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Medical Outsourcing
Medical outsourcing is a business process used by organizations like hospitals, nursing homes, and healthcare provider practices to obtain physician, nursing, healthcare technician, or other services in a managed services model. Physicians Outsourcing of emergency department physicians, as well as radiologists and anesthesiologists in operating rooms, grew rapidly in the United States in the 2000s due a combination of several economic forces, and medical staffing companies developed niche expertise in various medical specialties. Since 2008 a number of Swedish hospitals have used teleradiology services to outsource their emergency night-time radiology to Australia where daytime staff cover Swedish nighttime patients. Physician outsourcing has led to an increase in the number of people who received catastrophically large medical bills due to the outsourced physicians billing at out of network rates. A doctor in Tampa Bay claimed in 2015 that an emergency department she was staf ...
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Healthcare Provider
A health care provider is an individual health professional or a health facility organization licensed to provide health care diagnosis and treatment services including medication, surgery and medical devices. Health care providers often receive payments for their services rendered from health insurance providers. In the United States, the Department of Health and Human Services defines a health care provider as any "person or organization who furnishes, bills, or is paid for health care in the normal course of business." Individual providers In the United States, the law defines a healthcare provider as a "doctor of medicine or osteopathy who is authorized to practice medicine or surgery" by the state, or anyone else designated by the United States Secretary of Labor as being able to provide health care services. In general, this is seen to include: * Physician, a professional who practices medicine * Advanced practice provider, a trained health worker who has a defined sc ...
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Healthcare Technician
Health care, or healthcare, is the improvement or maintenance of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals and allied health fields. Medicine, dentistry, pharmacy, midwifery, nursing, optometry, audiology, psychology, occupational therapy, physical therapy, athletic training, and other health professions all constitute health care. The term includes work done in providing primary care, secondary care, tertiary care, and public health. Access to health care may vary across countries, communities, and individuals, influenced by social and economic conditions and health policies. Providing health care services means "the timely use of personal health services to achieve the best possible health outcomes". Factors to consider in terms of health care access include financial limitations (such as insurance coverage), geogra ...
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Managed Services
Managed services is the practice of outsourcing the responsibility for maintaining, and anticipating need for, a range of processes and functions, ostensibly for the purpose of improved operations and reduced budgetary expenditures through the reduction of directly-employed staff. It is an alternative to the break/fix or on-demand outsourcing model where the service provider performs on-demand services and bills the customer only for the work done. The external organization is referred to as a managed service(s) provider (MSP). Definitions A managed IT services provider is a third-party service provider that proactively monitors & manages a customer's server/network/system infrastructure, cybersecurity and end-user systems against a clearly defined Service Level Agreement (SLA). Small and medium-sized businesses (SMBs), nonprofits and government agencies hire MSPs to perform a defined set of day-to-day management services so they can focus on improving their services witho ...
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Emergency Department
An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the Acute (medicine), acute care of patients who present without prior appointment; either by their own means or by that of an ambulance. The emergency department is usually found in a hospital or other primary care center. Due to the unplanned nature of patient attendance, the department must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be Medical emergency, life-threatening and require immediate attention. In some countries, emergency departments have become important entry points for those without other means of access to medical care. The emergency departments of most hospitals operate 24 hours a day, although staffing levels may be varied in an attempt to reflect patient volume. History Accident services wer ...
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Teleradiology
Teleradiology is the transmission of radiological patient images from procedures such as x-rays photographs, Computed tomography (CT), and MRI imaging, from one location to another for the purposes of sharing studies with other radiologists and physicians. Teleradiology allows radiologists to provide services without actually having to be at the location of the patient. This is particularly important when a sub-specialist such as an MRI radiologist, neuroradiologist, pediatric radiologist, or musculoskeletal radiologist is needed, since these professionals are generally only located in large metropolitan areas working during daytime hours. Teleradiology allows for specialists to be available at all times. Teleradiology utilizes standard network technologies such as the Internet, telephone lines, wide area networks, local area networks (LAN) and the latest advanced technologies such as medical cloud computing. Specialized software is used to transmit the images and enable the rad ...
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Medical Billing
Medical billing, a payment process in the Healthcare in the United States, United States healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed. This bill is called a claim. Because the U.S. has a mix of government-sponsored and private healthcare, health insurance companies - otherwise known as payors - are the primary entity to which claims are billed for physician reimbursement. The process begins when a physician documents a patient's visit, including the diagnoses, treatments, and prescribed medications or recommended procedures. This information is translated into standardized codes through medical coding, using the appropriate coding systems such as ICD-10-CM and Current Procedural Terminology (CPT). A medical biller then takes the coded information, combined with the patient's insurance details, and forms a claim that is submi ...
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Health Insurance In The United States
In the United States, health insurance helps pay for medical expenses through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage. In addition to medical expense insurance, "health insurance" may also refer to insurance covering disability or long-term nursing or cust ...
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Envision Healthcare
Envision Healthcare is a United States healthcare company and national hospital-based physician group. History In December 2016, Envision and AMSURG merged, and shortly thereafter the company's stock replaced Legg Mason in the S&P 500 index. In 2017, the company's subsidiary EmCare, came under scrutiny due to healthcare consumers being shocked by high medical bills from Envision's out-of-network healthcare providers. In August 2017, Envision sold its ambulance unit, American Medical Response, for $2.4 billion to KKR, which it subsequently merged with a similar company it had already owned. In 2017, the company reported a net loss of $232.5 million on revenue of $7.8 billion. In June 2018, KKR announced that it was acquiring the rest of Envision for $9.9 billion, including the assumption or repayment of debt. In February 2020, Envision appointed Jim Rechtin as CEO. In April 2020, they were considering bankruptcy. In October 2020, it was announced that Cigna and Envisi ...
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Nursing Agency
A Nursing Agency (also known as Home Health Agency or Home Care Agency) is a service provider agency which provides nurses and usually health care assistants (such as Certified Nursing Assistants) to people who need the services of home healthcare professionals. Nurses are normally engaged by the agency on temporary contracts and make themselves available for hire by hospitals, nursing homes, eldercare centers, and other providers of care for help during busy periods or to cover for staff absences. Some nurses may be seconded to private clients who choose to receive their nursing care within their own homes. Nature of work As with other staffing agencies, a large amount of capital is necessary to operate, since nurses must be paid by the registry as often as they work, but the hospital or other institution utilizing the services of the registry might not pay the registry until several months after the work has been done. Profit margins for this type of business go between 4% and ...
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Nursing Shortage
A nursing shortage occurs when the demand for nursing professionals, such as Registered Nurses (RNs), exceeds the supply locallywithin a healthcare facilitynationally or globally. It can be measured, for instance, when the nurse-to-patient ratio, the nurse-to-population ratio, the number of job openings necessitates a higher number of nurses than currently available, or the current number of nurses is above a certain age where retirement becomes an option and plays a factor in staffing making the workforce in a higher need of nurses. The nursing shortage is global according to 2022 World Health Organization fact sheet. The nursing shortage is not necessarily due to the lack of trained nurses. In some cases, the scarcity occurs simultaneously with increased admission rates of students into nursing schools. Potential factors include lack of adequate staffing ratios, lack of placement programs for newly trained nurses, inadequate worker retention incentives and inability for st ...
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Revenue Cycle Management
Revenue cycle management (RCM) is the process used by healthcare systems in the United States and all over the world to track the revenue from patients, from their initial appointment or encounter with the healthcare system to their final payment of balance. It is a normal part of health administration. The revenue cycle can be defined as, "all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue." It is a cycle that describes and explains the life cycle of a patient (and subsequent revenue and payments) through a typical healthcare encounter from admission (registration) to final payment (or adjustment off of accounts receivables). A thriving healthcare revenue cycle reduces and prevents errors. Several factors contribute to errors, but an agile revenue cycle management framework can eliminate these challenges before they occur. Overview The revenue cycle begins when a patient schedules an appointment and it e ...
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Medical Tourism
Medical tourism is the practice of traveling abroad to obtain medical treatment. In the past, this usually referred to those who traveled from less-developed countries to major medical centers in highly developed countries for treatment unavailable at home. However, in recent years it may equally refer to those from developed countries who travel to developing countries for lower-priced medical treatments. With differences between the medical agencies, such as the Food and Drug Administration (FDA) or the European Medicines Agency (EMA), etc., which decide whether a drug is approved in their country or region, or not, the motivation may be also for medical services unavailable or non-licensed in the home country. Medical tourism most often is for surgeries (cosmetic or otherwise) or similar treatments, though people also travel for dental tourism or fertility tourism. People with rare conditions may travel to countries where the treatment is better understood. However, almost a ...
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