Importance of Medical Coding for Insurance

With health and diseases becoming a major issue these days around the world, it has become A LOT more important to have more and more coders involved in the medical field for insurance. But what is medical coding? A medical coder, clinical coding officer, or diagnostic coder are professionals involved in the health care sector who analyze clinical documents and using proper classification systems, assign standard codes to them. They provide medical coding guidelines and suggestions to help regulate the ways doctors, nurses, and other medical staff provide care for their patients. There are three main types of medical coding:

1) ICD (International Classification of Diseases): These are codes used for describing the cause of illness, injury, or death.

2) CPT (Current Procedural Terminology): These deal with anesthesia, surgery, pathology, radiology, measurement procedures, and new technological changes in the medical field.

3) HCPCS Healthcare Common Procedure Coding System): These include outpatient hospital care, medical aid, and Medicare.

Let us look at some points as to why coding is necessary for the medical field.

DATA SYSTEMS
When the coding is paired with the data systems of the hospitals, a powerful tool is made. By doing so, a large number of data from various hospitals, clinics, and other sources are stored, accessed, and used from one large online data system. This implementation helps in the transfer of any patient’s data from any hospital to another for any medical purpose. This information helps doctors to be more connected and make wiser decisions, especially in cases involving the life and death situation of the patient.

PATIENT CARE

Coding is very much required for reimbursements, which include submitting medical claims with insurance companies and bills between insurers and patients. The transfer of information for bill related purposes requires medical records, patient’s medical needs, lab results, pathology records (if any), and any other related documents. Appropriate payment is possible only when the required diagnostic codes are put in place, which also means to verify in case the medical claim is denied by the insurance company.

REGULATIONS

Medical billing and coding fall under the rules and guidelines of many countries and states. Coders in this field are also responsible for protecting the privacy of the patients and their families. They are supposed to take safeguards to preserve the confidential details concerning the patient and his/her medical background in a safe place. Electronic medical records fall under the International Classification of Diseases (ICD-10) codes issued by the World Health Organization (WHO).

Medical coding analysts are in the front line in healthcare data analytics. They work in many types of healthcare setups and not necessarily in hospitals and clinics. Their valuable service is very functional for research and development in the medical field.

How a Personal Finance Budget Will Save Your Financial Life

A personal finance budget is extremely important when it comes to your finances. Having a budget will allow you to manage your investments, your savings, and handle all of your bills in an effective manner.

Start the process by writing out all of your expenses. Then track your spending for at least a month, this includes not just your bills but your savings as well.

At the end of the month use the list of your expenses to categorize them either as needs or as wants. Please understand the basic difference here. A need is essential to your survival like food, shelter, clothes, heat. (it’s unlikely that you would survive for long without food, heat or shelter so money allocated to rent, work clothes, heating oil, are needs-you can extend this to things like transportation as you would not be able to get to work to earn income otherwise (unless you telecommute of course).

A want consists of something not absolutely necessary, but that you desire. Examples would be an iPhone, a gym membership or a pedicure, which you do not need to survive.

Then take a look at your wants list and eliminate the most superfluous. Of what’s left, if there is anything that you can save money on, think of alternatives..For instance, instead of getting your car professionally detailed, save money by getting it washed for 5 dollars by a kid on the block.

Examine your needs as well to see where there may be some saving opportunities. Then proceed to categorize them between fixed and flexible expenses. Your fixed expenses are the same every month, things like health insurance would be classified that way. Flexible ones like your groceries can vary every month.

Take your personal finance budget to the next level. Classify your expenses by due date, for instance, the rent bill should be reflected on the first of the month and if for instance a credit card payment is due on the 5th, it might be next on your chronological budget.

Continue classifying them by weeks, some will be constant (will appear every week- like groceries and gas for the car) and some will be periodic (once in a while- like scheduled car maintenance, heating oil charges or water and sewer charges.) Add up all your weekly expenses to see what cash outlay to anticipate. Total all four weeks and compare to your actual take home salary. Based on that, make sure you put enough in weekly savings to meet those bills when they come due.

If your expenses are greater than your income, take another look at your list and eliminate any “wants” items and re-examine your “needs” to see how you can save money. Call your credit card company to see if you can renegotiate a lower rate or switch to a cheaper prepaid cell phone plan.

Reprogram your house thermostat for lower settings- wear a sweater during the week-end and in the evening if need be. If you are still short, then it’s time to consider getting a second or part time job to supplement your income and meet your obligations.

From now on your personal finance budget will revolve around your needs rather than your wants. You only spend money on wants if you have extra at the end of the month and even then you should try to apply it to any form of debt you may have or to shore up your savings and investments.

If you find yourself in the happy position of having a surplus income over your expenses, establish some goals like a vacation fund or new house fund.

Monitoring your actual income/expenses against your personal finance budget is not a onetime thing, it should be done monthly to catch trends and make course corrections. Saving a dollar here and a dollar there can add up to serious money in the aggregate.

In creating a personal finance budget, remember to make it a priority to establish an emergency fund if it is not already in existence. A rule of thumb is 6 months worth of expenses but in this economy 9 months to a year is closer to what’s wise in my estimation.

Presuming you make $4,000 a month you would need to save $24,000 for the minimum of 6 months. If you make $1000 a month you would need to save $12,000 for the maximum yearly guideline. Do this before you spend $10,000 for a trip to Europe or buy that fancy motorcycle you only use a few times in the Summer.

Health Is The Most Important Wealth

If you’re fortunate enough to have employer-provided health insurance, that narrows your options down to the plans that your employer offers. If you don’t have coverage through your job, perhaps an organization or association that you belong to will allow you to buy health insurance through them at a group rate.

Another option is to check your local Obamacare health insurance marketplace to see if you qualify for an upfront premium credit, which would get you reduced premium costs. Even if you don’t qualify for the credit right away, buying your health insurance through the marketplace means you may qualify for it when you file your tax return for the year.

If you can’t, or won’t, get health insurance from any of these sources, you’ll have to fall back on buying a private plan. It will give you the widest range of options, but likely will be far more expensive.

Decide which type of policy to buy

Health insurance policies come in a variety of basic types, although you may not have access to all of these options through your preferred source. Health Maintenance Organizations (HMOs) are a very common type of health insurance policy. With an HMO, you’re required to use healthcare providers within the policy’s network, and you have to get a referral from your primary care physician in order to see a specialist.

Preferred Provider Organizations (PPOs) are also quite common. A PPO health insurance policy has a network, but you’re not limited to in-network care — although using network providers is cheaper — and you don’t need referrals to see specialists.

Exclusive Provider Organizations (EPOs) are a hybrid between HMOs and PPOs. You’re required to stick to the plan’s network, but don’t need referrals for specialists. Finally, Point of Service (POS) plans are a less common option that are essentially the opposite of an EPO. You’re not limited to the POS plan’s network, but do need a referral to see a specialist.

Of the four common types of plans, an HMO or EPO tends to be cheaper than a PPO or POS with the same level of coverage. However, if network coverage is poor in your area, or you’re uncomfortable limiting yourself to network providers, it may be worth paying a little more to get a PPO or POS policy.

More: Buyer beware: Long-term care costs are surging, survey says

More: Obamacare overhaul efforts are dead for now. What does that mean if you’re an Obamacare consumer?

More: Trump says he’ll negotiate with Democrats on health care plan

High deductible versus low deductible

All things being equal, the higher a plan’s deductible is, the lower the monthly premiums will be. A high deductible means that you’ll have to pay a lot of healthcare expenses yourself before the insurance policy kicks in, but if you have few or no medical expenses in a given year, these plans can be a bargain. Very low medical expenses means that you probably won’t surpass the deductible, even of a low-deductible plan, so getting a high-deductible plan keeps your insurance costs as low as possible while still protecting you in case something catastrophic happens.

If you decide to go the high-deductible route, getting a Health Savings Account (HSA)-enabled plan, and funding it with at least the equivalent of a year’s deductible, is your best option. An HSA plan neatly covers the biggest weakness of a high-deductible health insurance policy – namely, that you’d have to shell out a great deal of money on a major medical expense before the insurance would take over. If you have a full-year’s deductible tucked away in your HSA, you can just use that money to finance your share of the expenses, while simultaneously enjoying the triple tax advantage that an HSA offers.

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Comparing coverage

There are two major factors that affect how well a particular plan will cover your medical expenses: the plan’s network and its coverage policies. Even if you choose a plan with out-of-network options, like a PPO, you’re still better off using in-network health providers as much as possible because doing so will reduce your costs. And the rules that a given health insurance policy uses to decide what’s covered and what’s not – and how much the co-pays will be – can make a huge difference in how helpful a particular policy really is for you.

For example, if there’s a rather pricey medication that you take every day, you’ll definitely want to get a health insurance policy that lists that medication on its formulary. If you travel a lot, stick to plans that offer good out-of-area treatment options. And if you already have a primary care physician, you’ll definitely want to pick a plan that includes your doctor in its network.

Finding the best deal

If you’re stuck between two or three different policies and can’t decide which one to choose, try this exercise. Multiply the monthly premium by 12 to get your annual cost for a plan, then add in the plan’s out-of-pocket maximum. The result is the most you would end up spending on health care if you had one or more major medical expenses during the year. Do this calculation for each plan you’re considering, then compare the results. The plan with the lowest total is likely the best deal for you.

The Economic Importance Of The Home Based Business Industry

DEFINING THE HOME BASED BUSINESS

The home based business can be defined as a business whose primary office is in the owner’s home. The business can be any size or any type, as long as the office itself is located in a home.

In the USA, there are about 6.6 million home based businesses that generate at least 50% of the owner’s household income.(a)

“If one advances confidently in the direction of his dreams and endeavors to live the life he has imagined, he will meet with success unimagined in common hours.” – Thoreau

ESTIMATES OF THE TOTAL SIZE OF HOME BASED BUSINESS

“One study has estimated that the total number of people who run or are employed by home based businesses in South East England is in excess of 250,000 people, equivalent to 7% of the working population of the region.(c)

“While the average home entrepreneur business has two employees (including the owner), 39% have between two and five employees, and 10% have more than five. Using these average employment numbers, Emergent Research estimates that home entrepreneur businesses currently employ roughly 13.2 million Americans, including the owner.(a)

“To put these figures in perspective, let’s compare them to U.S. employment generated by two important industrial segments: venture-backed firms and the oil and gas industry. Analysis by the National Venture Capital Association shows that companies that received venture capital backing including such corporate giants as Intel, Microsoft, and Apple – employed 10.4 million in 2006.”(a)

THE IMPACT OF THE DEVELOPMENT OF THE INTERNET ON THE ECONOMY AND HOME BASED BUSINESS

The development of the internet has been and will be the big driving force in the development of the internet related home based business. Let us have a closer look at these developments. The following information is extracts from the McKinsey report.(b)

Two billion people are connected to the internet. This number is increasing by about 200 million per annum.
Almost $8 trillion exchange hands each year through e-commerce.
About one-third of small and medium-sized businesses extensively use web technologies.
The web has made possible new waves of business models and entrepreneurship. It has transformed industries.
The internet accounts for 3.4% of the GDP of the 13 countries that was part of the study. These countries represent 70% of the world GDP. The total contribution of the internet to the world economy is $1 672 billion or 2.9% of the total GDP.
The internet accounts for 6% of the GDP of countries like Sweden and the UK.
Over the past 5 years, the internet has contributed 21% of the GDP growth of the 13 countries that were studied. These countries represent 70% of the total GDP of the world.
This is a reflection of the small and medium-sized enterprises receiving a performance boost through the internet. These companies with a strong web presence grew more than twice as quickly than those with a minimal or no web presence.
The internet has become a very significant factor in the world economy and the growth of the economy. More specifically in jobs and wealth creation.
Online marketing represents 15% of total marketing worldwide.
The search requests by individuals on hard-to-find items or information was a total of 1 trillion requests during 2009.
In the USA, web surfers made purchases worth $250 billion in 2009; in the UK, it was $63 billion or 2.9% of the GDP. The average online shopper in the USA has spent $1 773 during the year. In the UK, $2 535 was spent on average.
The study concludes that the influence of the internet on the economic growth in the world, on job creation and generating wealth, is becoming more important and stronger.
For individual companies the internet lowers costs and increases revenue, productivity and profits. The internet helps these companies to accelerate growth in the export markets and to have access to new markets.
The introduction of broadband stimulates the development of the internet in those countries where it is being introduced. The internet stimulates growth in GDP, in job creation, wealth, and increases productivity.
In France, the internet has created a total of 700 000 jobs during the past 15 years.
The research of McKinsey indicates the growth in people connected to the internet, the importance of doing business via the internet, and the big influence that these new technologies have on the GDP of the world economies.

THE INFLUENCE THESE DEVELOPMENTS HAVE ON MY HOME BASED BUSINESS

Accurate research information is not available about the expected growth in the online home based business industry. I want to make some estimates based on the information discussed above:

The annual growth in people connecting to the internet is growing with about 10%.
The ability of the internet to:
Create new jobs. Give people an extra income stream. Have their own home based business and being self-employed. These changes create many new business opportunity.
The new technologies related to the internet will create new business models that will stimulate opportunities.
More and more trading and marketing is being done via the internet due to the development of new systems and technologies.
The improved communication systems and technology makes it cheaper, less risky, and more attractive to start a home based business.
The influence of the development of the internet on the growth in the GDP of the countries in the McKinsey study has been higher during the last five years than during the previous fifteen years. The trend is upwards. Many of the conclusions in this study indicate that the influence on economic growth in the future will be higher than in the past. Some developed countries like the UK have a more people using the internet than others, for example the USA. That indicates growth in many of the developed countries.
Due to the development and introduction of broadband in the less developed countries of the world, new trading and business opportunities will become available.
There is a trend that more people who want to work from home, as indicated by the following quote: “Nevertheless, home based business owners are much more satisfied with their quality of life than other small business owners. However, the majority of home based business owners do not appear to have made a financial trade-off in order to secure this quality of life.”(c)

These new technological developments, the changes in the economic environment and changes in the social needs of people will result in a higher growth rate in internet related businesses, as well as in online home based businesses, than the 10% annual increase in people becoming connected to the internet during the next few years. If one takes into consideration that the average growth in the GDP of the world is expected to be much less than 10% per annum during this period, then there has to be good business opportunities here.

This expected growth in GDP due to internet related business activities creates many online business opportunities for the online home based business owner.

A fast changing economic, business, and technological environment needs quick and big action. The opportunity of today might have disappeared tomorrow. This is the environment in which to dream-it-plan-it-do-it big. Our team wants to support like-minded people who want to join us on this journey. Take action. Do not postpone in this business environment.

Insurance Agency Lead Scoring

Many insurance agencies have not yet formalized their lead scoring system. This is a worthwhile endeavor for all agencies, and one which should be revisited every year, while tracking the return on investment of their marketing programs.

What is lead scoring? It is a methodology used to rank prospects against a scale, and then assign a value to determine interest level and distribution. For example, let’s say a trucking insurance lead appointment arrives at your agency. This lead is with an owner of 15 power units, they use company drivers, and they are unhappy with their carrier. Perhaps your lead scoring system falls on a 1 to 10 scale, and this lead is scored an 8. What might receive a higher score? And what types of leads are outside of profile, and what score would they receive? Perhaps prospects need to score an 8 to appear on your producer scorecards.

Is the lead distributed to producers by territory? Does your lead handling process vary by type of lead, product or prospect? For example, are commercial leads separated by large and small business, by industry or product? Are benefit leads parsed by groups over and under 50? And does your agency have a tracking system in place to determine how many leads showed for the appointment, moved into the pipeline, received quotes and ultimately convert into new business?

Salespeople, sales managers, producers and other business people often refer to prospects in vague terms such as: new, warm, hot, cold, likely, qualified, etc. These terms do little to better understand a sales pipeline or convey likelihood of purchase to other members of the team. Agencies can consider creating a simple prospect scorecard to resolve this issue and quantify their lead scoring. Formalizing lead scoring offers benefits such as:

Helps Producers create ideal attributes to form a buyer persona
Creates a simple numeric system to leverage your buyer persona
Assigns numeric values to rank your best prospects
Creates a simple qualification acronym to determine likelihood to close

What should be included in a prospect scorecard?

Use a prospect scorecard to quantify your approach to pipeline building. Some attributes of your ideal client might include revenue, growth rate, client type (business or consumer) and market niche. For example, are you targeting companies with $5m to $10m in revenue? Are your best prospects fast-growing firms, trucking companies, manufacturers or consumers?

If you’re selling to consumers, are they high net worth, middle-income, millennials or senior citizens? Are your prospects in a specific niche market such as banking, insurance, biotech, consulting, education, etc.? Create a scorecard with your ideal attributes and a customized qualification abbreviation to help you determine if you’re selling to an in-profile prospect.

Insurance agencies and brokers seeking to get to the next level with their insurance marketing and lead generation, but lacking the internal resources to achieve their marketing goals, can reach out to a proficient insurance agency marketing firm.

How to Select Your Insurance Advisor?

You must opt for a life insurance policy. If your finances allow, you must also get health insurance as well as home insurance. This way you would be able to save yourself from any sudden financial crisis. However, you need the best of persons when it comes to an insurance advisor. In this article, we will take you through five steps to hire the best LIC advisor in Delhi.

1. Always prefer a certified advisor

Your insurance advisor must have proper certification from the Insurance Regulatory and Development Authority (IRDA). This proves that he/she is not there to trick you or fraud you. Moreover, the guidelines laid down by this agency make sure that you are protected on all fronts. If a person is not certified by IRDA, legally he is not entitled to advise people on insurance. He may end up in jail. Therefore, before selecting an agent, make sure that he/she has all the necessary certifications.

2. He must be through with investment solutions

You must understand that insurance agents are much more than just a salesman. They must have a proper understanding of financial planning. They should be equipped with all the necessary information about the financial world, both domestic as well as globally. More importantly, your LIC advisor should have a proper understanding of your family and financial standing. This way he would be able to suggest you the best insurance for you. It is advised that you should first develop a good friendship with the advisor and only then allow him to enter your financial realm.

3. He must have a complete understanding of the product he wants to sell

The insurance advisor must have a thorough knowledge of all the insurance policies that his/her company sells. You should sit down and have a long conversation with him about the pros and cons of various policies. You must understand that every insurance company sells a hell lot of policies. Not all policies are meant for you. Your insurance advisor must suggest you the best policy for yourself after understanding your family and finances.

4. Does the follow-up?

He/she is a cheap insurance advisor if he/she forgets you after you have bought the insurance policy. This is not what a responsible advisor does. Even after you have bought the policy, you may have a hell lot of questions to be answered. He/she must update you about the product premium and all the necessary details to make the best of your insurance.

5. He must help you while fulfilling your claim

When a claim arises, an advisor plays a very important role. He is the sole contact person between the insurance provider and the policyholder. He must understand all the formalities that need to be fulfilled for a successful claim. If your claim is denied there was no point in opting for that insurance policy. A good insurance advisor will stand by you when you need him/her the most.

Is Insurance a Necessary Evil?

I have been experiencing an insatiable thirst to seek to answer this nagging question about whether insurance is a necessity in our country today. While the subject of insurance is broad and multi-faceted, I will seek to break down the perception of this subject so that our minds for a moment are not engrossed with the surreptitious picture of insurance agents’ incessantly cold-calling potential clients or pursuit of claims arising out of insurable risks by claimants.

Data from the Insurance Regulatory Authority (IRA) shows that the level of uptake of insurance in Kenya is at an all-time low of 3.3 percent. This cannot be compared to developed economies like South Africa where the numbers are at 14%. Many explanations have been advanced to show why Kenyans are still averse to taking up Insurance related products. One prominent argument is that the Per capita income (GDP) of the average income earner cannot be enough to support payment of premiums. The other school of thought is that the savings culture of Kenyans is still wanting.

While the arguments above may hold water, the fundamental understanding of insurance has not been taught to most of us from an early age. The subject of insurance I dare say is still shrouded with a lot of secrecy and misunderstanding akin to the mysticism surrounding ancient religions. The language used is still rather technical to the average person. I realize that at this point I must correct myself quickly and note that every profession has its language; for an engineer has to use engineering language, an architect the same etcetera. Insurance also has its language but if its proponents profess that it benefits almost all of humanity, shouldn’t it be clothed in language that is not so grandiose but easily palatable to the common man?

The responsibility of the stakeholders in the insurance industry is to bring customers’ perception to how insurance works in a language they can understand. This would entail offering a basic insight on what informs the underwriting decisions on various insurance products by insurers. I want to suggest that it would benefit insurers to have open days where they invite people and educate them on the fundamentals of insurance, on the meaning of risk, why insurance is important to any economy and most importantly the benefits of insurance at a personal level. Apart from honing their sales skills, sales professionals need to align themselves properly with the market in order to understand and respond well to their customers’ needs. More often than not, sales people are perceived to be aggressive, over-achieving individuals who are not honest and are quick to point to clients the dotted lines in the application document. This negative perception must stop. Insurance sales people contribute immensely to the overall economic growth and offer important services without which an economy could not function well.

Now back to our overarching theme. Any society is fraught with risks. The risk of death by accidents, accidental injury leading to permanent or temporary disability, the risk of fire arising out of man-made or natural sources e.g. lightning, subterranean fire etc, the risk of accidental injury at the place of work owing to the nature of employment, loss of luggage while travelling and many more. What insurance does is simply to classify the above mentioned risks and price them into premiums. The premiums are then pooled and it is from this pool of funds that claims are settled. The guiding principle here is that a risk should be quantifiable. A close analysis of your immediate environment will reveal many known and unknown risks. Insurance companies manage losses that arise out of insured risks. Think for a moment the costs borne by the insured if there was no insurance to mitigate these risks. Imagine a petrol station owner being held liable for damage by fire arising from his petrol station to his neighbors. If the owner does not have public liability insurance, he may find it difficult to raise money to meet his legal fees and hence may not protect his business. This is because the cost of a claim can far exceed what a business is able to raise and necessitate the shutting down of a business altogether. Many examples abound where insurance solve practical problems and mitigate a host of risks that can cripple businesses and slow economic growth. At a personal level, medical insurance is very vital. Think for a moment the rising cost of Medicare and consultancy fees not to mention the increasing costs of pharmaceutical medicines.

But there is an antithesis to such a healthy explanation and this is advanced by some who argue that risks are only imagined hazards. They posit that a risk is imagined and only ceases to be a risk when an actual occurrence happens. Some even counter a proposal to take up insurance dangerously by arguing that they have, for example, not been admitted to hospital for a number of years and see no need to take up a medical cover. While it is important to live healthy and avoid the hospital and its attendant costs, it would be farcical for one to wish they had a medical cover in the face of a medical emergency.

In conclusion, insurance is necessary to any growing economy like Kenya in spite of the low uptake. It not only creates employment and puts in abeyance the worry of meeting risks; it is an indicator of economic growth and a sign of a thriving economy. More needs to be done to educate the masses with regard to this subject. The responsibility lies squarely at the court of the regulator to put pressure on insurance companies to increase the uptake of insurance in the country. Incentives must be given to companies that have the highest level of penetration to make sure they maintain their influence and widen the market. Is insurance necessary? Indeed it is. Next time someone dissuades you from taking up an insurance plan, think again.