Basic vs. Extra Medical Coverage

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Posted on 22nd December 2010 by admin in Uncategorized

After I graduated from High School and started college.  I was considered an adult.  I was 18 and old enough to join the military.  Even will all of the new found responsibility and freedom, I didn’t feel like an adult until I was no longer a dependant on my parent’s medical coverage.  For some reason, that was when I started to feel all grown up…and completely out of my league.

Here is some important and basic information about medical coverage that can make your transition from dependant to independent a little easier to understand.  Allied Health can be comprehensive and easy to understand.

Basically healthcare is divided into basic and extra coverage.  Basic coverage includes services like preventive care, diagnostic tests, hospital care, extended care, emergency care, home health care and prescription drugs.  Bascially, basic coverage offers everything you would generally need covered for routine medical care.  Extra coverage includes dental care, vision care, drug and alcohol abuse treatment, chiropractic care and mental health care.  As you can see, extra coverage allows for some of the perks that healthcare offers but are not necessarily necessary.

In most instances you can choose the type of coverage you need.  Most people chose a healthcare coverage that has an affordable premium.  The broader and more extensive the coverage, the more expensive the premium cost will be.  Many people, especially struggling college students will forgo the extra coverage to maintain an affordable premium.

When choosing a medical policy, here are a few things to consider:

-Which policy offers basic medical coverage?

-Does your family history warrant your need for additional coverage due to an inherited disease or condition that is not covered under a basic medical insurance policy?

-If you are expecting to need additional family coverage for in the near future, then you should consider a policy that covers your spouse, maternity care and children.

It is always best to choose a policy that can provide for all of your basic needs.  The extra coverage is a bonus but can be sacrificed if necessary.  I consider dental coverage to be a necessity though and would never pass on the opportunity to add that to my healthcare policy.

Is Your Healthcare Policy A Good Value?

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Posted on 20th December 2010 by admin in Uncategorized

I know many people who do not have healthcare insurance.  Most do not think that the insurance is worth the cost of the monthly premium.  Before you cancel your policy or give up on considering a healthcare policy, there are a few questions you should ask yourself about the costs and benefits of health insurance for yourself.

The best place to start a personal assessment of your need for health insurances is by assessing your past medical history.  Some people hardly ever get sick and rarely see a doctor.  Others may experience chronic illnesses that require frequent doctor’s visits, medical tests, and possibly hospitalization and therapy.

If you are either extreme than you can assume that the less see a doctor the less likely you need medical insurance and the more you see the doctor the more you should have medical insurance.  This is primarily because frequent visits can become costly and you will likely have bills greater than your medical premium.  Keep in mind that physician’s charge higher rates to patients who are not insured.

Next, consider the types of illnesses you are at risk of contracting.  Your family medical history can provide a window into the illnesses that you may be most susceptible to getting.  Your personal habits, work environment, and previous medical history will affect your future health.  If you are a smoker, you increase your chance of getting cancer or emphysmeia and should consider having medical insurance as you get older.

It is wise to compare your actual health care costs with the projected costs identified from potential future illnesses.  If you determine the annual medical cost of caring for those illnesses and take into consideration the increase in annual fees, you can determine if acquiring healthcare coverage is a benefit worth the cost.

Pharmacology: How Antibiotics Work

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Posted on 17th December 2010 by admin in Uncategorized

I don’t know anyone who has not taken an antibiotic before.  These days, antibiotics are given out like candy by doctors.  My previous physician would prescribe me an antibiotic for everything that seems to ail me.  It became a little disconcerting and I eventually looked for a doctor who believed in dispensing antibiotics sparingly.  Pharmacology is the allied health field in charge of creating the antibiotics that are made available to the general public, and the industry is regulated by the F.D.A.

Antibiotics are designed to kill bacteria in different ways.  Penicillin is used to disrupt the building of cell walls in certain bacteria.  Bacteria do their best to build strong walls around their cells.  These walls are able to protect them from harmful chemicals and salts.  If the cell walls are not permitted to form completely, the bacteria will eventually break open and die when introduced to harmful chemicals.  Other antibiotics are designed to interfere with the ability of particular bacteria to produce proteins they need to grow or work on the mechanisms of a bacteria in other ways.

Not every antibiotic will affect all bacteria in the same way.  Penicillin is highly effective against Staphylococcus but not against E. coli.  However, there are different antibiotics that can counter E. coli.  There is a list of antibiotics that are effective against bacteria.  This list is referred to as the “spectrum activity.”  A broad-spectrum antibiotic can kill many different bacteria.  So far though, no one antibiotic has been found to be effective against all bacteria.

There are possible side effects when using an antibiotic.  All yeasts in the body are not affected by antibiotics.  When the antibiotic kills off most of the bacteria in the body- both the good and the bad- there is no competition left for the yeast.  This gives the yeast the opportunity to grow and thrive changing the microflora balance.

Some common side effects of antibiotic use include:

-Diarrhea, due to the overgrowth of the Clostridia difficile

-Vaginal yeast infections, caused by Candida

-Oral thrush, caused when Candida infects the mucous membranes of the mouth

Medical Billing and Coding: Following up On an Insurance Claim

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Posted on 16th December 2010 by admin in Uncategorized

Considering the large number of claims that are filed with insurance companies by medical practices or healthcare facilities every day, it is important that medical insurance specialists are able to keep track of the status of each claim that they submit.

Ideally, an insurer will respond within 14 days from the date that the claim is filed.  The medical insurance specialist should allow this 14 day window before calling the insurer for status of the claim.  On the 15th day, if there is no response from the insurer, the medical insurance specialist should call the insurer to verify claim was received and what stage of the process it is in.

Medical insurance specialists can benefit greatly by learning and becoming familiar with the insurer’s policies and schedules for processing claims.  By understanding the process, its stages, and requirements medical insurance specialists are able to learn shortcuts through the system that can help them to speed up the reimbursement time.

A remittance advice is the summary of the claims submitted by the healthcare provider to the insurer.  The remittance advice summarizes the claims into groups by healthcare provider.  Several patient claims can be listed for a single healthcare provider.  This can be confusing especially when reimbursements are lumped together into one check.  Each remittance advice should be carefully looked over and compared with the claims submitted by the healthcare provider to the insurer.

An explanation for each claim will appear on the remittance advice summary.  Explanations are made for every partially reimbursed or denied claim.

The Infant Sucking Reflex

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Posted on 10th December 2010 by admin in Uncategorized

Thank goodness infants are born with several feeding reflexes.  Have you ever considered how difficult it would be to try and teach a newborn how to latch onto a nipple and suck out the milk?  I can’t even describe the action of this process adequately to adults let alone a brand new baby.  Fortunately, the ability to feed is instinctive and the reflex to suck is especially strong in infants.

The sucking reflex is the automatic process an infant performs to draw out milk from a bottle or breast.  It is first observed in utero as early as 15 to 18 weeks gestation.  Preterm babies born before 34 to 35 weeks gestational age have a harder time sustaining an effective feeding for long periods of time.  Preterm infants are especially susceptible to becoming fatigued and may need to be admitted into a hospital due to poor feeding.

Infants with a weak sucking reflex should be monitored closely to ensure that they are growing adequately.  An infant may need to supplement feedings with additional milk, preferably the mother’s pumped hindmilk.

A weak sucking reflex might indicate an immature central nervous system, prematurity, delayed maturation, harm caused by insults to the prenatal central nervous, or systemic congenital problems.

Most infants have an overwhelming need to suck on something regardless of hunger.  Babies who are not hungry will continue to eat just to satisfy their desire to suck and usually spit up whatever can not fit into the stomach.  A pacifier, a clean finger or baby’s own hand are good alternatives to the breast or bottle when the baby is not hungry.

Medical Billing and Coding: Inpatient Billing Guidelines

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Posted on 9th December 2010 by admin in Uncategorized

Inpatient care is billed according to the services given.  Each service has its own fee and each charge is designated on the UB-92 from or in the diagnosis section of the HIPAA X12 837.

Several services can appear on the same claim form.  How this commonly works is the physician will visit the patient once when admitted, once each day that the patient is in the hospital or care facility and on the last day to discharge the patient.  Each visit has a separate charge and can appear on the same claims form.

Medical insurers only allow one visit from a physician on the same day unless there is a medical necessity.  If a more than one physician visits the same patient on the same day, usually only the first visit is covered by medical insurance.

Medical insurers will cover the costs of additional examinations from more than one physician on the same day as long as the primary physician requests the additional review. The purpose of additional visits must be described on each claim.

Medical insurers often require supportive documentation for inpatient claims. The insurer will want to ensure the patient’s diagnosis and the necessity of the procedures performed by the healthcare provider.  Medical reports and notes pertaining to the patient’s condition as well as preformed procedures should be included.  The healthcare provider is often asked to include a letter describing the patient’s condition, treatment and explanation for any extended hospital stay.

To prepare an inpatient claim, the medical billing and coding must identify the proper diagnosis codes that provide the greatest detail about the diagnosis.

Breast Feeding Can Prevent Major Health Care Risks

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Posted on 8th December 2010 by admin in Uncategorized

Breastfeeding is good for mother’s and babies.  There are many important benefits in the short and long term for both mother and child.  So, before you opt for formula and bottles, consider the benefits that nursing can have for you and your baby’s health.  I learned this at Midwife F.A.Q.

I can’t think of any parent who would want their child to have health problems.  One of the best ways of helping to prevent potential health care risks is by breastfeeding for at least nine months.  Of course, nursing for the first twelve months is ideal for baby.  Respiratory infections are reduced for children up to 7 years of age if they are breastfed for at least 15 weeks.  Parents with a family history of asthma should seriously consider mother’s milk exclusively for the first 15 weeks.

Babies that are breast fed have fewer incidences of dental caries compared to babies that are bottle fed.  Also, adults who were breast fed may have better cholesterol levels as adults.  Type 2 diabetes in adults may be reduced if the adult was exclusively breastfed for at least two months.

Mothers who breast feed reduce their risk for breast and ovarian cancer during the pre-menopausal period.  Hip fractures and osteoporosis are also reduced during the post-menopausal period as well as the risk of type 2 diabetes to young and middle-aged women who have lactated.

Breast feeding definitely provides many health benefits to mother and child and should be considered over artificial formulas if the opportunity to breastfeed is exists.

Abnormal Anatomy of an Infant’s Oral Cavity

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Posted on 7th December 2010 by admin in Uncategorized

An infant’s ability to breast feed properly and effectively is greatly influenced by the anatomy of the mouth.  The muscles of the face, neck and trunk can affect feeding.  In some instances of oral anatomy, maturation and growth can change the oral anatomy.  If these changes do not occur on their own, oral surgery may be able to correct any problems.

Weak lip tone is the lips inability to seal around the breast.  The amount of suction can be impaired by this abnormaliy.  This can make feeding more challenging, inefficient and tiring for the infant.  Under these circumstances, an infant is likely to reduce his intake.

A weak lip seal can cause breast milk to be lost during a feeding.  Premature infants or infants with muscular weakness or illness may have low muscle tone or weakness that can create stamina deficits.  These deficits eventually impair the infant’s ability to maintain a lip seal.  It is best to observe an entire feeding to determine if a weak lip seal is present.  Stamina related problems may occur at the latter end of a feeding.

Excessive lip tone occurs when the infant uses excessive reliance on lip activity to hold the breast in the mouth.  This may be the result of a neurological abnormality, or a sign of an injury to the tongue jaws or facial nerves.

Cleft lip is a common congenital mid-line defect that can sometimes be repaired surgically in early postpartum.  It does not significantly interfere with breastfeeding.

Nursing: Get a Strong Foundation

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Posted on 6th December 2010 by admin in Uncategorized

Once you have a strong foundation of experience in basic nursing care for adults, you can branch out into more specialized care, and you will have more options to go anywhere in your career.  You will always have the confidence that you have developed skills and seen and done a wide variety of procedures successfully.  If you don’t have this opportunity, opt for the most general experience you can get in your area.  Mo matter how much experience you may have gained in school, a good solid foundation as a generalist will give you the tools to build your career in any area of nursing.  This is important to consider when studying how to become a nurse.

One of the reasons most nurses leave nursing is because of burnout and feeling trapped with nowhere to go because they are so specialized and making a change would take too much re-education.  This seems to be true for those wishing to move from something like pediatrics into adult care.

A general background will give yo both the experience and the credibility to be able to move literally and to move upward.  The additional advantage is that even after a long career in a high specialized area, most nurses with a strong generalist foundation will find the courage to move into a whole new realm much more often that those who headed straight to their specialty area after graduation and stayed there for ten years.  These nurses tend to feel trapped because they have been pigeonholed and don’t have a general background to fall back on.  The nurse with the general med-surgical background has many opportunities to move directly out of the hospital into areas such as clinics, home health, and case management.  With some additional training or an internship in a specialized area, nurses can move into a multitude of areas such as; ICU, pediatrics, rehab, oncology, women’s health and clinical trials.

Anticoagulants: What are They?

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Posted on 3rd December 2010 by admin in Uncategorized

Anticoagulants are often prescribed to people who have medical conditions that require assistance in preventing blood from clotting.  Conditions that cause excessive clotting like leg or lung clots, irregular heart rhythm, artificial heart valves and blood clots in the heart often require the use of anticoagulants.  This blog and others may interest you if you are attempting to get your strength and conditioning certification.

There are two ways that an anticoagulant can prevent blood from clotting.  An anticoagulant can bind or precipitate calcium so that it is unavailable to the coagulation process.  It can also inhibit the formation of thrombin, which is needed to convert fibrinogen into fibrin during the coagulation process.

The most common anticoagulants are ethylenediaminetetraacetic acid (EDTA), citrates, heparin and oxalates.

EDTA prevents coagulation by binding to calcium.  It is used to preserve cell morphology and inhibits platelet clumping.  EDTA is often used to provide whole blood specimens for hemotology tests and is also increasingly being used in blood banks.  Blood specimens should be mixed with EDTA immediately after collection to prevent platelet clumping.

Citrates also prevent coagulation from occurring by binding to calcium.  Sodium citrate is most often used because it is effective at preserving the coagulation factors.

Heparin prevents thrombin formation in the blood.  The enzyme thrombin is necessary to convert fibrinogen into fibrin for clot formation.  When heparin is mixed immediately upon collection it prevents clot formation and fibrin from being created.

Oxalates precipitate calcium in the blood preventing coagulation.  Potassium oxalate is the most widely used.  Oxalate tubes should be filled to the stated capacity.  Excess oxalate can destroy the red blood cells and release hemoglobin into the plasma.