Akash Desai of the Philadelphia Department of Public Health (PDPH) presented on health insurance premium/cost-sharing assistance at the December 2016 meeting of the Ryan White Planning Council.
Health insurance provides coverage for medical expenses through a network of hospitals. It works by paying premiums on a regular basis, such as monthly or yearly. Then, when hospitalization is needed, the insurance pays covered costs while the policyholder provides identification documents. There are many types of health insurance policies available from both private insurers and government organizations. Purchasing insurance can be done online, through agents, or directly from insurer offices. Factors to consider include the network of covered hospitals and choosing coverage appropriate for one's family or employer's needs. Proper documentation is required both when hospitalizing and filing claims to receive benefits.
This document discusses health insurance options in India, including social health insurance schemes like ESIS and CGHS, voluntary private health insurance, and community-based health insurance (CHI). It notes that while social health insurance covers only a small portion of the population, voluntary insurance plans are often unaffordable for the poor. CHI has potential to improve access and reduce costs for vulnerable groups, but faces challenges in India due to poverty, illiteracy, and lack of institutional support. The government has launched various initiatives over the years, including state-run insurance programs and public-private partnerships, to expand coverage.
Healthcare challenges & solutions in indiakripak93
This document discusses the key challenges facing India's healthcare system and potential solutions. The main challenges are the large burden of infectious and chronic diseases, high maternal and child mortality rates, lack of universal access to healthcare, shortage of resources, and inadequate healthcare financing. Proposed solutions include strengthening public health programs, improving access to healthcare in rural areas, providing incentives for medical professionals to work in underserved areas, leveraging public-private partnerships, and increasing public financing of healthcare.
The document discusses various types of health insurance policies in India. It provides details on individual health insurance, critical illness policies, travel insurance, and personal accident policies. For individual health insurance, it outlines the benefits for individuals, scope and coverage of policies, exclusions, and ancillary benefits like maternity, dental and optical coverage. It also discusses critical illness policies, common illnesses covered, waiting periods, and exclusions. For travel insurance, it summarizes typical healthcare and non-healthcare covers as well as exclusions. Personal accident policies provide compensation for accidental death or disability.
This document provides an overview of health insurance, including definitions of key terms, models of health expenditure, and examples of health insurance systems in different countries. It discusses the history of health insurance beginning in Germany in 1883 and adoption in other countries. It also outlines the traditional model of health insurance focusing on insurers/employers and proposes a more flexible model to serve different populations. Private health insurance is described as having an important role to play in overall healthcare systems by enhancing access and increasing service capacity.
The document discusses hospital information management and hospital information systems. It defines key terms like hospital, information, health information management. It describes the objectives of health information management as acquiring, analyzing and protecting medical information to provide quality patient care. It also discusses how information systems can streamline hospital operations and increase efficiency.
This document outlines the basic steps and requirements for setting up a medical billing project between an India-based operations team and a US-based provider. It includes:
1. Necessary infrastructure for the India team such as medical billing software, servers, phones, and internet access.
2. Details on selecting billing software that can track unpaid claims and customized reporting.
3. The process for insurance enrollment including Medicare, Blue Cross, and Blue Shield.
4. Requirements for provider information needed from the US team.
5. Procedures for transmitting patient data from the US to India team through fax and email.
6. Roles for the India and US teams in claim processing, printing,
This document provides an overview of India's health system, including its historical evolution, key components, goals, and models of health care delivery. It discusses the health system at the central, state, and local levels in India. At the central level, the main organizations are the Ministry of Health and Family Welfare and the Directorate General of Health Services, which are responsible for policymaking, planning, and coordinating health programs and services. Implementation occurs at the state level through state health ministries and departments. Health care services are then delivered through a three-tiered system at the district, block, and village levels. The document also examines concepts of health systems, methods of financing, and challenges faced.
Health insurance provides coverage for medical expenses through a network of hospitals. It works by paying premiums on a regular basis, such as monthly or yearly. Then, when hospitalization is needed, the insurance pays covered costs while the policyholder provides identification documents. There are many types of health insurance policies available from both private insurers and government organizations. Purchasing insurance can be done online, through agents, or directly from insurer offices. Factors to consider include the network of covered hospitals and choosing coverage appropriate for one's family or employer's needs. Proper documentation is required both when hospitalizing and filing claims to receive benefits.
This document discusses health insurance options in India, including social health insurance schemes like ESIS and CGHS, voluntary private health insurance, and community-based health insurance (CHI). It notes that while social health insurance covers only a small portion of the population, voluntary insurance plans are often unaffordable for the poor. CHI has potential to improve access and reduce costs for vulnerable groups, but faces challenges in India due to poverty, illiteracy, and lack of institutional support. The government has launched various initiatives over the years, including state-run insurance programs and public-private partnerships, to expand coverage.
Healthcare challenges & solutions in indiakripak93
This document discusses the key challenges facing India's healthcare system and potential solutions. The main challenges are the large burden of infectious and chronic diseases, high maternal and child mortality rates, lack of universal access to healthcare, shortage of resources, and inadequate healthcare financing. Proposed solutions include strengthening public health programs, improving access to healthcare in rural areas, providing incentives for medical professionals to work in underserved areas, leveraging public-private partnerships, and increasing public financing of healthcare.
The document discusses various types of health insurance policies in India. It provides details on individual health insurance, critical illness policies, travel insurance, and personal accident policies. For individual health insurance, it outlines the benefits for individuals, scope and coverage of policies, exclusions, and ancillary benefits like maternity, dental and optical coverage. It also discusses critical illness policies, common illnesses covered, waiting periods, and exclusions. For travel insurance, it summarizes typical healthcare and non-healthcare covers as well as exclusions. Personal accident policies provide compensation for accidental death or disability.
This document provides an overview of health insurance, including definitions of key terms, models of health expenditure, and examples of health insurance systems in different countries. It discusses the history of health insurance beginning in Germany in 1883 and adoption in other countries. It also outlines the traditional model of health insurance focusing on insurers/employers and proposes a more flexible model to serve different populations. Private health insurance is described as having an important role to play in overall healthcare systems by enhancing access and increasing service capacity.
The document discusses hospital information management and hospital information systems. It defines key terms like hospital, information, health information management. It describes the objectives of health information management as acquiring, analyzing and protecting medical information to provide quality patient care. It also discusses how information systems can streamline hospital operations and increase efficiency.
This document outlines the basic steps and requirements for setting up a medical billing project between an India-based operations team and a US-based provider. It includes:
1. Necessary infrastructure for the India team such as medical billing software, servers, phones, and internet access.
2. Details on selecting billing software that can track unpaid claims and customized reporting.
3. The process for insurance enrollment including Medicare, Blue Cross, and Blue Shield.
4. Requirements for provider information needed from the US team.
5. Procedures for transmitting patient data from the US to India team through fax and email.
6. Roles for the India and US teams in claim processing, printing,
This document provides an overview of India's health system, including its historical evolution, key components, goals, and models of health care delivery. It discusses the health system at the central, state, and local levels in India. At the central level, the main organizations are the Ministry of Health and Family Welfare and the Directorate General of Health Services, which are responsible for policymaking, planning, and coordinating health programs and services. Implementation occurs at the state level through state health ministries and departments. Health care services are then delivered through a three-tiered system at the district, block, and village levels. The document also examines concepts of health systems, methods of financing, and challenges faced.
This document provides an overview of the different departments within the revenue cycle management process. It describes the key functions of each department including pre-registration, registration, treatment, medical records, coding, charge entry, claims transmission, payer cash posting, accounts receivables, collections, and quality and compliance. The document explains the purpose and processes involved at each step of the revenue cycle to manage patient information, code procedures, bill for services, obtain payment, and ensure compliance.
Information and Communication Technology ICT in HealthcareMadhushree Acharya
* Information & Communication Technology in Healthcare
* Need of ICT in Healthcare
* Constraints of implementation of ICT
* Implementation of ICT in various countries & India
* Various ICT Initiatives taken in India -
National health portal, Online Registration System, Mera Aspataal, SUGAM, NOTTO, Indradhanush Vaccine tracker, India fights Dengue, NHP Swasth Bharat, No more Tension Mobile app, Pradhan Mantri Surakshit Matritva Abhiyan Mobile App, Mother and Child Tracking System MCTS, Kilkari, Nikshay, m-cessation, m-Diabetes, Hospital Information System HIS, Health Management Information System HMIS, ANMoL, e-Aushadhi, e-Rakt Kosh, IDSP, Electronic Health Records EHR, Telemedicine.
Created - Feb 2018
Author - Dr. Madhushree Acharya, Academic JR, Community & Family Medicine, AIIMS Bhubaneswar
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
The document discusses strategies for promoting international medical tourism to India, noting that cardiac treatment and orthopedics are the most popular services. It outlines the major sources of international patients, including from SAARC countries, Africa, and the United States. The document also provides an overview of the business model and processes involved in facilitating medical tourism, from initial information gathering to finalizing travel plans.
Levels of health care and health care settingsRajdip Majumder
In this slide explain about Levels of health care and health care settings..
References taken from: 1. Text book of Community Health Nursing-I written by Lt. Col. KK Gill 2. Text book of Community Health Nursing written by Keshav Swarnkar
- Medical billing companies handle the process of submitting claims to insurance companies and getting paid for physicians' services, as the process is lengthy, complicated, and involves many rules and regulations.
- There are three main parties in medical billing - the physician, the insurance company, and the patient. Medical billing companies work to maximize collections for physicians while complying with insurance company rules and not penalizing patients.
- The main functions of medical billing companies are to process patient information and file claims with private insurance companies and government programs like Medicare and Medicaid in order to get healthcare providers paid on time.
This document provides an overview of the history and development of the Indian health system. It discusses the evolution of medicine from ancient practices intertwined with religion and magic to the development of modern scientific medicine. It outlines the key systems of traditional Indian medicine including Ayurveda and Siddha. It also summarizes the current structure of healthcare delivery in India, which involves both public and private sectors, as well as traditional medicine. The government aims to improve health indicators through national health programs and policies while still facing issues with public health infrastructure and availability of staff.
Medicare Part A provides coverage for inpatient hospital stays, skilled nursing facilities, home health care, and hospice care. It is funded through the payroll tax and people aged 65+ who are eligible for Social Security are automatically enrolled. Those not receiving Social Security benefits must apply. Part A covers hospital costs, nursing facilities for up to 100 days, home health care with a skilled need, and hospice care for terminally ill patients. Beneficiaries may have copays for certain services covered by Part A.
India currently lacks a centralized emergency medical services (EMS) system, with services being fragmented and variable across the country. The document discusses models of EMS in India including the dominant EMRI services and others in various states. It proposes a nationwide EMS system with key elements like standardized ambulances, a common toll-free call number, and agreements with both public and private empaneled healthcare facilities. Establishing such a system across India is estimated to cost between 1700-3000 crores (US$230-400 million) annually to support a fleet of 10,000 ambulances, which could help meet the national goal of spending 3% of GDP on healthcare. A reliable EMS system is argued to be increasingly
This document provides an overview of India's health care system and services. It discusses the purpose of health care and characteristics of a good health service. The major agencies that make up India's health care system are described, including the public health sector, private sector, indigenous medicine systems, voluntary agencies, and national health programs. It then focuses on primary health care in India, describing the three-tier rural health care delivery system and the roles of village health guides, local dais, anganwadi workers, and ASHAs at the village level. Finally, it discusses the sub-centre and primary health centre levels of the health care system.
The medical billing process involves several key steps:
1) Patients make appointments and provide their information;
2) Doctors examine patients, document medical records, and provide medical coding;
3) Coders assign codes to medical records which are then sent to billing;
4) Billers enter patient and visit details, submit claims to insurance, and handle payments and denials.
Medical billing involves submitting bills to insurance companies in a standardized format for medical services provided by doctors to patients. The main parties involved are the patient, provider, billing office, and insurance company. The responsibilities of the billing office include properly coding bills, ensuring compliance with insurance rules, maintaining records, filing claims, and following up. Billing offices have various departments like coding, claims processing, and accounts receivable. There are two main types of insurance companies - federal programs like Medicare and Medicaid, and private commercial insurers like Aetna and Blue Cross Blue Shield.
This document provides an overview of a company's revenue cycle management services. It discusses their experienced team, the full scope of services they provide including medical billing, coding, insurance verification and collections. It outlines their unique process for outsourcing these services which includes analyzing needs, establishing pilot programs, and specialized oversight teams. Graphical representations are also included showing the overall billing cycle and common reports generated from their services. Their specialties in various medical fields are listed at the end.
The document provides an overview of the complex U.S. healthcare system, including its decentralized market-based structure compared to other countries' centralized systems. It discusses key players like doctors, hospitals, insurers, and governments. It also covers major public programs like Medicare and Medicaid, as well as private insurance concepts like health plans, coding, and reimbursement structures including capitation and fee-for-service.
1) Special groups like children, women, disabled persons, HIV positive individuals and elderly people have certain rights formulated to protect them.
2) The rights of children include protection from abuse and access to education, healthcare and shelter. Women's rights are aimed at ensuring equality, protection from discrimination and violence, and adequate livelihood.
3) Disabled persons have rights related to education, employment, social security and living independently. HIV positive individuals' rights focus on confidentiality, access to treatment and banning discrimination. The elderly have rights regarding healthcare, pensions and protection from neglect.
This paper discusses the evolution of health care information systems and how they affect the day to day operations in hospitals today compared to years ago. It discusses the effect it has on patient care and reimbursement. It compares the collection of data today, using technology, and how data was collected years ago.
This document discusses home visiting and urine testing procedures. It provides guidance on conducting home visits, including collecting facts about the home and patient environment, examining and analyzing the situation, planning with the individual and family, taking action, and following up. The purposes of home visits are also outlined. Instructions are given for urine analysis tests to detect sugar, albumin, and microorganisms. The procedure involves collecting a urine sample, using Benedict's solution and acetic acid to test for sugar and albumin, observing any color changes, and properly disposing of and cleaning materials after testing.
Health information systems (HIS) allow for the optimization of healthcare information acquisition, storage, retrieval, and usage. Key advantages of HIS include centralized data access across locations, increased efficiency through easy access to patient records and test results, improved security and confidentiality of patient data, increased storage capabilities, and improved accuracy through automated flagging of abnormal test results. However, HIS implementation presents disadvantages as well, most notably very high upfront and ongoing costs. Learning new systems also presents a learning curve challenge for some. On balance, the advantages of data access, efficiency, and patient care improvements provided by HIS are worth the costs.
ABDM, formerly known as NDHM, is Ayushman Bharat Digital Mission which aims to create a unified digital health infrastructure in India. It consists of several facets including a health ID called ABHA card, health facility registry, health professional registry, and software vendors. ABDM uses interoperability standards like FHIR and NRCES to allow seamless exchange of health data between different systems. It specifies several digital health documents that can be exchanged such as diagnostic reports, discharge summaries, prescriptions, and more. ABDM provides a health ID card called ABHA which can be generated through various means including Aadhaar. It is not just for smartphone users and aims to benefit all Indian citizens.
Representatives from the Creative Arts Therapies program at Parkway Health and Wellness presented at the January, 2017 meeting of the Positive Committee. The presentation focused on what art therapy is and what services are provided at the organization.
This document provides an overview of the different departments within the revenue cycle management process. It describes the key functions of each department including pre-registration, registration, treatment, medical records, coding, charge entry, claims transmission, payer cash posting, accounts receivables, collections, and quality and compliance. The document explains the purpose and processes involved at each step of the revenue cycle to manage patient information, code procedures, bill for services, obtain payment, and ensure compliance.
Information and Communication Technology ICT in HealthcareMadhushree Acharya
* Information & Communication Technology in Healthcare
* Need of ICT in Healthcare
* Constraints of implementation of ICT
* Implementation of ICT in various countries & India
* Various ICT Initiatives taken in India -
National health portal, Online Registration System, Mera Aspataal, SUGAM, NOTTO, Indradhanush Vaccine tracker, India fights Dengue, NHP Swasth Bharat, No more Tension Mobile app, Pradhan Mantri Surakshit Matritva Abhiyan Mobile App, Mother and Child Tracking System MCTS, Kilkari, Nikshay, m-cessation, m-Diabetes, Hospital Information System HIS, Health Management Information System HMIS, ANMoL, e-Aushadhi, e-Rakt Kosh, IDSP, Electronic Health Records EHR, Telemedicine.
Created - Feb 2018
Author - Dr. Madhushree Acharya, Academic JR, Community & Family Medicine, AIIMS Bhubaneswar
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
The document discusses strategies for promoting international medical tourism to India, noting that cardiac treatment and orthopedics are the most popular services. It outlines the major sources of international patients, including from SAARC countries, Africa, and the United States. The document also provides an overview of the business model and processes involved in facilitating medical tourism, from initial information gathering to finalizing travel plans.
Levels of health care and health care settingsRajdip Majumder
In this slide explain about Levels of health care and health care settings..
References taken from: 1. Text book of Community Health Nursing-I written by Lt. Col. KK Gill 2. Text book of Community Health Nursing written by Keshav Swarnkar
- Medical billing companies handle the process of submitting claims to insurance companies and getting paid for physicians' services, as the process is lengthy, complicated, and involves many rules and regulations.
- There are three main parties in medical billing - the physician, the insurance company, and the patient. Medical billing companies work to maximize collections for physicians while complying with insurance company rules and not penalizing patients.
- The main functions of medical billing companies are to process patient information and file claims with private insurance companies and government programs like Medicare and Medicaid in order to get healthcare providers paid on time.
This document provides an overview of the history and development of the Indian health system. It discusses the evolution of medicine from ancient practices intertwined with religion and magic to the development of modern scientific medicine. It outlines the key systems of traditional Indian medicine including Ayurveda and Siddha. It also summarizes the current structure of healthcare delivery in India, which involves both public and private sectors, as well as traditional medicine. The government aims to improve health indicators through national health programs and policies while still facing issues with public health infrastructure and availability of staff.
Medicare Part A provides coverage for inpatient hospital stays, skilled nursing facilities, home health care, and hospice care. It is funded through the payroll tax and people aged 65+ who are eligible for Social Security are automatically enrolled. Those not receiving Social Security benefits must apply. Part A covers hospital costs, nursing facilities for up to 100 days, home health care with a skilled need, and hospice care for terminally ill patients. Beneficiaries may have copays for certain services covered by Part A.
India currently lacks a centralized emergency medical services (EMS) system, with services being fragmented and variable across the country. The document discusses models of EMS in India including the dominant EMRI services and others in various states. It proposes a nationwide EMS system with key elements like standardized ambulances, a common toll-free call number, and agreements with both public and private empaneled healthcare facilities. Establishing such a system across India is estimated to cost between 1700-3000 crores (US$230-400 million) annually to support a fleet of 10,000 ambulances, which could help meet the national goal of spending 3% of GDP on healthcare. A reliable EMS system is argued to be increasingly
This document provides an overview of India's health care system and services. It discusses the purpose of health care and characteristics of a good health service. The major agencies that make up India's health care system are described, including the public health sector, private sector, indigenous medicine systems, voluntary agencies, and national health programs. It then focuses on primary health care in India, describing the three-tier rural health care delivery system and the roles of village health guides, local dais, anganwadi workers, and ASHAs at the village level. Finally, it discusses the sub-centre and primary health centre levels of the health care system.
The medical billing process involves several key steps:
1) Patients make appointments and provide their information;
2) Doctors examine patients, document medical records, and provide medical coding;
3) Coders assign codes to medical records which are then sent to billing;
4) Billers enter patient and visit details, submit claims to insurance, and handle payments and denials.
Medical billing involves submitting bills to insurance companies in a standardized format for medical services provided by doctors to patients. The main parties involved are the patient, provider, billing office, and insurance company. The responsibilities of the billing office include properly coding bills, ensuring compliance with insurance rules, maintaining records, filing claims, and following up. Billing offices have various departments like coding, claims processing, and accounts receivable. There are two main types of insurance companies - federal programs like Medicare and Medicaid, and private commercial insurers like Aetna and Blue Cross Blue Shield.
This document provides an overview of a company's revenue cycle management services. It discusses their experienced team, the full scope of services they provide including medical billing, coding, insurance verification and collections. It outlines their unique process for outsourcing these services which includes analyzing needs, establishing pilot programs, and specialized oversight teams. Graphical representations are also included showing the overall billing cycle and common reports generated from their services. Their specialties in various medical fields are listed at the end.
The document provides an overview of the complex U.S. healthcare system, including its decentralized market-based structure compared to other countries' centralized systems. It discusses key players like doctors, hospitals, insurers, and governments. It also covers major public programs like Medicare and Medicaid, as well as private insurance concepts like health plans, coding, and reimbursement structures including capitation and fee-for-service.
1) Special groups like children, women, disabled persons, HIV positive individuals and elderly people have certain rights formulated to protect them.
2) The rights of children include protection from abuse and access to education, healthcare and shelter. Women's rights are aimed at ensuring equality, protection from discrimination and violence, and adequate livelihood.
3) Disabled persons have rights related to education, employment, social security and living independently. HIV positive individuals' rights focus on confidentiality, access to treatment and banning discrimination. The elderly have rights regarding healthcare, pensions and protection from neglect.
This paper discusses the evolution of health care information systems and how they affect the day to day operations in hospitals today compared to years ago. It discusses the effect it has on patient care and reimbursement. It compares the collection of data today, using technology, and how data was collected years ago.
This document discusses home visiting and urine testing procedures. It provides guidance on conducting home visits, including collecting facts about the home and patient environment, examining and analyzing the situation, planning with the individual and family, taking action, and following up. The purposes of home visits are also outlined. Instructions are given for urine analysis tests to detect sugar, albumin, and microorganisms. The procedure involves collecting a urine sample, using Benedict's solution and acetic acid to test for sugar and albumin, observing any color changes, and properly disposing of and cleaning materials after testing.
Health information systems (HIS) allow for the optimization of healthcare information acquisition, storage, retrieval, and usage. Key advantages of HIS include centralized data access across locations, increased efficiency through easy access to patient records and test results, improved security and confidentiality of patient data, increased storage capabilities, and improved accuracy through automated flagging of abnormal test results. However, HIS implementation presents disadvantages as well, most notably very high upfront and ongoing costs. Learning new systems also presents a learning curve challenge for some. On balance, the advantages of data access, efficiency, and patient care improvements provided by HIS are worth the costs.
ABDM, formerly known as NDHM, is Ayushman Bharat Digital Mission which aims to create a unified digital health infrastructure in India. It consists of several facets including a health ID called ABHA card, health facility registry, health professional registry, and software vendors. ABDM uses interoperability standards like FHIR and NRCES to allow seamless exchange of health data between different systems. It specifies several digital health documents that can be exchanged such as diagnostic reports, discharge summaries, prescriptions, and more. ABDM provides a health ID card called ABHA which can be generated through various means including Aadhaar. It is not just for smartphone users and aims to benefit all Indian citizens.
Representatives from the Creative Arts Therapies program at Parkway Health and Wellness presented at the January, 2017 meeting of the Positive Committee. The presentation focused on what art therapy is and what services are provided at the organization.
Working Toward Eradication (Hepatitis C/HIV Coinfection Presentation) - Alex ...Office of HIV Planning
At the October 2016 meeting of the Philadelphia Ryan White Part A Planning Council, Alex Shirreffs of the Philadelphia Department of Public Health discussed an ongoing project to improve the care continuum for HIV/HCV co-infected people of color.
Philadelphia FIGHT's PrEP Retention and Adherence Coordinator Devon Clark presented on HIV Pre-exposure Prophylaxis (PrEP) at the September 2016 meeting of the Positive Committee.
The OHP's Nicole Johns reviewed the process of putting together the Integrated HIV Prevention and Care Plan at the August meeting of the Philadelphia Ryan White Part A Planning Council.
This document provides an overview of the Ryan White HIV/AIDS Program and the Ryan White Planning Council (RWPC) in the Philadelphia Eligible Metropolitan Area. It describes the key parts and funding of the Ryan White legislation. The RWPC is responsible for conducting needs assessments, setting service priorities, allocating Part A funds, monitoring the administrative mechanism, and developing a comprehensive plan. It outlines the membership, committees, activities, and processes of the RWPC in carrying out these responsibilities.
Jacob Eden of the AIDS Law Project presented on Medicaid, Medicare, and ACA Insurance Plans at the November 2016 meeting of the Philadelphia EMA Ryan White Part A Planning Council.
Kathleen Brady of the PDPH presented the annual report on the HIV epidemic in Philadelphia at the February 2017 meeting of the Philadelphia Ryan White Part A Planning Council.
Ricardo Colon and Sebastian Branca of the Philadelphia AIDS Activities Coordinating Office presented on Client Services and Quality Management in Philadelphia at the March 2017 meeting of the Ryan White Planning Council.
This document summarizes PrEP outreach campaigns in multiple cities. It provides details on campaigns launched in New York, Chicago, Washington, San Francisco, and Ohio. The campaigns aimed to increase awareness and access to PrEP for at-risk groups like MSM of color through media campaigns, websites, community partnerships, and PrEP provider directories. Key elements included community input, diverse representation, simple educational materials, and collaboration between organizations.
Dr. Anne Frankel from Temple University presented the results of the most recent Youth Risk Behavior Survey (YRBS) in Philadelphia at the March 2016 meeting of the Philadelphia HIV Prevention Planning Group.
At the April 16th, 2016 meeting of the Philadelphia Ryan White Planning Council, Evelyn Torres and Sebastian Branca of the AIDS Activities Coordinating Office (AACO) presented their annual Client Services Unit (CSU) report.
Kathleen Brady - HIV in Philadelphia (Annual Epidemiological Presentation)Office of HIV Planning
On April 27, 2016, Kathleen Brady of the Philadelphia AIDS Activities Coordinating Office (AACO) presented her annual review of the HIV Epidemic in Philadelphia and the surrounding areas.
The scale and scope of private contributions to health systemsIDS
This presentation was given at a session at the Global Symposium on Health Systems Research in November 2010. Panelists included Ruth Berg, Gerry Bloom, Birger Forsberg, Kara Hanson, Gina Lagomarsino, Dominic Montagu, Stefan Nachuk
Putting The Sexy Into Safer Sex. Building Bridges Between The Sex World And P...IDS
This presentation was delivered by the Pleasure Project to a workshop at the Liverpool School of Tropical Medicine on improving the use of research in policy and practice.
Result based financng for health - Health Results Innovation Trust FundRikuE
The World Bank aims to improve health results in developing countries through a Results-Based Financing approach. A Health Results Innovation Trust Fund will provide grants and technical support to pilot RBF programs in select countries. These pilots will test how incentivizing health providers and consumers to achieve health targets can strengthen health systems and outcomes related to maternal and child health. The Fund will also support rigorous evaluations of the pilots and disseminate lessons learned to inform the design of RBF programs globally.
The evaluation assessed the performance of Ethiopia's Health Sector Pooled Fund Phase II (HPF-II) from July 2007 to June 2010. Key findings include that HPF-II effectively and efficiently supported priority health programs. However, the evaluation identified areas for improvement including enhancing technical assistance and capacity building, strengthening needs assessment and impact evaluation, and ensuring full utilization of funds by regional health bureaus. Overall the evaluation found that HPF-II is an effective mechanism for channeling funds to critical health programs in Ethiopia.
This document summarizes fund management processes for primary health centers (PHCs) in India. Funds come from state and national sources and are allocated to PHCs, village councils, and committees. Hospital Development Committees manage PHC funds and expenditures. Ward Health Committees are responsible for local health plans and activities. Medical Officers oversee fund disbursement and have spending authority within limits based on expenditure amounts. Funds support local health services, activities, materials, and community programs.
Aureos africa health fund presentation at uhf may conferenceUHF-EAHF2012
The Africa Health Fund invests in private healthcare companies in Africa to expand access to healthcare for low-income populations. It provides both equity and debt financing of $250,000 to $5 million for established, profitable companies. The Fund focuses on sectors like healthcare delivery, diagnostics, manufacturing, and retail pharmacy. It also offers technical assistance to strengthen operations and management in portfolio companies. With over $100 million in assets, the Africa Health Fund aims to finance socially responsible, financially sustainable private healthcare across the continent.
Health Insurance Terminology and Technology Tools-06-15Barbara O'Neill
This document provides information about health insurance terminology and technology tools. It defines key terms related to private health plans like HMOs, PPOs, and POS plans. It also defines terms like deductible, copay, coinsurance, out-of-pocket maximum, and premium. The document provides examples of how these costs are calculated based on medical bills and plan details. Additionally, it summarizes government programs like Medicare and Medicaid and other types of supplemental health insurance plans.
The document discusses key provisions and effects of the Affordable Care Act (ACA or Obamacare). It outlines provisions such as prohibiting denial of coverage for pre-existing conditions, expanding Medicaid eligibility, establishing health insurance exchanges, and requiring individuals to have health insurance coverage or pay a penalty. The effects discussed include more people gaining health insurance coverage through Medicaid expansion or subsidies, but also higher taxes, premiums and deficits. Critics argue it will negatively impact employment and access to doctors while supporters say it ends unfair insurance industry practices.
Cadillac Tax for Employers 101 - How to Avoid Penalties?benefitexpress
This webinar covers: what coverages are subject to the tax, how the excise tax is determined, what adjustments will be available in determining the tax, and who collects the tax.
Health Reform: What It Means for Small Business?Tom Daly
This document provides an overview and agenda for a presentation on health reform and what it means for startup businesses. The presentation will cover who the presenter is, the current state of health insurance in the US and a brief history, details of what happened with health reform, what changes will occur now and in future years, the impact on employers and employees, options and costs to consider, and will conclude with a question and answer section. Key dates that will be discussed include changes beginning in 2014 such as requirements for individuals to have coverage or pay a penalty and for companies with over 50 employees to offer coverage or pay a penalty.
The document provides information about enrolling in health insurance plans under the Affordable Care Act. It explains that the ACA expands coverage to those with pre-existing conditions and guarantees essential health benefits. It also discusses determining income eligibility for subsidies, how to enroll on or off the exchange, the types of available plans (bronze, silver, gold, platinum), penalties for being uninsured, and contacting an agent for assistance.
The document provides information about health insurance plans available under the Affordable Care Act (ACA). It explains that the ACA provides essential health benefits, consumer protections, and health insurance marketplaces. It also summarizes the different types of plans available - bronze, silver, gold, platinum, and catastrophic - and how they vary in terms of premium costs, deductibles, co-pays, and coverage. The document advises people to choose a plan based on their needs and income level to determine if they qualify for subsidies.
The document provides information about the Affordable Care Act (ACA) and enrolling in health insurance plans. It explains that the ACA provides protections like coverage for pre-existing conditions. It also describes essential health benefits that all plans must cover. The document then gives steps for enrolling including determining income level and whether to enroll on or off the exchange. It provides details on subsidies and how to calculate them. Finally, it outlines the different metal-tiered plan levels (catastrophic, bronze, silver, gold, platinum) and their coverage amounts and costs.
The document provides information about the Affordable Care Act (ACA) and enrolling in health insurance plans. It explains that the ACA provides protections like coverage for pre-existing conditions. It also outlines the essential health benefits all plans must cover. The document then gives steps for enrolling including determining income level and whether to enroll on or off the exchange. It details how subsidies work and how to calculate them. Finally, it describes the different metal-tiered plan levels (catastrophic, bronze, silver, gold, platinum) and their coverage and cost-sharing structures.
The document provides information about the Affordable Care Act (ACA) and enrolling in health insurance plans. It explains that the ACA provides protections like coverage for pre-existing conditions. It also describes essential health benefits that all plans must cover. The document then gives steps for enrolling like determining income and subsidies. It outlines the different metal-tiered plan levels (catastrophic, bronze, silver, gold, platinum) and how they vary in terms of costs and coverage. Finally, it provides contact information for RLee Insurance Solutions which can assist with enrollment.
The document summarizes key provisions of the US health reform law and how it will be implemented over time. Within the first year, young adults can stay on parents' insurance until age 26 and seniors will get prescription drug coverage assistance. By 2014, most Americans will be required to have health insurance or pay a penalty, health insurance exchanges will be set up, and Medicaid eligibility will expand. The reform establishes new rules and taxes for insurers and employers and seeks to expand coverage and accessibility of healthcare.
This webinar focused on what the new healthcare law, the Affordable Care Act, means for small businesses. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
Hosted by the United States Department of Health and Human Services and Small Business Majority. This webinar focused on what the new healthcare law, the Affordable Care Act, means for Alabama small businesses. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
Personal Finance Course Health Insurance Slides With ACA InfoBarbara O'Neill
This document summarizes key aspects of health and disability insurance. It discusses how insurance can ease the financial burden of illness or injury by transferring the risk of loss through premium payments. Different types of coverage are available including medical expense insurance and disability income insurance. The document also outlines important laws like COBRA, HIPAA, and the Affordable Care Act, as well as sources of health insurance like employers, private markets, and government programs. Major topics covered include health plan types, costs, benefits, and government programs like Medicare and Medicaid.
Guidelines for the Colorado Health Benefit Exchange and our Federal Exchange are still up in the air. What do these various funding, administration, and oversight issues mean for employers and how will plan pricing, availability, and benefits be addressed? This presentation is designed for the Colorado business leader who needs to understand the current state of the exchanges. In this session, we’ll go over the very latest developments and how they could impact local businesses, discuss how you can create a proactive multi-year benefits strategy, and introduce resources to help you stay on top of this constantly changing landscape.
high value care to reduce waste in health caremukeshkakkar
This document discusses health care costs and payment models. It defines different types of health care costs including charges, reimbursements, and out-of-pocket costs. It describes how traditional payment models like fee-for-service can promote cost variation and lack transparency. It also discusses recent value-based reforms like accountable care organizations (ACOs) and pay for performance models that aim to improve quality and reduce costs. The document provides examples of estimating out-of-pocket costs and explores how insurance status impacts clinical recommendations and adherence.
What the New Healthcare Law Means for Your North Carolina Small BusinessSmall Business Majority
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The Affordable Care Act (Obamacare): The BasicsJeffrey A. Cook
The document summarizes the key provisions and timeline of the Affordable Care Act (ACA) for businesses and individuals. It outlines that by 2018, businesses with over 50 employees must provide health insurance where 95% of full-time employees are covered, or face penalties. It also mandates that all individuals have health insurance through state or federal exchanges, with penalties for non-compliance increasing each year. The document suggests using supplemental benefits from ProVantage to help individuals and employees save money on out-of-pocket costs for high deductible plans required by the ACA.
Health insurance marketplace waco rotary club 10.7.13WacoRotary
The document summarizes key aspects of the Affordable Care Act (ACA) and the Health Insurance Marketplace. It notes that the ACA mandates health insurance coverage and the marketplace allows individuals and small businesses to purchase plans online. It provides details on plan types, subsidies available, penalties for non-compliance, and timelines. It also discusses Texas' decision to not expand Medicaid and the impact. Finally, it proposes an education campaign by Providence Healthcare to increase awareness and enrollment in the marketplace.
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2. PURPOSE
• Define health insurance terms
• What is premium and cost-sharing assistance?
• Analysis of cost
3. DISCLAIMER
• This report is based on the current plans and cost-
reducing features offered through the Affordable
Care Act Marketplace.
• The future state of the ACA is uncertain and subject
to substantial changes by the new administration
and Congress.
4.
5. WHAT YOU PAY ENTIRELY ON YOUR OWN
P R E M I U M
“The amount you pay for your
health insurance every month.”
• Fixed fee that you pay to
maintain your insurance
every month
• Like paying a fixed monthly
bill to keep Internet service
“The amount you pay for covered
health care services before your
insurance plan starts to pay.”
• Fixed limit for the year
• Let’s say it’s $2500. Once
you’ve spent $2500 of your
own money on doctor visits,
medications, and/or
procedures, you’ve met the
deductible for the year.
• Does not include premiums
S O U R C E : H E A L T H C A R E . G O V G L O S S A R Y
D E D U C T I B L E
6. WHAT YOUR INSURANCE WILL HELP PAY
C O P A Y M E N T
“A fixed amount…you pay for a
covered health care service after
you’ve paid your deductible.”
• Each type of service that has
a copay has a fixed dollar
cost. For example, the copay
for a PCP visit for any reason
could be $30, for any generic
drug $10, etc.
• Called a copayment since
you’re paying part of the
service and insurer is paying
part
C O I N S U R A N C E
“The percentage of costs of a
covered health care service you
pay…after you’ve paid your
deductible.”
• Let’s say you’ve spent up to
that $2500 deductible.
• You’ve paid full price on
certain medical services so
far. From now on, you will
only pay a percentage, like
20%, for those medical
services, while the insurer
pays the rest.
S O U R C E : H E A L T H C A R E . G O V G L O S S A R Y
7. THE MOST YOU’LL PAY PER YEAR
O U T - O F - P O C K E T
M A X I M U M / L I M I T
“The most you have to pay for
covered services in a plan year.
After you spend this amount on
deductibles, copayments, and
coinsurance, your health plan
pays 100% of the costs of
covered benefits.”
• Fixed limit for the year
• Does not include premiums
• Will be greater than or equal
to deductible
S O U R C E : H E A L T H C A R E . G O V G L O S S A R Y
8. WHAT IS THE AFFORDABLE CARE ACT?
• The Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable
Care Act (ACA) or Obamacare, is a United States federal statute enacted by President
Barack Obama on March 23, 2010. Together with the Health Care and Education
Reconciliation Act amendment, it represents the most significant regulatory overhaul of the
U.S. healthcare system since the passage of Medicare and Medicaid in 1965.
• The Affordable Care Act was intended to increase health insurance quality and affordability,
lower the uninsured rate by expanding insurance coverage and reduce the costs of
healthcare. It introduced mechanisms including mandates, subsidies and insurance
exchanges
• Some key provisions:
• Coverage of several preventive services without charging patient extra
• Insurers can’t deny applicants based on pre-existing conditions
• Small businesses and individuals can purchase coverage through Marketplace
• Penalty for not enrolling in a health plan if it is available and affordable
• Premium tax credit and cost-sharing reduction available
S O U R C E : U . S . D E P A R T M E N T O F H E A L T H A N D H U M A N
S E R V I C E S , 2 0 1 5
9. WHAT ARE THE FEDERAL SUBSIDIES?
P R E M I U M T A X C R E D I T
• Lowers cost of monthly premium
• Eligibility:
• 100% to 400% of Federal
Poverty Level
• Cannot have catastrophic health
plan
• Three options:
• Take it in advance (APTC), so
that you pay less on the premium
each month
• Pay the whole premium cost
every month and get the tax
credit at once when filing taxes
• Combination of the above
• Amount can vary based on income
C O S T - S H A R I N G
R E D U C T I O N
• Lowers out-of-pocket maximum
• Eligibility:
• 100% to 250% of FPL
• Must have Silver plan
• Subsidy will be “automatically
applied” to Silver plans when
enrolling
• Amount can vary based on income
S O U R C E : K A I S E R F A M I L Y F O U N D A T I O N , 2 0 1 6
10.
11. HRSA HAB PCN #16-02
“Health Insurance Premium and Cost-Sharing Assistance provides financial
assistance for eligible clients living with HIV to maintain continuity of health
insurance or to receive medical and pharmacy benefits under a health care
coverage program.”
Requirements:
• Coverage has to have “at least one drug in each class of core antiretroviral
therapeutics…”
• Paying insurance has to be more cost-effective than paying full price on drugs
and HIV medical services
Service Provisions:
• Can pay health insurance premiums, and/or cost-sharing, and/or “standalone
dental premiums” for the client
S O U R C E : H E A L T H R E S O U R C E S A N D S E R V I C E S
A D M I N I S T R A T I O N , 2 0 1 6
12. HRSA HAB PCN #13-05
• “RWHAP funds may be used to cover the cost of
private health insurance premiums, deductibles,
and co-payments…”
• “In states with a Federally-Facilitated Marketplace,
grantees and subgrantees will need to work directly
with health insurance issuers to facilitate premium
payments by the RWHAP for individual clients.”
S O U R C E : H E A L T H R E S O U R C E S A N D S E R V I C E S
A D M I N I S T R A T I O N , 2 0 1 4
13. HRSA HAB PCN #14-01
• If you’re getting a premium tax credit, you need to file taxes.
• The amount of the APTC is determined during enrollment. If the client’s
income changes between then and tax filing time, it’s possible the APTC will
be more or less than the actual premium tax credit a client should receive for
that year.
• If APTC ends up being too little:
• They could receive the additional money through a “refund from the IRS” or a
“reduction in overall tax liability.”
• The grantee has to “vigorously pursue” that excess credit and has to put it
back into this service category.
• If APTC ends up being too much:
• Grantees “may use RWHAP funds to pay the IRS any additional tax liability a
client may owe to the IRS solely based on reconciliation of the premium tax
credit.”
S O U R C E : H E A L T H R E S O U R C E S A N D S E R V I C E S
A D M I N I S T R A T I O N , 2 0 1 5
14. RYAN WHITE CAP ON CHARGES
• According to RWHAP legislation, there is a cap on what clients can be
charged for HIV services yearly. Included in these services are health
insurance costs, such as out-of-pocket expenses and premiums.
• The cap is a certain percentage of the client’s annual gross income.
• The table below shows the maximum amount clients can be charged for HIV
services by income range.
% FPL Maximum Cumulative Charges as % of
Income
≤ 100% FPL 0%
101 to 200% FPL 5%
201 to 300% FPL 7%
> 300% FPL 10%S O U R C E : H E A L T H R E S O U R C E S A N D S E R V I C E S
A D M I N I S T R A T I O N , 2 0 1 3
15. CLIENT SCENARIO
• Client has individual income of $29,000, which is 244% FPL
• Based on RWHAP cap, cumulative charges cannot exceed 7% of yearly
income, or $2030
• Therefore, the most this program would pay for client is $2030
• Client should qualify for premium tax credit and cost-sharing reduction
• Chooses Keystone HMO Silver Proactive plan
• Estimated monthly premium: $158.74
• Primary physician visit: $30
• 12 months of premiums adds up to $1904.88, so already close to reaching
$2030 cap
• This assumes that premiums count toward the cap
• Leaves $125.12 to spend on doctor visits, medications, etc.
S O U R C E : H E A L T H C A R E . G O V P L A N S & P R I C E S
16.
17. HOW MANY CLIENTS ARE ELIGIBLE?
• Criteria:
• Between 138 and 500% FPL
• Individual, private coverage
• Uninsured
• Based on CY 2015 RWHAP data for HIV+ clients in Philadelphia EMA:
• 209 clients with incomes between 138 and 500% FPL on individual,
private insurance
• 421 clients with incomes between 138 and 500% FPL with no insurance
• A total of 630 eligible clients
• This assumes these are incomes for a single-person household. Since family
size is not recorded in CAREWare, it is possible incomes used above are for
multiple-person households.
S O U R C E : C Y 2 0 1 5 R W H A P D A T A F O R P H I L A D E L P H I A E M A
18. WHAT IS MAX. COST FOR THIS PROGRAM?
• Multiplied each of the 630 incomes by 0.05, 0.07, or 0.10, depending on
which income range it fell in, to get each RWHAP cap.
• The cap is the most that client can be charged for RWHAP services, including
health insurance costs, for the year.
• Added these capped amounts together to get the most this program would
need to pay for premiums plus out-of-pocket expenses
• Maximum cost for 630 clients is $1,227,847.
• Does not include administration costs
• This assumes that the only RWHAP service a client is charged for is health
insurance. It also assumes premiums count toward the cap.
19. # OF CLIENTS IF AWARDED LEVEL FUNDING
• $160,000 is allocated for this service category at level funding
• If paying up to cap for the lowest-income clients, program can cover 173
clients
• If paying up to cap for the highest-income clients, program can cover 30
clients
• This assumes none of the $160,000 is used for administrative costs.
20. NEW JERSEY HIPP
• NJ Dept. of Health runs Health Insurance Premium Program (HIPP)
• Funded through prescription drug rebates
• Took 2 years for full implementation
• Anticipated $11 million to be allocated for program
• Currently $3 million allocated
• Have 450 clients with average cost of $350 per client per month
($1,890,000)
• Program is administered by the State – 2 FTEs and 3 temporary
workers
21. CONSIDERATIONS
• All eligible clients between 138 and 250% FPL should be enrolled in a Silver
plan to utilize the premium tax credit and cost-sharing reduction
• Clients between 138 and 400% who are eligible for a premium tax credit
should choose to take it in advance. This reduces the likelihood that clients
would need to return money to the program.
• Should try to enroll clients in Medical Assistance for Workers with Disabilities,
if eligible
• PA program
• HIV diagnosis
• Countable income less than 250% FPL
• ≤ $10,000 in countable resources
• Doing paid work of some kind
22. CONSIDERATIONS cont’d
• If paying out-of-pocket expenses:
• Need mechanism to track charges client incurs from providers and insurer
• Need to make sure client doesn’t get charged more than their RWHAP cap
• If paying premiums:
• Too little APTC? Need procedure to get $ money back from client
• Too much APTC? Need procedure to pay $ back to IRS
23. REFERENCES
"2017 Health Insurance Plans & Prices." HealthCare.gov. U.S. Centers for Medicare & Medicaid Services. Web.
<https://www.healthcare.gov/see-plans/#/plan/results>.
"Explaining Health Care Reform: Questions About Health Insurance Subsidies." Kaiser Family Foundation. Kaiser Family
Foundation, 01 Nov. 2016. Web. <http://kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-
health/>.
"Glossary." HealthCare.gov. U.S. Centers for Medicare & Medicaid Services. Web. <https://www.healthcare.gov/glossary/>.
Health Resources and Services Administration. HIV/AIDS Bureau. Clarifications Regarding the Ryan White HIV/AIDS Program and
Reconciliation of Premium Tax Credits under the Affordable Care Act. 3 April 2015. Web.
<http://hab.hrsa.gov/sites/default/files/hab/Global/1401policyclarification.pdf>.
Health Resources and Services Administration. HIV/AIDS Bureau. Clarifications Regarding Use of Ryan White HIV/AIDS Program
Funds for Premium and Cost-Sharing Assistance for Private Health Insurance. 6 June 2014. Web.
<http://hab.hrsa.gov/sites/default/files/hab/Global/pcn1305premiumcostsharing.pdf>.
Health Resources and Services Administration. HIV/AIDS Bureau. Ryan White HIV/AIDS Program Services: Eligible Individuals &
Allowable Uses of Funds. U.S. Department of Health and Human Services, 2016. Web.
<http://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf>.
Health Resources and Services Administration. HIV/AIDS Bureau. Ryan White HIV/AIDS Program Part A Manual. U.S. Department
of Health and Human Services, 2013. Web. <http://hab.hrsa.gov/sites/default/files/hab/Global/happartamanual2013.pdf>.
Secretary, HHS Office of the. "Key Features of the Affordable Care Act By Year." HHS.gov. U.S. Department of Health and Human
Services, 13 Aug. 2015. Web. <http://www.hhs.gov/healthcare/facts-and-features/key-features-of-aca-by-year/index.html>.