Table of Contents
Health planning
Planning is a process that generates the strategic decision in the field of operational details, which is mainly based on the analysis and collection of information regarding the well-being of the country over a wider area. While Health planning is a process whereby health needs in all aspects is characterize in many countries due to it constrains that may have been responded to have particularly severe various people. This is a major transmissible severe such as Aids, TB, Polio and other non crucial diseases like malaria that often been experience in different places under climatically changes especially diseases which are less communicable to be recommended in by the world health origination body for the need of health care.
Needs for patient to apply an insurance cover
This are preferred plan that some companies used to inspect the total performance a health care is insured to their network. This is atypically network used by hospitals that are registered by network companies. The network centre charged the hospital that preferred a total fee according to their expenditures and services they offer and what amount they charge on the preferred providers (Rejda, 1999). With this PPO, is only guarantee for the lower amount that doctors pocket being quit low? But it sound more important for the hospital since they only those who are using this service provide from it but if in turn they change to be out of this network they will incur a lot on healthcare providers. Though PPO is more flexible to use, the amount charged is lower when you choose to visit the doctor, specialist or any staff member outside this network. Over these measures all, the health care ministry should give and order that every patient must apply for national health card (NHIF). This will now insure the patient health over network attendance and billing being advantageous to families and society from the ministry of health. Within this insurance, the basic benefits will be achieved and majorly, the medical cover over health insurance policy will be provided. This is characterizes by deductible of bills being lower than the entire clause they may have required to insured.
A long with this, measures all the medical care is combined with terms and ordinary life insurance that the patient will specified faced on total amount in time and date they may have attended in dual bill payment. So payment will only conducted based on the place, country, basically, certain types of payments to a foreign visitor are more taxable, while other bills may not be the same regardless on the services admitted to. Certain, payments will only be tax to one foreigner who may not have been tax from different countries though this is an exemption in a tax treaty.
Reason for coding
Health care has issued this coding for the privacy and services that may be base on the hospital by numeric and alphabetical codes to be assigned to all patients diagnosed, and methods provided by the ministry of health. These records of coding assist in summarizing the bills to insure the company for their reimbursement (Mcllwraith & Madden, 2006). Within these codes, the hospital clients have set a medical billing machine, which will calculate all the adequate codes over its documentation specified in the doctor's records. This is proved by the medical treatment from the time a patient was admitted up to its discharge. Since all coding provide is needed, the documentation or daily records show the necessity and supportive explanation over the services that a patient was given to and summarizes the actual treatment the patient required. Also coding will assist the companies over random reviews in-patient if they provide right treatment to their patient. This is assign to all patients and the organization to supervise if their clients charge is accordingly to their corresponded.
Explanation of CPT
CPT is a five digit codes, nomenclature with other American Medical Association, thus this codes define a figure used in numbers for assigning all patient who attends various hospital for the purpose of recording, usually identify by the services provided to patient according to medical, surgical and all diagnostic services they need. This coding will be used by insurance to identify the reimbursement amount a patient may have received from the practitioner over the insurer. Since all patient shares the same codes to mean same thing, they will require ensuring their regularity. It must be noted that all the regular documentation offered to all patients should reflect the total amount a patient was attended to may not be the same to all necessarily reimbursement they get. With all this codes, American health information management association has managed to indentify all numeric codes, descriptive term, and modifiers all the reports that the physician has performed (Flood, 2003).
ICD coding
This is an International Classification of Disease, which is used to assign all codes to patient to diagnoses associate in patient admitted, discharge, and all physician analysization over the state. This code is mainly base in the real healthy community to provide all documentation morbidity details and its yearly updates. This coding was invented by U.S. national centre for health statistic as the extension of ICD system so that they could collect, analyst and capture more of the hospital patient services morbidity details and every sector arguments provided to this methods codes being added. Of all this codes, it detailed the diagnostic codes listing all the procedural services codes.
HCPCS coding
This code has two levels namely:
Level one: this code shows all the current edition CPT whereas the second level only sate the national codes which represent all the medical prescription given and all the requirement provided in the CPT. Within this HCPCS level I all the digits is consider being aligned in one level to provide the categories and codes used by the providers to assemble all the services the hospital patients visited, surgical methods, X-rays procedures, management advisors and all other staff medical services they give. However, all hospital applies this level I codes to enter their hospital based services in laboratory and radiological methods to give to all other parties. This is mainly represented to be approximately 80 per cent of the HCPCS codes being capitulate to the office for reimbursement annually.
While level II has the following codes:
This is mainly referred to national codes since it is used to report the medical services provided in Level I CPT. This codes shows only the injection over drugs, ambulance services and all the physician services. They provide physician to accurately give information regarding the patient all the services they were given from his admission to that hospital. This service documentation shows all the doctors attendance.
What is an EOB
This if a form provided by the insurance company to you over the total explanation that your physician performed, what they might have cost, the total cover insured by the insurance and how much you need to pay to the accounts over your attendance in the hospital.
Note: this EOB is not a bill, though it shows all the details regarding the your bills was received and stored
Other important insurance terms
Much other insurance may be required over this insurance such as:
Maternity insurance, dental insurance policy, HMO insurance, Balance billing, birthday rule, clean claims, coordination of benefits, life and death health insurance a among others,
Therefore, Balance billing for example , is a billing made by the government to insured the health of a patient, this is an agreement between the insurance companies over the hospital, that the doctors clears the discount bill by a small pay, then they grant it you the patient for their discount (Mcllwraith & Madden, 2006). Of this entire insurance first, we need to understand that knowing our coverage our insurance will be able to replace cost, which in the event of the total cost, the policy will provide reimbursement, up to the total limit the company need to do, and they will replace all the structure. Though our determination may not be accurate, the appraisal of the replacements should be first be made.