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PubMed1999

Medical care collection or recovery. Department of Veterans Affairs. Final rule.

This document amends VA's medical regulations concerning collection or recovery by VA for medical care or services provided or furnished to a veteran: (1) For a non-service connected disability for which the veteran is entitled to care (or the payment of expenses of care) under a healthplan contract; (2) 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 (3) 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 establishes methodology for charging "reasonable charges" consistent with the statutory amendment. The charges billed using this methodology, as appropriate, 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 will 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 therefore 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 continues to 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. Also, the regulations are 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↗
PubMed2000

[Individual outcome-oriented cardiologic rehabilitation treatment].

Cardiac rehabilitation and subsequent intensified aftercare is capable, of increasing the rate of occupational reintegration not only over the short-term, but also over a period of two years. In addition to improving physical performance, this enhances the patient's self-confidence, decreases anxiety and reduces depression. Since, two years after completion of cardiac rehabilitation and aftercare, the percentage of those lost to gainful employment and in need of an early pension is appreciably less in the interventional group as compared with controls, this program would appear to be of particular economic importance for social security/national insurance carriers. For this reason, the Westphalian Social Security Carrier has initiated the regular use of this concept in its cardiological hospitals.

Adult↗
PubMed1999

[Microbial exposure in collection of residential garbage--results of field studies].

Since 1995 the communal accident insurance carrier of the county Wetfalen-Lippe conducts investigations into the exposure to biological agents related to refuse collection. Total fungal exposure during refuse collection turned out to range from 10,000 up to 750,000 colony forming units per cubic meter. Most of the measurement values exceeded the limit of 50,000. During hot periods in the summertime, the concentration of Aspergillus fumigatus increased up to 90,000 cfu/m3. The mean values of the bacterial concentrations ranged from 15,000 up to 50,000 cfu/m3, the endotoxin concentration from 12 up to 59 EU/m3. In the driver's cabin fungal exposure sometimes exceeded 10,000 cfu/m3 especially in autumn and winter. Maximum values were 5,000 cfu/m3 for bacteria and 15 EU/m3 for endotoxins. High values were measured irrespective of the kind of refuse.

Air Microbiology↗
PubMed2000

[Development of second-line occupational health services: toward an integrated network of insurers and care providers].

OBJECTIVE: To describe the development of the second-line Occupational Health Services and the role of private insurance companies in it over the period 1994-1999. DESIGN: Descriptive cross-sectional study. METHOD: Data were collected in 1999 from written documents and supplementary interviews with the five largest private providers of disability insurance, the National Insurance Institute, nine Occupational Health Services of different natures and 24 institutions for second-line occupational health service. RESULTS: After the privatization of the Health Law in 1996 and parts of the Law on disability Insurance, most employers covered the risk of continued payment of wages in case of disability with private insurers. These attempted to keep claims down by active engagement in arbitration, treatment and diagnostics of disabled employees so as to counteract avoidable absenteeism. Under the influence of the insurance companies, a trend developed toward integrated nation-wide chains in which the services provided by insurers, by occupational health services and by implementing institutions are geared for one another. CONCLUSION: Commercial provision of Occupational Health Service is a new, demand-active form of care provision in which the financier plays a key part. This provision of services supplied important innovating impulses for health care in its entirety because of its large scale, strong protocolling of processes and management on the basis of continuous cost-benefit analyses. A lucid and socially acceptable regulation of commercial providers of occupational health services was lacking.

Health Personnel↗