The health insurance industry matured between 1940 and 1960.  The earlier successes of the founding of Blue Cross and Blue Shield proved to the insurance industry that there was a way to offer medical insurance without being exposed to widespread fraud as the insurance industry originally believed.  Improvements in medicine during this period also increased the demand for medical care.  The medical industry focused on offering medical insurance to employed workers who were traditionally young and healthy and therefore were without health insurance.  The health insurance market grew 700% between 1940 and 1950.  Blue Cross and Blue Shield set policy rates using the community rating system because they were not for profit organizations.  The community rating system required that the same premium be charged regardless of whether the subscriber was healthy or sick.  The insurance industry used the experience rating system to set premiums.  In the experience rating system, the premium was set based on the claims the subscriber submitted.  That is, a healthy subscriber paid a lower premium then a sick subscriber.  Insurance companies used the experienced rating system to set premiums.  In the experience rating system, the premium was set based on the claims, the subscriber submitted.  That is, a healthy subscriber paid a lower premium that a sick subscriber.  Insurance companies used the experienced rating system to their advantage by targeting groups of healthy people who subscribed to Blue Cross and Blue Shield.  The experienced rating system enabled insurance companies to offer a lower premium to these groups then to the groups paid to Blue Cross and Blue shield for the same coverage.  It didn’t take long for the insurance companies to have more subscribers then Blue Cross and Blue Shield.  Tomorrow we will look at Blue Cross and Blue Shield and review how they began.

No tags

If you are studying to become a medical billing and coding specialist, you should also take the time to get an idea about how the healthcare industry works today.  Lets take a look back in history and observe really quickly how the healthcare industry has  changed in the United States.  Going all the way back to before 1920, the cost of medical treatment was low.  The reason it was less is attributed  simply to the medical technology being very limited and procedures were much more primitive then today.  Most treatments were performed in a persons home including surgery!  You might recall old movies where someone is sick and the doctor comes to the patient with his little black medical bag.  One common procedure was bleeding a patient (which seems very dangerous now.)  These were the beginning years of modern medicine where a physician was just beginning to learn about antisepis, bacteriology,and immunology.  Scientists were in the first stages of improving medical technology by inventing now contraptions such as; the blood pressure machine and X-rays.  Back then most people had pretty low medical expenses.  In fact, the most costly part of becoming ill was the loss of wages because you couldn’t work if you were sick.  Families have been purchasing health insurance for a long time, however, medical coverage was much different.  Health insurance in those days was called “sick insurance”  and it didn’t cover medical expenses.  Sick insurance only covered lost wages which is now like today’s disability insurance.  Insurance companies didn’t offer health insurance because they didn’t have a method to prevent against fraud, or also to define pre-existing conditions.  They were afraid (much like today) that an unhealthy person might purchase a medical insurance policy claiming he was healthy.  The premium would be based on a healthy person and then the insurer might lose money when the person submitted the claims for procedures undergone by an unhealthy person.  This is still a problem today….determining what is considered a healthy person and making premiums that match each individual.

No tags

Medical costs are skyrocketing. If you are studying how to become a medical billing and coding specialist, health care costs and bills will be a big part of your understanding and education. There are numerous reasons given by the medical industry for this rise in fees.  Some reasons are ture and others are half-truths.  Regardless, medical insurers divise ways to reduce reimbursements paid to healthcare providers.  A widely used method is to negotiate with heatlhcare providers a fixed reimbursement for commonly performed prodedures.  Healthcare providers who reach terms with a medical insurer become a member of the medical insurer’s network of health care providers. Since reimbursement is fixed, medical insurers lower their risk of high reimbursement and therefore can offer better terms if patients receive a procedure from a healthcare provider who is within the medical insurer’s network rather than from the healthcare provider who is out of network.  The terms of agreement with healthcare providers relfect fees that that healthcare provider will be reimbured by the medical insurer.  Usually 90% to 100% of the fee is reimbursed if the healthcare provider is in network as opposed to 80% if it is out of network.  The patient will have to pay the difference.  This gives health patients a financial incentive for using only the in network healthcare providers.  Healthcare providers expect to see an appreciable increase in their business if they join the network.  However, the healthcare provider might have to lower fees.  The medical insurer can reduce the increase in medical cost by negotiating fixed fees, which enables the insurer to offer better terms to employers.  In turn this attracts more business, generating additional premiums that can be invested.  Some medical insurers run health maintenance organizations A.K.A. HMO’s.  In many cases, these are healthcare facilities run and operated by the insurers and provide the insurer the opportunity to reduce the expenses of operating the facility by negotiating better prices with suppliers.  Patients who use HMO’s don’t pay anything for medical procedures other than their premiums.

No tags

Allied Health Care providers are divided into two economic categories; these two categories are for profit and not for profit.  A “for”  profit helath care provider charges fees that cover expenses and return a profit.  Profit money is collected by the healthcare provider that exceeds expenses and is distributed to its owners or share holders to as a reward for investing money in the business.  An owner can be a physician, a group of physicians, or anyone who gave money to start the healthcare business.  A “not” for profit healthcare provider charges fees that cover expenses only.  Theoretically, no money is left over.  There isn’t a profit and there aren’t any investors.  Not-for-profit healthcare providers strive to bring in enough money to cover expenses and to have enough money left over to handle unexpected expenses for emergencies.

You’ve probably heard the story about the hospital that charged a patient a dollar for an aspirin when the local grocery store sells a bottle of aspirin for 69 cents.  This is true.  The hospital probably paid a penny for he aspirin but charded a dollar to bring in addtional revenue.  Revenue is money that is paid to a healthcare provider.  Allied Health Providers seek to have as much money and as many revenue streams as possible.  A revenue stream is a product or service that is sold to bring in revenue.  For example; the parking lot fee at the hospital, or the rental fee for telephones and televisions are also examples of how hospitals bring in revenue.  The amount of revenue that can be generated by a revenue stream depends on the amount of money the healthcare provider charges for a product or service.  All allied health facilities try to maximize the money generated by each revenue stream in order to provide the cash needed to run their operation.  This is true regardless of whether the healthcare provider is for profit or not for profit.

No tags

The healthcare industry is governed by the economic rule of supply and demand.  This rule states simply that a demand by consumers for a product and service will cause someone to provide those products and services.  If there is no demand, then no one will invest time and money into making a product or providing the services.  For example, a town of 100 people has a demand for a physician.  However, the demand is too small to attract  a physician because there wouldn’t be enough sick people to make it profitable for the physician to set up a a practice there.  As the town grows to 5000 people the demand for healthcare services increases to a level that makes it profitable for one physician to open a practice in town.  Still there wouldn’t be enough sick people to support a hospital.  A town of 50,000 or more might merit a hospital.  A for-profit health care provider enters a market when demand is enough to return a profit, and won’t stay in a town that is unprofitable.  Sometimes the government will supplement agencies that are not-for-profit so that healthcare providers can remain in an unprofitable market.  This is important to consider if you are interested in making a medical billing and coding salary.  Although many specialists are able to work from home and on-line, this is not always an option.  Students of Medical Billing and Coding must consider whether or not their geographic location has demand for medical billing and coding.  If after analysis, a coding specialist realizes that they may have to move, it is prudent to look in cities or towns that have enough people to demand specialists.  The Medical billing and coding industry is expected to have a steady rise in demand and salary over the next 15 years.  Medical billing and coding is an excellent option to become an allied health professional, or to work in the allied health field.

No tags

Did you ever wonder how physicians and hospitals keep everything straight and get paid?  Probably not, because here in America we don’t pay for our medical care directly; instead our medical insurer pays for it.  We simply visit our physicians office or the hospital and provide information about our health insurance.  We might be asked to pay a co-pay, but that is merely a fraction of the actual medical bill.  After a patient’s treatment, allied health care providers, including physicians, hospitals, and other healthcare facilities, submit our medical bill to the medical insurer.  If the bill is approved, the medical insurer pays our healthcare provider directly.  Without good medical billing and coding specialists, this would be impossible for the health care system to regulate and facilitate.  Many allied health facilities see hundreds of patients per day.  Fortunately healthcare providers can rely on medical billing and coding specialists and medical insurance specialists who know how to prepare these bills with the correct supporting documentation so the medical insurer can authorize payment.  Our method of paying for healthcare has evolved over the last century, and continues to evolve with Obama and the health care policies he is looking to implement and impose.  Many Americans don’t even have health insurance today and when we are legally required in the next couple of years to get it, the demand for medical billing and coding is going to go through the roof!  Imagine that 40% of Americans are going to be looking to be insured.  Today, slick marketing techniques normally reserved for selling a product for profit, are being used to sell prescriptions, medical tests, and hospital services.  We believe as the demand for medical billing and coding specialists increases rapidly, so will the salary.  Medical billing and coding is an excellent field to consider if you are looking for a career in the allied health fields.

No tags

Many of us don’t bother to give a second thought to how our physicians, a hospital, and other allied health professionals in the healthcare industry get paid.  We simply make an appointment, provide our information about medical insurance, and then pay whatever amount is required for the co-pay.  The co-pay is usually such a small fraction of the cost.  Have you ever wondered who pays the rest of the costs?  Or maybe  you don’t have health insurance and you are required to pay.  Many doctors and allied health facilities provide a discount for people without insurance because it eliminates work for their Medical bulling and coding specialist.  If you do, in fact, have insurance, it is your health insurance who pays the cost.  Healthcare providers have a series of required steps to submit  an insurance claim.   This procedure must be followed along with supporting documents justifying any treatments we received during our visit…..to make sure it is covered.  Only if the claim is submitted by the health care provider, is the claim approved and the necessary parties paid.  This can be a good system for covering medical expenses from the patient’s perspective, however, some situations can be a problem for health care providers who care for hundreds of patients every day with each having different coverage and each requiring individual care and treatment.  Who assembles all these bills and supporting documents for each patient each day?  All allied health professionals could easily be in a bind if there wasn’t a constant stream of reimbursements from the health insurance companies.  Your healthcare provider has taken on a large responsibility to keep everything in balance.  They have assumed responsibility for making sure they have the finances to pay the cost of; medical administrative staff, rent, utilities, and vendors who provided medical supplies and pharmaceuticals to treat you.  These expenses are paid before your healthcare provider is reimbursed by the medical insurer for your visit.  Reimbursements stop flowing when insurance company may deny a claim or delay processing them.  Many times this is caused by medical billing and coding error.  Honest, and sometimes dumb mistakes can cause insurers to withhold reimbursements until the healthcare provider submits a correct claim.  It is important if you wish to become a Medical billing and coding specialist to take your job seriously.  Many other allied health professionals depend on you.

No tags

Entering the field of medical transcriptionist is an excellent choice if you are starting over in your career.  In fact, most the individuals that enter the medical transcriptionist field are in fact established professionals who are making a career shift. The field is made up primarily of women who have a desire to work from home.  Most of these women have been through school previously and already had one career.  Lots of these women now have children, and staying at home becomes a high priority, but do not have the flexibility financially not to work. Medical transcription is an ideal field for individuals such as; women from their 20s and 30s who would like to be home, 50 and up who may need more then retirement can provide, and military wives.  Because medical billing and coding is a portable profession that can move with them, military wives have found medical transcription and medical billing and coding to meet their needs for flexibility geographically.  Since their spouses are deployed and constantly moving all over the world, this profession allows military spouses to remain employed consistently with the same employer rather than having to constantly change employers each time they happen to get re-stationed. The job force for medical transcriptionist is mainly comprised of women in their late 20s and older.  The medical transcription industry would like to engage a younger work force, but the idea of working from home is not very appealing to most students who have just graduated high school and are ready to find their first full time job.

No tags

There is some training involved if you are interested in the Allied Health Field of Medical Transcriptionist.  For example, some medical transcription programs do some pre-screening tests to ensure that all applicants are able to understand, write and speak english.  Language is an important aspect of the job since it deals mainly with the documentation and communication of medical jargon.  Another skill that is beneficial if you are hoping to be a medical transcriptionist is accurate typing skills and speed. One standard of typing speed may be 45-50 words per minute. At the very least, some basic typing skills are essential to enter any medical transcription training program.  Most medical transcription training programs are achieved at a certificate level although some are can be an associate’s degree level as well.  The certificate training programs generally take 10-12 months.  A degree or certificate is not required for practicing in this field, however, unskilled transcriptionists may have a difficult finding a job since productivity and speed are important in this field.  Tomorrow we can learn more about the agencies which regulate who is qualified in this field.  Some other common questions are; who performs the certification?  Since there is no required certification or training to become a medical transcriptionist, is continued education required or neccesarry as it is in so many other allied health fields?    We will be examining everything one will need to know if they want to obtain a job as a medical transcriptionist.

No tags