#third party payer

[titleknown]

...I feel like when people end up griping about how others say "both parties are the same" in the context of US politics, in pushing back against that sentiment they kinda overlook what's animating a decent part of it.

Cause, like, the parties are in fact very different, given one's the Unhinged Fascist Khorne Cult Party and the other is Everyone Else, but I've noticed that at the root of the complaint that the parties are the same; especially on the left; it's rooted in less what they do and more in what they won't do.

IE, the policies that would actually help them are so far outside of the Overton Window due to a combo of right-wing dominance and the Dems being bitch-ass cowards and brown-nosers, that they feel that the parties are interchangable because the results in terms of things that will get done for them is the same, IE jack shit.

Like, the big one is single-payer healthcare, but I think we can cite other examples, we've all seen 'em.

And like, y'all know me, I'm super critical of anti-electoralism, if only because we're not doing shit to solve my big issue (copyright being Too Fucking Long and Too Fucking Much) without engaging at least a bit with the electoral system, and ditto for a lot of other issues.

Instead of nonvoting or trying to brute-force third parties in a system designed to crush them, I generally believe in stuff like Ranked Choice Voting, the Interstate Voting Compact and murdering the filibuster as better levers to push so we can kill the two-party system and get shit done that isn't "blow up civillians overseas" or "pass yet another censorship bill"

But I feel like acting like people saying "both parties are the same" is nihilism and not a statement of feeling underrepresented aren't really helping, and comes off as apologizing for the assholes who failed them because they cared more about lobbyist money or institutionalism than human fucking life.

And it does so in a way that definitely isn't gonna get people to vote or; more importantly; isn't gonna help at getting those people on your side to do things to create a world where they actually are represented.

[starmocha]

Hi there. I'm back with theory #3 for Sylus' myth. Which....might be less evidence-heavy than the first two and really just me talking out of my ass. I started writing at midnight because that's just on brand clown behavior of me 🙃 ANYWAY...

People who haven't read Rafayel, Xavier, and Zayne's myths, please tread carefully, because I will touch upon them briefly and allude to events in their myths.

Quick recap from first post:

Theory 1: Sylus and MC must have been destined lovers in a past life, but due to whatever conflict, Sylus decided to break his bond with her for her protection and accept any punishment that comes with it, which could mean to be ruler of a place he has no desire for, an imprisonment of sort.

Theory 2: Destined lovers, but perhaps a third party interfered out of jealousy or spite. Could Sylus have been caught and framed of a crime and been literally imprisoned, thus forcing him and MC to separate?

So...I half-joked in a post that my new theory is that Sylus sold his soul to the devil. Or, you know, maybe he is the devil himself. This is partly stemmed from the Long-Awaited Revelry trailer, which has the word "demon" over a shot of him and later in the same trailer, one of Sylus' companion forms is aptly titled "Otherworldly Visitor". Make of that as you will.

And with the new trailer for No Defense Zone, we see that Sylus' right eye glows in a demonic way, similar to his in the LAR trailer. Even the atmosphere in both scenes seem a bit supernatural. Now....I didn't want to go there, but, um................do you suppose he is an incubus? 😭😭😭 The shot after "demon" has the word "desire," which can have a sexual connotation.

For those who don't know, an incubus is a male demon who preys on women sexually.......it would explain his kinky behavior in NDZ 💀 but I digress.......

Some of the first lines we hear from Sylus:

"Even if you wanted to sell your soul, you still have to find someone who can pay the price."

"Want some help? Yes? No? Maybe so?"

These lines reinforce the idea of "deal with the devil". In the new theme song, Visions opposées, the singer also sings this line: "Mais c'est le prix à payer" (But that's the price to pay). It could just be figurative, or it could hold some literal truth, because I found it interesting how that verse overlaps with Sylus' scenes. I doubt it's a coincidence since the devs are so good at planting seeds.

From the chorus, in order, we hear:

[MINOR RAFAYEL, XAVIER, & ZAYNE SPOILERS]

"But that's the price to pay / o'love" - Rafayel, God of the Sea, is separated by MC. His price? His civilization.

"Stars will always shine / But with pain" - Xavier and MC are separated (side note: I don't have the second half of Xavier's first myth yet, so I can't elaborate too much. But I've seen enough references to understand the scene depicted in the MV)

"Though separated / Hearts cling on" - Zayne (The Foreseer) is separated from MC in many lifetimes. The memories of their love are tied to the jasmine flowers even if they forget.

[END SPOILERS]

"That's the price to pay / Yet lovers endure forevermore"

This is the verse that plays over Sylus' scene. What is his price? Does the following verse mean that he and MC must always endure something? Hardship? Misfortune?

When the chorus repeats a second time near the end, all of the above verses coincide with the intended love interest. It absolutely can be argued that all four love interests paid a price for their love, and not just Sylus. This whole tangent was brought up to follow with the whole "deal with the devil" aspect. As stated previously, I wouldn't be surprised if the devs and songwriters intended for the lyrics to have layers upon layers of meaning in relation to the stories.

Also take into consideration the lyrics from the song in Sylus' first official trailer, Tangible Shackles:

The outlaw again celebrates this encounter in fate It's time to break the seal they set in mind It's time they will have to pay the price

To me, though, in this song, the verse sounds very vengeful. It sounds almost vindictive, as if someone must be punished for whatever wrongdoing done against Sylus.

Watching the interview for Visions opposées, it seems the LADS team has shared enough of the intended stories for the songwriters to understand and pen the songs we hear. I trust that there will be complete clarity to the lyrics once we're able to understand Sylus' myth.

Love is the privilege of mortals

A gift the gods covet in vain

Astra, you ass, is that you

Now remember the first official trailer for Sylus? Yeah. Long-Awaited Revelry. Do you know what "revelry" mean? 'Cause I sure as heck didn't and kept wanting to read it as rivalry

revelry. noun. a situation in which people are drinking, dancing, singing, etc. at a party or in public, especially in a noisy way. — Cambridge Dictionary

To put it simply, "long-awaited party," which with the new knowledge of the timeline of scenes shown, we can clearly see a scene of MC entering a ballroom where Sylus is at in the trailer.

What type of party is this? Long-awaited? Maybe an engagement? In the MV, you can catch a brief glimpse of guests in the background watching MC enter. It seems almost like Sylus is waiting to show her off. The dance they share also seem intimate, and Sylus' expression is very soft and tender.

Previously, I alluded that it looks like MC and Sylus' wrist are bounded by a thread, similar to the Red Thread of Fate, but afterwards, I had my doubts, and if in keeping with the theme of being trapped, perhaps they were actually cuffed? I have previously mentioned that handcuffs have shown up often in the trailers.

To be cuffed together makes it seem like it wasn't a choice for one or both people. Kind of pondering if maybe MC might have sold her soul to Sylus, thus becoming bounded to him?

I have also made a lot of references to the myth of Hades and Persephone previously (still holding onto it with every fiber of my being tbqh), BUT for the sake of this third theory, let's revise the above scene to mean...

Sylus, a demonic creature, is trapped on the dark side while MC is a mortal on the light side (mortal realm). He knows their love can never be, so he forces whatever bond they made together to break, setting her free to remain in the mortal realm while he remains trapped in the Underworld.

Interestingly, Sylus conjures up a gun, pressing it to his chest where his heart would be. And he makes MC shoot him. ....thus breaking their bond? Or killing him idk man

This appears to be the following appearance of him after he is shot in his chair:

I'm sorry if this seems out of left field and my mind works in a weird way, but.....the scene above kind of made me think of the Roman/Greek myth for Cupid/Eros and Psyche. Rather, I was thinking of the scene where after her jealous sisters manipulated her and planted seeds of doubts, Psyche betrays her husband's trust and broke her promise to not view his face and learn of his identity. She carries a dagger with the intention of killing him.

In the aforementioned myth, Psyche does journey into the Underworld during a final trial set forth by Cupid/Eros' mother, Venus/Aphrodite. Other than that, there might not be many other correlations I can make in regard to the scene depicted in Visions opposées.

Speaking of Cupid (Roman name, but aka Eros in Greek mythology), however, it's also worth noting that Cupid was described as a "demon of fornication" by some mythographers. Take this part with a grain of salt since this was due to adapting the Roman myth for Christian usage. I do, however, vaguely recalled in some Greek/Roman myths, Eros/Cupid was viewed as devious by the other gods due to him being able to make both mortals and the gods fall in love depending on his whims, be it out of mischievousness or malice.

So....Cupid....God of desire....erotic love.............that earlier incubus comment I made?? 😭 This part I am definitely pulling out of my ass. 💀 Let's just wrap this post up. 🫠

If we look at the myth from the angle that Sylus is a demon, then....

Theory 3: Sylus is a demon who has come across MC, and for whatever reason, she is desperate to make a deal with a demon, thus bounding herself to him. Perhaps over time, Sylus grows to adore her, but maybe MC betrays his trust, whether it be intentional or at the manipulation of others? Could he have tested her when he made her shoot him? Was he willing to die for her, even if it's at her hands?

Uhhhh.....yeah. This theory seems more far-fetched. 🫠 Well, thanks for your time! If any of the crumbs I've presented stirred any theories from you all, I'd love to hear it! Bye. 💕

[queen-esther]

I'm so glad to find another woman on this site who is happy that Kamala lost and that Trump's team won. My immediate family, my church, and even my county are very relieved, but I haven't seen much of that relief here. Unsurprisingly so, because I know how pro choice tumblr is, even compared to the US population. I know a lot of pro life activists have been saying that neither candidate was going to further the pro life movement, but Kamala's campaign was outright hostile to the pro life movement, whereas Trump at least has some pro lifers on his team. Trump also allows individual states to ban abortions, whereas Kamala would probably try to legalize it everywhere.

Yes, exactly. Neither side is perfect, but I wasn’t about to let perfect be the enemy of good when making my decision to vote. Trump has always said he wants to leave the abortion issue up to the states, and frankly, he’s the President who appointed some of the Supreme Court Justices responsible for overturning Roe in the first place. Since he won this election, there’s a very good chance he will have more SC picks that could tip the odds further in our favor in the future, too. As a pro-lifer, this was the most desirable outcome of the two, as there was a very real danger of President Harris signing federal abortion access into law if it was brought to her desk, trying to push through executive orders favoring abortion, making tax payers pay for abortions, appointing Justices who would be sympathetic to the pro-choice cause, and more. Trump has not tried and will not try to do any of those things. There was no way I could stomach voting third party or abstaining from voting with the crossroads we were at.

[anarkittyuwuuniverse]

"Although DSM III considerably expanded the range of behaviors defined as markers of mental disorder, the manual never actually defined what exactly qualified these behaviors as mental disorders. The creation of a classification system in which symptoms signified and thus qualified as markers of a mental or emotional disorder now pathologized a wide range of behaviors. For example, “oppositional disorder” (coded 313.81) is defined “as a pattern of disobedient, negativistic, and provocative opposition to authority figures,” “histrionic personality disorder” (coded 301.50) occurs when individuals are “lively and dramatic and always drawing attention to themselves,” and “avoidant and personality disorder” (coded 301.82) is characterized by “hypersensitivity to potential rejection, humiliation, or shame and unwillingness to enter into relationships unless given unusually strong guarantees of uncritical accep-tance.” With the attempt to carefully codify and classify pathologies, the category of mental disorder became very loose and very wide, including behaviors or personality traits that merely fell outside the range of what psychologists postulated was “average.” Behaviors or personality features that might have been previously categorized as “having a bad temper” were now in need of care and management and were henceforth pathologized. Herb Kutchins and Stuart Kirksuggest that the codification of pathologies is related to the close connection between mental health treatment and insurance coverage. DSM III grew out of the need to make the relationship between diagnosis and treatment tighter so that insurance companies (or other payers) could process claims more efficiently. As Kutchins and Kirk put it, “DSM is the psychotherapist’s password for insurance reimbursement.” DSM—which provides the code numbers to be listed on the claims for insurance reimbursement—is the bridge connecting mental health professionals and such large money-giving institutions as Medicaid, Social Security Disability Income, benefit programs for veterans, and Medicare. Not only is it used by the majority of mental health clinicians, but it is increasingly used by third parties such as “state legislatures, regulatory agencies, courts, licensing boards, insurance companies, child welfare authorities, police, etc.” In addition, pharmaceutical industries have an interest in the expansion of mental pathologies that can then be treated with psychiatric medications. As Kutchin and Kirk eloquently put it, “For drug companies, . . . unlabeled masses are a vast untapped market, the virgin Alaskan oil fields of mental disorder.” Thus the DSM, willfully or not, helps label and chart new mental health consumer territories, which in turn help expand pharmaceutical companies. Hence the expansion of the category of mental illness, dysfunction, or emotional pathology is related to the professional and financial interests of mental health professionals and drug companies. It is also related to the increasing use of psychological categories to claim benefits, compensations, or extenuating circumstances in courts. In this process, the DSM has clearly considerably enlarged the scope of psychologists’ authority, who now legislate over such questions as how much anger may be appropriately expressed, how much sexual desire one should have, how much anxiety one should feel, and which emotional behaviors should be given the label of “mental disease.”" -Saving the modern soul: Therapy, emotions and the culture of self-help by Eva Illouz

[sasquatchandleatherjacket]

I can’t understand how anyone can sit through a hospital budget meeting and still think for-profit health insurance is our best option. 118 days on average to close an account. Massive increase in denials. BILLIONS of dollars a year that third party payers not paying out just at my one hospital alone. And of course, those scum buckets are posting record profits quarter after quarter. How have we collectively been brainwashed into accepting this. Shareholders are getting rich by denying CT scans and chemo for children with cancer and half the country is like “fuck yeah I love my shitty commercial insurance! Freedom!!!!”

[follow-up-news]

Consulting firm McKinsey & Co has agreed to pay $78 million to resolve claims by U.S. health insurers and benefit plans that it fueled an epidemic of opioid addiction through its work for drug companies including OxyContin maker Purdue Pharma. The settlement was disclosed in papers filed on Friday in federal court in San Francisco. It marked the last in a series of settlements McKinsey has reached resolving lawsuits over the U.S. opioid epidemic. Plaintiffs accused McKinsey, one of the leading global consulting firms, of contributing to the deadly drug crisis by helping drug manufacturers including Purdue Pharma design deceptive marketing plans and boost sales of painkillers. McKinsey previously paid $641.5 million to resolve claims by state attorneys general and another $230 million to resolve claims by local governments. It has also settled cases by Native American tribes. Friday’s class action settlement, which requires a judge’s approval, resolves claims by so-called third-party payers like insurers that provide health and welfare benefits.

[dapperpea]

I just got a call from my specialist pharmacy for my specialty medication. The brand name specialty medication I take is over $5k/month but the medication's manufacturer gives me a coupon to make it $35/month. However, they changed the coupon so instead of covering $180k max per year it only covers $15k max per year. But if I use the generic (which comes from a different manufacturer, but is also shipped out through this specialty pharmacy) the coupon is for $30 per month, with no max per year. Anyway, the brand name's manufacturer's coupon is running out, so I can pay over $500 for this shipment and $5k for the rest of the shipments this year, or can swap to the generic, or I can use another program.

This other program they suggest is a third-party (company? nonprofit?) for rare diseases. If I apply and get accepted, they'll pay for up to $10k for prescriptions for the year (just under two months' worth of brand name specialty meds). Then I can go back to the brand name med's manufacturer to apply for their assistance program, but their assistance program caps people earning 4x the federal poverty level, which is about exactly what I earn. So I might get into their program, or I might not. Surprise!

Well, I was using the generic last year with the same health insurance I have now, but this year my health insurance told me they'd only accept the brand name. From what the specialty pharmacy told me, the brand name costs 20k per shipment but my insurance only pays 12k and the manufacturer accepts it, but the generic is $18k per shipment but my insurance has to pay $15k. I call my health insurance to ask what the likelihood of getting the generic authorized is, and they tell me they have their own coupon program, and this brand name medication is marked as authorized for it. I can call and the health insurance's coupon program will make it cost $0/month. Weird, they say, the specialty pharmacy should have known that and told you.

So anyway, anyone who says single-payer healthcare would be too complex and raise prices can eat my entire ass, both cheeks, and I'm convinced drug manufacturers and health insurance companies are in some sort of ponzi scheme together to bilk people and the government for money.

[dumbestthingiveeverheard]

Dumbest Thing I've Ever Heard: 7/31/2023

Fifth Place: Erick Erickson

On 7/30/2023, Mr. Erickson tweeted the following:

Starting to see more and more progressives demand public swimming pools. Get ready for the next entitlement program.

Not public swimming pools! Anything but public swimming pools!

By the way, the top reply is somebody pointing out that the city Erickson lives in--has multiple public swimming pools:

I'm sorry, I can't get over this: Erickson is seriously concerned that progressives are going to--what exactly? Use tax payer dollars to make the community better? That's really something you view as a concern? As one Twitter user put it:

i like that the worst thing this guy can imagine is americans collectively deciding to use the wealth they produce and the taxes they pay to give themselves something nice

Fourth Place: Stephen Strang

Right-wing watch posted a clip of him on Friday talking about allowing drag queens to read to children, he says "They would not let someone dressed up in a Nazi uniform go in and read stories to children."

First off, who exactly is the "they" in this case? Second off, there is obviously no comparison between the ideology of the most genocidal and murderous regime of the twentieth century and people dressing in drag, and the fact that you think these two things are on even remotely the same level shows there is something wrong with you.

Third Place: Donald Trump

NBC reached out to forty-four of Trump's former cabinet officials to see how many of them would support his 2024 run for re-election--only four did. Those four, for those curious, are Mark Meadows, Ric Grenell, Matthew Whitaker, and Russ Vought. A Tea Party holdover who played a key role in the Freedom Caucus until he was made Trump's Chief of Staff and who appeared in a debunked creationist propaganda film, a small time ambassador who once got into a fight with Nick Fuentes over if he was immoral for being a homosexual, a failed Congressional candidate turned Attorney General, and a man who is only known for hindering Biden's transition to the Presidency, respectively.

What I find funny though is not that this group of nitwits have endorsed Trump's re-election, but that they are the only ones who worked with Donald Trump to have done so. If so few of the people who were around Donald feel comfortable giving him a second term, what should that say to the rest of us?

Second Place: Jonathan Chait

What's wrong with this picture?

If you said the fact that it implies the corruption of a Supreme Court Justice is on the same level as the corruption of the son of the President despite one actually having the power to impact people's lives and the other not, you'd be correct. However, this false comparison is the entire basis of New York Magazine's article "The Sleaze Problem: How Democrats can clean up the Supreme Court and address the Hunter Biden affair." Why Democrats need to address the Hunter Biden affair--which is little more than trumped up charges against a private system--I'm not sure.

The column even sees its author admitting that nothing Hunter Biden did was illegal while also accepting the incorrect notion that nothing Clarence Thomas did was illegal.

The article proposes that Democrats should propose an ethics code for the Supreme Court while aiming for Republican support through also creating a stricter ethics code around the actions of family members of politicians. Of course, Chait admits this wouldn't actually work because doing so would indict the Trump kids even more than Hunter Biden--but on the bright side, at least the Democrats now have an answer for the irrational and nonsensical charges against Hunter Biden. If only Democrats would play into GOP talking points, that would show them.

Winner: Samuel Alito

Did you know that nothing in the Constitution gives Congress the power to regulate the Supreme Court? Well that's what Samuel Alito thinks--of course, it isn't actually true. Congress specifically has the power to stop courts from ruling on specific issues, to determine who is on the Supreme Court, and various other forms of regulation--but Alito doesn't want to mention that, because that could get in the way of his power grab.

Samuel Alito, you've said the dumbest thing I've ever heard.

[kenresearchcompany]

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[belanova]

Everyone goes on about like "OMG they should've just communicated they're soooo Bad at it!" But the thing that started the escalating was something that wasn't fully in either's hands

Luzu taxed quackity cuz he did it to everybody else but he then added the personal tax of losing which was the first blow to Quackity's perception of luzu

But the second came from the tax people themselves mistreating Quackity, by threatening him and having guns up to his face if he didn't pay it immediately

Which then gives quackity the image that luzu is a massive dictador of not only rigging the elections but harming people for shit they couldn't control and there goes the story

But the thing is how would've luzu ever known the tax payers were going to treat quackity like that yknow? I personally think he shouldn't have made the tax personal and just said it was gorvenment funding

But also how can luzu stop the tax payers from mistreating the people cuz yeah he can fire them later but the damage is already done

Cause the taxes were always inevitable regardless if luzu and quackity were Friends or not but the tax payers never got told to act like that so they did it on their accord towards k!quackity

Which means the whole reason the friendship broke up was a complete third party

[dinosaurcharcuterie]

Honestly? I work with dinosaur healthcare tariffs in Germany, which didn't have universal-universal healthcare until shockingly recently. Basically, if you were rich enough or were legally a bureaucrat, you didn't have to get cover. You could, but you didn't have to. And you had/still have access to private tariffs, which supposedly give you preferential/superior treatment while you pay less. After a certain age, you can't switch out of the private system. Getting a more modern tariff would involve getting a health checkup, making them prohibitively expensive in most cases.

So these older tariffs are still around and in use, with a lot of clauses related to the "overuse of healthcare" included and active.

Stuff like "disposable hygiene products" aren't covered. They supposedly thought people would hand in bills for toilet paper, infant diapers and menstrual/postpartum products. The result? No incontinence products, of any kind, ever.

Medical care provided by nurses outside the home, same thing. The logic being, people would avoid going to hospital or calling a doctor and instead "lazily" get "pampered" by a private nurse in the comfort of their own home, or possibly bill nursing costs for intimacy services. So now it's administrative hell for patient and insurance alike each time someone needs daily help putting on compression wear correctly, or measuring blood pressure, or having bandages changed to avoid a hospital stay.

Same with the extra costs for having a physio go to your house. If you're too poorly to move, you should be in hospital. Absolutely no way this backfires. It's not like people already in a wheelchair would even get accepted for private healthcare. Unless someone gets cover as a child of someone with cover. Or marries someone with cover. Or gets old. Or is involved in an accident where no third party is at fault. Or has a degenerative condition that no one picked up on when they signed on as an apparently healthy 30-something.

The REALLY old tariffs even have a catalogue of what care is covered, to what monetary sum per visit and per year, and ab-so-fucking-lutely nothing beyond that. Insurance law says you can't add cover for anything if it might raise premiums, so these, written up briefly after the discovery of pencillin, don't cover such needless tech-bro fripperies like most modern cancer treatments, at-home blood sugar monitors, the use of tadalafil for medical applications, or, uh, economic inflation. They do cover sitting in a cave inhaling radon gas, in case your doctor is willing to prescribe that instead. You'll get a whole €1,02 back per session. And by doctor, they mean PC. Specialist fees are paid out at 70%, and cap at €25,52 per year.

Wouldn't want to risk the overuse of healthcare, after all.

(And that is just one of the reasons why I'm for a single payer healthcare system.)

[yatharthhospitalnews]

Yatharth Hospitals: Ensuring Excellence In HealthCare

Inception of Yatharth Hospitals in 2010 was done with a vision to provide quality and personalised healthcare to improve the well-being of patients and communities. Today, Yatharth Hospitals has state-of-the-art facilities in Noida, Noida Extension, Greater Noida, Faridabad, and Jhansi-Orchha with over 2300 beds. A team of over 700 doctors are associated with the group including some of the nationally and internationally renowned faculty. Yatharth Hospitals always strive to raise the standards of medical treatment in the region by adopting world-class infrastructure, advanced technology, and experienced and talented professionals. 

Its Yatharth Group’s tireless perseverance in establishing a landmark healthcare chain of seven hospitals in four states of India- Uttar Pradesh, Madhya Pradesh, Haryana, and New Delhi, hence, addressing the state’s and country’s growing need for high-quality advanced healthcare. Yatharth’s contributions to healthcare have been widely recognized by patients, doctors, the healthcare fraternity, and the community at large.

Yatharth Group has also achieved the prestigious NABH (National Accreditation Board for Hospitals & Healthcare Providers) and NABL (National Accreditation Board for Testing and Calibration Laboratories) accreditation for its hospitals. This recognition reflects its commitment to delivering the highest quality healthcare with an unwavering focus on patient safety, cleanliness, and clinical excellence.

What is NABH Accreditation?

NABH accreditation is a gold standard for healthcare quality in India, aligned with international standards. Endorsed by the International Society for Quality in Healthcare (ISQua), it ensures that a hospital adheres to stringent protocols for patient care, safety, and operational efficiency.

Benefits for Patients

Patients are at the core of Yatharth Hospitals' mission, and NABH accreditation reinforces this commitment by ensuring:

Top-Notch Quality Care: Patients receive world-class treatments delivered in a clean and hygienic environment.

Highly Qualified Medical Staff: All medical professionals are rigorously trained and credentialed, ensuring safe and effective care, while following strict safety protocols.

Patient Rights and Satisfaction: Rights are respected, privacy is safeguarded, and feedback is regularly collected to improve the patient experience.

Safe and Transparent Processes: From diagnostics to treatment, every step of care is aligned with NABH standards for safety and efficiency.

Benefits for Yatharth Hospitals

The accreditations are not just a recognition but a catalyst for continuous improvement:

Commitment to Excellence: It fosters a culture of innovation and improvement, ensuring the best clinical outcomes.

Enhanced Community Trust: The accreditation strengthens the community’s confidence in the quality of the care.

Benchmarking with Global Standards: Yatharth Hospitals compare and adapt practices similar to top healthcare providers worldwide, including care, safety, infection-free, and hygiene practices. 

Medical Tourism Potential: With the recognitions, Yatharth Hospital is well-positioned to attract patients from around the globe.

Insurance Empanelment: Accreditation ensures seamless partnerships with insurance companies and third-party payers, making healthcare financing easier for patients.

Competitive Advantage: In a growing healthcare market, NABH certification sets Yatharth Hospitals apart as a trusted name in patient care and safety.

Cleanliness: A Pillar of Our Care Philosophy

Across all locations—Noida, Noida Extension, Greater Noida, Faridabad, and Jhansi-Orchha—Yatharth Hospitals maintains spotless environments with rigorous cleaning protocols. Our focus on hygiene ensures a safe and infection-free experience for every patient and visitor.

Your Trusted Partner in Health

Whether you’re searching for updates on Yatharth Hospital news, researching Yatharth Hospital cases, or exploring healthcare excellence, the Yatharth standards of care speak to its dedication to quality.

Choose Yatharth Hospitals for safe, clean, and reliable care—because your health deserves nothing less than the best.

For more information, visit your nearest Yatharth Hospital or explore our services online.

[industrynewsupdates]

Population Health Management Market Forecast: Growth, Trends, and Opportunities

The global population health management market size is expected to reach USD 280.8 billion by 2030 and is anticipated to grow at a CAGR of 22.0% from 2024 to 2030, according to a new report by Grand View Research, Inc. The healthcare industry is shifting toward the adoption of healthcare IT solutions, including electronic health records (EHR) and population health management (PHM) for value-based compensation. Population Health Management (PHM) solutions can process clinical, financial, and operational data that help improve efficiency and patient care. The health management program is also witnessing changes in medical reimbursement due to the increasing emphasis on value-based payment models.

PHM assists in the stratification of at-risk population groups and the identification of high-cost diseases. Besides, increasing use of machine learning and artificial intelligence in analytics is likely to drive the market growth. With rapid advancements in technology, PHM is likely to offer a win-win situation for healthcare providers. For instance, the use of data analytics is expected to help reduce costs, increase productivity, and offer improved clinical outcomes.

The key participants are engaged in strategies such as product launches, collaborations, partnerships, and joint ventures among others to expand their global footprints and product portfolio. Alternatively, rising strategic acquisitions, new product launches, and partnership deals are other factors fueling market expansion.

Gather more insights about the market drivers, restrains and growth of the Population Health Management Market

Population Health Management Market Report Highlights

• In terms of product, the services product segment held the largest market share in 2023, as healthcare providers prefer in-house maintenance services. Demand for PHM services is increasing among hospitals and other healthcare organizations to involve third parties to assess patient data

• In terms of delivery mode, cloud-based segment is anticipated to register the fastest CAGR over the forecast period as it offers the end-user with faster, effective, and efficient clinical outcomes

• In terms of end-use, healthcare providers held the largest market share in 2023. The providers can focus effectively on patient care and reducing overall costs. The large market share is attributed to the implementation of value-based care using healthcare analytical tools

• Based on region, North America was the largest regional market in 2023 and is likely to retain its position over the forecast period, as the providers, payers, providers-payers, and accountable care organizations promote the use of PHM services

• In Asia Pacific, the market is expected to witness the fastest CAGR over the forecast period due to rising healthcare expenditure and improving healthcare infrastructure in the region. Acquisitions and business partnerships with other market players are some of the strategic initiatives undertaken by key players to strengthen their market presence

Browse through Grand View Research's Healthcare IT Industry Research Reports.

• The global clinical risk grouping solution market size was estimated at USD 703.10 million in 2023 and is anticipated to grow at a CAGR of 13.13% from 2024 to 2030.

• The global digital therapeutics market size was estimated at USD 6.2 billion in 2023 and is expected to grow at a CAGR of 27.2% from 2024 to 2030. 

Population Health Management Market Segmentation

Grand View Research has segmented the global population health management market based on product, delivery mode, end-use, and region.

Population Health Management Product Outlook (Revenue, USD Million, 2018 - 2030)

• Software

• Services

Population Health Management Delivery Mode Outlook (Revenue, USD Million, 2018 - 2030)

• On-Premise

• Cloud-based

Population Health Management End-use Outlook (Revenue, USD Million, 2018 - 2030)

• Providers

• Payers

• Employer Groups

Population Health Management Regional Outlook (Revenue, USD Million, 2018 - 2030)

• North America

o U.S.

o Canada

• Europe

o UK

o Germany

o France

o Italy

o Spain

o Sweden

o Norway

o Denmark

• Asia Pacific

o Japan

o China

o India

o Australia

o Thailand

o South Korea

• Latin America

o Brazil

o Mexico

o Argentina

o Colombia

• Middle East & Africa

o South Africa

o Saudi Arabia

o UAE

o Kuwait

Order a free sample PDF of the Population Health Management Market Intelligence Study, published by Grand View Research.

[blogofmastermind]

How Data Outsourcing is Revolutionizing Healthcare Billing and Improving Financial Outcomes

In an era where healthcare costs continue to rise and reimbursement rates become more stringent, managing the financial health of a healthcare organization has become a more intricate challenge than ever. From medical billing to revenue cycle management (RCM), these processes are crucial in ensuring healthcare providers are paid accurately and on time for the services they render. However, manual billing and traditional approaches are often prone to errors, inefficiencies, and delayed payments.

This is where data outsourcing comes into play. By leveraging specialized third-party services to handle billing, coding, and RCM functions, healthcare organizations can achieve more efficient processes, reduce administrative costs, and improve cash flow. In this blog, we’ll explore how outsourcing is transforming healthcare billing and the role it plays in enhancing overall financial performance.

Understanding the Role of Data Outsourcing in Medical Billing

Medical billing is the process of submitting claims to insurance companies or patients in order to receive compensation for healthcare services provided. The complexity of medical billing, which involves adhering to various insurance policies, coding standards, and legal requirements, makes it a demanding task for in-house teams. Data outsourcing in this context refers to partnering with a third-party service provider that handles the medical billing process.

Outsourcing billing functions allows healthcare providers to offload the responsibility of dealing with insurance claims, coding errors, compliance issues, and payment collection, all of which can significantly impact the financial stability of the practice.

The Challenges of In-House Medical Billing

Managing medical billing in-house can be a cumbersome and resource-intensive task. Some of the challenges faced by healthcare organizations that choose to handle billing internally include:

High Operational Costs: Maintaining an in-house billing department requires hiring and training specialized staff, as well as investing in expensive billing software and infrastructure.

Complexity of Coding and Compliance: Medical codes change regularly (e.g., ICD, CPT, HCPCS), and staying compliant with insurance payer requirements and government regulations (such as HIPAA) can be overwhelming.

Claim Denials and Rejections: Billing errors, whether from inaccurate coding or incorrect patient information, often result in claim denials. Addressing these denials and resubmitting claims can be time-consuming.

Revenue Leakage: Inefficient billing systems or untracked claims can result in missed opportunities for reimbursement, leading to lost revenue.

Staffing Issues: High turnover rates in billing departments, especially in small practices, can affect consistency and create delays in processing claims.

Why Outsource Data for RCM and Medical Billing?

Outsourcing the Revenue Cycle Management (RCM) and medical billing processes to a specialized service provider can address many of these challenges. Here’s how data outsourcing can help:

1. Access to Industry Expertise

Outsourcing partners bring deep industry knowledge to the table. These companies specialize in medical billing, coding, and RCM, so they are well-versed in the nuances of insurance claims, payer-specific requirements, and regulatory standards. They ensure that claims are submitted with the correct codes, reducing the risk of rejections and denials.

2. Streamlined Billing and Coding Processes

Outsourcing providers use advanced technologies that automate billing and coding processes. This streamlining significantly reduces the manual workload, minimizes errors, and accelerates the overall claims submission process. With automation tools, billing cycles become shorter, leading to faster payments and improved cash flow.

3. Reduced Claim Denials

One of the most significant advantages of outsourcing medical billing is the reduction in claim denials. Outsourcing partners have dedicated teams that handle claims resubmissions and follow-ups with insurers. They monitor claims in real time and identify any issues before they result in denials, ensuring a smoother reimbursement process.

4. Improved Cash Flow and Revenue Cycle Efficiency

With specialized billing professionals working on your behalf, you can expect a faster turnaround time for claim submissions and payments. Outsourcing ensures that claims are processed quickly and accurately, reducing the time it takes to receive payments. As a result, healthcare providers see improvements in their accounts receivable (AR) performance and an overall healthier revenue cycle.

5. Scalability and Flexibility

Outsourcing providers can scale their services to meet the changing needs of healthcare organizations. Whether you're a small practice that needs help during seasonal peaks or a large hospital system looking to streamline billing processes across multiple departments, outsourcing can accommodate growth and fluctuations in demand. With outsourcing, you don't need to worry about recruiting and training more staff during busy periods.

6. Cost Savings

Outsourcing medical billing and RCM reduces the need for in-house staff, training, and infrastructure investments. By paying only for the services rendered, healthcare organizations can cut operational costs without compromising the quality of billing services. Additionally, outsourcing partners often offer pricing models based on performance or transaction volumes, so the costs remain predictable.

7. Improved Focus on Patient Care

When the burden of billing and administrative tasks is outsourced, healthcare providers can redirect their attention to patient care. This results in better clinical outcomes and enhanced patient satisfaction, which are essential in today’s competitive healthcare environment.

Benefits of Data Outsourcing in RCM Beyond Billing

While medical billing is a critical aspect of RCM, outsourcing can have a broader impact on the entire revenue cycle:

1. Insurance Verification and Eligibility Checks

Outsourcing companies can handle patient insurance verification, ensuring that patients’ coverage details are accurate before services are rendered. This prevents delays in reimbursement caused by coverage errors and helps with front-end revenue cycle management.

2. Denial Management

Outsourcing providers can track denied claims, identify trends, and implement corrective actions to reduce future denials. By focusing on the root causes of claim rejections, they help healthcare providers avoid long-term revenue leakage.

3. Financial Reporting and Analytics

Outsourcing partners typically offer detailed reporting and analytics that provide insights into a healthcare organization’s financial performance. Providers can track key metrics such as collections, denial rates, and payment trends, enabling them to make data-driven decisions and improve their revenue cycle.

Selecting the Right Data Outsourcing Partner

To maximize the benefits of data outsourcing in medical billing and RCM, it’s essential to select the right partner. Consider the following factors when choosing an outsourcing provider:

Experience and Industry Knowledge: Look for a partner with a proven track record and expertise in your specific area of healthcare.

Data Security and Compliance: Ensure the provider is HIPAA-compliant and has robust data protection measures in place.

Technology and Tools: Make sure the outsourcing company uses the latest billing and coding software, automation tools, and reporting systems.

Customer Support: A reliable outsourcing partner should offer excellent customer service, with dedicated support to address any issues or concerns.

Conclusion

The growing complexities of healthcare billing and revenue cycle management are prompting more organizations to look toward data outsourcing as a viable solution. By outsourcing medical billing and RCM functions to specialized providers, healthcare organizations can significantly improve accuracy, reduce operational costs, enhance revenue collection, and focus more on patient care.

As the healthcare industry continues to evolve, outsourcing will play an increasingly important role in ensuring that providers receive the compensation they deserve while improving their overall operational efficiency.

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There's supposedly over 161 million registered voters in the U.S., in 2024 (it was 168 million in 2020, apparently about 7 million people died or got taken off the registration, which might be voter suppression) a total of about 141 million votes have been counted for both Harris and Trump so far.

And there's millions more citizens who are eligible to vote but have never been registered.

Trump won the popular vote by about 5 million this time, but there's still about 20 million people on the voter rolls who evidently aren't part of the Democrat+Republican totals. Those 20 million (and, votes are still being counted, so the final total might be less, though I did round the Trump total up to 73 million and the Harris total up to 68 million, for my convenience) either didn't vote (at least for the presidency) or voted third party.

Since the electoral college is what decides who the president is, though, it does depend on where those 20 million live. And I'm doing this on my phone, and don't have the time or energy to do that statistical breakdown for every single state, how many registered voters per state vs. how many people did or didn't vote in that state.

Harris got about as many votes as Clinton in 2016, maybe a few million more, Trump got about as many votes as he got in 2020, if a little less.

A lot of the swing states that went for Trump, did have Abortion initiatives and other progressive initiatives on the ballot, many of which passed, and a few of them supposedly had local elections that went blue, even when the counties themselves still went for Trump, or the district voted for a republican for a congressional seat.

And, like, that's odd, honestly. Like, a possible explanation is that, progressive voters turned up, voted for a democratic mayor or state senator or governor or abortion rights or whatever, then left all the federal selections blank. Because while state legislatures and governors can't actually do a lot about foreign policy, they can, in fact, do things to people in their states and cities.

But for that to be true it would require a big difference between the vote totals for Trump+Harris in those states and the vote totals for those down-ballot races, and. There doesn't seem to be, at first glance? It seems like otherwise democratic voters, or voters who voted for progressive ballot initiatives. Voted for Trump anyway. And 20 million registered voters just didn't turn up.

And, to be cynical for a moment? It isn't like the Israel/Palestine conflict started on October 7th. Palestinians have suffered wrongdoing by the government of Israel since the modern state of Israel's founding, and Israel has had better weaponry and American support for a very long time and they've definitely dropped bombs before. And they've also had the illegal settlements in the West Bank for years.

And all of that was also already true in 2020, and Biden supported Israel back then too. His political stance on Israel didn't change between then and now. Biden already said he would never support Medicare for all, or single-payer healthcare, everyone knew he was moderate/conservative, right-wing, on a lot of issues. Biden in 2020 had some support from some "never Trump" Republicans who endorsed him as well.

And Biden could be associated with Obama and Obama's handlings of the wars in Iraq and Afghanistan, as Obama's VP. And the U.S. armed forces who actually answered to Obama were the ones doing war crimes and drone and missile strikes for that.

But it seems like Biden was able to get away with it and get 10 million more people to vote for him, very possibly, because he was a white guy. The same complaints had a harder time. Sticking.

Its not like nobody had complaints about the Biden campaign's mismanagement. His history of gaffes, the time he was in a basement and nobody saw him for weeks.

Then again, maybe Biden just got lucky that Covid happened, and Trump clearly and obviously mismanaged it. And Harris, in turn, got associated with the slow economic recovery from Covid, lead by the Biden Admin, and with all the wars in Ukraine and Israel/Palestine that Biden evidently didn't do well enough resolving.

Wars that, again, had already been happening, going back to when Putin's Russia annexed Crimea back in 2014, and, again, the very long history of the Israel-Palestine conflict. But I guess people don't care as much when it isn't in their news feeds or their social media timelines.

...Honestly. The thing that gets me about the popular vote totals is that. Trump went from 63 million in 2016, to over 74 million in 2020, and he's still at almost 73 million now.

So, yeah, there's 20 million people who didn't vote this year, aside from the millions who aren't registered, but. 10 million more people voted for him than voted for him the first time he won.

And. That's a lot scarier to me, in all honesty.

"I don't want to see anyone blaming abstaining voters for this!"

Of course you don't. The entire idea of abstaining was that you could pretend this didn't involve you. Not getting blamed was more important to you than doing any kind of damage control, more important than protecting any of the people you said you wanted to protect. And in this moment, I don't really care what you want. Of course, this isn't entirely your fault. Of course other people made this worse. But if you're going to pretend you had nothing to do with this, forgive me if I ignore you.

[hayleymedbil]

Navigating Medical Billing Contracts: Key Insights for Healthcare Providers

Navigating Medical ⁣Billing Contracts: Key Insights for Healthcare Providers

In the complex world of healthcare, understanding medical⁣ billing contracts is crucial for providers aiming to optimize their revenue ‌cycle. From negotiating favorable terms to comprehending reimbursement rates, navigating this landscape effectively can significantly impact a practice’s financial health. In this article, we’ll explore essential insights, practical tips, and the benefits of managing your billing contracts wisely.

Understanding Medical Billing Contracts

A medical ⁤billing contract ​is an agreement between healthcare providers and third-party ‌payers,​ such‍ as insurance companies or Medicare. These ⁢contracts outline terms concerning reimbursement rates, ⁤billing procedures, and patient responsibilities. ⁣Understanding‍ these elements is key for providers who want‌ to maximize revenue‍ and minimize denials.

The Importance of ⁣Clear Contract Terms

A well-structured ⁣medical billing contract should include:

Reimbursement Rates: ​Clear definitions of how ⁣services will be paid.

Billing Procedures: Specifications ‍on how and ​when claims should be submitted.

Dispute Resolution: Processes in place for handling⁣ billing disputes.

Termination Clauses: Conditions under which either party can terminate the contract.

Benefits of⁤ Well-Negotiated Medical Billing Contracts

Navigating medical billing contracts effectively can yield numerous benefits for healthcare ‌providers:

Increased Revenue: Favorable negotiations can lead to higher reimbursement rates.

Reduced Denials: Clear procedures minimize the risk of claim denials.

Improved Cash Flow: Efficient ⁤billing practices enhance timely reimbursements.

Enhanced Relationships: Strong partnerships with⁣ payers can lead to​ better communication and support.

Key Insights ⁣for Navigating Contracts

1.‍ Conduct Thorough Research

Before entering negotiations, conduct an audit of your current billing practices and⁤ familiarize yourself with the market standards. Understanding average reimbursement​ rates for ⁤your specialty ‌can provide leverage.

2. Negotiate ⁤Terms Effectively

Don’t hesitate to negotiate every⁢ aspect of your contract, from reimbursement rates to payment timelines. Consider the following:

Present data on ‍your practice’s performance, including patient volume ‍and services offered.

Be prepared to discuss trends in reimbursements and adjustments based on ⁣your recent ‍staffing or technology investments.

3. Monitor Contract Performance

Once contracts are in place,‌ continuously monitor their performance to ensure compliance with the terms. Regular tracking can highlight issues early, allowing for timely resolution.

Common Pitfalls to Avoid

While navigating the landscape of medical billing contracts, healthcare providers should be⁤ aware of potential pitfalls:

Ambiguous Language: Ensure that contracts use clear, ⁤unambiguous ‍language.

Overlooking Hidden Fees: Investigate any administrative or hidden fees associated with billing services.

Not Understanding Coding Guidelines: Stay informed about coding changes that can affect billing.

Case Studies:‌ Successful Contract Negotiations

Case ⁣Study 1: A⁣ Rural Clinic

A rural clinic increased its ​reimbursement rate⁤ by ‌15% by detailing its patient demographics and healthcare services offered during negotiations with a local insurance provider.‍ The clinic ⁢maintained meticulous records of treatment outcomes, which proved instrumental in their argument for higher rates.

Case Study ⁢2: A Specialty Practice

A specialty practice successfully reduced its denial rates by 30% after‌ revising‍ its medical billing contract to include clearer ⁢definitions of services covered and included checkpoints for ​necessary documentation.

Practical Tips ⁣for Effective Management

To further enhance your experience with medical billing contracts, consider the following practical tips:

Educate Your Staff: Ensure your team⁢ understands ‌billing procedures and contract terms.

Utilize Technology: Leverage software​ solutions to track claims and‍ manage contracts effectively.

Regularly Update Contracts: ⁤ Review contracts annually and re-negotiate as​ necessary based on‍ changes in services or market conditions.

Conclusion

Navigating‍ medical billing contracts⁣ is an essential component of a healthcare provider’s business strategy. By understanding the key elements of these contracts, negotiating effectively, and monitoring ⁤performance, healthcare providers ⁤can secure better financial outcomes. The insights provided in this‍ article are meant to empower providers in their efforts to manage their medical billing contracts efficiently, ultimately enhancing ⁤patient care and practice sustainability.

https://medicalcodingandbillingclasses.net/navigating-medical-billing-contracts-key-insights-for-healthcare-providers/