersection of the scientific, clinical, and economic factors affecting the development of PPM, including its effects on the drug pipeline, on reimbursement of PPM diagnostics and treatments, and on funding of the requisite underlying research; and it examines recent empirical applications of PPM.
£106.40
Elsevier - Health Sciences Division Bucks 2019 ICD10CM Physician Edition
Book Synopsis
£86.32
Elsevier Health Sciences ICD10CMPCS Coding Theory and Practice 20212022
Book Synopsis
£75.04
Elsevier - Health Sciences Division ICD10CMPCS Coding Theory and Practice 20232024
Book SynopsisTable of Contents1 The Rationale for and History of Coding 2 The Health Record as the Foundation of Coding 3 ICD-10-CM Format and Conventions 4 Basic Steps of Coding 5 General Coding Guidelines for Diagnosis 6 Introduction to ICD-10-PCS 7 General Coding Guidelines for Other Medical- and Surgical-Related Procedures and Ancillary Procedures 8 Coding Medical and Surgical Procedures 9 Symptoms, Signs, and Abnormal Clinical and Laboratory Findings Not Elsewhere Classified, and Z Codes (ICD-10-CM Chapters 18 and 21, Codes R00-R99, Z00-Z99) 10 Certain Infectious and Parasitic Diseases (ICD-10-CM Chapters 1 and 22, Codes A00-B99, U07.1, U09.9) 11 Neoplasms (ICD-10-CM Chapter 2, Codes C00-D49) 12 Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism (ICD-10-CM Chapter 3, Codes D50-D89) 13 Endocrine, Nutritional, and Metabolic Diseases (ICD-10-CM Chapter 4, Codes E00-E89) 14 Mental, Behavioral, and Neurodevelopmental Disorders (ICD-10-CM Chapter 5, Codes F01-F99) 15 Diseases of the Nervous System, Diseases of the Eye and Adnexa, and Diseases of the Ear and Mastoid Process (ICD-10-CM Chapter 6, Codes G00-G99, Chapter 7,Codes H00-H59, and Chapter 8, Codes H60-H95) 16 Diseases of the Circulatory System (ICD-10-CM Chapter 9, Codes I00-I99) 17 Diseases of the Respiratory System (ICD-10-CM Chapters 10 and 22, Codes J00-J99, U07.0) 18 Diseases of the Digestive System (ICD-10-CM Chapter 11, Codes K00-K95) 19 Diseases of the Skin and Subcutaneous Tissue (ICD-10-CM Chapter 12, Codes L00-L99) 20 Diseases of the Musculoskeletal System and Connective Tissue (ICD-10-CM Chapter 13, Codes M00-M99) 21 Diseases of the Genitourinary System (ICD-10-CM Chapter 14, Codes N00-N99) 22 Pregnancy, Childbirth, and the Puerperium (ICD-10-CM Chapter 15, Codes O00-O9A) 23 Certain Conditions Originating in the Perinatal Period, and Congenital Malformations, Deformations, and Chromosomal Abnormalities (ICD-10-CM Chapter 16, Codes P00-P96 and Chapter 17, Codes Q00-Q99) 24 Injury and Certain Other Consequences of External Causes and External Causes of Morbidity (ICD-10-CM Chapter 19, Codes S00-T88 and Chapter 20, Codes V00-Y99) 25 Burns, Adverse Effects, and Poisonings (ICD-10-CM Chapters 19 and 20, Codes S00-Y99) 26 Complications of Surgical and Medical Care GLOSSARY ABBREVIATIONS/ACRONYMS ILLUSTRATION CREDITS INDEX
£75.99
Elsevier - Health Sciences Division Bucks 2023 HCPCS Level II
Book SynopsisTable of ContentsIntroduction Guide to Using the 2023 HCPCS Level II Codes Symbols and Conventions 2023 HCPCS Updates Anatomy Illustrations 2023 Index 2023 Table of Drugs 2023 HCPCS Level II Modifiers 2023 HCPCS Level II National Codes Appendix A: Jurisdiction List for DMEPOS HCPCS Codes Appendix B: General Correct Coding Policies for National Correct Coding Initiative Policy Manual for Medicare Services
£73.14
Elsevier Health Sciences Bucks Workbook for StepbyStep Medical Coding 2024
Book SynopsisTable of Contents1. Reimbursement, HIPAA, and Compliance 2. An Overview of ICD-10-CM 3. ICD-10-CM Outpatient Coding and Reporting Guidelines 4. Using ICD-10-CM 5. Chapter-Specific Guidelines (ICD-10-CM Chapters 1-10) 6. Chapter-Specific Guidelines (ICD-10-CM Chapters 11-14) 7. Chapter-Specific Guidelines (ICD-10-CM Chapters 15-22) 8. Introduction to CPT 9. Introduction to the Level II National Codes (HCPCS) 10. Modifiers 11. Evaluation and Management (E/M) Services 12. Anesthesia 13. Surgery Guidelines and General Surgery 14. Integumentary System 15. Musculoskeletal System 16. Respiratory System 17. Cardiovascular System 18. Hemic, Lymphatic, Mediastinum, and Diaphragm 19. Digestive System 20. Urinary and Male Genital Systems 21. Reproductive, Intersex Surgery, Female Genital System, Maternity Care and Delivery 22. Endocrine and Nervous Systems 23. Eye, Ocular Adnexa, Auditory, and Operating Microscope 24. Radiology 25. Pathology/Laboratory 26. Medicine 27. Inpatient Coding Appendix A: Reports Appendix B: Answers to Odd-Numbered Workbook Questions
£33.24
Elsevier Health Sciences Bucks StepbyStep Medical Coding 2024 Edition
Book SynopsisTable of ContentsUNIT 1 Reimbursement CHAPTER 1 Reimbursement, HIPAA, and Compliance UNIT 2 ICD-10-CM CHAPTER 2 An Overview of ICD-10-CM CHAPTER 3 ICD-10-CM Outpatient Coding and Reporting Guidelines CHAPTER 4 Using ICD-10-CM CHAPTER 5 Chapter-Specific Guidelines (ICD-10-CM Chapters 1-10) CHAPTER 6 Chapter-Specific Guidelines (ICD-10-CM Chapters 11-14) CHAPTER 7 Chapter-Specific Guidelines (ICD-10-CM Chapters 15-22) UNIT 3 CPT and HCPCS CHAPTER 8 Introduction to CPT CHAPTER 9 Introduction to the Level II National Codes (HCPCS) CHAPTER 10 Modifiers CHAPTER 11 Evaluation and Management (E/M) Services CHAPTER 12 Anesthesia CHAPTER 13 Surgery Guidelines and General Surgery CHAPTER 14 Integumentary System CHAPTER 15 Musculoskeletal System CHAPTER 16 Respiratory System CHAPTER 17 Cardiovascular System CHAPTER 18 Hemic, Lymphatic, Mediastinum, and Diaphragm CHAPTER 19 Digestive System CHAPTER 20 Urinary and Male Genital Systems CHAPTER 21 Reproductive, Intersex Surgery, Female Genital System, and Maternity Care and Delivery CHAPTER 22 Endocrine and Nervous Systems CHAPTER 23 Eye, Ocular Adnexa, Auditory, and Operating Microscope CHAPTER 24 Radiology CHAPTER 25 Pathology/Laboratory CHAPTER 26 Medicine UNIT 4 Inpatient Coding CHAPTER 27 Inpatient Coding 697 Differences Between Inpatient and Outpatient Coding APPENDIX A Online Resources APPENDIX B Exercise, Quick Check, and Toolbox Answers APPENDIX C Learning Objective and Glossary Review Answers APPENDIX D EHR Screens Glossary Figure Credits Coder's Index Index
£80.74
Harvard University Press Fixing Medical Prices
Book SynopsisMiriam Laugesen goes to the heart of U.S. medical pricing: to a largely unknown committee of organizations affiliated with the American Medical Association. Medicare’s ready acceptance of this committee’s advisory recommendations sets off a chain reaction across the American health care system, leading to high—and disproportionate—rate setting.Trade ReviewIn Fixing Medical Prices: How Physicians Are Paid, Miriam Laugesen opens the ‘black box’ of policy choices embedded in the nation’s health financing system. Her thorough analysis of physician pricing exposes how seemingly technical decisions on physician prices are actually highly political—riddled with conflicts of interest and largely immune from public accountability. Policymakers and the public owe Miriam Laugesen a debt of gratitude for shining a light on fundamental policy flaws. We now have no excuse for failing to correct them. -- Judith Feder, Georgetown UniversityOur medical prices are too high. Moreover, these prices are grossly misaligned with what Americans really need. Warped prices reflect the arcane political economy of our $3 trillion medical system. In this beautiful book, Miriam Laugesen combines the rigor of political science with the granular knowledge of health services research to illuminate these pathologies. Most importantly, she provides a road map to do better. This is an important book. -- Harold Pollack, University of ChicagoCombining interviews, thoughtful historical perspective, and statistical analysis, Miriam Laugesen offers the best study yet on the politics of physician payment in the United States. A weak administrative apparatus in Washington makes the power of the House of Medicine all the more formidable. The results of that process—including the power of specialty doctors and the weakness of primary care providers—should interest and trouble us all. -- Daniel Carpenter, Harvard UniversityWill people still care about these issues for the next four years? I hope so, because this is the best book I know of on Medicare pricing and its influence on pricing throughout the broader U.S. health care system. -- Tyler Cowen * Marginal Revolution *In Fixing Medical Prices, Miriam Laugesen takes a deep dive into the weeds of U.S. medical pricing policy to uncover problems with how Medicare sets physician payments. -- Kathleen M. Haddad * Health Affairs *Fixing Medical Prices is a superb book on a subject—how Medicare determines what it pays physicians—that is both exceedingly complex and arcane, yet also critically important in terms of impacting the structure of health care finance, organization and delivery…The book should be required reading for health policy scholars, medical students, medical historians, and anyone interested in how money—in the form of Medicare payment policy—shapes U.S. health care. -- Rick Mayes * Bulletin of the History of Medicine *
£30.56
MP-MTB University of Manitoba Press Medicares Histories Origins Omissions and
Book SynopsisMedicare is arguably Canada's most valued social program. As federally-supported medicare enters its second half-century, Medicare's Histories brings together leading social and health historians to reflect on the origins and evolution of medicare and the missed opportunities characterizing its past and present.Table of Contents Chapter 1 Chief Complaint: Physician Discontent with Canadian Medicare Chapter 2 Medicine in the “Muskeg Metropolis:” Health Service Transformation in Canadian Resource Towns, 1960-1975 Chapter 3 From Health Care Policy to Professional Politics: Medicare and Allied Health Professionals in Quebec, 1960-1990 Chapter 4 Did Medicare Make Nursing Work Invisible? Chapter 5 “One foot on each side of the border:” Dr Frederick Dodge Mott, Rural Health, and “Socialized” Medical Care in the United States and Canada, 1930s-1970s Chapter 6 What Was Socialized Medicine? Revisiting the Radical Pre-History of Medicare Chapter 7 Medicare vs. Medicine Chest: Court Challenges and Treaty Rights to Health Care Chapter 8 Mental Health and Medicare: Who Cares? Chapter 9 Medicare and Maternity: Historicizing Inequities in Women’s Health Chapter 10 Becoming Not a Stranger: Home care for rural elders in the age of Medicare Chapter 11 Medicare in Canada from a Disability Rights Perspective, Ontario c. 1975-1990 Chapter 12 Prevention or Cure: The Contested History of Public Health and Medicare, 1960-2018 Chapter 13 Medicare Unfinished: Pharmacare and Denticare
£23.96
John Wiley & Sons Inc Medicare For Dummies
Book SynopsisMedicare madesimple Medicare brings valuable benefits to more than 58 million people and growing, but most of us don't even know the basics of how Medicarecanworkbest for us.That'swhereMedicare For Dummies, 4thEditioncomes in,explaining howthis complexsystem functions and helping youconfidentlynavigate your way through the mazetoget the most out of your coverage. This indispensable resourceuntanglesMedicarein friendly, straightforward language.Stepbystep, you'll learnwhenand howto enroll,waysto avoid costly mistakes, andhowtofindthe plan that brings the most benefit to you and your family. Reduce out-of-pocket expenses Know your rights and protections Choose the best policy for you Using this reassuring and comprehensive guide, you'll be able to get the answers to all your questions,find guidance on how to actandthenget on with getting the benefits you need. Table of ContentsIntroduction 1 About This Book 2 Foolish Assumptions 3 Icons Used in This Book 4 Beyond the Book 4 Where to Go from Here 5 Part 1: Getting Started with Medicare 7 Chapter 1: The Nuts and Bolts of Medicare: What It Is and How It Works 9 Addressing Some Upfront Questions 10 Coming to Terms with the ABCs (and D) of Medicare 12 Part A 13 Part B 14 Part C 15 Part D 15 Recognizing That You Have Choices and Must Make Timely Decisions 16 Chapter 2: Spelling Out What Medicare Covers (A Lot, but Not Everything) 19 Understanding What Part A and Part B Cover 20 Necessary medical care 20 Preventive care 21 Specialized care in certain circumstances 24 Medical supplies and equipment 28 Knowing What Part D Covers 30 Making sense of drug coverage that can vary throughout the year 30 Finding out about formularies 32 Determining when drugs are covered by Part A, Part B, or Part D 34 The Gaps: Discovering What Medicare Doesn’t Cover 35 Routine hearing, vision, dental, and foot care 35 Home safety items 36 Nursing home care 37 Medical services abroad 38 Services that may be nice but aren’t necessary 38 Distinguishing When Coverage Comes with Limits 39 Limits on hospital stays 40 Limits on skilled nursing facility stays 41 Limits on mental health benefits 41 Limits on therapy services 42 Chapter 3: Understanding What You Pay Toward Your Costs in Medicare 45 Boning Up on Premiums, Deductibles, and Co-payments 46 Part A costs 47 Part B costs 49 Part D costs 50 Medicare Advantage costs 51 Paying Higher-Income Premiums 52 Understanding who’s liable for the surcharges 53 Figuring out what the surcharges cost you 56 Getting the surcharges waived 57 Paying Different Premiums than Other People in Certain Years 59 Paying Medicare Taxes While Receiving Medicare Benefits 61 Chapter 4: Reducing Your Out-of-Pocket Expenses in Medicare 63 Purchasing Medigap Insurance 64 Examining Medigap policies 65 Choosing and buying a Medigap policy 70 Qualifying for Help from Your State 70 Medicaid 71 Medicaid medical spend-down programs 72 Medicare Savings Programs 73 PACE plans 74 State Pharmacy Assistance Programs 75 Examining Whether Extra Help Can Lower Your Drug Costs 76 Qualifying for Extra Help 77 Applying for Extra Help 78 Choosing a drug plan with Extra Help 85 Considering Other Ways to Cut Costs 88 Taking income tax deductions for Medicare costs 88 Lowering drug costs without Extra Help 90 Part 2: The Hows and Whens of Medicare 93 Chapter 5: Qualifying for Medicare 95 Hitting the Milestone of Age 65 96 Debunking some qualification myths 96 Meeting the requirements for Parts A, B, and D 97 Qualifying for Part A on your own work record 98 Being eligible for Part A on someone else’s work record 100 Qualifying for Medicare under Age 65 on the Basis of Disability 102 Receiving disability payments 103 Suffering from permanent kidney failure (ESRD) 105 Living with Lou Gehrig’s disease (ALS) 106 Falling through the Cracks: Health-Care Options if You Can’t Get Medicare Yet 106 Nice work if you can get it: Landing a job with benefits 106 Paying for COBRA temporary insurance 107 Purchasing individual insurance through the online Marketplace 107 Buying health insurance outside of the Obamacare Marketplace 109 Getting health care without insurance 110 Chapter 6: Enrolling in Medicare at the Right Time for You 111 At a Glance: Surveying Situations That Affect Enrollment Timing 112 Understanding Your Initial Enrollment Period 114 Using your IEP at age 65 114 Taking advantage of your IEP when you have disabilities 115 Delaying Part B if You’ll Qualify for a Special Enrollment Period Later 116 Being able to delay Part B without penalty 117 Knowing what to do about Part A if you delay Part B 119 Heeding a special warning if you have a health savings account at work 120 Using the special enrollment period 122 Enrolling in Other Specific Situations 123 You’re a legal permanent resident 123 You live outside the United States 124 You’re in a nontraditional marriage or domestic partnership 127 You’re incarcerated 128 Deciding Whether and When to Sign Up for Part D Drug Coverage 129 Assessing drug coverage you have from elsewhere 129 Debating whether you need Part D if you don’t take medications 131 Figuring the best time to enroll in Part D 132 Understanding the Consequences of Not Signing Up at the Right Time 133 Missing your deadline for Part B 135 Passing your deadline for Part A 138 Neglecting your deadline for Part D 140 Figuring out whether you can get a late penalty revoked 142 Chapter 7: Discovering How to Sign Up for Medicare 145 Being Automatically Enrolled in Medicare Parts A and B 146 Sign Me Up! Applying for Medicare Parts A and B 147 Signing up from inside the United States 148 Enrolling while you’re living abroad 152 Opting Out of or Disenrolling from Part A or Part B 153 Declining Part A 154 Opting out of Part B 155 Disenrolling from Part B 157 Knowing When Your Coverage Begins 158 When you sign up during the first three months of your IEP 160 When you sign up during IEP months four through seven 160 When you are awarded Medicare coverage retroactively 161 Transitioning from Obamacare to Medicare 162 Figuring out whether you need to make the switch 163 Knowing how and when to switch from Marketplace to Medicare 165 Chapter 8: Understanding How Medicare Fits In with Other Health Insurance 169 Understanding Medicare’s Coordination of Benefits System 170 Helping Medicare help you: Filling out your initial enrollment questionnaire 171 Keeping Medicare informed if your coverage changes 172 Seeing How Medicare Works with an Employer’s Health Insurance Plan 172 Working with insurance from a current employer 173 Having insurance from a former employer 176 Figuring Out How Other Federal Health Benefits Fit In with Medicare 180 The Federal Employees Health Benefits Program 180 TRICARE and TRICARE For Life 183 The Veterans Affairs health system 186 The Indian Health Service 188 The Black Lung Program 188 Mixing Medicare with Workers’ Comp or No-Fault or Liability Insurance 189 When you first make a claim 190 If the claim isn’t settled promptly 190 When the claim has been settled 191 Part 3: Making Smart Choices among Medicare’s Many Options 193 Chapter 9: Making Sense of Medicare’s Many Options 195 Seeing the Big Picture: Your Starting Point to Navigating the Medicare Maze 196 Understanding the consequences of your choice of system 196 Weighing the two systems 199 Recognizing when you may not have a choice 202 Being on your guard against “auto-enrollment” 203 Digging into the Details of Traditional Medicare versus Medicare Advantage 205 Opting for traditional Medicare 205 Looking at Medicare Advantage plans 207 Checking out three other types of Medicare health plans 211 Discovering How Medigap Policies Differ from Medicare Advantage Plans 212 Chapter 10: Choosing Wisely If You Go with Traditional Medicare 215 Understanding the Need to Compare Part D Plans Carefully 216 Knowing what not to do 216 Defining “the best plan” 217 Recognizing that comparing plans is worth the effort 218 Seeing how comparing plans can save big bucks 219 Getting organized with two crucial lists 221 Picking the Part D Plan That’s Best for You 223 Assessing the Plan Finder’s reliability 224 Using the Medicare Plan Finder to discover options available to you 225 Drilling down to important bits of info when comparing Part D plans 228 Choosing the Medigap Supplemental Policy That’s Best for You 233 Choosing a Medigap policy 233 Buying a Medigap policy at the right time 235 Buying Medigap if you’re under 65 237 Suspending a Medigap policy 239 Chapter 11: Making Smart Choices If You Opt for Medicare Advantage 241 Comparing Medicare Advantage Plans 242 Comparing plans’ medical benefits 243 Adding prescription drug coverage 247 Choosing the Medicare Advantage Plan That’s Right for You 250 Figuring out which providers accept the plans you’re considering 250 Enrolling in a Medicare Advantage plan 251 Taking action if you change your mind 252 Chapter 12: Getting Help in Making Medicare Choices 255 One on One: Getting Personal Help on Medicare Issues 256 Asking family and friends 256 Contacting State Health Insurance Assistance Programs 257 Calling Medicare’s help line 258 Seeking advice from other sources 260 Buyer Beware! Avoiding Scams and Hard-Sell Marketing 261 Steering clear of outright scams 262 Resisting hard-sell marketing tactics 265 Part 4: Navigating Medicare from the Inside 269 Chapter 13: Starting Out as a New Medicare Beneficiary 271 Playing Your Cards Right 272 Understanding when to use each card 272 Replacing your cards 275 Beyond the Cards: Checking Out the Extent and Limits of Your Coverage 275 Managing Premiums 277 Discovering different ways to pay Medicare premiums 277 Knowing what can happen when you don’t pay your premiums on time 281 Keeping Track of Your Expenses 284 Understanding Medicare Summary Notices 284 Maintaining hard-copy records you can rely on 287 Tracking information online 288 Dealing with Doctors 288 Finding doctors who accept Medicare patients 289 Understanding what doctors can charge you 289 Filling Prescriptions for the First Time with a Part D Plan 292 When does my coverage begin? 292 Which kind of pharmacy can I use? 293 What happens if I go to an out-of-network pharmacy? 295 How do I prove I have Part D coverage? 296 How can I ensure I get my meds? 297 Chapter 14: Getting the Inside Scoop on Using Certain Medicare Benefits 301 Taking a Closer Look at Part A 302 Understanding hospital benefit periods 302 Taking note of the three-day rule 304 Defining observation status 305 Being aware of the improvement standard 308 Fighting premature hospital discharge 309 Proceeding if the hospital makes a mistake 310 Knowing your rights in a skilled nursing facility 310 Zooming In on Part B 314 Checking on whether Medicare will cover your treatment 314 Receiving a notice saying that Medicare may not pay 315 Determining whether you can find out a service’s cost in advance 317 Maximizing your chances for coverage 318 Recognizing your right to second opinions 319 Filing a claim directly to Medicare 320 Delving into Part D 321 Understanding how a plan may restrict your drug coverage 322 Grappling with the tier system of co-pays 324 Navigating the doughnut hole 327 Using Part D to get the shingles vaccine 328 Taking advantage of free Medication Therapy Management benefits 329 Chapter 15: Changing Your Medicare and Medigap Coverage 331 Switching Coverage during Open Enrollment or Disenrollment 332 The open enrollment period 332 The disenrollment period 333 Taking Advantage of Special Enrollment Periods 334 Recognizing when you can use SEPs to change plans 335 Making sure your records and prescriptions are transferred 339 Dropping a Plan (Or Being Dropped) 341 Leaving a plan on your own 341 Getting the boot from your plan 342 Deciding Whether to Stay or Switch to Another Plan for Next Year 344 Reading your Annual Notice of Change to understand plan alterations 344 Comparing plans (yes, all over again!) 346 Looking at extra factors influencing your decision 347 Changing to Another Medigap Policy 348 Knowing the consequences of switching Medigap policies 349 Exploring a change of Medigap coverage 350 Exercising your right to a 30-day free look 350 Chapter 16: Knowing Your Rights 351 Understanding Your Right to Accurate Information 351 Knowing whom to call 352 Seeking a second opinion 353 Asking for an Investigation 354 Requesting equitable relief 354 Contacting an ombudsman 355 Reaching out to your Quality Improvement Organization 355 Getting ahold of your plan 356 Filing a grievance 356 Taking Steps toward an Appeal 357 Obtaining a formal denial 358 Requesting a coverage determination 358 Having a game plan in mind before you move ahead with an appeal 360 Filing a Formal Appeal 361 Walking through the five levels of appeal 361 Getting help in making an appeal 366 Part 5: The Part of Tens 367 Chapter 17: Top Ten Medicare Mistakes 369 Thinking You Must Reach Full Retirement Age before Signing Up 370 Assuming You Don’t Qualify If You Haven’t Worked Long Enough 370 Failing to Enroll in Part B When You Should 371 Believing You Don’t Need Part B If You Have Retiree or COBRA Coverage 371 Not Signing Up for Part D Because You Don’t Use Prescription Drugs 372 Picking a Part D Drug Plan for the Wrong Reasons 372 Misunderstanding Enrollment Periods 373 Being Too Late to Buy Medigap with Full Protections 373 Failing to Read Your Annual Notice of Change 374 Not Realizing You May Qualify for Help to Lower Your Costs 375 Chapter 18: Ten Ways to Stay Healthier beyond Age 65 377 Taking Action to Avoid Falls 377 Exercising Regularly 379 Quitting Smoking 379 Eating Healthfully 380 Cutting Out Soft Drinks and Extra Sugar 381 Keeping an Eye on Prescription Drugs 381 Continuing to Work or Stay Active 382 Staying Connected and Engaged 382 Keeping Your Brain in Shape 383 Addressing Tough Choices before They’re Necessary 383 Part 6: Appendixes 385 Appendix A: Sources of Help and Information 387 Government Help Lines and Websites 387 The Centers for Medicare & Medicaid Services 388 The Social Security Administration 388 State Health Insurance Assistance Programs 389 The Eldercare Locator 394 Independent Sources of Direct Help 394 The Medicare Rights Center 394 The National Alliance for Hispanic Health 395 The National Asian Pacific Center on Aging 395 Resources for Saving Money 396 Consumer Information and Advocacy Organizations 397 Sources for Updates on Medicare 398 Appendix B: Glossary 399 Index 405
£23.99
McGraw Hill LLC Understanding Health Policy A Clinical Approach Eighth Edition
£40.49
John Wiley & Sons Novick Morrows Public Health Administration
Book Synopsis
£81.90
Johns Hopkins University Press Modernizing Medicare
Book SynopsisTop policy experts offer Medicare reform solutions for the millions of seniors whose health care depends on America's fastest growing federal entitlement. In Modernizing Medicare, editors Robert Emmet Moffit and Marie Fishpaw bring together a rare combination of leading scholars and policy practitioners to outline a vision for Medicare reform and provide solutions for the millions of seniors whose health care depends on it. Contributors include a former Medicare trustee, a former Medicare administrator, and a former director of the Congressional Budget Office. Detailing Medicare's biggest problems, this team of top policy experts offer solutions based on personal freedom of choice, transparency of price and performance, and market competition among health plans and providers that will secure patients more affordable, more accountable, and higher quality medical care. They also address Medicare's reform needs and analyze the promising performance of the Medicare Advantage program. The
£49.30
Rowman & Littlefield Medicare Meltdown How Wall Street and Washington
Book SynopsisTrade Review...Bolsters the case we have been making that Medicare must be preserved and strengthened... without shifting costs to seniors who are already paying a large share of their modest incomes for health care. -- Max Richtman, president and CEO, National Committee to Preserve Social Security and MedicareA thoughtful contribution to the debate surrounding the future of Medicare. -- Bernie Sanders, U.S. SenatorRarely have I felt as justified in supporting a book. Any person who cares about American public life, politics or their own personal well-being should closely read this book. -- Amitai Etzioni, professor, George Washington University; founder of the Society for the Advancement of Socio-EconomicsA riveting read, this eyebrow raising and pupil dilating book frames 'entitlement' in a new light and uncovers some inconvenient truths. -- Jennie Chin Hansen, former CEO of American Geriatrics Society, past president of AARPThe most powerful analysis of Medicare I have seen in my career. -- Jean E. Johnson, dean, School of Nursing, The George Washington UniversityCourageous authors like Rosemary Gibson and Janardan Prasad Singh are shining a spotlight on how Wall Street and the health care industry's sense of entitlement are contributing to the financial meltdown of Medicare. -- Randy Block, Gray Panthers National BoardAfter exposing the hidden impact of medical errors, Rosemary Gibson and Janardan Prasad Singh take on financial and political intrigues in the Medicare program. Medicare Meltdown is a lively polemic, leaving no prisoners in a provocative exposé of the $600 billion Medicare program. -- Kip Piper, president, Health Results Group, LLCThis expose is quite readable. It is shocking, depressing, and educational. Everyone should read this book. * American Journal of Health-System Pharmacy *Table of ContentsIntroduction Part I: How Much Is Medicare Costing You? 1: 15 Medicare Facts That Will Astonish You 2: They’re Coming for Your Social Security 3: Will Democrats and Republicans Really Fix Medicare for You? 4: Swiss Cheese Medicare: More Holes Than Cheese Part II: Where Your Money Goes: The Business of Medicare 5: A House on Medicare Drive 6: Bill, Baby, Bill 7: A Country Without Red Lights Part III: How Wall Street Determines the Care You Get 8: Medicare’s One Percent 9: When Wall Street Health Care Comes to Main Street 10: Wall Street and Government: Born Forty-Eight Seconds Apart Part IV: The Entitled and the Entitlers: Taking a Slice of the American Pie 11: Seven Habits of an Entitled Health Care Industry 12: Hedge Funds: The Newest Beneficiaries of Medicare’s Entitlement 13: The Entitlers: The White House and Congress Part V: Saving Medicare 14: Pull the Emergency Brake 15: Public Interest, Not Private Gain 16: Recycle the Waste, Restore the Dream Notes Index About the Authors
£18.04
McFarland & Co Inc Mismanaged Money in American Healthcare
Book Synopsis Warren Buffett famously invoked the metaphor of a tapeworm when describing what healthcare is to the American economy. The United States spends approximately 20% of its gross national product on healthcare, but it is unclear where the money goes or who is minding the store. This healthcare crisis is mostly about money--not lack of money, but rather misspending of money. From the perspective of a healthcare auditor and provider, this work describes the problems of American healthcare finance and proposes solutions. Extensive charts and graphs are used to trace where money goes in the American healthcare system, while other topics such as ethics in healthcare billing, un-auditable hospital costs and scams are discussed. There is evidence that clearly identifies where the money goes, and its destination may surprise the reader.Table of Contents Table of Contents Introduction by Lisa Famiglietti Tables, Charts and Maps 1. Death Rode a Pale Horse in 2020 2. The Medicaid Cluster 3. Where Does the Drug Money Go? 4. Money, Politics, and Data 5. Required Profits and MCOs 6. Coding and Billing 7. The Curious Case of CPT Code 92507 8. Curiouser and Curiouser 9. Managed Care Organizations: Down the Rabbit Hole 10. Regulations and Estimates 11. Regulation Failures: Third-Party Recovery and Site-Neutral Requirements 12. Cost-Shifting and the Flip and Roll 13. Scams with Teeth, Regulations without Teeth 14. Solutions for Unauditable Hospital Costs 15. Unnecessary Surgeries and Tests 16. Ethics in Healthcare Billing 17. Adding Up the Costs Chapter Notes Bibliography Index
£27.54
Cornell University Press Health Insurance Politics in Japan
Book SynopsisJapan is the fastest aging country, with the largest super-aged society in the world and growing larger by the day, yet its universal health care costs are relatively low. In Health Insurance Politics in Japan, Takakazu Yamagishi draws back the curtain for an international audience and investigates how Japan has been able to control health care costs through health insurance politics.Covering the period from the Meiji Restoration to the Abe Administration, Yamagishi uses a historical institutionalist approach to examine the driving force behind the development of health insurance policies in Japan. Yamagishi pays special attention to the roles of government and medical professionals, the main actors of the policymaking and medical worlds, in this development. Health Insurance Politics in Japan pushes Japan into the spotlight of the international conversation about health care reform.Trade ReviewIn this meticulously researched synthesis, Yamagishi explains when and why Japanese medical practices and health insurance policies have changed since the mid-19th century. * Choice *Table of ContentsIntroduction: To Understand the Health Insurance Policy Development in Japan 1. Westernizing Medicine 2. Reacting to Deteriorating Health 3. Improving People's Health for War 4. Reforming Health Care with the United States 5. Achieving Universal Health Insurance 6. Consolidating Universal Health Insurance 7. Making Universal Health Insurance Survive 8. Japanese Health Care in the Globalization Era Conclusion: For the Future of Health Insurance Politics
£35.10
Nova Science Publishers Inc Medicare: Financing, Insolvency and Fraud
Book SynopsisMedicare is the nations health insurance program for persons aged 65 and older and certain disabled persons. Medicare consists of four distinct parts: Part A (Hospital Insurance, or HI); Part B (Supplementary Medical Insurance, or SMI); Part C (Medicare Advantage, or MA); and Part D (the outpatient prescription drug benefit). Medicare covered over 58 million people in 2017 and has wide-ranging impact on the health-care sector and the overall U.S. economy. The Part A program is financed primarily through payroll taxes levied on current workers and their employers; these taxes are credited to the HI Trust Fund. From its inception, the HI Trust Fund has faced a projected shortfall. The 2018 Medicare Trustees Report projects that, under intermediate assumptions, the HI Trust Fund will become insolvent in 2026, three years earlier than estimated in the prior years report as discussed in chapter 1. As reported in the next 2 chapters, spending under the program (except for a portion of administrative costs) is considered mandatory spending and is not subject to the appropriations process. Thus, there generally are no limits on annual Medicare spending. Medicare is most acutely impacted by the sequestration of mandatory funds, since Medicare benefit payments are considered mandatory spending. Special sequestration rules limit the extent to which Medicare can be reduced in a given fiscal year. Chapter 4 focuses on reducing expenditures, unnecessary utilization, and improper payments through prior authorization. The Centers for Medicare & Medicaid Services (CMS) has begun using prior authorization in Medicare through a series of fixed-length demonstrations designed to measure their effectiveness, and one permanent program. The billions of dollars in Medicare outlays as well as program complexity make it susceptible to improper payments, including fraud. Although there are no reliable estimates of fraud in Medicare, in fiscal year 2017 improper payments for Medicare were estimated at about $52 billion. The last 2 chapters address ways to prevent and manage Medicare fraud.
£67.99
Nova Science Publishers Inc Health Insurance: Requirements, Challenges, and
Book SynopsisSince 1 January 2014, most individuals have had to maintain health insurance coverage or pay a penalty for noncompliance implemented through the Internal Revenue Code (IRC). To comply with this individual mandate, individuals need to maintain minimum essential coverage, which includes most types of public and private health insurance coverage. A majority of Americans have health insurance from the private health insurance (PHI) market. Health plans sold in the PHI market must comply with requirements at both the state and federal levels; such requirements often are referred to as market reforms. During the Obama Administration, the two federal agencies primarily responsible for administering the private health insurance provisions in the Affordable Care Act (ACA) -- the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS), and the Internal Revenue Service (IRS) within the Treasury Department -- took a series of actions to delay, extend, or otherwise modify the laws implementation.
£138.39
Nova Science Publishers Inc Opioid Use and Misuse in the Medicare System
Book SynopsisThe Medicare program serves as the healthcare coverage provider to over 58 million beneficiaries. In serving the over age 65 population, Medicare accounts for a large share of total opioid prescriptions. In 2016, one out of every three beneficiaries was prescribed an opioid through Medicare Part D. While many Medicare beneficiaries with serious pain-related conditions are being properly prescribed opioids, there is mounting evidence of opioid misuse in the Medicare system. This book looks at a proposed programs which seek to increase screening and thus, early detection of potential opioid use disorder upon entry into the Medicare program.
£138.39
Nova Science Publishers Inc Health Care Insurance: Background, Coverage and
Book SynopsisOn October 12, 2017, President Trump issued Executive Order (E.O.) 13813, entitled "Promoting Healthcare Choice and Competition Across the United States." E.O. 13813 generally aims "to facilitate the purchase of insurance across state lines and the development and operation of a healthcare system that provides high-quality care at affordable prices for the American people." Chapter 1 answers frequently asked questions (FAQs) about E.O. 13813 and subsequent rulemaking and provides background information about AHPs, STLDI, and HRAs. The individual insurance market is 18 million Americans. It is those Americans who are getting hammered the most by the higher premiums and the higher co-pays and deductibles. Chapter 2 focuses on addressing high-cost individuals through reinsurance; continuing the cost-sharing reduction payments; and third, more flexibility for States. Enrollment in private health insurance plans continued to be concentrated among a small number of issuers. A highly concentrated health insurance market may indicate less competition and could affect consumers' choice of issuers and the premiums they pay. Chapter 3 describes changes in the concentration of enrollment among issuers in overall individual, small group, and large group markets, and individual and small group exchanges. A majority of Americans have health insurance from the private health insurance (PHI) market. The first part of chapter 4 provides background information about health plans sold in the PHI market and briefly describes state and federal regulation of private plans. The second part summarizes selected federal requirements and indicates each requirement's applicability to one or more of the following types of private health plans: individual, small group, large group, and self-insured.Table of ContentsPrefaceBackground Information on Health Coverage Options Addressed in Executive Order 13813Stabilizing Premiums and Helping Individuals in the Individual Insurance MarketPrivate Health Insurance: Enrollment Remains Concentrated among Few Issuers, including in ExchangesFederal Requirements on Private Health Insurance PlansIndex.
£163.19
Nova Science Publishers Inc Health Insurance: Stabilizing Premiums,
Book SynopsisBefore the ACA, sick people often couldn't get health insurance due to a pre-existing condition. If they were able to get coverage, they often paid significantly more for it than someone without a pre-existing condition. Today, millions of Americans no longer have to worry about large bills due to annual or lifetime limits on benefits. Yet, there is still a serious affordability problem in the individual market, especially for those who rely on the individual market for coverage but are not eligible for financial assistance and those facing rising deductibles. Chapters 1 discuss ways to stabilize premiums and help individuals obtain affordable insurance through the individual insurance market. Healthcare reform should empower individuals and families to make decisions for themselves based on what fits their needs and their budget. One of the best tools we have to accomplish this goal is consumer-directed health plans that are paired with health savings accounts, or HSAs. These plans offer lower premiums and a higher deductible to encourage better use of healthcare services as examined in chapter 2 IHS provides care to American Indians and Alaska Natives through a system of health care facilities. The Patient Protection and Affordable Care Act (PPACA) provided states with the option to expand their Medicaid programs, and created new coverage options beginning in 2014, including for American Indians and Alaska Natives. Chapter 3 describes (1) trends in health insurance coverage and third-party collections at federally operated and tribally operated facilities from fiscal years 2013 through 2018, and (2) the effects of any changes in coverage and collections on these facilities.
£113.59
Nova Science Publishers Inc Fraud, Abuse and Overpayments in the Medicare and
Book SynopsisChapter 1 focuses on how the Centers for Medicare and Medicaid Services (CMS) identifies and combats waste, fraud, and abuse in both traditional Medicare and the Medicare Advantage program. Reducing improper payments is critical for protecting the integrity of the program and ensuring that taxpayer dollars are well spent. The Medicaid program, which provides vital health care to over 70 million Americans, regardless of preexisting conditions. GAO and the Department of Health and Human Services (HHS) Office of Inspector General (OIG) published reports on continued weaknesses and program integrity risks and Medicaid managed care. Clearly, there is a need for greater transparency on how managed care organizations spend Federal dollars and greater program integrity and oversight in Medicaid in general. Chapter 2 talks about the rate of improper payments in the Medicaid program.
£138.39
Nova Science Publishers Inc Health Insurance Exchanges, Premium Tax Credits
Book SynopsisSince 2014, millions of individuals have purchased coverage through the health insurance exchanges established under Patient Protection and Affordable Care Act (PPACA). PPACA altered the individual health insurance market by setting federal standards for coverage and subsidizing exchange coverage for certain low-income individuals. In the first 5 years of exchanges, issuers have moved in and out of the market and increased premiums, but little is known about issuers' claims costs or the factors driving their business decisions. Chapter 1 examines (1) claims costs of issuers participating in exchanges, and (2) factors driving selected issuers' changes in exchange participation, premiums, and plan design. GAO reviewed data from nine issuers participating in five states, which were selected to represent a range in size, tax status, and exchange participation. During open enrollment, eligible returning consumers may re-enroll in their existing health insurance exchange plan or choose a different plan. Those who do not actively enroll in a plan may be automatically re-enrolled into a plan. Chapter 2 examines 1) the extent to which plans identified as benchmark plans remained the same plans from year to year, and how premiums for benchmark plans changed; 2) the proportion of exchange consumers who were automatically re-enrolled into the same or similar plans, and how these proportions compared to those for consumers who actively re-enrolled, and 3) the extent to which consumers' financial responsibility for premiums changed for those who were automatically re-enrolled compared to those who actively re-enrolled. Chapter 3 discussed the amendments to title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth. Certain individuals without access to subsidized health insurance coverage may be eligible for premium tax credits, as established under the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended). The dollar amount of the premium credit varies from individual to individual, based on a formula specified in statute. Individuals who are eligible for the premium credit, however, generally are still required to contribute some amount toward the purchase of health insurance as described in chapter 4. During the summer of 2018, the Trump Administration issued final rules governing coverage offered through association health plans (AHPs) and short-term, limited-duration insurance. Chapter 5 describes how the Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) analyzed the new rules and determined how those rules would affect the agencies' projections of the number of people who obtain health insurance and the costs of federal subsidies for that coverage.
£138.39
Nova Science Publishers Inc Medicare: Value-Based Care, Pharmacy Benefit
Book SynopsisOver the course of the last few years, our healthcare system has begun a shift toward rewarding physicians for the quality of care rather than the quantity, and building off these efforts, providers, doctors, health systems, and payers are willing to explore new value-based arrangements and open the door to providing new benefits for their beneficiaries. The Medicare Access and CHIP Reauthorization Act began to shift Medicare towards being a more value-based payment system. Chapter 1 discusses the models that are working toward improve the quality of care and reducing cost. Total expenditures for the Medicare Part D drug program exceeded $100 billion in 2016. Part D plan sponsors may use a pharmacy benefit manager (PBM) to provide drug benefit management services for Part D coverage, such as negotiating drug rebates and other price concessions and paying pharmacy claims. Policymakers have sought a better understanding of PBMs' roles in the drug supply chain and plans' and PBMs' efforts to manage Part D drug spending and use. Chapter 2 examines, (1) the extent to which Part D plan sponsors use PBMs, (2) trends in rebates and other price concessions obtained by both PBMs and plan sponsors for Part D drugs, and (3) how PBMs earn revenue for services provided to Part D plans. The Social Security Act requires boards of trustees to issue reports to Congress by April 1 each year on the financial status of the Social Security and Medicare trust funds. Chapter 3 (1) describes how the boards of trustees develop the annual Trustees reports, and (2) examines the extent to which the boards of trustees have provided the reports to Congress by the April 1 deadline, and what factors account for any delays. The Centers for Medicare & Medicaid Services (CMS) implemented a competitive bidding program (CBP) for certain durable medical equipment (DME), such as wheelchairs and oxygen. The Patient Protection and Affordable Care Act required CMS to adjust fee-for-service payment rates for certain DME items in non-bid areas. On January 1, 2016, adjusted rates for 393 items went into effect in non-bid areas. Chapter 4 examines (1) payment rate reductions and any changes in the number of suppliers; (2) any changes in the utilization of rate-adjusted items; and (3) available evidence related to potential changes in beneficiaries' access to rate-adjusted items.Table of ContentsPreface; Examining Barriers to Expanding Innovative, Value-Based Care in Medicare; Medicare Part D: Use of Pharmacy Benefit Managers and Efforts to Manage Drug Expenditures and Utilization; Social Security and Medicare: Improved Schedule Management Needed for More Timely Trust Fund Reports; Medicare Fee-For-Service: Information on the First Year of Nationwide Reduced Payment Rates for Durable Medical Equipment; Index.
£163.19
Nova Science Publishers Inc Medicaid: Politics, Policy, and Key Issues
Book SynopsisMedicaid is a big deal. It is the U.S. health insurance safety net for low-income pregnant women and children, but it also affects many people above the poverty line, including disabled people in middle-class families and aged adults who, in an unsettlingly common pattern, live working class or middle class lives but lose all assets during extended nursing home stays. Now that the Affordable Care Act of 2010 (ACA) is implemented, Medicaid also covers many low-income, non-elderly, non-parent adults. The complex world of Medicaid is swirling with questions. What does Medicaid do for people? Why do people tend to support or oppose Medicaid policy? What is it like to be a Medicaid beneficiary? Will social divisions or administrative red tape eventually sink the program, or will it grow? This book helps answer these questions. Each chapter contains insights useful for practitioners and researchers alike. This book is also useful for both beginners and specialists. Each chapter introduces a key issue then takes a deep dive into the most important nooks and crannies of the program. This book also raises new questions. For those interested in answering these questions, the following chapters offer a wide range investigative techniques that future Medicaid researchers could employ. Warning: the work will not be easy. Medicaid is complex and constantly changing. Yet whether readers want to understand ongoing changes or create changes of their own, they are likely to find much of the information they need in the chapters that follow.Table of ContentsPreface; Personal Narratives from Oregons Medicaid Expansion; The Impact of the ACA on Insurance Coverage Disparities after Four Years; Federally Qualified Health Centers: From the Fringes to the Mainstream; Administrative Burdens in Medicaid; The Quiet Politics of Medicaid Work Requirements; Medicaid and Racial Restriction: Moving Beyond the Welfare-Entitlement Dichotomy in the Analysis of Income-Targeted Programs; Medicaid Family Planning Expansions: A Case Study of the Implementation of Georgias Planning for Healthy Babies Program; Medicaid Coverage Across the Income Distribution under the Affordable Care Act; Changes in Medicaid for People with Disability; Medicaids Consumer Paradox: The Case of Substance Use Disorder; Restructuring Medicaids Long Term Care Benefit: Shifting Services from Institutions to Communities; Index.
£163.19
Nova Science Publishers Inc Engaging & Influencing Consumers
Book SynopsisThe Medicare Payment Advisory Commission recognises the importance of engaging consumers in the movement to promote greater quality and efficiency in the healthcare system. In this project, MedPAC contracted with Mathematica Policy Research, Inc. (MPR) to explore what can be learned from other public health campaigns in other arenas about strategies for engaging consumers and influencing their behaviour.
£39.74
American Academy of Pediatrics Pediatric Mental Health: Coding Quick Reference
Book SynopsisCompletely updated for 2024, this quick reference card includes codes specific to children’s mental health, environment, and family history. It is a valuable resource for any practice, and it serves as a complement to Promoting Mental Health in Children and Adolescents: Primary Care Practice and Advocacy. Topics include Initial psychosocial assessments Brief primary care interventions Full diagnostic assessments Monitoring for symptoms and functioning New for 2024 New Healthcare Common Procedure Coding System (HCPCS) codes for behavioral health integration services This 11′ × 17′ chart is laminated for extra durability
£22.91
American Academy of Pediatrics Pediatric Coding Q&A: Expert Advice From the AAP
Book SynopsisFor years, the AAP Coding Hotline has been a trusted resource for pediatricians and others with coding conundrums. Pediatric Coding Q&A:Expert Advice from the AAP Coding Hotline is a compilation of the hotline’s “greatest hits,” featuring guidance on everything from coding for specific clinical conditions to applying both common and evolving coding concepts. Readers will also find coding tips peppered throughout the guidance as well as lists of resources for learning more about individual conditions and concepts.Table of ContentsIntroduction Administrative Examinations (including sports physicals) and FormsSports Physicals Examinations Required For Overseas Transfer Foster Care or Protective Services Check-up Completion of Forms Coding Completion of Court Documents After-hours, Emergency, Weekend or Holiday Services Services Provided on Holidays Offering After-hours Preventive Visits After-hours Telephone Service Nurse Visits During Regularly Scheduled Weekend Hours Allergy and Immunologic Services Epinephrine Injector Demonstration Evaluation and Management and Allergy Testing Coding a Discontinued Ingestion Challenge Administration of Oral Diphenhydramine Asthma Asthma – Prescription Drug Management Diagnosing Asthma at Preventive Visit Coding the Asthma Control Test Refill of Asthma Medications During Preventive Visit Inhalation Treatment and Demonstration of Nebulizer Inhalation Treatment via Metered-dose Inhaler Attention-deficit Hyperactivity Disorder (ADHD) ADHD Rating Scales Date of Service for ADHD Rating Scales Assessment for ADHD Without Diagnosis ADHD Follow-up Visit Rating Scales as Data Elements ADHD as a Moderate Complexity Problem Diagnosis Codes for ADHD Patient Not Present for ADHD Visit Autism and Developmental PediatricsDiagnosis Coding for Autism Adding a Developmental Pediatrician Autism Screening and Testing Developmental Testing Time Developmental Testing and Evaluation and Management Services Behavioral HealthChildhood Grief Health Behavior Assessment and Intervention Interprofessional Consultations with Mental Health Professionals. Discussion of management with Behavioral Health Professional Counseling for Alcohol or Substance Use Service Provided Without Patient Present Behavioral Health Service to Parent Psychiatric Services by a Pediatrician Billing and Claims CompletionDowncoding of Claims Using Modifiers National Provider Identifiers (NPIs) on Claims Billing for Locum Tenens Speaking with Child’s Guardian Ad Litem Breastfeeding and Lactation CounselingCodes for Breastfeeding Support and Lactation Counseling Payer Policies for Reporting Breastfeeding Support and Lactation Consultations Lactation Counseling as a Split or Shared Service Medical Decision-making: Discussion with Lactation Consultant BurnsEvaluation and Management of Burn Sunburn Follow-up of Minor Burn Injury Follow-up of Burn Injury Requiring Treatment Telephone or Telemedicine Visit for Burn Injury Debridement of Non-thermal Burn Cerumen RemovalCerumen Removal with Irrigation and Instrumentation Cerumen Impaction Partially Removed Cerumen Removal Cerumen Removal with an Evaluation and Management Service Cardiac ConditionsMultisystem Inflammatory Syndrome in Children (MIS-C) Follow-up Electrocardiography with Purchased Professional Component Pericardiocentesis Office Visit for Family History of Ventricular Tachycardia CircumcisionCircumcision with Evaluation and Management Service Circumcision with Lysis of Adhesion Circumcision with Complication Post-circumcision Cellulitis Circumcision With Physician Supervision Clinical Staff/Nurse ServicesDevelopment Screening by Clinical Staff Tuberculin Skin Test Reading a Tuberculin Skin Test Nurse Care Coordinator Telemedicine 99211 ConcussionComplexity of Problem for Concussion Diagnosis Coding: Concussion Follow-up Electronically-administered Concussion Test Congenital ConditionsLigature of Accessory Digits Neonatal Ear Molding Ultrasound for Congenital Hip Dysplasia ContraceptionComplexity of Problem for Contraception Services Contraceptive Injection Contraceptive Prescription at Preventive Medicine Visit Contraceptive Prescribed as Treatment DepressionComplexity of Problems: Depression and Anxiety Reporting a Positive Depression Screening Follow-up of Depression and Other Chronic Condition Depression and Complexity of Problem Eating Disorders and Medical Nutrition TherapyManaging Eating Disorders in Complex Illnesses Nutritional Counseling at a Preventive Medicine Visit Initial or Subsequent Medical Nutrition Therapy FeverFebrile Infants Fever and Streptococcal Sore Throat Foreign BodiesEar Tube or Foreign Body Removal Foreign Body Removal by Irrigation Foreign Body Removal from Foot Foreign Body Removal Using a Needle Attempted Foreign Body Removal Removal of Multiple Foreign Bodies of Ear Removal of Earring FracturesNursemaid Elbow Global Care for Radial Fracture Influenza Immunization During the Global Period Codes for Supply of Splints Genitourinary ServicesLysis of Adhesions as a Planned Procedure Labial Adhesion Hearing and VisionEar Pulling without Diagnosed Problem Eye Examination with Fluorescein Dye Preventive Medicine Visit with Hearing and Vision Screening Failed Hearing Screening at School Diagnosis of Failed Newborn Hearing Screening Vision and Hearing Tests in Evaluation of Underachievement in School Otoacoustic Emissions Hyperbilirubinemia and JaundiceOffice Visit for Jaundice Jaundice Suspected at Preventive Visit Preventive Visit and Office Visit for Jaundice Level of Care for Hyperbilirubinemia Office Visit Resulting in Readmission for Phototherapy Immunization AdministrationImmunization Administration with Health Risk Assessment Immunization Without Physician Counseling Reporting Immunization Administrations with and without Counseling Reporting Immunization Counseling without Administration Vaccines for Children and Medical Cost Sharing Plans Documentation of Immunization Counseling with Administration IntegumentaryWorsening Impetigo Stye of Eyelid with Other Skin Infection Raynaud’s Phenomenon – Nailfold Capillaroscopy Incision and Drainage of Multiple Abscesses Cryotherapy of Warts and Evaluation and Management Service Interpretation and Translation ServicesCode for Use of Interpreter Service Extended Service Time Due to Interpreter or Translator Laboratory ServicesLaboratory Tests and Medical Decision-making Visit to Provide Results of Testing Influenza A/B Testing Lipid Testing for Patient on Atypical Antipsychotic Diagnosis Code for Lead Screening Diagnosis Code for Titers Order at School Admission Examination Maternal Depression ScreeningProcedure Code for Maternal Depression Screening Reporting Positive Maternal Depression Screening Maternal Depression Screening and Preventive Service Newborn Attendance at DeliveryMedical Necessity of Attendance at Delivery Attendance Subsequent to Birth Attendance at Delivery and Newborn Hospital Care Newborn – Hospital CareExtended Normal Newborn Care Normal Newborn Care Throughout Admission Newborn Same Date Admission and Discharge Normal Care Versus Hospital Care Newborn Suspected to be Affected by Maternal Condition Newborn – Transfer from NICU Split or Shared Visits Newborn – Critical or Intensive CareNeonatal Definition Gestational Age and Birth Weight Normal Newborn and Neonatal Intensive/Critical Care on the Same Date Newborn Critical or Intensive Care Transfer Back to Birth Hospital Interfacility Transfer in Same Group Practice Split or Shared Neonatal Critical or Intensive Care Services Newborn Interfacility Transport Newborn Care – Office or Outpatient CareNewborn Visit – New or Established Patient Newborn Preventive Care Newborn Follow-up Weight Check Under-Immunization of Parents of Newborn Newborn Code for Screening for Hip Dysplasia Newborn Umbilical Granuloma Umbilical Granuloma Newborns and Transitional Care Management ObesityLaboratory Testing for Obesity-related Conditions Preventive and Problem-Oriented Services Evaluation and Management of Obesity Oral HealthFluoride Varnish and Evaluation and Management Consultation for Preoperative Clearance Preventive ServicesPreventive Medicine Evaluation and Management Service Preventive Medicine Services by Residents Codes for Screening Instruments Multiple Standardized Screening Instruments Preventive Screenings and Work Relative Value Units Respiratory ConditionsRespiratory Syncytial Virus Diagnosis Code Respiratory Syncytial Virus Prophylaxis Office Emergency Care for Respiratory Distress Diagnosis Coding for Influenza A Units for Infectious Agent Detection of COVID-19 and Influenza A and B Same-date Administration of Palivizumab and Influenza Vaccine Nasopharyngeal/Tracheal Suctioning Telephone Service for Worsening Respiratory Infection Telephone Service Regarding Multiple Siblings Social Determinants of Health (SDOH)SDOH and Medical Decision-making Family History of Domestic Violence Identified Need for Childcare Assistance Index
£63.75
Nova Science Publishers Inc Health Insurance: Issues, Challenges &
Book SynopsisIn this book, the authors present current research in the study of the issues and challenges of health care insurance from across the globe. Topics discussed in this compilation include the assessment of the efficiency of hospitals in Botswana; the public long-term care insurance system in Japan; an examination of service delivery when there is an integration of health insurance and care provisions; estimating the total health expenditure on households by sources of financing and providers in Gambia; and social and private insurance systems in The Netherlands.
£63.74
Skyhorse Publishing Maximize Your Medicare: 2020-2021 Edition:
Book SynopsisIncluding the most up-to-date information for 2020-2021. Confused by Medicare? Get answers from Maximize Your Medicare, an informative guide by nationally-recognized expert Jae W. Oh. Maximize Your Medicare helps readers understand how to choose and what to choose when deciding on Medicare options. This book shows readers how to: Enroll
£12.74
Skyhorse Publishing Maximize Your Medicare: 2022-2023 Edition:
Book Synopsis"Jae Oh’s Maximize Your Medicare is the best book I’ve read on understanding all of the Medicare options and how Medicare intersects with other health insurance options." —Wade Pfau, Professor of Retirement Income at The American CollegeIncludes the Most Up-to-Date Information for 2022-2023 Confused by Medicare? Get answers from Maximize Your Medicare, an informative guide by nationally recognized expert Jae W. Oh. Maximize Your Medicare helps readers understand how and what to choose when deciding on Medicare options. This book shows readers how to: Enroll in Medicare and avoid never-ending penalties Compare Medigap vs. Medicare Advantage Discern the differences among Parts A, B, and D Increase benefits every year Avoid costly errors Deal with special circumstances Get the most from the plan Additional information for this new edition includes: Putting it Together: the steps you need to take to be a Savvy Medicare Consumer New coverage options for Diabetes and End-Stage Renal Disease patients How the ACA enhancements can change your retirement decision-making path Written in a clear and concise style, Maximize Your Medicare is a vital resource for every American aged sixty-five or older, as well as for their families and care coordinators. ged sixty-five or older, as well as for their families and care coordinators.
£12.74
Skyhorse Publishing Maximize Your Medicare: 2024-2025 Edition:
Book Synopsis"Jae Oh’s Maximize Your Medicare is the best book I’ve read on understanding all of the Medicare options and how Medicare intersects with other health insurance options." —Wade Pfau, Professor of Retirement Income at The American CollegeIncludes the Most Up-to-Date Information for 2024-2025 Confused by Medicare? Get answers from Maximize Your Medicare, an informative guide by nationally recognized expert Jae W. Oh. Maximize Your Medicare helps readers understand how and what to choose when deciding on Medicare options. This book shows readers how to: Enroll in Medicare and avoid never-ending penalties Compare Medigap vs. Medicare Advantage Discern the differences among Parts A, B, and D Increase benefits every year Avoid costly errors Deal with special circumstances Get the most from the plan Additional information for this new edition includes: Putting it Together: the steps you need to take to be a Savvy Medicare Consumer New coverage options for Diabetes and End-Stage Renal Disease patients How the ACA enhancements can change your retirement decision-making path Written in a clear and concise style, Maximize Your Medicare is a vital resource for every American aged sixty-five or older, as well as for their families and care coordinators. ged sixty-five or older, as well as for their families and care coordinators.
£12.74
Nova Science Publishers Inc Medigap: A Primer on Medicare Supplement
Book SynopsisMedicare is a nationwide health insurance program for individuals aged 65 and over and certain disabled individuals. The basic Medicare benefit package provides broad protection against the costs of many, primarily acute, health care services. However, Medicare beneficiaries may still have significant additional costs, including co-payments, coinsurance, deductibles, and the full cost of services that are not covered by Medicare. In 2008, about 17% of Medicare beneficiaries purchased the private supplemental insurance known as Medigap to fill some of the cost gaps left by Original Medicare. This book provides an overview of Medigap insurance with a focus on the history of Medigap legislation; the various types of Medigap plans; consumer protections awarded to Medigap beneficiaries; and the requirements facing the insurance providers and the National Association of Insurance Carriers (NAIC).
£126.74
Nova Science Publishers Inc Medicare: Elements & Economics
Book SynopsisMedicare is a nationwide health insurance program for individuals aged 65 and over and certain disabled individuals. This book provides an overview of the elements and economics of Medicare. Topics discussed include the Medigap supplemental program; medicare hospital readmissions; Medicare''s skilled nursing facility benefit basics and issues; Medicare financing and triggers; Medicare Advantage risk adjustment and risk adjustment data validation audits; and Medicare physician payment updates and the sustainable growth rate (SGR) system.
£152.99
Nova Science Publishers Inc Health Insurance Exchanges Under the Affordable
Book SynopsisThe fundamental purpose of a health insurance exchange is to provide a structured marketplace for the sale and purchase of health insurance. The authority and responsibilities of an exchange may vary, depending on statutory or other requirements for its establishment and structure. The Patient Protection and Affordable Care Act (ACA) requires health insurance exchanges to be established in every state by January 1, 2014. ACA provides certain requirements for the establishment of exchanges, while leaving other choices to be made by the states. This book outlines the required minimum functions of exchanges, and explains how exchanges are expected to be established and administered under ACA. The coverage offered through exchanges is discussed, as are how the exchanges will interact with selected other ACA provisions.
£63.74
Nova Science Publishers Inc Medicare Home Health Benefit: Elements & a
Book SynopsisThe Medicare home health benefit provides coverage for home visits by skilled health care professionals. To be eligible for the home health benefit, a beneficiary must meet three different criteria. The beneficiary must (1) be homebound, (2) require intermittent skilled nursing care and/or skilled rehabilitation services, and (3) be under the care of a physician who has established that the home health visits are medically necessary in a 60-day plan of care. A beneficiary who meets these requirements is entitled to a 60-day episode of Medicare coverage for home health visits, and is then entitled to an unlimited number of 60-day episodes so long as he or she continues to meet the eligibility requirements. There is no cost-sharing requirement for home health services. Roughly 9.6% of Medicare fee-for-service (FFS) beneficiaries (or 3.4 million individuals) used home health services in 2010. Home health services are provided through home health agencies (HHAs), most of which (90%) are freestanding -- HHAs not affiliated with an institution such as a hospital or a nursing facility. The number of HHAs participating in Medicare grew by 57% between 2000 and 2010 (from 7,528 to roughly 11,800), with a vast majority of the increase in for-profit freestanding HHAs. This book describes home health eligibility criteria, home health services, characteristics of Medicare beneficiaries who use home health services, and home health providers. Further, this book describes in detail the Medicare home health prospective payment system (HH PPS), provides an overview of Medicare home health payments, and discusses issues for Congress related to the Medicare home health benefit.
£119.99
Humanix Books MEDICARE SURVIVAL GUIDE: Get the Benefits You
Book Synopsis“The decisions you make when you sign up for Medicare can impact your costs — and your quality of care — for the rest of your life. No one gives better advice about Medicare than Diane Omdahl. “ — Terry Savage, Author of The Savage Truth on Money and Nationally Syndicated Financial Columnist Get the most out of Medicare. Get your maximum earned benefits for yourself and your family.Every day, over 10,000 Americans will become eligible for Medicare, but most of us don’t even know the basics. When do I enroll? What does it cover? Do I need Part B? You could watch the commercials or reply to direct mail. You could ask your best friend. Or you can take charge of these very important decisions and READ THIS BOOK! Medicare expert Diane J. Omdahl will take you through all the steps to making the right decisions at the right time. Avoid costly mistakes and scams and ensure that Medicare works for you.Trade ReviewPraise for MEDICARE FOR YOU: A Smart Person's Guide by Diane J. Omdahl RN MS“The decisions you make when you sign up for Medicare can impact your costs — and your quality of care — for the rest of your life. No one gives better advice about Medicare than Diane Omdahl. “ — Terry Savage, Author of The Savage Truth on Money and Nationally Syndicated Financial Columnist“Pick up this book, and you are 235 pages away from having real expertise in our Medicare options, enrollment issues and the inevitable complexities of navigating a government plan.” — Bob Veres, “Inside Information” NewsletterTable of ContentsTABLE OF CONTENTS to Medicare For You: A Smart Person's Guide by Diane J. Omdahl, RN, MSGET MEDICARE RIGHT IN 7 EASY STEPSINTRODUCTION STEP ONE: PREPARE FOR MEDICARELearn the terms. Medicare Part A, B, D. Medicare supplement plan. Medicare Advantage plan. Guaranteed issue right. Buy a bigger mailbox. Get another recycling bin. Put new batteries in your remote control. Facts about TV ads. Resist calling the phone number on the screen. Establish or update your healthcare power of attorney.Confirm your eligibility for Medicare. Eligible to enroll in Medicare. Eligible for premium-free Part A. Create a my Social Security account.Know when to take action.STEP TWO: DETERMINE YOUR TIMINGThree enrollment periods that are for getting into Medicare.Initial Enrollment Period - everyone must pay attention. Myth: must enroll at age 65. Guidance for specific situations Receiving Social Security benefits before age 65. Giving up coverage or no coverage. Employer group health plan. 20 or more employees. Fewer than 20 employees. Keeping coverage after age 65. HSA Creditable drug coverage. Other types of coverage (COBRA, individual, retiree, VA). Enrollment instructions. Part B Special Enrollment Period -for those who could delay enrollment. Who qualifies. Enrollment instructions. General Enrollment Period - oops, you’re too late. Enrollment instructions. Late enrollment penalty. STEP THREE: GET TO KNOW THE PARTS OF MEDICAREConfusion: Medicare has four parts.Medicare has three parts and they combine to make two paths. First the three parts. Medicare Part A. Medicare Part B. Medicare Part D. Then the paths (introduction). Original Medicare. Medicare Advantage. STEP FOUR: PICK YOUR BEST MEDICARE PATH (HOW THEY WORK) Original Medicare Medicare supplement (Medigap policy) and Part D drug plan. Physicians, rules. Medicare Advantage Types of plans. Networks. Coverage rules Out-of-pocket maximum. Medicare giveback. Extra benefits. Changing paths down the road. Guaranteed issue right. 46 states and NY, CT, MA, ME. Medigap OEP. Medicare Advantage Trial Period. When to change paths. Open Enrollment Period. Medicare Advantage Open Enrollment Period. Other opportunities. Moving out of plan’s service area. STEP FIVE: LIVING WITH MEDICAREPart D drug coverage. Networks, preferred and standard pharmacies. Tiers of drugs. Formulary. Payment stages. Drug plan deductible. Donut hole. $35 insulin. Medicare costs. Part B premium. Medicare supplement, drug plan, Advantage plan. Premiums. EOB. Medicare summary notice. IRMAA. Life-changing event. One-time income. Preventive services. Welcome to Medicare visit. Annual wellness visit. Vaccines. Part B - flu, pneumonia, COVID. Part D - shingles. Moving.POA not enough Medicare representative. Plan representative. Medicare scams.STEP SIX: KNOW WHEN YOU NEED MORE HELPSSDI.Not eligible for premium-free Part A.Domestic partner.FEHB.Coverage after employment ends. COBRA. Retiree plan. VA, TFL. Expatriate.HSA.Appeals.STEP SEVEN: PAY ATTENTION TO COVERAGE EVERY YEAROpen Enrollment periods.Notice of changes.Update Social Security informationINDEXREFERENCES
£17.09
Nova Science Publishers Inc Medicare Outpatient Therapy Services: Selected
Book SynopsisMedicare''s outpatient therapy benefit covers services for physical therapy, occupational therapy, and speech-language pathology. These services can be beneficial when medically necessary but may be subject to inappropriate use. Outpatient therapy services are designed to restore function that patients have lost due to illness or injury and to help patients maintain improved function. This book examines methods of improving Medicare''s payment system for outpatient therapy services; discusses the implementation of the 2012 manual medical review process; analyses the billing procedures involved in Medicare outpatient therapy services; and finalises the discussion with payment systems available for outpatient therapy services.
£52.49
Nova Science Publishers Inc Children's Health Insurance: Comparisons of CHIP
Book SynopsisConsumers may obtain health insurance from a variety of public and private sources, which can help protect them from the costs associated with obtaining medical care. Health insurance typically includes costs to consumers, which may vary for a number of factors, including scope of coverage, cost-sharing provisions, and federal or state requirements. Recent federal laws --specifically, PPACA and the Children''s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) -- further define coverage and cost parameters for certain health insurance plans available to consumers now and in 2014, when exchanges are required to be operational, and include provisions to increase children''s access to coverage. This book provides a baseline comparison of coverage and costs to consumers in separate CHIP plans and benchmark plans in select states; describes how coverage and costs might change in 2014; and describes how access to care by CHIP children compares to other children nationwide.
£73.49
World Scientific Publishing Co Pte Ltd Health Microinsurance: Implementing Universal
Book SynopsisThis book is the first and only study on implementing Universal Health Coverage in poor, rural and informal settings, with end-to-end guidance for rolling out a demand-driven and needs-based health insurance model. The chapters are comprehensive, covering topics such as data collection and analysis for contextual risk assessment, the design of suitable benefits packages, how to price microinsurance, insurance education for illiterate or innumerate populations, the setting up of governance bodies and training staff for key roles, and information management.The book contains insights gained from years of fieldwork in several countries and is valuable reading for undergraduate and graduate students and practitioners of health microinsurance. As a companion to the author's first book, Financing Micro Health Insurance: Theory, Methods and Evidence, this book provides the only current source of information on implementing health microinsurance. The practical guidelines to setting up and operating a microinsurance scheme are accompanied by impact evaluation, chapter exercises and Issue Briefs that present examples of using tools that are necessary for successful implementation.
£121.50
World Scientific Publishing Co Pte Ltd Model Of Health Plan Payment And Quality
Book SynopsisThe book pulls together a series of articles by the authors that initiated the research areas of 'optimal risk adjustment' and 'optimal quality reporting.' The papers present the basic theoretical models and link them to empirical application. Design of health insurance premiums to achieve efficient and fair outcomes is also covered. The chapters in the book also cover the intellectual development of approaches to health insurance regulation, beginning with more abstract models to those with explicit empirical and policy applications.
£93.60
