"Navigating the Healthcare Maze"
Utilization management is not an area of healthcare that most clinical nurses are particularly familiar with. Utilization management nurses do, however, play an important role in the behind-the-scenes clinical care of patients. Utilization management nurses ensure that the care that has been provided or is going to be provided is necessary and the best use of … Read more
One of the many difficult decisions you must make as an adult is figuring out health insurance. With options, initials, deductibles, and the rest, it can be an intimidating and often daunting process. Managed healthcare, like with an HMO, has become commonplace over the last 20 years. In fact, some 70 million Americans currently use … Read more
Patients admitted to hospitals today often require multiple medical experts to meet their needs. Having a roster of medical experts vastly improves the care the patient receives. But the division of labor presents a number of problems. A concurrent review evaluates the current level of care that a patient is receiving and determines if any … Read more
In 2016, Medicare recipients spent over $5,000 in out-of-pocket expenses. If you did not have any supplemental coverage during this time, you could have paid up to $7,400 out of pocket. The insurance and healthcare industry is a tricky field to navigate. A retrospective review validates claims, payment, and coverage from services already received. Keep … Read more
Did you know that 145.6 million patients go to hospital emergency rooms all over the United States every single year? On top of that whopping statistic, there are general admissions, direct-to-care patients, and other admissions that don’t go through the ER. Each hospital carefully tracks and monitors each one of these patients, and one of … Read more
According to a 2020 study by InstaMed, medical bills are confusing to more than 70% of patients. On top of that, 80% of patients were surprised by a medical statement they received. These numbers are staggering. Patients should know how much money they will owe for a doctor’s visit or medical procedure beforehand. One way patients can understand their financial … Read more
Are you struggling to understand your medical bill? Bills from hospital visits and treatments can be very complex. Every test, procedure, and treatment need to be clearly marked on the bill in a way that can be easily understood. This is why the healthcare industry uses standardized codes. But to the uninitiated, these codes can … Read more
Medicare severity-diagnosis-related groups, abbreviated as MS-DRGs, are categories of inpatient hospital stays. The Medicare system uses them to determine reimbursements for hospitals, skilled nursing facilities, and hospices. A hospital stay can range from one day to 100 days. The most expensive MS-DRGs have the longest average stays. These expensive hospital services may include open-heart surgery or lung … Read more
If you’ve never heard of ancillary services before, you’re in the right place. Learn what these are and why you should care today.
In recent years, healthcare delivery systems have been focused on providing patients as much freedom of choice when it comes to their personal healthcare. These common types also allow for efficiency, lowered costs, and ease of use. 1. Telemedicine Although telemedicine existed before the COVID-19 pandemic, it has seen monumental growth in recent years. A … Read more