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At least 667 records · Page 37Linked to original sources
PubMed2003

Finance issue brief: health care claims payment: prompt payment: year end report-2003.

Since the mid 1990's state legislators and regulators have worked to resolve the complex issue of timely payment of health care claims. They have been challenged with bridging the communication gap between provider and payor and forced to address such base problems as what determines a correctly billed service. As time has progressed it is ever apparent that the completion of payment for services is dependent on many variables, not just simply timely processing of a claim.

Accounts Payable and Receivable↗
PubMed1992

Rehabilitation and insurance relationships.

The ultimate goal of the health care process is to restore an individual to a maximal level of function within the constraints of the existing pathology. It is unfortunate, however, that this potential is often underestimated so that the individual is deprived of reintegration in society. Rehabilitation is the unfinished business of medicine. Reasonable goals need to be identified and clear cost benefit projections need to be established regarding any intervention. To decrease an individual's dependency means that the lifetime cost of care of the individual decreases dramatically. Physical independence and cognitive competency reestablish for the patient optimal levels of health care that need to be facilitated, and involve integrated, innovative insurance liaisons to assure achieving this goal.

Cost Control↗
PubMed1992

Use of medical insurance claims for surveillance of occupational disease. An analysis of cumulative trauma in the auto industry.

Medical insurance claims, linked with work histories for a large automotive manufacturer over a 3-year period, identified large numbers of cases of potentially work-related diseases, including 30,600 episodes of probable cumulative trauma disorders (CTD). CTD incidence rates were calculated within five plants, and high-risk areas identified, however, unknown differences in medical insurance coverage by exposure group limited interpretation. Case-control analyses, with controls also identified by insurance claims, addressed coverage and produced age-adjusted and sex-adjusted estimates of risks. All five plants had departments with statistically significant, elevated risks for one or more of the diagnoses carpal tunnel syndrome, CTD of other upper extremities, rotator cuff syndrome, CTD of the neck and of the lower back. Medical insurance claim data linked with work history provide the basis for practical and comprehensive surveillance for CTD and potentially a variety of other occupational diseases.

Accidents, Occupational↗
PubMed2003

Finance issue brief: HMO medical directors: year end report-2003.

Medical directors of managed care organizations have the ultimate responsibility of deciding the treatments for which a health plan will pay. Cognizant of consumer concerns over the power inherent in the position, states are seeking to inject more accountability into the decision-making process. Lawmakers have begun to grapple with whether medical directors should be required to hold a medical license from the state in which they work and, by extension, whether they should be under the jurisdiction of the state medical board.

Decision Making↗
PubMed1998

Medicare program; establishment of the Medicare Coverage Advisory Committee and request for nominations for members. Notice.

This notice announces the establishment of the Medicare Coverage Advisory Committee that will advise the Secretary of Health and Human Services and the Administrator of the Health Care Financing Administration, as requested by the Secretary, whether medical items and services are reasonable and necessary under title XVIII of the Social Security Act. This notice requests nominations for members for the Committee. This notice also announces the signing by the Secretary on November 24, 1998 of the charter establishing the Committee. This charter ends at close of business on November 23, 2000 unless renewed by the Secretary.

Advisory Committees↗
PubMed2003

Coordination of benefits.

Figuring out who is supposed to "pay first" when your client has Medicare and other health benefits can be confusing both for you and your clients. In this brief we discuss how Medicare coordinates payment of claims with other health benefits.

Cost Sharing↗
PubMed2002

The use of nursing home and assisted living facilities among private long-term care insurance claimants: the experience of disabled elders.

Little is known about individuals in nursing homes (NHs) and assisted living facilities (ALFs) who receive private long-term care (LTC) insurance benefits. No one knows whether claimants and/or their families feel they are getting good value for their premiums, or whether the presence of private insurance influences the type of care people get. This brief provides descriptive information on disabled private LTC insurance policyholders receiving LTC benefits in these settings, comparing them to institutionalized elders who lack such insurance. The information shows that private LTC insurance benefits are targeted to individuals with significant functional and/or cognitive impairments; that claimants are satisfied with their policies although many report unmet needs; and that private LTC insurance gives claimants access to alternatives to nursing home care.

Aged↗
PubMed2002

The impact of private long-term care insurance on claimants: formal and informal care in the community.

Policy makers show continuing interest in the potential for long-term care (LTC) insurance to save public money by reducing pressure on the Medicare and Medicaid programs. Although the purchase of LTC insurance is being encouraged by government - through tax incentives and the offering of private LTC insurance as an option for public employees - little is known about how benefits are used, whether those claiming benefits feel they are getting good value for their money, and whether the patterns of formal (paid) and informal (unpaid) service use differ for insurance claimants compared to similarly disabled persons without private LTC insurance. This brief provides information on older people claiming LTC insurance benefits and compares their experiences to those of non-privately insured older people who need LTC. We conclude that LTC insurance is an important source of support for those who lack informal support from family and friends. However, LTC insurance remains a complex product; claimants need help in using their benefits to obtain the appropriate level and quality of care and in understanding at the time of purchase how much protection they need.

Activities of Daily Living↗
PubMed2004

[Insurance for civil responsibility in professional medicine: insurance systems and coverage for posterity].

The author presents the systems of medical liability insurance available on the Belgian market; they are at the moment based on loss occurrence, claims made or fact occurrence. The systems based on loss occurrence and on claims made impose the provision of an additional premium. Problems connected with changing the insurance company are touched upon, including sometimes a necessity to provide a precedence premium.

Belgium↗
PubMed2004

The claims morass.

Explore the source record for details and available documents.

Efficiency, Organizational↗