hmo models

HMO Models

One of the many difficult decisions you make as an adult is determining which health insurance plan is best for you and your family. Purchasing health insurance can be an intimidating and often daunting process.  Over the past 20 years, managed healthcare plans called HMOs, have become commonplace. In fact, some 70 million Americans currently … Read more

concurrent review

Concurrent Review in Healthcare

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

retrospective review

Retrospective Review in Healthcare

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

doctors standing in a line

Levels of Care in a Hospital

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

stethoscope laying on money

Contractual Adjustment in Healthcare

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

What Are Revenue Codes in Healthcare? A Complete Guide

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

MS-DRG: What is a Medicare Severity-Diagnosis Related Group?

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

telemedicine doctors addressing patient at home

Types of Healthcare Delivery Systems

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

doctor close up

What is APC in Healthcare?

In healthcare, APC stands for either advanced practice clinician or ambulatory payment classification. What is an Advanced Practice Clinician (APC)? Advanced practice clinicians are clinicians who are not doctors, but provide a role that is very similar to a doctor. Advanced practice clinicians typically refers to advanced practice registered nurses (APRNs) and to physician assistants (PAs). An APC is a healthcare … Read more