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At least 325 records · Page 18Linked to original sources
PubMed2004

The check is in the mail: determinants of claims payable timing among health maintenance organizations.

This paper used financial data from health maintenance organizations (HMOs) in the United States from the period 1985 to 2001 to examine the determinants of claims payable--the dollar amount of services rendered to enrollees but for which the HMO has not yet paid providers, such as physicians and hospitals. Claims payable management is important because delaying payments to providers can jeopardize provider operations and reduce HMO operational flexibility. The results show that HMOs manage claims payable with a multi-period perspective designed to evoke favorable responses and to avoid unfavorable ones from external parties, and to maintain flexibility for unexpected conditions. Higher HMO profitability, quicker receipt of premiums by the HMO, increased provider involvement, and greater local control of the HMO lead to faster payment to providers. Implications for HMO managers, providers, employers, and regulators are discussed.

Accounts Payable and Receivable↗
PubMed2004

Antidepressant medication use among First Nations peoples residing within British Columbia.

Very little is known about antidepressant medication use among First Nations people in Canada. This information would be useful to begin estimating the prevalence of conditions treated with this class of medications and planning appropriate programs. Antidepressant medication claims for First Nations people residing within British Columbia were extracted from the Non-Insured Health Benefits pharmacy database. During 2001, 9.8% (95% CI = 9.81, 9.79) of the population filled a prescription for antidepressant pharmacotherapy, claimant mean age was 40.3 years and the female:male ratio was approximately 3:1. The most common medications were Paxil, Apo-Amitriptyline, Effexor, and Celexa. Use of this medication class is common and more research is needed in this area of study.

Adult↗
PubMed1990

Managing health care costs: strategies available to small businesses.

Although health care costs continue to rise at an alarming rate, small businesses can take steps to help moderate these costs. First, business firms must restructure benefits so that needless surgery is eliminated and inpatient hospital care is minimized. Next, small firms should investigate the feasibility of partial self-insurance options such as risk pooling and purchasing preferred premium plans. Finally, small firms should investigate the cost savings that can be realized through the use of alternative health care delivery systems such as HMOs and PPOs. Today, competition is reshaping the health care industry by creating more options and rewarding efficiency. The prospect of steadily rising prices and more choices makes it essential that small employers become prudent purchasers of employee health benefits. For American businesses, the issue is crucial. Unless firms can control health care costs, they will have to keep boosting the prices of their goods and services and thus become less competitive in the global marketplace. In that event, many workers will face a prospect even more grim than rising medical premiums: losing their jobs.

Commerce↗
PubMedDate not supplied

Coverage, technology assessment, and the courts.

Coverage decisions by third-party payers are relying more and more heavily on the conclusions of technology assessment programs about the safety and effectiveness of technologies applied in specific clinical situations. Assessment programs vary markedly in the sophistication and rigor of their methodology. Payers differ as to how such assessment information is integrated into their decision-making processes. Finally, coverage decisions about a specific technology can vary widely across the country.

Blue Cross Blue Shield Insurance Plans↗
PubMed1991

Use of statistical sampling and extrapolation in overpayment audits of physicians.

The successful defense of claims for physician overpayments by insurers requires the health care attorney to be familiar with the statistical sampling procedures employed during these types of audits. In this article, the author describes when audits are initiated, the factors that are taken into account in determining if statistical sampling is appropriate, how the statistical sampling study is conducted, and what defenses the health care attorney can assert when confronted with the results of a statistical sampling audit.

Insurance Claim Review↗
PubMed1991

Resisting disclosure of mental health records during Medicaid investigations and audits.

In a previous article, the author discussed the legal foundation for resisting the disclosure of medical and mental health records, the nature of the right to confidentiality of medical and mental health records, the privileges against disclosure, how those privileges are lost, and the health care provider's liability for improper disclosure. In this article, the author offers a "nuts and bolts" approach to resisting the disclosure of mental health records for counsel representing health care practitioners and institutions involved in Medicaid audits and investigations.

Confidentiality↗