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See below for a selection of the latest books from Medical insurance category. Presented with a red border are the Medical insurance books that have been lovingly read and reviewed by the experts at Lovereading. With expert reading recommendations made by people with a passion for books and some unique features Lovereading will help you find great Medical insurance books and those from many more genres to read that will keep you inspired and entertained. And it's all free!
Learn facility-based coding by actually working with codes. ICD-10-CM/PCS Coding: Theory and Practice provides an in-depth understanding of inpatient diagnosis and procedure coding to those who are just learning to code, as well as to experienced professionals who need to solidify and expand their knowledge. Featuring basic coding principles, clear examples, and challenging exercises, this text helps explain why coding is necessary for reimbursement, the basics of the health record, and rules, guidelines, and functions of ICD-10-CM/PCS coding. 30-day trial to TruCode (R) Encoder Essentials gives you experience with using an encoder, plus access to additional encoder practice exercises on the Evolve website. ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting provide fast, easy access to instructions on proper application of codes. Coverage of both common and complex procedures prepares you for inpatient procedural coding using ICD-10-PCS. Numerous and varied examples and exercises within each chapter break chapters into manageable segments and help reinforcing important concepts. Illustrations and examples of key diseases help in understanding how commonly encountered conditions relate to ICD-10-CM coding. Strong coverage of medical records provides a context for coding and familiarizes you with documents you will encounter on the job. Illustrated, full-color design emphasizes important content such as anatomy and physiology and visually reinforces key concepts. NEW! Updated ICD-10 codes and coding guidelines revisions ensure you have the most up-to-date information available.
This book critically examines the evolution and design of medical insurance schemes for the poor in India. It covers a range of medical insurance schemes that have been implemented by worker unions, state and Central government. It examines the experience of those who access these schemes and the limitations faced.
Weiss Ratings Guide to Health Insurers is the first and only source to cover the financial stability of the nation's health care system, rating the financial safety of more than 6,000 health maintenance organizations (HMOs) and all of the Blue Cross Blue Shield plans - updated quarterly to ensure the most accurate, up-to-date information.
Over 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.
Before 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.
Since 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.
Chapter 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.
On 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.
The 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.