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PubMedDate not supplied

Fraud and abuse: the payer's perspective.

As the health care sector consumes an ever-increasing portion of our nation's gross national product (GNP)), forecast to represent 15 percent of the GNP by the year 2000, increasingly intensive efforts are being used to control the growth rate of these costs. Medicare fraud alone is estimated to represent $2 billion yearly. Abusive billing of private health insurers represents a far larger amount. This article discusses the concept of fraudulent and abusive physician billing practices.

Abstracting and Indexing↗
PubMedDate not supplied

Outpatient care from the payer's perspective.

Beginning with this issue of Physician Executive, members of the Society on Insurance of the American College of Physician Executives will provide an ongoing column for readers on the unique point of view of the health care insurer. The column starts with an offering by the Chairman of the Society on the physician executive's role in resolving the anomalies of the health care payment system.

Ambulatory Care↗
PubMed1991

Blanks on medical records may give payers denial ammo.

Incomplete and inaccurate patient records have always left hospitals vulnerable to losing malpractice suits. But increasingly, good records mean hospitals are more likely to collect on bills that are scrutinized by utilization review firms, Medicare peer review organizations and other such bill examiners. That places a higher premium than ever on paying meticulous attention to a patient's medical record.

Documentation↗