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At least 469 records · Page 26Linked to original sources
PubMed1998

Cashing in on out-of-state Medicaid claims!

In summary, billing out-of-state claims can be time-consuming but productive. It just takes time, information from the states and consistent follow-up. Unicare Corporation began billing out-of-state accounts in 1989. Providers referred accounts to us that they normally would have written off--either because the balances were too small, they were not enrolled, or they did not have a large enough staff to dedicate time to this payer. In 1997, Unicare recovered more than $92 million for our clients. We accomplished this by focusing on uninsured admissions, medical necessity and out-of-state claims processing for providers.

Admitting Department, Hospital↗
PubMed1999

[Automated anesthesia billing by electronic anesthesia record keeping system].

There has been loss of anesthesia fee by errors of filling out billing sheets manually. A large loss of anesthesia fee was pointed out by the audit during the past several years. In order to prevent these billing error, we have developed an automated anesthesia billing system combined with an electronic anesthesia record keeping (EARK) system. The system derives all the anesthesia cost-related parameters from the EARK database and calculates anesthesia fee according to the logic of the Japanese health care insurance system. After implementing the system, anesthesiologists and circulating nurses became free from filling out billing sheets. The accuracy of the automated billing was proved by the comparison with hand filled sheets. The survey showed that the system prevented 2.5 million yen of billing loss in a month. Such an economic impact of the system proves the rationale of an EARK as a cost containment tool.

Anesthesia↗
PubMedDate not supplied

Laboratory end-stage renal disease testing.

The Department of Health and Human Services, Office of Inspector General has incorporated end-stage renal disease (ESRD) into its 1999 Work Plan. Specifically, they will focus on identifying inappropriate Medicare payments for clinical laboratory services and their medical appropriateness. Under Medicare's composite rate reimbursement system, certain laboratory tests at established frequencies are covered under the composite rate. Any additional tests billed that are beyond the established frequencies must be supported by medical necessity. When billing laboratory tests for ESRD patients, it is important to know what tests are covered and at what frequencies under the composite rate. It also is important to understand the use of the 50/50 rule for determining whether automated multichannel tests are billable. This article reviews these details and provides insight into how laboratories should apply these rules when billing for ESRD testing.

Clinical Laboratory Techniques↗
PubMed1999

Securing insurance protection against fraud and abuse liability.

Healthcare organizations concerned about corporate compliance need to review securing appropriate insurance coverage as part of their corporate compliance program. Provider organizations often mistakenly expect that their directors and officers liability (D&O), malpractice, or standard errors and omissions (E&O) insurance policies will cover the cost of Medicare fraud and abuse fines. The insurance industry has developed a specific billing E&O insurance product to cover providers that run afoul of government fraud and abuse statutes.

Fees and Charges↗
PubMed1999

Slovenian national health insurance card: the next step.

The Slovenian national health insurance company started a full-scale deployment of the insurance smart card that is at the present used for insurance data and identification purpose only. There is ample capacity on the cards that were selected, to contain much more data than needed for the purely administrative and charging purposes. There are plans to include some basic medical information, donor information, etc. On the other hand, there are no firm plans to use the security infrastructure and the extensive network, connecting the insurance company with the more than 200 self service terminals positioned at the medical facilities through the country to build an integrated medical information system that would be very beneficial to the patients and the medical community. This paper is proposing some possible future developments and further discusses on the security issues involved with such countrywide medical information system.

Computer Security↗
PubMed1999

Digital radiography and California third parties.

Acceptance of digital radiography is increasing but has not yet progressed to the mainstream. A key factor in widespread use of this advancement is acceptance--both theoretical and technological--by dental health plans for claim submissions. This article details a survey of California third parties to examine their practices, concerns, and plans regarding digital dental radiography.

Humans↗