Bundling Medical Insurance Codes – Stop Loosing Money To "Bundled" Medical Insurance Claims

What exactly is “bundling” anyway? It is when an insurance carrier combines two or more CPT codes, substituting one overarching code, often ignoring modifiers along the way. This practice can cut down on your receivables. When codes are bundled, the codes are grouped together and the insurance carrier will only allow the fee schedule allowance for the one code that they feel is appropriate.

There are ways to get around bundling. First you need to make sure you are billing the claim properly on the initial submission. For example, if you are billing for an E&M code for a patient who comes in with high blood pressure but the patient is also complaining of knee pain and you end up doing an aspiration of the knee joint, then you need to make sure you use the correct modifiers to indicate what you are doing. You want to bill the E&M code, say it is a 99213, with a 25 modifier to indicate that it is a separate and distinct service provided during the same visit. Then you would bill for the aspiration of the knee joint with the appropriate code using a 59 modifier to indicate a distinct procedural service.

It is quite necessary to know the proper use of all the different modifiers to get full reimbursement for your services. Also as important is the ability to read an EOB (explanation of benefits statement) correctly. EOBs can be fairly complicated and it is important to understand what the insurance company did with the claim.

When the claim is processed and you receive the EOB you need to make sure the insurance company allowed both codes separately. After all, you did an office visit to manage to high blood pressure and you did the aspiration which was completely separate from the office visit.

If the insurance carrier bundles your codes you should file an appeal. In many cases the insurance carrier will reprocess the claim and unbundled the codes if you go through the appeal process.

The appeal does not have to be complicated. It can be a form letter that you design where you just need to fill in the blanks. A lot of carriers bundle the claims on initial processing because the majority of offices will not appeal the claim. Just think how much money they save!

You may think that it’s not worth the time to appeal but you may be surprised if you knew how much money you actually lost over time. If you have a system in place to file the appeals that is a fairly simple process it won’t take much time and you can increase your receivables. In my opinion, it is worth the effort.

Copyright 2007 – Michele Redmond

Source by Michele Redmond

What is Mesothelioma?

Pleural mesothelioma is one of the most common types of lung cancer and is usually brought on by exposure to asbestos. When asbestos is inhaled, the micro fibers pass down the airways and become embedded in the pleura ( the thin outer lining of the lungs). This induces serious scarring and chronic inflammatory lesions on this delicate tissue. Over a period of time these lesions and scars slowly develop into pleural mesothelioma, a deadly form of lung cancer for which there is no definative cure. These asbestos micro fibers sometimes also settle in the abdomen, leading to the development of peritoneal mesothelioma. This type of cancer, although less common, is just as deadly.

Just like asbestosis, pleural and peritoneal mesothelioma usually have a long period of dormancy after exposure before clinical signs start to show. In fact some patients do not show symptoms for 40 years after exposure.

The common symptoms of pleural mesothelioma are:

Coughing up small amounts of blood

Stomach / belly pain

Shortness of breath/ wheezing

Chronic cough

Chronic fatigue

Weight loss

Chest pain

Unfortunately mesothelioma (both pleural or peritoneal) is in most cases fatal. Sadly most patients die within two to three years of diagnosis. However, recently researchers have made great steps in finding useful treatments for the disease.

Available Mesothelioma Treatments are:

Palliative drainage of fluid from the chest (pleural cavity)

Surgery

Chemotherapy

Radiation

Gene therapy

Photodynamic therapy

Immunotherapy

If you have been diagnosed with asbestosis, mesothelioma, or asbestos exposure-related lung cancer, you could be entitled to compensation, depending on when you were exposed, where you were exposed, and where the companies you believe to be responsible currently reside.

Source by David Barnet

Insure Your Home Against Natural Disasters

Are you familiar with the term “all risk” insurance? Your answer is probably ‘yes, of course’. But are you sure you understand it properly? You may feel inclined to think that it covers all hazards, as the name implies. It is indeed the broadest kind of property policy that can be acquired, but this doesn’t mean that it indemnifies all losses. Only losses which are not specifically excluded are automatically covered.

So, pay special attention to the list of exclusions. Otherwise, you may have the unpleasant surprise to discover that, after your property has been damaged, the insurance company will simply not pay, because the disaster that had hit you was on the exclusions list.

Typical homeowners policies usually offer protection against damage-causing events like fire, lightning, explosion, falling objects, wind and theft. They do not include coverage of devastation provoked by natural disasters. Natural disasters refer to phenomena, such as a hurricane, tsunami, flood, drought, an earthquake, a landslide, a volcanic eruption etc. that cause extensive human casualties and/or property damage.

Considering that in our today’s world calamities can strike at any time in almost any place – from Australia to Hawaii, from Chile to India, from the USA to China – we are all potentially exposed to the vagaries of nature. That is why, in order to strengthen our feeling of security, it is good to provide our belongings with a natural disasters policy. Sometimes they are sold as a separate policy to supplement an existing one. Other times, for an additional annual fee, insurers will add calamities coverage to the existing agreement.

For business professionals who provide advice to their customers it is of vital importance to benefit from a professional indemnity insurance, as a cover for claims brought against them due to their professional negligence. We have in view experts from the fields of Accounting and Finance Service, Building, Transport Industries, Architecture etc. who are subject to negligent act, error or omission. Similarly, for properties situated in areas prone to natural hazards it is to the same extent of capital importance to rely on a safe haven: natural disasters insurance.

Source by Jack Wogan

Top 7 Questions to Ask When Evaluating Income Protection Insurance

If comparing income protection insurance options was simply a matter of comparing prices of the various policies on offer, it would be a relatively easy task… but with the large number of policy variations in the market – all designed with different outcomes in mind, the job can be quite complex for the uninitiated. In this article I have identified what I think are the main things that you might consider in conjunction with price to ensure that you are getting true value for your insurance dollar.

1. How is ‘disablement’ defined under the policy?

The definition of disability is the door that you will need to unlock in order to get paid under an income protection insurance policy.

Some policies express disablement as being incapacitated to an extent where you are unable to do certain duties of your occupation, other policies base their definition on your capacity to continue to earn income. A few policies offer a combination of both.

There are also many variations within these two main definitions which could effect your ability to make a claim.

Remember, your insurance policy is a legal contract between you and your insurer – so the way that things are defined in that document will shape the way your policy works at claim time.

2. How long will my income policy continue to pay me if I have a major claim?

Some policies will continue to pay for a lifetime in the event of a permanent disability and others have benefits that cease after just 12 months.

There are also many policies on the market that have a different maximum claim period depending whether your income protection claim is as result of an accident as opposed to illness.

If you have (or are considering) a policy with a different payout for injury vs illness then you will also need to ask…

(a) how both injury and illness are defined in the policy and…

(b) whether a claim could be jeopardised if complications that arise indirectly from an injury are classified as an illness.

3. How long after I make a disability insurance claim do I have to wait before I can get paid?

Policies can have an excess of 7, 14, 30 days or even longer before you become entitled to claim payments. The longer that you can afford to manage financially before needing a replacement income, the cheaper the price.

You should also find out whether the policy pays weekly, fortnightly, monthly in arrears, etc.

If an income protection policy has a 30 day excess and pays monthly in arrears then you could be waiting 2 months or more before you start to see the money flow.

4. How much will my income protection policy actually pay me each month if I have a claim?

More specifically, you should find out whether the amount insured is an agreed value amount or whether your claim entitlement calculated based on actual pre-disability earnings that could vary depending on when you claim.

It’s possible, depending on your policy, that you may be required to prove your income at claim time whilst other policies accept proof of income at the time the insurance is purchased.

5. How does my income insurance cover me if I am partially disabled?

You will need to be aware of…

a) whether the policy includes benefits for disablement that limits your earning capacity but does not prevent you from working altogether and

b) whether partial disablement benefits are restricted to allow payment only after you have had a period of total disablement. Remember, there are many illnesses in particular that are degenerative in their nature and could impact on your ability to survive financially.

6. How do my income protection insurance rates change over time?

Rates can be fixed for the term of the policy or stepped, i.e. they increase over time. They may also increase further with CPI.

Most importantly, you will want to know whether there is any rate penalty that you may incur as a result of having a claim.

7. What assistance does the income policy provide assistance with rehabilitation?

After a long term disability in particular, there may be a point in time when you feel that you want to get back into the workforce in order to improve your position.

It’s important that you know whether the company will assist you in this way or whether they will hinder you by offsetting any future income that you may earn against future benefit payments.

Source by Andrew Clark

The Different Types of Asbestos

Asbestos is a naturally occurring mineral. It does not conduct heat or electricity, is chemically inert, odorless, fire-resistant and insoluble. These physical properties made the mineral suitable for a wide range of commercial applications. Some products that contain it are: adhesives, brake pads, clutch plates, ceiling tiles, wall panels, shingles, electrical breakers, fire curtains and boiler insulation. There are six types of asbestos. These are tremolite, actinolite, chrysotile, anthophyllite, amosite and crocidolite.

Tremolite was not used as extensively in products as other types of asbestos. However, it was used in products such as talcum powder. This type of asbestos is found in ultramafic rock that can be found in the U.S., Europe and other regions. The color of tremolite can vary from brown to gray or white to green.

Actinolite can be found in metamorphic rocks. It can be green, white or grey in color. Its commercial applications include home insulation products and vermiculite products.

Chrysotile is also known as white asbestos is the most commonly observed type of asbestos. It is different from other types in that it has curled fibers. Other types have straight and needle-like fibers.

Aanthophyllite occurs in ultramafic rocks. It is less commonly encountered than other types of asbestos. It is more commonly found in countries such as Norway and Finland. It is dark brown in color. Aanthophyllite has been used in cement tiles, insulation material and plumbing related products.

Amosite is also known as brown asbestos or Grunerite. Its origin can be traced to Africa. Commercial applications of amosite include cement sheet and pipe insulation.

Crocidolite is also known as blue asbestos. It can be found in Africa and Australia. It accounts for about 4% of the asbestos that was used in the U.S. Although, it is often blue in color, it can also be grey. About 18% of people who have mined crocidolite have died from mesothelioma. Crocidolite was used to make cement products.

Exposure to asbestos can lead to cancers such as lung cancer and malignant mesothelioma. People suffering from these illnesses need to explore their legal options because the law allows substantial financial compensation to those who have been recklessly exposed to asbestos. Legal claims for compensation however, must be filed in a timely manner. An experienced mesothelioma attorney can obtain significant financial assistance for a mesothelioma patient from a mesothelioma settlement.

Source by Hameem Kader

Business Tax Deductions

As we enter mid-March, taxpayers begin to become very

interested in deductions. Following are a few that

you may be entitled to claim.

Deductible Expenses

· Office expenses

· Rent or lease payments

· Advertising

· Costs of goods sold

· Insurance costs

· Utilities

· Payments to independent contractors [file form 1099]

· Accounting fees

· Legal fees

· Communication expenses

· Credit Card Interest for business charges

· Travel expenses

· Vehicle expenses

· Business-related meals and entertainment

· Uncollected receivables

· Bank fees on business accounts

· Interest payments on notes

· Excise and fuel taxes

· Employment taxes

· Real estate tax paid on business property

· Special local assessments for repairs or maintenance to

business property

· Promotional costs that create goodwill such as sponsoring

a youth team

· Business association dues

· Business-related magazines

· Casualty losses

· Beverage services

· Credit bureau fees

· Taxi fares

· Telephone calls made on trips

· Self-employment tax [if applicable]

Sales Tax Deduction Option

The American Jobs Creation Act of 2004 provides all

taxpayers with the option to claim a deduction for state and

local sales taxes instead of state and local income taxes.

If you purchased a high cost item during 2004, you may find

that the total sales tax you pay far exceeds your state

income tax payment. If so, you should determine whether you

should claim a larger deduction by using the IRS Optional

State Sales Tax Tables found in IRS Publication 600.

The new sales tax deduction is a windfall for taxpayers in

Alaska, Florida, Nevada, Texas, Washington, South Dakota and

Wyoming. These states do not tax the income of their

residents, which makes the sales tax deduction a very

valuable deduction indeed! Regardless, taxpayers in all

states should the possibility of claiming a sales tax

deduction.

Source by Richard Chapo

Insurance Appraisal Clause – Resolving an Impasse in Your Claim

What if, after all you’ve done, you and your adjuster/insurance company are at an impasse on the value of your property? It’s now time to invoke the Appraisal Clause in your insurance policy. The Appraisal Clause is found in all insurance policies, and was designed to establish a procedure to allow disputed amounts to be resolved by disinterested parties. The appraisal clause can be found in every homeowners policy, in every policy covering commercial buildings, in all business policies, as well as in every renters policy…even automobile policies.

The Appraisal Clause is usually found in the policy under the Heading “Conditions” and/or “What to do after a loss.”

Don’t confuse the Appraisal process with Arbitration. The Appraisal Clause does not bind either party to its findings. In arbitration, the findings of the arbitrator are usually binding on both parties.

The Appraisal Clause is meant to be the method for determining disputed values. Appraisal cannot be used to determine what is covered. That is for a court of law to decide. If you have dispute with the company on whether or not something is covered, then you must file a lawsuit against your insurer to get that determination.

HERE’S A REALLY IMPORTANT TIP!!! You don’t have to wait until you’re hopelessly deadlocked with the adjuster or insurance company to invoke the Appraisal Clause. The Appraisal procedure has been invoked more often by insurers, who have greater understanding of the terms and conditions of their policies. But you, the insured or policyholder, can do it any time.

I’m not suggesting that you become uncooperative. But occasionally, I talk to people who are having real difficulties with their adjuster or insurance company. Taking the claim to Appraisal sometimes stops all the drama.

In my experience as both an appraiser and an umpire, I’ve found that disputes can be resolved more quickly by appraisal than the resolution you might get with litigation. The cost of the appraisal process is also significantly lower that the cost of litigation.

Here’s what the Appraisal Clause reads in my Homeowner Insurance policy:

“If you and we fail to agree on the amount of loss, either may

demand an appraisal of the loss. In this event, each party will choose

a competent appraiser within 20 days after receiving a written request

from the other. The two appraisers will choose an umpire. If they

cannot agree upon an umpire within 15 days, you or we may request

that the choice be made by a judge of a court of record in the state

where the “residence premises” is located. The appraisers will

separately set the amount of loss. If the appraisers submit an

agreement to us, the amount agreed upon will be the amount of loss.

If they fail to agree, they will submit their differences to the umpire.

A decision agreed to by any two will set the amount of loss.

Each party will:

a. pay its own appraiser, and

b. Bear the other expenses of the appraisal and umpire equally.”

Each party appoints an independent, disinterested appraiser. In past experience, I’ve seen the insured or policyholder try to appoint the Public Adjuster who is handling his claim as the appraiser. This should never be done, as that PA is not a disinterested party.

The appraisers evaluate the loss independently. The appraisers can still negotiate and reach an agreed amount of the damages. But, if they cannot agree, they work together to choose a mutually acceptable umpire. If the two appraisers cannot agree on the selection of an umpire, either side may appeal to the local court for the appointment of someone to serve in that capacity.

An umpire must also be a disinterested party, and must be impartial, of good moral character and possessing a good reputation. He also must be willing to listen. No umpire should be chosen that has any financial interest in the outcome of the appraisal. Any other consideration other than the hourly rate of compensation for the umpire is not acceptable.

Once the umpire has been chosen, the appraisers each present their loss assessment. Often, this involves informal testimony from the parties involved in the claim. To help the umpire gain a more complete understanding of the details of the loss, the appraisers and the umpire sometimes meet at the loss location and review the loss details. The umpire will subsequently provide a written decision to both parties. If any two parties agree to the amount of the loss, that amount becomes the claim amount. However, if one of the parties does not agree, then the case can still be turned over to legal counsel for litigation.

Question: May the insured or insurer reject the other parties’ choice of appraiser?

Answer: In 2005, the New York Department of Insurance issued a ruling on this question as follows:

“Whether an appraiser appointed by either of the parties is competent and disinterested (or “independent”) is a question of fact for a jury and is outside the determination of this Department.”

ANOTHER TIP!! Notice that there are very specific time limits in the Clause. You MAKE SURE that you choose your appraiser and notify the adjuster within the time limit in your policy. The time limit for both appraisers to choose an umpire begins on the day that both sides choose their appraiser.

Watch very carefully to see if the insurance company and/or adjuster chooses their appraiser within that time limit. If they do not, they have violated the terms and conditions of their policy. You can file a complaint with your state’s Department of Insurance for Unfair Claims Practice violations.

My recommendation, in the event of an appraisal, is to call a Claims Consultant. You might also consider contacting a public adjusting company in your area. The Claims Consultant or PA know insurance policies, know the Appraisal Clause, and know property values. The Claims Consultant or PA are the perfect choices for helping you prove the values of the property of your claim.

Source by Russell Longcore

Living Life Six Months at a Time

I recently found myself in the Carbone cancer center at the University of Wisconsin once again. It had been six months since I was last there. Six months since my last CT scan. Six months since I sat in the small examining room awaiting the arrival of my oncologist to review my scan with me and talk about where I’ve been and where I’m at and most importantly, where I am going. I was truly nervous. This is my first six-month review. Prior to this I was being seen every three months before that every month and prior to that every day.

Six months does not seem like a long time if it is put into the perspective of a normal lifetime. If you happen to be me, a current lung cancer survivor, six months represents the longest time you’ve gone without medical supervision for the past three years.

When I was first told that I did not have to return for six months, I was very excited. The things I could do in six uninterrupted months would be wonderful. I must tell you that the first three months were just that, I was at the peak of my limited energy. I was writing and speaking with potential sponsors and donors. I met with and spoke with company executives regarding cancer products and research. I spoke with cancer patients and gave support. For three months I was on top of my game. Then somewhere in that stretch it dawned on me that three months had passed and my internal cancer clock went off. I started thinking about things far too much. I started to question the six months I was given and began to worry about the additional three-month grace period.

As soon as concerns and doubts began to creep into my thoughts, my mood began to change, my productivity dropped and I started to withdraw from things, I was not a pleasant person to be around and I didn’t see it at all. My family did, what was invisible to me was crystal clear to them. Our non-profit organization (GFLCCO) also suffered as I withdrew from writing for a while and stopped aggressively trying to get our message out. For the next couple of months, I was a mess.

It was soon May and my pre-exam paranoia was at full height. My wife and son had sat down with me and pointed out my personality change and although I couldn’t understand it at first the more I thought about it the more I realized I had traveled this path before.

My wife and I soon found ourselves on a plane and in Chicago. A few days later I found myself sitting in the all too familiar waiting room at the UW and then waiting in the examining room once more.

I had written about similar things many months earlier and finally refined and published it as an article in December of last year. The article is entitled, “Living Life Three Months At A Time.” I re read it, which by the way if you haven’t read it I suggest you do because this is obviously the second in the series and I wouldn’t want you to fall behind the other people who have done their homework.

Although I went through treatment over three years ago, I still consider myself as a current small cell lung cancer survivor. I am ever mindful that cancer is a tricky thing and sometimes like a bad horror movie sequel, it comes back to stalk the survivor of the original film. I think that fact is still the haunting factor of the follow up visit whether it be three or six months. It’s the thought that someone is going to have to look you in the eyes and tell you that you are going to go through it all over again. That thought lurks in the back of my mind more then I care to admit. I feel good for the most part. I still can only walk so far, talk so long, and I still can lose my breath from something as simple as putting on a pair of socks. Walking up a flight of stairs can sometimes take my breath away faster then loves first kiss, but I certainly don’t feel like the cancer is flaring up. Of course, three years ago, the news that I had cancer to begin with floored me because what I thought was my yearly bout of bronchitis or possible pneumonia turned out to be lung cancer. After that shock, I came to the UW where they went in through my nose to take a sample from my lung and came back with the verdict of “small cell” lung cancer. I was pretty excited, I remember saying with complete sincerity, “Small cell, that’s good isn’t it?” “I mean it could be ‘ Large cell’ that would be bad, right?” The room went silent. The difference between large and small cell cancer was explained to me along with the knowledge that operating would not be an option.

I rarely replay the series of events that led to the discovery, diagnosis and treatment of “my” cancer.

My cancer.

As I looked around the waiting room I saw an older gentleman sitting alone and a memory of three years prior flooded in.

I was speaking with a gentleman I met in the same waiting room that I was currently seated in the spring of 2007, shortly after I began treatment. He was older then I but because we were going through something similar, we had common ground to have a comfortable conversation regarding cancer. He referred to his cancer as “my” cancer. I asked why he would make it that personal? His reply is timeless. He said, “Son, it don’t get more personal then cancer.” It was his second go round with cancer so he had wisdom to share, he told me,” You’re cancer is a new part of your life. You’ve got to get to know it, get personal with it, find it’s weakness, then fight it to the death.” I was brought back to the present as an elderly woman wearing a breathing apparatus made her way past where I was seated and gently nudged my chair as she passed.

I thought about these things I learned from my friend three years ago and many other things that I have learned along the way, and for the first time in a month began to feel at ease, I found peace of mind.

I watched the people come and go, studying their faces as they spoke to one another. I tried to read their eyes to look into their soles and offer some type of reassurance that I have no right to offer. I kept waiting for the little plastic messenger that the clinic uses which, by the way, is the same one that you would be handed while your waiting for your table at a restaurant. You know the one I mean, the round one that vibrates and then the little red lights light up. I remember thinking once that maybe when this thing lit up, someone would come out of the back with a pizza and I would pay him or her and go home. It never happened. So many people coming and going, so many lives altered by cancer.

I waited as long as I could, but I needed my blood work done before I went for my scan. So as much as I didn’t want too, I rose to my feet and walked into the lab to have blood drawn.

As much as I have already twisted and turned in this article, I must once again head into another direction for a moment, please bare with me.

I have both written and spoken about this before, including the “Three Months” article. More then almost anything else in the world, more then clowns, more then spiders. More then clowns posing as spiders or visa/versa. I hate the thought of someone trying to draw blood from me. Let me make sure you understand me here. I do not have a fear of needles. I do not have any reaction to seeing or the thought of blood. My cancer treatment consisted of radiation twice a day combined with three consecutive days of chemotherapy every three weeks and constant blood work. By the end, and to this day, I have very few options to offer as far as veins in my arms, which makes for an interesting and sometimes painful trip to the lab. I am what is referred to as a ‘hard stick’. All right, put all the schoolboy jokes aside because it’s not funny, and I will tell on you. The one saving grace is that the lab staff at the UW is top notch and even when my veins do not want to cooperate, they make it all bearable. Still the thought of blood being drawn keeps me up at night. What someone who has not been through something like this must be thinking. I mean it really is comical if you think about it. To go through all of this and the biggest concern is that someone is going to struggle a little putting a needle in your arm.

With the blood being drawn and on its way to be analyzed, it was time to move upstairs to the CT area.

The CT waiting room, not the main one you start out in with pizza messenger in hand waiting for the little red lights to signal your acceptance into the inner sanctum. The second one. It’s a small quaint waiting room that you wait in with others just before your scan. The nurse asks things about your allergies, if you’ve had another scan recently and if you have a port left in your arm from your earlier trip to the lab. This is the second hurdle I must clear to vanquish my anxiety. The nurse will test the port to make sure that it is suitable for the contrast that is injected into you during the scan. If the port is no good, then it must be removed and the vein hunt begins again. My port was good this time around, I’ve not always been this fortunate.

Anyway, the CT waiting room can be a social gathering as we share “why were here today stories” over cups of barium and outdated magazines. I always meet the most wonderful people and sometimes have heard the most heartbreaking stories in this tiny waiting room on the third floor. I have never shared any of these CT waiting room stories with anyone, I think it would be a violation of trust somehow. I will tell you that I have learned, drawn strength from and always taken away something from my years of visiting the third floor. The scan itself is a breeze.

Back we go to the second floor waiting room to see my oncologist, the man who along with the efforts of my radiologist and first and foremost my wife, are responsible for me still hanging around. We met as we always do, exchanged pleasantries, caught up with what we each had been doing over the past six months, a brief check of thing to make sure my basic parts were still functioning. Then the moment we have all been waiting for, the review of my scan.

There I am up on the screen, the Dr. points out where the 10cm tumor started in my right lung, how it had attached itself to my esophagus. He shows where it currently lies much smaller and lying inactive at the moment. The unknown being if it’s dead or simply sleeping as a small survivor in its own right. We look at the deterioration at the top of the lung then move to the left lung. He points out the line across the scan which signifies the place where a fine surgeon in Mauston, WI. removed a large portion of my ‘good’ lung and glued and stapled the remainder together after both lungs collapsed at the same time landing me in the hospital for a month in 2008. We talk about the fact that there has been no significant change in my condition for the past six months and he tells me that my next appointment will also be six months from now. Time freezes for a moment…..It restarts after I have reset my life clock for another six months. It starts after I do the math to see where that puts me in time. Another six months. Set and mark, and once again time begins to move forward with a fresh set of months in front of me like a fresh set of downs must look to the football quarterback of a struggling team. I thank him for all he’s done for my wife and I, we shake hands and Lindsy and I leave the small room and schedule our next appearance.

Just like that, it’s over. I’m on my own for another six months barring anything unforeseen. I feel great, once again revitalized by the gift of another six months. I want to write, to get back to seeking sponsors and rooting out donations for the GFLCCO. My time in the waiting rooms reminded me that there are many people out there who are at the beginning of treatments or are watching someone they love go through treatments and that they are the people that my wife and I set out to help when we formed our non-profit. So many people coming and going, so many lives altered by cancer.

I am once again an active participant in the world around me, I remember when I was going through treatment and I began thinking and looking at things differently then I once had. I remember again why I started viewing things in a new light. I am ready to once again continue traveling down my new path.

The transition from three-month visits to six-month visits had by far a greater effect on me then I anticipated. As things go, I spend my life now learning new things not only about myself but about the world around me. Hopefully I learned enough to deal a little better with the next six months and hopefully the six after that.

The lesson learned here is one that was simply forgotten. Life in itself is too easily taken for granite and one needs to be reminded of that fact from time to time or you can easily step off your path and get lost in the woods around you. Make the most of the life you have.

Never spend more time focusing on the inevitable destination then you do enjoying the journey.

I would hate to think that I or anyone else for that matter would fight that hard to live and be fortunate enough to survive only to spend their remaining time worrying about a reoccurence. Besides, this set of articles is a trilogy and I would be remiss if I left the earth prior to writing part three, “Living Life One Year At A Time.”

Until then, I’m still basically the same as every other person on the face of the planet, trying to stumble their way through life.

I just now do it six months at a time.

Source by Tim Giardina

Optimal Cost Structure and Effective Scale Economies

How do firms choose their cost structure? What is the nature and function of scales of operation? What are sources of functional and dysfunctional scales of operation? These policy questions relate to the optimal overhead of a business enterprise-the appropriate mix of expenditures that maximizes the return on investment and shareholders’ wealth while minimizing the cost of operations, simultaneously.

Clearly, effective economies of scale (MES-Minimum efficiency scale) are correlated with optimal cost structure and critical to sound business strategies designed to maximize the wealth producing capacity of the enterprise. In these series on effective expenditure management, we will focus on the pertinent strategic overhead questions and offer some operational guidance. The overriding purpose of this review is to highlight some basic cost theory, strategic expenditures relationships, and industry best practices. For specific financial management strategies please consult a competent professional.

As we have already established, the optimal cost structure and appropriate scale of operation for each firm differs markedly based on overall industry dynamic, market structure-degree of competition, height of entry/exit barriers, market contestability, stage of industry life cycle, and its market competitive position. Indeed, as with most market performance indicators, firm-specific cost structure position in insightful only in reference to the industry expected value (average) and generally accepted industry benchmarks and best practices.

One of the most important contributions of economic science to management science is the principle of optimality-derivative of Bellmann Equation-the dynamic programming method which breaks decision problem into smaller sub-problems and early applications in economics by Beckmann, Muth, Phelps and Merton, and the resultant Recursive model. In practice, any optimization problem has some objectives often referred to as the objective functions such as maximizing output, maximizing profit, maximizing utility, minimizing total cost, minimizing cycle time, minimizing distribution cost, minimizing transportation cost, etc.

Types of Cost Structure:

Cost Structures consist of a mix of fixed costs, variable costs and mixed costs. Fixed costs include costs that remain the same despite the volume of goods or services produced within current scale of production. Examples may include salaries, rents, and physical manufacturing facilities. A number of high capital-intensive businesses, such as airlines and manufacturing companies, are characterized by a high proportion of fixed costs which may constitute effective barriers to entry for new industry entrants. Please note that effective exit barriers are effective entry barriers. When firms cannot easily exit unprofitable markets due to high exit barriers, they should not enter such markets in the first place.

Variable costs vary proportionally with the volume of goods or services produced. Labor-intensive businesses focused on services such as banking and insurance are characterized by a high proportion of variable costs. In practice, variable costs frequently factor into profit projections and the calculation of break-even points for a business or project.

Mixed cost items have both fixed and variable components. For example, some management salaries typically do not vary with the number of units produced. However, if production falls dramatically or reaches zero, then attrition may result. This is evidence that all costs are variable in the long run.

Finally, a firm with a large number of variable expenses (compared to fixed expenses) may exhibit more consistent per-unit costs and hence more predictable per-unit profit margins than a company with fewer variable costs. However, a company with fewer variable costs (and hence a larger number of fixed costs) may magnify potential profits (and losses) because revenue increases (or decreases) are applied to a more constant cost level.

Most business enterprises define cost structure in terms of costs incurred in relation to a cost object or activity. And because some expenditures can be difficult to define, we often implement an activity-based project to more closely assign expenses to the cost structure of the cost activity or object in question and use activity-based accounting. Note that time required to complete any given activity is the critical factor in cost management. Therefore, to minimize the overhead of any activity or project it is critical to minimize the time required to complete the activity or project. The following are examples of key elements of the cost structures of various expenditure objects:

Product cost structure: Under this structure there are fixed costs which may include direct labor and manufacturing overhead; and Variable expenses which may include direct materials, production supplies, commissions, and piece rate wages. Service cost structure: Under this cost structure there are fixed expenses which may include administrative overhead; and Variables costs which may include staff wages, bonuses, payroll taxes, travel and entertainment.

Product line cost structure: Under this structure there are fixed costs which may include administrative overhead, manufacturing overhead, direct labor; and Variable costs which may include direct materials, commissions, production supplies; and Customer cost structure: Under this structure: Under this cost structure there are fixed costs there are administrative overhead for customer service, warranty claims; and Variable costs which may include costs of products and services sold to the customer, product returns, credits taken, early payment discounts.

The optimal Cost Structure is the combination of fixed and variable costs that minimizes the total operating overheads while maximizing net operating income simultaneously. The Cost Structure describes all costs-(fixed and variable) incurred to operate a business model. Further, Cost structure refers to the types and relative proportions of fixed and variable costs that a business enterprise incurs. In practice, the cost concept can be classified by region, product line, product item, customer group, department, or division, etc.

In cost-based pricing strategy, cost structure is used as a technique to determine effective prices, as well to identify areas in which expenses might potentially be reduced or at least subjected to better management control. Therefore, the cost structure concept is a useful management accounting tool that that has many financial accounting applications.

All business models have costs associated value creation- which occurs with the addition of actual or perceived value to a customer for a superior good or service; value delivery-creating and maintaining effective mutually beneficial and satisfying customer relationships; and value capture-which occurs through changes in the distribution of value in the good or service and production chain. The objective function is to minimize total operating expenditures. Such overheads can be calculated relatively easily after isolating cost drivers, key activities, key inputs; key resources, and strategic partnerships.

It is our experience that operating costs can be minimized in every business model. Additionally, low cost structures are more important to some business models than to others. Therefore it is useful to distinguish between two broad categories of business models: Cost-driven and Value-driven (many business models fall in between these two extreme categories).

The DuPont model demonstrates that Return on Investment is calculated as the product of Profit Margin (Net Income/Sales) and Turnover Rate (Sales/Total Assets). DuPont analysis indicates that ROE is affected by three factors- Operating efficiency, which is measured by Profit Margin; Asset Use Efficiency, which is measured by Total Asset Turnover; and Financial Leverage, which is measured by the Equity Multiplier: ROE = Profit Margin (Profit/Sales) * Total Asset Turnover (Sales/Assets) * Equity Multiplier (Assets/Equity).

Types of Business Models:

Cost-driven business model-Most Cost-driven business models focus on minimizing overheads wherever possible. This approach aims at standardization and least cost method by creating and sustaining the leanest possible Cost Structure, using low and dynamic price value propositions, maximum automation, and strategic outsourcing.

Value-driven business model– Under this business model most companies are often less concerned with the cost implications of a particular business model design, and instead their main focus is on value creation. Premium value propositions, customization and a high degree of personalized service often characterize value-driven business models.

Some Operational Guidance:

In practice, firms seeking to optimize cost management must optimize time management. One of the most significant revelations of Activity Based Accounting is the impact of time and activity in firms’ overall operating cost: Cost structure is activity driven and activity is time driven. Therefore, time is the most critical factor is effective cost management. Simply put, firms must reduce time required to execute specific activity to reduce cost associated with the specific activity, ceteris paribus.

Additionally, firms seeking to leverage and optimize scale economies must optimize cost savings derivative of specific scale of operation. Please note that scales of operation may be functional and log-run-cost reducing derivative of experience curve; learning effects; scope economies; division of labor; specialization; horizontal as well as vertical differentiation or dysfunctional and long-run-cost increasing derivative of reactive and entrenched management with musty and personality-driven vision; organizational inertia; adaptive and abusive supervision; increasing bureaucratic cost; lack of innovation; increasing internal and external transaction costs.

In sum, firms optimize cost structure through effective time management and optimizing scales of operation. Therefore, firms seeking to maximize the profit producing capacity of the enterprise must formulate and execute dominant efficient and effective cost management strategies based on appropriate combination of costs that maximizes the return on investment and shareholders’ wealth while minimizing the cost of operations, simultaneously. As we have already established, there is growing empirical evidence suggesting firms that opt for scale and volume tends to outperform those that opt for premium, ceteris paribus.

Source by James Gaius Ibe

Perks of Consulting With a Claims Adviser

When it comes to insurance claims, the process is often a lot more complicated and stressful than people would imagine. Whether we are talking about a business insurance claim, or a personal claim, insurance policies are by nature complex and without expert knowledge policies are often misunderstood, or clauses misinterpreted, resulting in a pay-out amount that is lower than what is fair. The best way for individuals to ensure they are protected during this process is by speaking with a claims adviser.

With regards to TPD insurance claims or trauma insurance claims, it is even more important to speak with an adviser. A total or partial disability insurance policy means that you are going to get paid a significant amount of money if you become totally and permanently disabled. However, the issue that many policyholders will face is that these policies are a maze of clauses and specifications, which leaves you totally dependent on the insurance company to properly figure the payment(s) that you are entitled to receive. An insurance claims adviser knows the ins and outs of policies and they work for you, not the insurance company.

But what is a claims adviser going to do with respect to your TPD insurance claims? A lot of people ask this question, and the answer is that an insurance specialist is going to assess your TPD or trauma insurance claims, as well as identify how to approach the matter with your provider. They will assess your circumstances and let you know whether you may be eligible for a claim, and how you can best proceed to get the money that you feel you are owed. Dealing with a claims adviser removes a lot of stress from your shoulders.

Another reason why you will want to deal with a top claims adviser is because they typically have relationships with the insurance companies. Communicating with insurance companies might be difficult given the industry-specific language you’d need to know. But when you have a claims adviser working for you, they know the business and can talk directly with the insurance company on your behalf.

If they already have a relationship with that company, it stands to reason they can efficiently get through all the bureaucracy and paperwork that is synonymous with these organizations. They may get you a result that is very palatable given your condition. And in most cases, they will get you a claims result that might not have been possible without their support. Many people think it makes no sense to pay someone to get money from an insurance company but, in some cases, you are going to need to pay a little bit to a claims adviser so you can realize the full amount that is due to you.

Source by Edmund Brunetti