Types of Social Security Disability Benefits
The Social Security Administration has established a number of different types of disability programs. Although the medical rules are similar under each program, the technical rules on eligibility set each program apart. What program you may be eligible for depends on a number of factors, including your work history, age, household income and marital status. You may be eligible for more than one type of benefits, but generally SSA will pay you the higher benefit amount of any one program you may be entitled to.
Disability Insurance Benefits: This program, also known as "DIB" or Title II benefits, awards benefits to individuals who, because of a physical or mental impairment, are unable to work at a "substantial" gainful level, and their condition has existed or is expected to exist for at least a 12 month period. By "substantial," SSA means the claimant would be unable to earn over $900.00 per month because of their disability. This dollar amount increases slightly every year. To be eligible for DIB, a claimant must have worked long enough and paid enough into Social Security through their FICA taxes to be "insured." As a general rule, if a claimant worked at least five of the last 10 years, he would be "insured" for purposes of DIB. How much a claimant receives each month if found disabled and entitled to DIB is based on how much he "paid into" the system during his working life. Generally, the longer someone has worked and the higher his earnings, the more he would be paid if found disabled. Individuals found disabled and entitled to DIB benefits may be awarded retroactive benefits. Retroactive benefits can only go back one year from the date of the initial application. There is a five-month waiting period from the date the claimant is determined to be disabled until entitlement to DIB benefits begin. To illustrate this, if a claimant files a claim for DIB on January 1, 2006 alleging disability as of February 2005, and SSA determines he is disabled and his disability began February 1, 2005, he would be eligible for retroactive benefits starting in July 2005. In addition to receiving individual DIB benefits, your minor children may also qualify for auxiliary benefits based on your disability. These benefits are granted in addition to any benefit you receive. To ensure any minor children are awarded any benefits they may be entitled to, it is important you furnish the names and Social Security numbers of any minor children you have to SSA. The children do not have to live in the same household to be eligible for auxiliary benefits.
Supplemental Security Income: This program, also known as SSI or Title 16 benefits, is a "needs-based" program in which individuals with little or no resources or assets may receive disability benefits. The medical criteria for SSI eligibility is the same as that used for DIB - a physical or mental impairment which prevents you from working at a "substantial" gainful level, and the condition has existed or is expected to exist for at least a 12 month period. Effective January 2007 the SSI payment for an eligible individual is $623 per month and $934 per month for an eligible couple. There is no retroactive eligibility for SSI benefits: benefits can go back only to the month in which your claim was filed. Unlike DIB, there is no five-month waiting period for entitlement to SSI, so your eligibility would begin the month in which you filed your claim or were determined to be disabled, whichever is later. A claim for SSI benefits can also be filed on behalf of any minor children with a disability; however, as with Adult SSI claims, to be entitled to SSI benefits the household income must be below certain limits.
Disabled Adult Child: This program provides disability benefits to adult children of deceased or disabled parents. In addition to the medical requirement that you have a physical or mental impairment which prevents you from working at a "substantial" gainful level, and the condition has existed or is expected to exist for at least a 12 month period, you must also show that your condition has existed and has been disabling since before your 22nd birth date. In addition, you must be the adult child of a parent who is currently receiving DIB benefits, or the Adult child of a parent who is deceased and was "insured" for purposes of eligibility for DIB benefits. It is not necessary that the adult child ever worked because benefits are paid on the parent's earnings record. The adult child must not have worked and earned "substantial earnings" for an extended period at any point after turning 22; however, certain expenses the adult child incurs in order to work may be excluded from these earnings. An adult child already receiving SSI benefits should check to see if benefits may be payable on a parent's earnings record. Higher benefits might be payable and entitlement to Medicare may be possible.
Disabled Widow's/Widower's Benefits: If you are a disabled widow or widower age 50 or older you may be able to receive benefits off your spouse's (or former spouse's) Social Security record. If you are a widow or widower from a spouse you were divorced from, to be eligible for benefits you need to have been married to your spouse for 10 years or longer and your disability must have started before age 60 and within seven years of the date in which the worker died. If you were married to your spouse when they passed away, Social Security does not require that you were married for 10 years. In either case, you will need to provide proof of relationship in the form of your marriage certificate or divorce decree, along with your spouse's death certificate when you file for benefits. If you file a claim for Disabled Widows/Widower's benefits and DIB or SSI benefits, you will receive only the higher monthly benefit amount of the two programs.
Medical Insurance: Once you are found disabled and entitled to Social Security disability benefits, you will also be eligible for medical insurance though Medicare or Medicaid. If you filed a claim for DIB, Disabled Adult Child or Disabled Widow's/Widower's benefits, you may be eligible for Medicare. However, eligibility for Medicare does not start until you have been disabled for 25 months. If you are approved for Social Security benefits under any of the above-listed programs, SSA will contact you approximately two months before your eligibility for Medicare begins. If you have already been disabled for 25 months, be sure to keep a record of all medical bills as you may be reimbursed by Medicare for these expenses. There is no waiting period for Medicaid; however, your income and resources must be very low to qualify. If you have applied for and have been approved for SSI you probably qualify for Medicaid. You may think that Medicaid and Medicare are the same, but actually they are two different programs. Medicaid is a state-run program that provides hospital and medical coverage for people with low income and little or no resources. Each state has its own rules about who is eligible and what is covered under Medicaid. Some people qualify for both Medicare and Medicaid. For more information about the Medicaid program, contact Social Security or your local social services or welfare office.
This article has been written to give you a general overview of the Social Security disability programs and the disability process. As this article may not address all questions you might have, please contact us for further information.
Article Source: http://EzineArticles.com/?expert=James_Greeman
Tuesday, October 21, 2008
How is an Attorney Paid For Social Security Disability Claims?
Attorneys who represent Social Security disability claimants generally do so under a "contingency fee agreement." That is, the client does not pay the attorney unless and until the case is resolved and Social Security benefits have been awarded. A representative who wants to charge or collect a fee from a claimant for services provided in any proceeding before the Social Security Administration (SSA) under the Social Security Act (the Act), must first obtain SSA's authorization. To do so, a representative must use one of two mutually exclusive fee authorization processes: the fee agreement process or the fee petition process. Under the fee agreement process, an attorney can collect no more than 25% of of back benefits recovered, or $5,300, whichever is less. If the attorney is unsuccessful in obtaining benefits, there is no charge.
Fee Agreement Process Before SSA decides the claim, the representative or the claimant may file a fee agreement. Generally, SSA will approve an agreement (under § 206(a)(2)(A) of the Act) if the other statutory conditions are met and no exceptions apply. If SSA approves the fee agreement and no one requests administrative review, the fee specified in the agreement is the maximum fee the representative may charge and collect.
Fee Petition Process After the representative's services in the case have ended, he or she may petition for a fee. SSA reviews the fee petition and authorizes a "reasonable" fee (under §206(a)(1) of the Act) for the specific services provided.
A fee agreement is a written statement signed by the claimant and his or her appointed representative specifying the fee the representative expects to charge and collect, and the claimant expects to pay, for services the representative provides in pursuing the claimant's benefit rights in proceedings before the Social Security Administration (SSA). For SSA to approve a fee agreement, the representative must submit it before the date of the first favorable determination or decision SSA makes on a claim after the representative's appointment. If the representative does not submit a fee agreement by that date, SSA assumes the representative either will file a fee petition or waive a fee.
If the representative submits a fee agreement before the date SSA makes a favorable decision, SSA will approve the fee agreement at the time of the favorable decision if the statutory conditions for approval are met and no exceptions to the fee agreement process apply. Once SSA approves the fee agreement, the fee specified in the agreement is the maximum fee the representative may charge and collect for all services in the claim.
A fee petition is a written statement signed by a claimant's representative requesting the fee the representative wants to charge and collect for services he or she provided in pursuing the claimant's benefit rights in proceedings before the Social Security Administration (SSA).
SSA presumes that the representative will either file a fee petition or waive his or her fee if the representative does not file a fee agreement before the date SSA makes the first favorable determination or decision. A representative who elects to use the fee petition process generally files the petition after his or her services in the case have ended. Based on this petition, SSA will authorize a reasonable fee for the specific services provided.
The fee agreement and fee petition process are not interchangeable. However, if a representative elects the fee agreement process but SSA does not approve the agreement, or if an SSA reviewing official upholds a disapproval of a fee agreement on administrative review, the representative must file a fee petition if he or she wants to charge and collect a fee for their services.
The Social Security Act and SSA regulations prohibit representatives from charging or collecting any fee for representational services that SSA has not authorized, or that is more than the maximum amount SSA authorized. Any representative found to have charged or collected an unauthorized fee may be suspended or disqualified from practice before SSA and will be barred from appearing before SSA until full restitution is made. The representative also is subject to fines and imprisonment.
Article Source: http://EzineArticles.com/?expert=James_Greeman
Fee Agreement Process Before SSA decides the claim, the representative or the claimant may file a fee agreement. Generally, SSA will approve an agreement (under § 206(a)(2)(A) of the Act) if the other statutory conditions are met and no exceptions apply. If SSA approves the fee agreement and no one requests administrative review, the fee specified in the agreement is the maximum fee the representative may charge and collect.
Fee Petition Process After the representative's services in the case have ended, he or she may petition for a fee. SSA reviews the fee petition and authorizes a "reasonable" fee (under §206(a)(1) of the Act) for the specific services provided.
A fee agreement is a written statement signed by the claimant and his or her appointed representative specifying the fee the representative expects to charge and collect, and the claimant expects to pay, for services the representative provides in pursuing the claimant's benefit rights in proceedings before the Social Security Administration (SSA). For SSA to approve a fee agreement, the representative must submit it before the date of the first favorable determination or decision SSA makes on a claim after the representative's appointment. If the representative does not submit a fee agreement by that date, SSA assumes the representative either will file a fee petition or waive a fee.
If the representative submits a fee agreement before the date SSA makes a favorable decision, SSA will approve the fee agreement at the time of the favorable decision if the statutory conditions for approval are met and no exceptions to the fee agreement process apply. Once SSA approves the fee agreement, the fee specified in the agreement is the maximum fee the representative may charge and collect for all services in the claim.
A fee petition is a written statement signed by a claimant's representative requesting the fee the representative wants to charge and collect for services he or she provided in pursuing the claimant's benefit rights in proceedings before the Social Security Administration (SSA).
SSA presumes that the representative will either file a fee petition or waive his or her fee if the representative does not file a fee agreement before the date SSA makes the first favorable determination or decision. A representative who elects to use the fee petition process generally files the petition after his or her services in the case have ended. Based on this petition, SSA will authorize a reasonable fee for the specific services provided.
The fee agreement and fee petition process are not interchangeable. However, if a representative elects the fee agreement process but SSA does not approve the agreement, or if an SSA reviewing official upholds a disapproval of a fee agreement on administrative review, the representative must file a fee petition if he or she wants to charge and collect a fee for their services.
The Social Security Act and SSA regulations prohibit representatives from charging or collecting any fee for representational services that SSA has not authorized, or that is more than the maximum amount SSA authorized. Any representative found to have charged or collected an unauthorized fee may be suspended or disqualified from practice before SSA and will be barred from appearing before SSA until full restitution is made. The representative also is subject to fines and imprisonment.
Article Source: http://EzineArticles.com/?expert=James_Greeman
Friday, October 17, 2008
The Internet Surfing Heart Device
Technology has proven over time that there is no problem that cannot be overcome given the will to succeed, the time to develop the appropriate knowledge, and the inherent ability for the human mind to imagine. This astonishing component of the human existence has occurred once again in the area of medical treatment.
George Woods, a 73-year-old Canadian man, has received a revolutionary device that will inevitably change the way heart healthcare is handled all over the world. The device is called the Vision 3D and is about the size of a quarter. In order to monitor the heart, it has wires that extend to specific veins and also directly to the heart.
Mr. Woods has suffered from numerous heart attacks and two bypass surgeries. His doctor decided to give him the device because of his week heart and also the long distance that he has to travel to get to the hospital.
What is remarkably unique about the device is that it links to a transmitter about the size of a keyboard. This transmitter is able to download vital information about the patient allowing the doctor to determine what to do for the next visit, or if the patient needs to come in immediately. This unique property allows the patient to do periodic check-ups with the doctor from home.
The doctor is able to even fix very minor issues remotely as well. Medtronic is the company responsible for creating this revolutionary device. The device is not for everyone, as it is recommended for individual with only very serious heart conditions.
Experts anticipates that the device will reduce wait times, the number of hospital visits throughout the year, and will also open up space for very serious and urgent conditions that require extensive medical treatment.
However this milestone could bring about concern for what lies in the future. The ability to access physiological information about an individual remotely and possibly manipulate that physiology has some people worried. Researchers have discovered that these devices are capable of delivering deadly electric shocks to the heart, which means that it could be possible for individuals to commit murder from the click of a mouse.
Even with Medtronic current devices, malfunction has been a problem. These machines are entrusted with lives, and through technical error take them away. If big companies like Medtronic are going to play the game of medical treatment, they must be held accountable for the seriousness of mistakes made.
Article Source: http://EzineArticles.com/?expert=Joseph_Devine
George Woods, a 73-year-old Canadian man, has received a revolutionary device that will inevitably change the way heart healthcare is handled all over the world. The device is called the Vision 3D and is about the size of a quarter. In order to monitor the heart, it has wires that extend to specific veins and also directly to the heart.
Mr. Woods has suffered from numerous heart attacks and two bypass surgeries. His doctor decided to give him the device because of his week heart and also the long distance that he has to travel to get to the hospital.
What is remarkably unique about the device is that it links to a transmitter about the size of a keyboard. This transmitter is able to download vital information about the patient allowing the doctor to determine what to do for the next visit, or if the patient needs to come in immediately. This unique property allows the patient to do periodic check-ups with the doctor from home.
The doctor is able to even fix very minor issues remotely as well. Medtronic is the company responsible for creating this revolutionary device. The device is not for everyone, as it is recommended for individual with only very serious heart conditions.
Experts anticipates that the device will reduce wait times, the number of hospital visits throughout the year, and will also open up space for very serious and urgent conditions that require extensive medical treatment.
However this milestone could bring about concern for what lies in the future. The ability to access physiological information about an individual remotely and possibly manipulate that physiology has some people worried. Researchers have discovered that these devices are capable of delivering deadly electric shocks to the heart, which means that it could be possible for individuals to commit murder from the click of a mouse.
Even with Medtronic current devices, malfunction has been a problem. These machines are entrusted with lives, and through technical error take them away. If big companies like Medtronic are going to play the game of medical treatment, they must be held accountable for the seriousness of mistakes made.
Article Source: http://EzineArticles.com/?expert=Joseph_Devine
Medicare - Dispelling the Myths
To say that Medicare is a labyrinth of legal jargon that's beyond the comprehension of the average American is an understatement. When it comes to Medicare and a Texas Medicare supplement, what you don't know can definitely hurt you. In fact, many people simply don't have the right information to make educated decisions - something that could come to haunt them down the road. Here are some common myths about Medicare, and some facts about finding a Medicare supplement in Texas.
Myth #1: Medicare automatically covers me after I retire.
Retirement and Medicare are unrelated. Unless you receive Medicare for a disability, you must be 65 years old in order to be eligible for Medicare benefits.
Myth #2: The government will automatically enroll me in Medicare.
You won't necessarily receive automatic enrollment; rather, it depends upon your work history. If you've worked 40 quarters in the United States, you'll be automatically enrolled in Medicare Part A. If you started receiving Social Security benefits when you were 62, you'll automatically be enrolled in Part B, but have the option of declining the coverage if you're covered by, for example, a group health plan.
If you haven't worked 40 quarters, you have to enroll in Medicare through your local Social Security office. Similarly, if you aren't collecting Social Security benefits, you have to go to the Social Security office to enroll in Part B.
Myth #3: Medicare will cover all of my medical expenses.
In truth, Medicare Part A covers your room and board while you're in the hospital or in a skilled nursing facility. It doesn't cover any medical services. Plus, there's a $1,000 deductible for the length of your stay in the hospital, plus 60 days. In other words, if you spend a couple of days in the hospital in January, and have to go back in April, you'll have to pay $1,000 each time.
Medicare Part B partially covers services like doctors' fees, lab visits, costs associated with surgery, x-rays, and so forth. Typically, you have to pay a deductible each year, as well as 20 percent of your medical bills. Keep in mind that, if you receive care that is not covered by Medicare, you'll be responsible for 100 percent of the cost.
Myth #4: Medicare Parts C and D will fill in the gaps in my coverage.
Medicare Parts C and D are seemingly even more convoluted than Parts A and B. Part C is optional coverage offered by private insurance companies. In order to get Part C, you have to give up your coverage under Parts A and B. Part D is optional prescription drug coverage that has myriad variables, such as premiums, co-pays, coverage gaps, and co-insurance. You can choose which prescription drug plan best fits your needs.
Finding a Good Medicare Supplement
When you have gaps in your medical insurance, it's as though you're constantly standing on a precipice, never knowing if an illness or hospitalization is going to wipe out your life savings, force you to sell your home, or otherwise wreak havoc on your finances. With the right Medicare supplement in Texas, however, you can fill in the gaps and limit your medical expenses to your cost of Part B, Part D, and the supplement.
Fortunately, it's easy to find the best Texas Medicare supplement for your needs. While calling one insurance company after another and trying to compare apples to oranges can be a nightmare, you can easily go online to find Medicare supplement quotes. The best companies allow you to fill out your information online, and even have agents who can instantly provide you with pricing for the 10 leading companies in the state. This way, you can find the best company and rate for your supplemental plan.
Article Source: http://EzineArticles.com/?expert=Chris_Robertson
Myth #1: Medicare automatically covers me after I retire.
Retirement and Medicare are unrelated. Unless you receive Medicare for a disability, you must be 65 years old in order to be eligible for Medicare benefits.
Myth #2: The government will automatically enroll me in Medicare.
You won't necessarily receive automatic enrollment; rather, it depends upon your work history. If you've worked 40 quarters in the United States, you'll be automatically enrolled in Medicare Part A. If you started receiving Social Security benefits when you were 62, you'll automatically be enrolled in Part B, but have the option of declining the coverage if you're covered by, for example, a group health plan.
If you haven't worked 40 quarters, you have to enroll in Medicare through your local Social Security office. Similarly, if you aren't collecting Social Security benefits, you have to go to the Social Security office to enroll in Part B.
Myth #3: Medicare will cover all of my medical expenses.
In truth, Medicare Part A covers your room and board while you're in the hospital or in a skilled nursing facility. It doesn't cover any medical services. Plus, there's a $1,000 deductible for the length of your stay in the hospital, plus 60 days. In other words, if you spend a couple of days in the hospital in January, and have to go back in April, you'll have to pay $1,000 each time.
Medicare Part B partially covers services like doctors' fees, lab visits, costs associated with surgery, x-rays, and so forth. Typically, you have to pay a deductible each year, as well as 20 percent of your medical bills. Keep in mind that, if you receive care that is not covered by Medicare, you'll be responsible for 100 percent of the cost.
Myth #4: Medicare Parts C and D will fill in the gaps in my coverage.
Medicare Parts C and D are seemingly even more convoluted than Parts A and B. Part C is optional coverage offered by private insurance companies. In order to get Part C, you have to give up your coverage under Parts A and B. Part D is optional prescription drug coverage that has myriad variables, such as premiums, co-pays, coverage gaps, and co-insurance. You can choose which prescription drug plan best fits your needs.
Finding a Good Medicare Supplement
When you have gaps in your medical insurance, it's as though you're constantly standing on a precipice, never knowing if an illness or hospitalization is going to wipe out your life savings, force you to sell your home, or otherwise wreak havoc on your finances. With the right Medicare supplement in Texas, however, you can fill in the gaps and limit your medical expenses to your cost of Part B, Part D, and the supplement.
Fortunately, it's easy to find the best Texas Medicare supplement for your needs. While calling one insurance company after another and trying to compare apples to oranges can be a nightmare, you can easily go online to find Medicare supplement quotes. The best companies allow you to fill out your information online, and even have agents who can instantly provide you with pricing for the 10 leading companies in the state. This way, you can find the best company and rate for your supplemental plan.
Article Source: http://EzineArticles.com/?expert=Chris_Robertson
Arthroscopic Shoulder Treatment in India - Get It
Indian orthopedic surgery hospitals provide very good treatment facilities to abroad patients for their arthroscopic shoulder treatment in India. Arthroscopic shoulder surgery is most advanced surgical technique available for the treatment of shoulder disorders. As the surgical technique is performed by most expert surgeons of India, the risk involved in the process is very less and the success rate of shoulder surgery in India is also very high. Thus many abroad patients are getting attracted to India for their treatment in India at low cost. The cost of treatment in Indian orthopedic surgery hospitals is very less as compared to the cost of treatment in abroad orthopedic surgery hospitals. Getting arthroscopic shoulder surgery done from Indian orthopedic surgery hospitals has become most adoptable option for abroad patients.
Arthroscopic shoulder surgery is a common orthopedic procedure that is used to diagnose and treat problems in joints. The most common type of arthroscopy is arthroscopic shoulder surgery. Other common arthroscopic surgeries include knee, elbow, wrist, ankle, and hip arthroscopy. Arthroscopic surgery is most commonly performed on the knee and shoulder joints. The reason the knee and shoulder are the most commonly arthroscoped joints is that they are large enough to manipulate the instruments around, and they are amenable to arthroscopic surgery treatments. In technical way, any joint can be arthroscoped. The most common arthroscopic procedures include repairing cartilage and meniscus problems in the knee, and removing inflammation and repairing rotator cuff tears in the shoulder. Shoulder arthroscopy is a surgical procedure for arthroscopic shoulder repair. With this procedure complete disorders of shoulder can be removed. Shoulder arthroscopy is performed through "portals". These are small incisions, generally about half of an inch to an inch long in the skin, are located over particular areas of the joint that the orthopedic surgeon will need to operate upon. Small plastic tubes, called "cannulas" are then inserted into the portals so that instruments can easily be placed in the shoulder joint. Shoulder arthroscopy itself involves inserting a specially designed video camera with a very bright fiber optic light source into the shoulder joint so that the important parts of the joint can be seen. Once the procedure is finished, the instruments, camera, and cannulas are removed, the wounds are closed with either suture or staples. Shoulder arthroscopy is an advanced surgical procedure for the correction of shoulder disorders and highly result oriented surgery. The success rate of shoulder arthroscopy is very high worldwide and the recovery time after the surgery is very less as compared to other surgical procedures as the surgical technique is most advanced.
Arthroscopic shoulder treatment in India is a very good option nowadays for those abroad patients seeking low cost shoulder arthroscopy. With arthroscopic shoulder treatment in India patients can get free from shoulder disorders at the most affordable price. The success rate of arthroscopic shoulder treatment in India is very high as the surgical procedure is performed by most expert arthroscopic surgeons of India. The surgical technique available for the treatment of shoulder disorders are most advanced thus the risk involved in the process is reduced and the recovery time required after the surgery is very less. The cost of treatment in Indian orthopedic surgery hospitals is very less as compared to the cost of arthroscopic shoulder surgery in abroad orthopedic surgery hospitals. Thus many abroad patients are getting attracted to India for their low cost treatment.
Article Source: http://EzineArticles.com/?expert=Ravi_Jeswani
Arthroscopic shoulder surgery is a common orthopedic procedure that is used to diagnose and treat problems in joints. The most common type of arthroscopy is arthroscopic shoulder surgery. Other common arthroscopic surgeries include knee, elbow, wrist, ankle, and hip arthroscopy. Arthroscopic surgery is most commonly performed on the knee and shoulder joints. The reason the knee and shoulder are the most commonly arthroscoped joints is that they are large enough to manipulate the instruments around, and they are amenable to arthroscopic surgery treatments. In technical way, any joint can be arthroscoped. The most common arthroscopic procedures include repairing cartilage and meniscus problems in the knee, and removing inflammation and repairing rotator cuff tears in the shoulder. Shoulder arthroscopy is a surgical procedure for arthroscopic shoulder repair. With this procedure complete disorders of shoulder can be removed. Shoulder arthroscopy is performed through "portals". These are small incisions, generally about half of an inch to an inch long in the skin, are located over particular areas of the joint that the orthopedic surgeon will need to operate upon. Small plastic tubes, called "cannulas" are then inserted into the portals so that instruments can easily be placed in the shoulder joint. Shoulder arthroscopy itself involves inserting a specially designed video camera with a very bright fiber optic light source into the shoulder joint so that the important parts of the joint can be seen. Once the procedure is finished, the instruments, camera, and cannulas are removed, the wounds are closed with either suture or staples. Shoulder arthroscopy is an advanced surgical procedure for the correction of shoulder disorders and highly result oriented surgery. The success rate of shoulder arthroscopy is very high worldwide and the recovery time after the surgery is very less as compared to other surgical procedures as the surgical technique is most advanced.
Arthroscopic shoulder treatment in India is a very good option nowadays for those abroad patients seeking low cost shoulder arthroscopy. With arthroscopic shoulder treatment in India patients can get free from shoulder disorders at the most affordable price. The success rate of arthroscopic shoulder treatment in India is very high as the surgical procedure is performed by most expert arthroscopic surgeons of India. The surgical technique available for the treatment of shoulder disorders are most advanced thus the risk involved in the process is reduced and the recovery time required after the surgery is very less. The cost of treatment in Indian orthopedic surgery hospitals is very less as compared to the cost of arthroscopic shoulder surgery in abroad orthopedic surgery hospitals. Thus many abroad patients are getting attracted to India for their low cost treatment.
Article Source: http://EzineArticles.com/?expert=Ravi_Jeswani
Tuesday, October 14, 2008
Why Should Health Care Be Affordable?
Access to proper health care has become a major problem in the contemporary America. Millions of people, insured or uninsured, are facing escalating medication costs. This pathetic condition affects not only the health of the individuals' but also the economy and quality of the life. A drastic rise in the health care premiums over the past decade has made health insurance not affordable for many families and has resulted in the increase of the percentage of the people who are uninsured. The number of people who are uninsured has mounted to over 47 millions in the past few years. Overall, in simpler terms, we can say that the reason why people are uninsured is because they cannot afford it.
Many people, today, are in a kind of a situation where one medical emergency can bring in financial ruin and this is mainly because of the expensive health care costs and the prescriptive medicines which take a largest share of their pocket. This situation calls for grave measures that have to be taken in providing affordable health care to everyone. In fact, it is not only the responsibility of the government but is the duty of everyone right from organizations to individuals to work together in making health care affordable to everyone.
With a motive of making health care affordable to all, some companies started offering plans that allows one save up to 80% on the medical bills. Providing huge discounts on the bills will definitely reduce the burden on the individuals.
Article Source: http://EzineArticles.com/?expert=Nithya_Srp
Many people, today, are in a kind of a situation where one medical emergency can bring in financial ruin and this is mainly because of the expensive health care costs and the prescriptive medicines which take a largest share of their pocket. This situation calls for grave measures that have to be taken in providing affordable health care to everyone. In fact, it is not only the responsibility of the government but is the duty of everyone right from organizations to individuals to work together in making health care affordable to everyone.
With a motive of making health care affordable to all, some companies started offering plans that allows one save up to 80% on the medical bills. Providing huge discounts on the bills will definitely reduce the burden on the individuals.
Article Source: http://EzineArticles.com/?expert=Nithya_Srp
Hospital Acquired Conditions and Your Health System's Bottom Line
The current Medicare payment system is considered to be prospective, in that the amount paid to a hospital for a patient is fixed in advance and depends only on the diagnoses and major procedures reported at discharge. In reality, payments under this system have never been completely prospective, being influenced to some degree by what happens to an individual patient during a hospitalization. For example, higher payments are made on behalf of patients in whom clinically significant complications develop after admission than for those with the same diagnosis who have no such complications. There are also so-called outlier payments that partially compensate hospitals for the additional expenses incurred for very-high-cost cases. With regard to preventable complications, these retrospective features of the DRG payment system have harbored a perverse incentive: hospitals that improved patient safety and eliminated problems such as nosocomial infections saw their Medicare revenues, and sometimes their profits, reduced.
Believing that this counterproductive incentive should be eliminated, Congress instructed the Secretary of Health and Human Services in 2005 to "select at least 2 conditions that are (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines." After issuing a proposed set of measures and considering comments from stakeholders and experts, CMS decided to disallow incremental payments associated with eleven secondary conditions that it sees as preventable complications of medical care. These conditions, if not present at the time of admission, will no longer be taken into account in calculating payments to hospitals after October1, 2008.
The eleven selected conditions include:
1. Foreign Object Retained After Surgery (750 cases nationally in 2007)
2. Air Embolism (57 cases)
3. Blood Incompatibility (24 cases)
4. Stage III and IV Pressure Ulcers (257,412 cases)
5. Falls and Trauma (193,566 cases)
6. Catheter-Associated Urinary Tract Infection (12,815 cases)
7. Vascular Catheter-Associate Infection (29,536 cases)
8. Surgical Site Infection-Mediastinitis after Coronary Artery Bypass Graft (69cases)
9. Surgical site infections following elective procedures
10. Glycemic Control issues such as diabetic ketoacidosis, nonketotic hyperosmolar coma, diabetic coma, and hypoglycemic coma (16,060 cases)
11. Deep Vein Thrombosis / Pulmonary Embolism (140,010 cases)
While the new reimbursement rules present significant risk to hospitals and health systems, they also create great opportunity to develop world class quality management processes, infrastructure, and organization.
Significant Financial Impact
The new rule will result in hospitals seeing substantial reductions in payment for the care of individual patients with preventable complications. For example, if a patient were admitted to a Boston-area hospital with pneumonia and developed a urinary tract infection or bed sores during the hospitalization, the hospital would currently be paid $6,253.58, under DRG 89 ("pneumonia with complications"); under the new rule, if there were no other complications, the hospital would be paid only $3,705.38, under DRG 90 ("simple pneumonia"), a difference of $2,548.20 (a reduction of approximately 40%).
A study of the reimbursement impact on nosocomial urinary tract infections alone at one New York hospital was reported in AHIMA Perspectives online journal. The urinary tract remains a significant site for hospital-acquired infections, with 66 percent to 86 percent of UTIs being associated with urinary catheterization. The prevention of UTIs represents a potentially rich opportunity to reduce the incidence of hospital-acquired infections. Analysis of w/CC vs. without CC DRG-pair reimbursement for patients having a secondary diagnosis of UTI, and under the assumption that the UTI was the reason for upcoding to the with complication DRG, resulted in the hospital receiving $4.5 million greater reimbursement due to the nosocomial infection. Three DRGs were randomly selected for detailed chart review, and within that subset it was determined that the nosocomial infection was the sole reason for about 15% of the higher DRG assignment. Extrapolation of this to the entire population resulted in an estimation that the hospital would have received $675,000 less in Medicare reimbursement for the UTI issue alone.
Vascular catheter associated infection represents another major area of risk for hospitals. A significant number of patients rely on vascular access devices, like PICC lines, to deliver needed medication. The line has to be placed and maintained in a specific manner, or it has a potential to cause a catheter-related bloodstream infection (CRBSI.) CRBSI, along with ventilator-associated pneumonia (which CMS is considering adding to the selected conditions list for FY2009), are the two most costly infections to treat. Analysis in one Midwestern hospital identified that the average cost to treat a CRBSI was $91,000, whereas the average reimbursement was about $67,000; an operational loss of $24,000. As of Oct. 1, 2008, reimbursement will be zero. The CDC estimates 250,000 central line-associated infections occur in the United States annually, with an attributable mortality rate of 12 to 25 percent.
This reimbursement change represents the leading edge of a series of anticipated CMS reforms of provider payment, which include a shift toward pay for performance. Hospitals may therefore view the new policy as a harbinger of things to come and act in anticipation of more substantial reimbursement changes. Nine additional HACs are being considered for addition to the reimbursement exclusions in October, and 43 additional are being considered for implementation in FY 2010. Finally, as was observed with the DRG reimbursement system, private third party payers will be expected to adopt a similar approach.
Proactive Solutions
Just as advent of the Prospective Payment System revolutionized hospital Cost Management in the two decades ago, pay for performance will revolutionize hospital Quality Management over the next decade. To prepare your health system for this change in the game, we recommend you take the following steps:
* Assess your Health System Quality Management Readiness. Evaluate how your Health System stacks up in the five Critical Markers of quality management effectiveness: Strategy, Process, Infrastructure, Organization and Culture. Identify Gaps and corrective strategies.
* Estimate the impact on your Hospital or Health System. Using macro data analysis and chart sampling estimate your risk exposure by major diagnostic category and HAC.
* Identify the Gaps. Identify major problem areas and identify the required metrics, clinical and process improvements, available technology enablers, and organizational enhancements required to significantly reduce your risk exposure.
* Design the Fix. Assemble multidisciplinary process improvement teams to develop effective Present on Admission (POA) assessment processes, address the root cause of quality gaps leading to hospital acquired conditions, and to design innovative sustainable solutions.
* Implement the Fix. Test and refine the designed solutions in innovation labs and adopt a Quality Accelerator approach to integrating the solutions into the fabric of your health system.
* Measure the Results. Design and implement monitoring systems that measure the effectiveness of your efforts and provide closed loop feedback to ongoing quality management activity.
When healthcare quality is high, everything else follows. Patients are delighted. Physicians and employees are happy, efficient and effective. Market share rises. Margins increase. Your organization grows and thrives.
Scott Hodson is a Principal in Maverick Healthcare Consulting.
Article Source: http://EzineArticles.com/?expert=Scott_Hodson
Believing that this counterproductive incentive should be eliminated, Congress instructed the Secretary of Health and Human Services in 2005 to "select at least 2 conditions that are (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines." After issuing a proposed set of measures and considering comments from stakeholders and experts, CMS decided to disallow incremental payments associated with eleven secondary conditions that it sees as preventable complications of medical care. These conditions, if not present at the time of admission, will no longer be taken into account in calculating payments to hospitals after October1, 2008.
The eleven selected conditions include:
1. Foreign Object Retained After Surgery (750 cases nationally in 2007)
2. Air Embolism (57 cases)
3. Blood Incompatibility (24 cases)
4. Stage III and IV Pressure Ulcers (257,412 cases)
5. Falls and Trauma (193,566 cases)
6. Catheter-Associated Urinary Tract Infection (12,815 cases)
7. Vascular Catheter-Associate Infection (29,536 cases)
8. Surgical Site Infection-Mediastinitis after Coronary Artery Bypass Graft (69cases)
9. Surgical site infections following elective procedures
10. Glycemic Control issues such as diabetic ketoacidosis, nonketotic hyperosmolar coma, diabetic coma, and hypoglycemic coma (16,060 cases)
11. Deep Vein Thrombosis / Pulmonary Embolism (140,010 cases)
While the new reimbursement rules present significant risk to hospitals and health systems, they also create great opportunity to develop world class quality management processes, infrastructure, and organization.
Significant Financial Impact
The new rule will result in hospitals seeing substantial reductions in payment for the care of individual patients with preventable complications. For example, if a patient were admitted to a Boston-area hospital with pneumonia and developed a urinary tract infection or bed sores during the hospitalization, the hospital would currently be paid $6,253.58, under DRG 89 ("pneumonia with complications"); under the new rule, if there were no other complications, the hospital would be paid only $3,705.38, under DRG 90 ("simple pneumonia"), a difference of $2,548.20 (a reduction of approximately 40%).
A study of the reimbursement impact on nosocomial urinary tract infections alone at one New York hospital was reported in AHIMA Perspectives online journal. The urinary tract remains a significant site for hospital-acquired infections, with 66 percent to 86 percent of UTIs being associated with urinary catheterization. The prevention of UTIs represents a potentially rich opportunity to reduce the incidence of hospital-acquired infections. Analysis of w/CC vs. without CC DRG-pair reimbursement for patients having a secondary diagnosis of UTI, and under the assumption that the UTI was the reason for upcoding to the with complication DRG, resulted in the hospital receiving $4.5 million greater reimbursement due to the nosocomial infection. Three DRGs were randomly selected for detailed chart review, and within that subset it was determined that the nosocomial infection was the sole reason for about 15% of the higher DRG assignment. Extrapolation of this to the entire population resulted in an estimation that the hospital would have received $675,000 less in Medicare reimbursement for the UTI issue alone.
Vascular catheter associated infection represents another major area of risk for hospitals. A significant number of patients rely on vascular access devices, like PICC lines, to deliver needed medication. The line has to be placed and maintained in a specific manner, or it has a potential to cause a catheter-related bloodstream infection (CRBSI.) CRBSI, along with ventilator-associated pneumonia (which CMS is considering adding to the selected conditions list for FY2009), are the two most costly infections to treat. Analysis in one Midwestern hospital identified that the average cost to treat a CRBSI was $91,000, whereas the average reimbursement was about $67,000; an operational loss of $24,000. As of Oct. 1, 2008, reimbursement will be zero. The CDC estimates 250,000 central line-associated infections occur in the United States annually, with an attributable mortality rate of 12 to 25 percent.
This reimbursement change represents the leading edge of a series of anticipated CMS reforms of provider payment, which include a shift toward pay for performance. Hospitals may therefore view the new policy as a harbinger of things to come and act in anticipation of more substantial reimbursement changes. Nine additional HACs are being considered for addition to the reimbursement exclusions in October, and 43 additional are being considered for implementation in FY 2010. Finally, as was observed with the DRG reimbursement system, private third party payers will be expected to adopt a similar approach.
Proactive Solutions
Just as advent of the Prospective Payment System revolutionized hospital Cost Management in the two decades ago, pay for performance will revolutionize hospital Quality Management over the next decade. To prepare your health system for this change in the game, we recommend you take the following steps:
* Assess your Health System Quality Management Readiness. Evaluate how your Health System stacks up in the five Critical Markers of quality management effectiveness: Strategy, Process, Infrastructure, Organization and Culture. Identify Gaps and corrective strategies.
* Estimate the impact on your Hospital or Health System. Using macro data analysis and chart sampling estimate your risk exposure by major diagnostic category and HAC.
* Identify the Gaps. Identify major problem areas and identify the required metrics, clinical and process improvements, available technology enablers, and organizational enhancements required to significantly reduce your risk exposure.
* Design the Fix. Assemble multidisciplinary process improvement teams to develop effective Present on Admission (POA) assessment processes, address the root cause of quality gaps leading to hospital acquired conditions, and to design innovative sustainable solutions.
* Implement the Fix. Test and refine the designed solutions in innovation labs and adopt a Quality Accelerator approach to integrating the solutions into the fabric of your health system.
* Measure the Results. Design and implement monitoring systems that measure the effectiveness of your efforts and provide closed loop feedback to ongoing quality management activity.
When healthcare quality is high, everything else follows. Patients are delighted. Physicians and employees are happy, efficient and effective. Market share rises. Margins increase. Your organization grows and thrives.
Scott Hodson is a Principal in Maverick Healthcare Consulting.
Article Source: http://EzineArticles.com/?expert=Scott_Hodson
Subscribe to:
Posts (Atom)
