Friday, September 20, 2013

Good links to understand Health Insurance Domain

Was quite impressed with the simple and lucid language used on to explain the basic of Health Insurance in US. The following articles are worth a perusal for anyone wanting to jump-start on the fundamental concepts in Healthcare.

HMOs vs. PPOs – What Are the Differences Between HMOs and PPOs?
What Is a Health Insurance Provider Network? and also this link.
What's the Difference Between Copay and Coinsurance? and also here.
Why Is Health Care So Expensive?
What Is Hospice Care?
What’s the Difference Between Medicare and Medicaid?
Why do we need healthcare reforms? and What are the dangers of having uninsured people?
What is ACA (Affordable Care Act) or ObamaCare? Another good link here.
What Is a Health Insurance Exchange?
Bronze, Silver, Gold & Platinum–Understanding the Metal-Tier System
What are Health Saving Account and Flexible Saving Accounts?
Understanding Claims Adjudication
What are ICD-9 or ICD-10 Codes?
What is HIPAA regulation around privacy of patient information?
Myths About HIPAA, Patients and Medical Records Privacy
Explanation of Benefits - Understanding Your EOB  : EOB goes to the member
What is ERA? : ERA goes to the provider during electronic payments. EDI 835
What is Individual Mandate?
What is MLR? (Medical Loss Ratio). Another link here.
What are Consumer Directed Health Plans (CDHP)?
What is the National Practitioner Data Bank (NPDB)?
What is SBC? (Summary of Benefits and Coverage)
What is provider credentialing?
What are tiered network health plans?
Who runs Medicare and Medicaid? Centers for Medicare & Medicaid Services (CMS)
What is OIC (Office of the Insurance Commissioner)?
What is medical necessity?
What does NCQA (National Committee for Quality Assurance ) do?
What Is the Coordination of Benefits?

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