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Results for “Insurance Claim Reporting”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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At least 361 records · Page 20Linked to original sources
PubMed1990

Unbundling could be costing you a bundle.

Here's what you need to know about the mysterious world of code manipulation. Consultants and payers claim it's responsible for physician charges increasing at an alarming rate.

Abstracting and Indexing↗
PubMed1997

Behavioral call centers help keep a lid on costly mental health claims.

A california managed care company is applying new technology to Medicare managed care patients with congestive heart failure. The program allows patients to monitor medications and daily vital signs--and it is resulting in fewer hospitalizations and a reduction in the need for other skilled care.

Cost Control↗
PubMed1997

National Committee on Vital and Health Statistics: publication of recommendations relating to HIPAA health data standards--HHS. Notice.

Section 1172 (f), Subtitle F of Pub. L. 104-191, the Health Insurance Portability and Accountability Act of 1996, requires the Secretary of Health and Human Services to publish in the Federal Register any recommendation of the National Committee on Vital and Health Statistics (NCVHS) regarding the adoption of a data standard under that law. On September 9, the NCVHS submitted recommendations to the Secretary relating to the unique identifier for payers, the unique identifier for individuals, and security standards. Accordingly, the full text of the NCVHS recommendations relating to HIPAA data standards is reproduced below. The text of the recommendations is also available on the NCVHS website: http@aspe.os.dhhs.gov/ncvhs/.

Computer Security↗
PubMed1997

Managing disabilities in an integrated health environment: the experience of Aetna.

Disability-related outlays are increasing at a rate well above the medical inflation rate. This article discusses the experience of one company in its attempt to manage these skyrocketing costs, by developing a new program that integrates health and related benefits by combining the medical and human resources interventions into a unified program. The authors discuss the initiation, development and progress of the program, concluding with measured results revealing reduced lost work time, improved employee health and productivity, and reduced disability costs.

Cost Control↗
PubMed1998

Understanding managed care organizations' liability exposure.

Managed care organizations can minimize their liability exposures by staying informed about industry changes and by implementing a comprehensive risk management program. Typically, managed care organizations face three general exposure areas: directors and officers liability (e.g., exposures associated with nonclinical aspects of an organization); errors and omissions (e.g., exposures involving the day-to-day operations of managing the health care received by an organization's members); and financial loss, or provider excess (e.g., exposures that occur when certain catastrophic events expose the organization to financial peril).

Credentialing↗
PubMed1998

Medicare program; coverage and administrative policies for clinical diagnostic laboratory tests; intent to form Negotiated Rulemaking Committee--HCFA. Notice of intent to form Negotiated Rulemaking Committee and notice of meetings.

The Balanced Budget Act of 1997 requires the Secretary to establish a Negotiated Rulemaking Committee under the Negotiated Rulemaking Act and the Federal Advisory Committee Act. The Negotiated Rulemaking Committee's (the Committee) purpose will be to negotiate national coverage and administrative policies for clinical diagnostic laboratory tests under Part B of the Medicare program as required by the Balanced Budget Act of 1997 (BBA). The Committee will consist of representatives of interested parties that are likely to be significantly affected by the proposed rule. The Committee will be assisted by a neutral facilitator. The BBA outlines the scope of issues to be negotiated by the Committee. We specifically request public comment as to whether we have identified the interests that will be affected by key issues listed below.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1998

Contingency arrangements do not necessarily equal fraud and abuse.

Many healthcare organizations avoid entering contingency-based arrangements with consulting firms that specialize in Medicare revenue optimization because they fear Federal investigation of such an arrangement might lead to a finding of fraud and abuse. A Medicare fraud alert issued by the HHS Office of the Inspector General (OIG) appears to justify that fear, suggesting that contingency arrangements are inherently unethical. Nonetheless, current Federal regulations clearly allow healthcare organizations to enter into contingency-based relationships with consulting firms to seek legitimate optimal payment. Healthcare organizations may do so without fear of Federal legal action if they ensure that the consultant is ethical and competent and that the DRG review process used is both legitimate and retrospective, subjecting all recommended changes to approval by both the healthcare organization and appropriate peer review organization.

Abstracting and Indexing↗
PubMed1998

Preventing revenue loss by complying with Medicare regulations.

Educating staff, performing billing audits, and appealing claim denials can help agencies ensure compliance with Medicare regulations and prevent loss of revenue. By preparing in advance, agencies ensure a smoother ride through (what are quite often) turbulent investigations.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1998

Medicare and state health programs: fraud and abuse; issuance of advisory opinions by the OIG--HHS. Final rule.

In accordance with section 205 of the Health Insurance Portability and Accountability Act of 1996, this final rule sets forth the specific procedures by which the Department, through the Office of the Inspector General (OIG), in consultation with the Department of Justice (DoJ), will issue advisory opinions to outside parties regarding the interpretation and applicability of certain statutes relating to the Federal and State health care programs. The procedures for submitting a request and obtaining an advisory opinion from the OIG were established through interim final regulations published in the Federal Register on February 19, 1997. In response to public comments received on these interim final regulations, this final rule revises and clarifies various aspects of the earlier rulemaking.

Fraud↗