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PubMed1998

Medical care collection or recovery--VA. Proposed rule.

This document proposes to amend VA's medical regulations concerning collection or recovery by VA for medical care or services provided or furnished to a veteran: For a non-service connected disability for which the veteran is entitled to care (or the payment of expenses of care) under a health-plan contract; For a non-service connected disability incurred incident to the veteran's employment and covered under a worker's compensation law or plan that provides reimbursement or indemnification for such care and services; or For a non-service connected disability incurred as a result of a motor vehicle accident in a State that requires automobile accident reparations insurance. Previously, by statute VA was authorized to charge "reasonable costs" for such care or services. However, amended statutory provisions now authorize VA to charge "reasonable charges." Accordingly, this document proposes to establish methodology for charging "reasonable charges" consistent with the statutory amendment. Under the proposal, the charges billed using this methodology, as appropriate, would consist of inpatient facility charges, skilled nursing facility/sub-acute inpatient facility charges, outpatient facility charges, physician charges, and non-physician provider charges. Reasonable charges for outpatient dental care and prescription drugs not administered during treatment would continue to be billed using the existing cost-based methodology. Pursuant to statutory authority, VA has the right to recover or collect the charges from a third party to the extent that a provider of the care or services would be eligible to receive payment therefor from that third party if the care or services had not been furnished by a department or agency of the United States. With respect to a third-party payer liable under a health plan contract, consistent with the statutory authority, the third-party payer would have the option of paying to the extent of its coverage, either the billed charges or the amount the third-party payer demonstrates it would pay for care or services furnished by providers other than entities of the United States for the same care or services in the same geographic area. Using the methodology in this proposed rule, the data for calculating actual amounts for the various inpatient facility charges, skilled nursing facility/sub-acute inpatient facility charges, outpatient facility charges, and physician charges at individual VA facilities for the period August 1998 through September 1999 are set forth in a companion document published in the "Notices" section of this issue of the Federal Register. Also, under the proposal, the regulations would be clarified to state specifically that billing methodology based on costs will continue to be applied to establish charges for medical care furnished in error or on tentative eligibility, furnished in a medical emergency, furnished to certain beneficiaries of the Department of Defense or other Federal agencies, furnished to pensioners of allied nations, and furnished to military retirees with chronic disability.

Accounts Payable and Receivable↗
PubMed1998

Medical care collection or recovery--VA. Notice.

In a companion document published in the "Proposed Rules" section of this issue of the Federal Register, we proposed to amend VA's medical regulations concerning collection or recovery by VA for medical care or services provided or furnished to a veteran: (i) For a non-service connected disability for which the veteran is entitled to care (or the payment of expenses of care) under a health-plan contract; (ii) For a non-service connected disability incurred incident to the veteran's employment and covered under a worker's compensation law or plan that provides reimbursement or indemnification for such care and services; or (iii) For a non-service connected disability incurred as a result of a motor vehicle accident in a State that requires automobile accident reparations insurance. The proposed rule includes methodology for establishing charges for VA medical care or services. Using this methodology, information for calculating proposed charge amounts at individual VA facilities for inpatient facility charges, skilled nursing facility/sub-acute inpatient facility charges, outpatient facility charges, and physician charges is set forth below. If this methodology were adopted subsequently as a final rule, the applicable data in this document, designed for the period August 1998 through September 1999, would be used for the period from the effective date of the final rule through September 1999. Accordingly, interested parties may wish to retain this document for future reference.

Accounts Payable and Receivable↗
PubMed1978

Private health insurance plans in 1976: an evaluation.

Private health insures collected a record $39.4 billion in premiums and returned $35 billion in benefits to their subscribers in 1976--a reflection of the steadily rising cost of health care, higher utilization, and the demand for expanded services. The industry experienced a net underwriting loss of $611 million, mainly because claims and operating expenses under insurance-company group business ran 3 percent above premium income. About 77 percent of the civilian population had some form of private hospital insurance, and about the same percentage had some form of surgical insurance. Lesser proportions were covered for other types of care. An estimated 12--13 percent of the population under age 65 had no economic protection against the costs of illness or health-related care--under either a private insurance plan or public program. Although virtually all of the aged were covered by Medicare, some 13--15 million bought private insurance, most of it under plans that covered some or all of the gaps in the Federal program.

Age Factors↗