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At least 469 records · Page 26Linked to original sources
PubMed1988

Hospitals can improve cash flow by managing preauthorizations.

Managing third-party requirements for payment is becoming increasingly complex. Specifically, preauthorizations and other utilization control features have greatly affected how both physicians and hospitals deal with insurance companies and other third-party payers. Providers that can effectively and efficiently manage the preauthorization process have the opportunity to transform an administrative burden into a competitive advantage.

Accounting↗
PubMed1989

Hospitals as third-party administrators.

Hospitals that are skilled at managing the health insurance claims of their employees will be well-positioned to take advantage of the growing demand for third-party administration of claims. In the process, the hospital also may enhance its image as a high-quality provider of cost-effective health care and gain the business of managed care entities in need of solid utilization management services.

Health Benefit Plans, Employee↗
PubMed1989

New developments in managed care litigation.

This article discusses recent litigation attempting to impose liability for managed care decisions on alternative delivery systems and recent state legislation allocating such liability among the participants in managed care programs.

Delivery of Health Care↗
PubMedDate not supplied

The erosion of physician-patient privilege and patient confidentiality.

With the proliferation of third party payers for health care who exercise utilization management, there has been an erosion of the physician-patient privilege and patient confidentiality. The kinds of medical information obtained by third party payers under the guise of claims administration violate the spirit if not the actual laws pertaining to physician-patient communication. It presents three episodes involving the first author in which that communication was violated by third parties administering health care benefits. Recommendations are made to protect that confidentiality in this era of increasing cost management.

American Medical Association↗
PubMed1986

Medicare program; procedures for determining whether providers, practitioners, or other suppliers of services are liable for certain noncovered services--HCFA. Final rule.

These regulations revise the way we apply limitation of liability for certain noncovered services furnished by providers, practitioners, and suppliers of Medicare services under section 1879 of the Social Security Act. We will no longer apply an administrative mechanism, commonly known as the favorable presumption, in determining whether a hospital, skilled nursing facility, or home health agency should be held liable for furnishing a noncovered service. The decision to make or deny payment for these noncovered provider services will now be made after an analysis of the circumstances, without the use of a presumption as to whether the provider did not know or could not be expected to know that furnished services were noncovered.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1987

A legal services perspectives on representing Medicare home health patients.

The Medicare home health program lacks the basic legal protection for patients and providers that are commonplace in other public programs. These shortcomings include: 1. inadequate appeals procedures for both patients and providers; 2. overly restrictive eligibility criteria; 3. a lack of adequate public input into agency rule making and inadequate public information on specific coverage standards; 4. a reimbursement system that interferes with provider medical judgments. This is not the way the Medicare program was intended to run and the last few years have seen an increase in litigation to correct these problems. Such litigation is time-consuming and frustrating but experience shows that it is worth the trouble. As stated by a home health agency director whose patients were on the winning site of three recent lawsuits, "It takes tremendous effort, but you can beat the system."

Aged↗