Healthcare Professionals

You may wonder who helps you when you are sick. Who takes good care of you when you are confined in the hospital or clinic? They can be found in every hospital, clinic or health care setting, and they are called healthcare professionals.

Healthcare professionals are people who devote their time in providing good care to people who are sick or to people who need attention with regards to health related matters. They are equipped with the knowledge and skills that are needed in order to help those who are in need. For example, in order to treat certain illnesses or diseases, a person will have a degree in medicine and will become a doctor. Doctors are the ones who assess you when you are sick and diagnose your illness. They are the ones who prescribe you your medication/s in order to aid you in recovering from illness. The doctors cannot perform all the tasks in dealing with patients alone, they need the help of other healthcare professionals.


One of them would be the nurse. The nurse assists the doctor in providing care for the patients. They are the ones who monitor the condition of the patient when they are confined in the hospital. They aid in the daily activities of patients who cannot perform on their own. The nurses are the ones who spend most of the time with patients in the hospital. Another healthcare professional would be the medical technologist. They are the ones who are responsible in obtaining blood samples of patients to help properly diagnose the condition of the patient. The medical technologist work hand in hand with the pathologist in studying the blood of the patient, so as to determine whether the underlying cause of the illness can be found in the blood. Each of the healthcare professionals perform a specific task in order to help the patients recover and be able to get back to good health.

Healthcare Professionals

The healthcare professionals do not rely only on their knowledge and skills when providing good quality care to their patients. They also need the use of medical equipment in order to endow their patients with quality service that is needed to facilitate their fast recovery. For example, the nurse uses the nebulizer for the patient who has asthma. The nebulizer aids in administering the medication needed by the patient to alleviate his or her condition. Another example would be when the doctor coordinates with the physical therapist to assist the patient in conducting physical therapy.

The physical therapist in turn will use medical equipments such as an overhead trapeze, which is installed on the patient's bed, in order to help the patient use his or her own muscles when turning from side to side in order to facilitate range of motion exercises. All of the medical equipment being used has its purpose to assist in the improvement of the condition of a patient and the healthcare professional. The healthcare professional in turn must be knowledgeable enough on how to use the medical equipment in order to provide the most excellent care that will aid the patient in gaining good health.

Healthcare Professionals

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PPO Health Insurance Plans - The Pros & Cons

PPO is short for Preferred Provider Organization. PPO health insurance plans are based on contractual relationships that the insurance companies have with the organizations. The term "organizations" refers to the healthcare providers, doctors, hospital, clinics, etc.

Thus, PPO plans have pre-approved lists of healthcare providers called the Participating (In-Network) Provider list. But they also allow you to see healthcare providers who are not on the list called the Non-Participating (Out-of-Network) Provider list.


Note that when you use a non-participating provider you will end up paying more than if you had used one in-network.

PPO Health Insurance Plans - The Pros & Cons


  • Access: You have access to a larger number of doctors and facilities.
  • Choice: You can chose whatever doctor you want to see for your healthcare needs.
  • Specialists: you do not have to have a referral to a specialist.
  • Primary Care Physician: You do not have to chose and be tied to a primary care physician.
  • Negotiated Fees: When you use a participating provider, the amount charged will be a negotiated amount less than the provider would charge someone without the plan.

  • Deductible: There is almost always a deductible to be met.
  • Co-Insurance: After the deductible is met, there is a co-insurance amount that you are responsible for paying the average being 30% of the cost.
  • Out of Pocket Expenses: Overall, PPO plans cost you more between the deductible and co-insurance and other out-of-pocket expenses.
In the end it comes down to what is important to you. Are you willing to pay extra for open access to the healthcare provider of your choice?

Whether you want a PPO, HMO, or HSA, you should consult a local health insurance agent or broker to help you find the right plan.

PPO Health Insurance Plans - The Pros & Cons

Corinne Mitchell has worked in the insurance industry for 10+ years and currently works with the Group Insurance Benefits Specialists at

Read her blog for more tips.

Make sure you get expert advice and find the right coverage for you and your employees.

Comparing the Pros and Cons of Outsourced Healthcare Coding

Deciding on whether to outsource any portion of your healthcare facility's revenue cycle department is something that cannot be taken lightly. And facilities have different options when outsourcing the coding function. Some facilities have chosen to keep the coding in-house and only outsource the processes involved with electronic claims submissions, collections and financial reporting. However, with the increased number of audits, health care facilities are deciding to outsource all revenue cycle functions including the coding of claims.

The implication of inaccurate coding is significant. A healthcare facility should look at their available resources when determining if the coding should be outsourced. One only has to look at the two types of coding errors: "overcoding" and "undercoding." The obvious ramification of overcoding is potential for an extended audit; repayment and possible penalties and fines. Undercoding or what providers call "defensive coding" results in millions of dollars of lost revenue.


Pros of Outsourced Coding

Comparing the Pros and Cons of Outsourced Healthcare Coding

As mentioned, healthcare providers are seeing audits from all areas. These claims audits include RAC, MIC, MAC, CERT, PERM, MFCU, ZPIC and others. With more claims audits, the healthcare industry is seeing a higher demand for qualified coders. One benefit of outsourcing the coding tasks is that the headache of hiring an individual with coding experience is no longer an issue.

Medical coding rules can be arduous. A coder must be privy to CPT rules, Correct Coding Initiative Edits (CCI), ICD-9-CM (and soon ICD-10-CM), Local Carrier Determination (LCDs) and National Carrier Determinations (NCDs). With small practices, those individuals who are granted the task of "coding" are also given other responsibilities which affect the amount of time they have on applying, learning and keeping abreast of all of the rules. Utilizing a company who only hires qualified individuals to conduct the coding tasks, provides confidence that the claims are being submitted based on the appropriate rules and policies.

The American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) provide various ways of obtaining the required continuing education credits. Many ways are affordable and do not require leaving your desk. However, many of these ways are not as specialty specific as you would find at regional and national conferences. With attending offsite conferences, the expenses are increased. The budgets in many health care facilities cannot accommodate the expenses associated with continuing education classes. Outsourcing the coding to a company eliminates this extra expense.

With the above benefits of outsourcing the coding, comes due diligence on the health care facility's end. It is imperative that it is understood that these companies do provide specialty specific continuing education and that they provide their staff with the appropriate resources that spell out all of the coding rules and policies.

Cons of Outsourced Coding

So what are the cons involved in the outsourcing of the coding? For one, when mentioning the benefits of using a coding company, we are making the assumption that their employees are qualified and educated on the coding rules. Negative outcomes have been shown with physicians of certain specialties that have more difficult coding scenarios. This is often seen with Interventional Radiology and Neuro Surgery. Although the coding company may have qualified individuals, they may not be experts on these more difficult specialties. It is imperative that you find out if your designated coder is educated on your specialty. Ask for the bios and CVs of the coders who will be working on your claims. In addition, coders lose their credentials. It is easy to contact the AAPC and AHIMA to determine if the coder who is submitting your claims has allowed her credentials to lapse. Find out what type of continuing education they have received in the past; get specifics.

Unless you contract with a coding company that only deals with claims in one particular part of the country, you are taking the gamble that they are truly applying LCDs and other regional coding policies to your claims. If you are a provider in Louisiana and you are utilizing the services of a company out of Minnesota, you must get confirmation that the coding company is experienced with Medicare, Medicaid and other third-party payers in your state.

Beyond the coding tasks, there is the remainder of the revenue cycle process that can be outsourced. The process for outsourcing billing can be pretty straightforward. Typically superbills and other documents are scanned and electronically sent or mailed to the medical billing service. If the practice is using EHR software, the patient's superbill is stored and electronically transmitted to the billing service. The medical billing service takes care of the data entry and claim submission on behalf of the provider. The company will also follow up on denied claims, work unpaid accounts (A/R management) and send out-patient statements. The mere fact that they do not have to deal with any of this is the major reason that providers choose to outsource. In this outsourcing scenario, the fee for outsourcing these revenue cycle tasks is based on a percentage of gross collections. The industry average for these fees is approximately 7 percent of gross collections.

Compare hard costs: Calculate the expense of doing it in-house (salary and overhead of your billing staff, amount of time you are spending on billing, third-party fees for claims clearinghouses, billing related supplies such as claim forms) versus the billing company fees (which are typically a percentage of collections). Many organizations provide salary surveys that can assist you with average cost of billing staff.

Compare soft costs and intangibles: This comes down to the basic hassle of dealing with daily billing issues and all issues related to human resources. Is dealing with these issues worth it?

Compare effectiveness: You must take into account the quality of the resources that you would have in-house versus assessing the potential effectiveness of a third-party. If you have done billing in-house, you can measure your collection rates; turnaround times and other points of billing to practices of the same specialty and size. This could assist you in determining how well your billing staff is doing. Another question that you could ask yourself is how often do you get reports regarding A/R, charges, and collections?

Any business decision requires acknowledgment of cost benefit, good business practice and common sense for the company. When determining whether to outsource the billing, consider these facts and apply them to your daily practices. The ultimate decision comes down to one thing and that is how can we practice medicine and maintain a business in the most efficient way.

Comparing the Pros and Cons of Outsourced Healthcare Coding

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Income Tax Implications of The Healthcare Reform Act - Obama Care

On March 23, 2010 President Obama signed the Landmark Health Care Reform Act and was immediately challenged in court. The result was that many people were left confused about the law and its' effect your personal bottom line and taxes in particular.

The new law which incorporates a slew of new regulations and requirements for businesses and individuals is intended to increase the number of people covered by medical insurance and by doing so reduce the cost for everyone. The Health Care Reform Act commonly referred to as Obama Care is being phased in over the course of eight years with the vast majority of the law in place by the end of 2014.


One of the ways the law is intended reduce costs is through the creation of state-based exchanges. These exchanges allow lower income individuals and families to purchase coverage by taking advantage of cost sharing. Small businesses may also purchase insurance through the state exchanges and take advantage of similar cost benefits. The state exchanges will be available to individuals and families who are between 133-400% of the federal poverty level which is incomes from about ,050. to ,200 for a family of four.

Income Tax Implications of The Healthcare Reform Act - Obama Care

The Health Care Reform Act, Obama Care does require that individuals without employer provided health coverage purchase their own or be subject to a tax penalty. The penalty for not purchasing coverage is based on income and therefore varies. The tax penalty will be eased into effect and at its' maximum will run from 5 to ,085. per year. For a family of four with a household income of ,054. the average tax penalty will be about ,251. per year.

The majority of households, estimates range from 70-80%, who do not have some form of employer based health coverage will be eligible for premium support and as such will have access to state exchanges. The average family of four with a household income of ,000 a year will pay about ,400 a year for insurance.

The cost for an average family of four breaks down as follows:

Household Income: ,000.

Total Cost of Insurance: ,853.

Tax Credit: ,468.

Final Cost to Taxpayer: ,385.

The Henry Kaiser Family Foundation website provides a great tool to calculate your actual cost for health insurance beginning with the year 2014. The health reform subsidy calculator allows you to put in your family income, size and your age and calculates exactly what your costs will be.


In most cases businesses who employ more then 50 people, full-time, will be required to provide health insurance coverage under this law. The law states that if you have more then 50 full-time employees and at least one of them receives the premium support tax credit a fee (tax penalty) of ,000 per full-time employee (excluding the first 30) will be assessed. This applies only to employers who do not offer health coverage already.

For employers who do offer coverage but still have a full-time employee who receives a premium support tax credit the employer will have to pay a tax penalty of ,000. for each full-time employee receiving a credit or ,000. per employee, excluding the first 30, whichever is less.

It is important to note that all the tax penalties for employers pertain to full-time employees only. For example a business with 100 employees of which only 49 are full-time is exempt from providing coverage.

Income Tax Implications of The Healthcare Reform Act - Obama Care

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Reasons For Increasing Healthcare Costs

Healthcare in America has become unaffordable for an average individual due to the increase in the costs. These costs are straining burden on the individuals and have become a top issue in the country. Some reasons behind the increasing healthcare costs would be the latest medical technology that's coming up, lack of price controlling mechanism and rising costs of insurance. Let's look into these factors a little bit in detail.

As one can clearly see, day to day new medical devices, techniques and drugs are being introduced in the market and charges levied on such services are being high. This can be understood by a simple fact that the treatment of the most common dental ailments would cost you anything not less than 0 which is more than twice the amount of other countries. Government's policies to extend coverage for all the Americans could not fundamentally happen as expected due to the lack of health price control mechanisms. This failure made the health care costs soaring and pushed up the costs. Insurance companies are increasing the costs to make significant gains from the increasing health care costs. This increase in the premiums has reached a point where it has become unaffordable to the people.


Many survey reports clearly analyzes the conditions and present a detailed description of facts about the increasing health care costs and insurance premiums in America. The most common thing all these reports suggest is to control the health care costs but they don't come up with a solution of resolving it. Overall, it affects the consumers. The only solution, which is considered to be the best in the contemporary America, is discount plans that reduce your health care costs to a greater extent and provide a sigh of relief to the consumers.

Reasons For Increasing Healthcare Costs

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Reasons For Increasing Healthcare Costs




Differences Between the Republican and Democratic Healthcare Reform Bills

The Republican Party has spent the past several months serving as vocal opposition to the healthcare reform bills supported by the Barack Obama administration and Democratic members of Congress. During that time, they have seen success in influencing public opinion. However, many were frustrated that Republicans hadn't offered their own plan. Surely they didn't believe that the health insurance system in the U.S. is perfect the way it is? Well, the wait is over. Senate Minority Leader John Boehner has acknowledged the public's demand for an alternative with the debut of the GOP's healthcare reform bill. Obviously, a party that has disagreements with most parts of the Democrats' bills in the House of Representatives and Senate has written a significantly different bill. How exactly are the proposals different?

  • Length: The Democrats' bill is a whopping 1,990 pages long. Meanwhile, the Republican version clocks in at a more reasonable 230 pages. Most politicians should find the latter's length (akin to the average novel) more manageable than the entire encyclopedia that is the former.
  • Mandate: Republicans have eliminated the mandate that would require virtually all individuals to buy health insurance plans, as well as one that would force employers to provide insurance. Those mandates are central to the Democratic bill; their intent is to make sure that the cost of health insurance is spread among a large pool, as opposed to only the sickest of our population.
  • Pre-existing Conditions: Unlike the bills proposed by the Democrats, the Republican bill would not ban health insurance companies from denying coverage to those with pre-existing conditions. This falls in line with the party's more anti-regulatory stance on business.
  • Interstate Insurance Sales: People will be allowed to buy a health insurance plan across state lines under the Republican bill. Insurance is cheaper in some states, since there are fewer requirements or restrictions on what insurers do or do not cover.
  • Abortion Coverage: The Republican bill includes stricter prohibitions on funding of abortions. Democrats have already included a provision that would prevent federal subsidies (given to low income individuals to buy insurance) from being used directly on abortion services. However, the Republicans go further by preventing people who receive the subsidies from buying any health insurance plan that covers abortion entirely--even if they never end up using that particular option. The Republican party has a stronger pro-life base, so this provision could help draw them in. On the other hand, this could also backfire against the Republicans, who have capitalized off the grassroots anger over the possibility of a government bureaucracy making your health care decisions for you.
  • Medical Malpractice: Trial lawyers have been loyal contributors to Democratic politicians. That may be why there isn't significant legislation involving medical tort reform in their bill. Republicans would like to limit jury awards for things like pain and suffering. The most plaintiffs could be awarded would be 0,000 in medical malpractice cases (excluding actual, proven economic harm)
  • Cost: The most recent estimates show the Democrats' plan as costing over trillion over the next decade, while Republicans haven't yet revealed how much their plan will cost. Given how much they complain about the Democratic proposals super-sizing the national debt, it can reasonably be expected that their bill will have a lower price tag.


As you can see, there are significant differences in the bills. Above all, Republicans acknowledge that their bill would insure less people than the Democratic bill. Although both parties care about lowering the percentage of uninsured individuals and families in addition to the budget deficit, there is a trade-off. The latter appears to be a higher priority for the GOP. It appears inevitable that healthcare reform will pass at some point, possibly before the end of this year. The details of the Democratic proposals have been discussed for weeks, while the solutions presented by the Republicans have just made their formal debut. Boehner plans to finalize his party's bill soon, in order for it to be presented when debate on the finalized Democratic bill begins on the House floor. So far, neither strategy for reforming our healthcare system seems ideal. Despite that, it is positive that more options are being presented to the American people. The greater number of minds put together, the faster we can fix the unavailability of affordable health insurance plans in this country.

Differences Between the Republican and Democratic Healthcare Reform Bills
Differences Between the Republican and Democratic Healthcare Reform Bills

Yamileth Medina is an up and coming expert on Health Insurance and Healthcare Reform. She aims to help people realize that they can get affordable health insurance plans right now while waiting for a public option, if it ever gets passed. Yamileth lives in Miami, FL.