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At least 127 records · Page 7Linked to original sources
PubMed2006

Annual prevalence of diagnosed schizophrenia in the USA: a claims data analysis approach.

BACKGROUND: Schizophrenia is a debilitating chronic mental illness. However, the annual prevalence of schizophrenia is not well understood because of under-representation of schizophrenia patients in epidemiological surveys. This study used multiple administrative claims databases to estimate the annual prevalence of diagnosed schizophrenia in the USA. METHOD: The annual prevalence of diagnosed schizophrenia in the USA was estimated for different health insurance coverage groups. The prevalence for privately insured individuals was calculated from an administrative claims database of approximately 3 million privately insured beneficiaries covering the period 1999-2003. The prevalence for Medicaid enrollees was calculated from California Medicaid claims covering the period 2000-2002. The prevalence for Medicare and Medicaid/Medicare dual eligibles was estimated using a combination of both databases. Published statistics were used to estimate the prevalence of schizophrenia in the uninsured and veteran populations and to weight the prevalence rates obtained to the population of the USA. RESULTS: The 12-month prevalence of diagnosed schizophrenia in the USA in 2002 was estimated at 5.1 per 1000 lives. The Medicaid population was identified with the highest prevalence rate among the populations studied. Sensitivity analyses taking into consideration the Veterans Affairs population only changed the estimate slightly to 5.3 per 1000 lives. CONCLUSION: Analyses of administrative claims data contribute to the understanding of the prevalence of diagnosed schizophrenia.

Adolescent↗
PubMedDate not supplied

Average hospital charges for percutaneous transluminal coronary angioplasty, 1993: geographic variations.

Claims to Metropolitan Life Insurance Company by group health insured and their dependents for a percutaneous transluminal coronary angioplasty (PTCA) averaged $21,760 in 1993. The charges varied by as much as 68 percent among the 22 states in which at least 50 PTCAs were performed. The highest average total charges were reported in Colorado and California, where they were 29 and 26 percent, respectively, above the average for the United States as a whole. The lowest average total charge was reported in Ohio, where the PTCA cost $16,770-23 percent lower than the national average. An average of 4.3 days of hospitalization was required for a PTCA. Hospital charges (room and board and ancillary fees) accounted for 78 percent of the total PTCA charges to insurance. The charges for the operating room, laboratory, blood bank, respiratory therapy and other ancillary fees together accounted for 80 percent of the total hospital bill and averaged $13,550 for the country as a whole. Physicians' fees averaged $4,740 across the United States and ranged from a high of $5,930 in Connecticut to a low of $3,730 in Michigan. These PTCA total charges were close to half the charge reported for a coronary artery bypass graft (CABG) in 1992 and the length of stay was also about half that for a CABG.

Angioplasty, Balloon, Coronary↗
PubMed1983

Efficacy of reporting systems of adverse reactions to drugs and care.

Only 13% of adverse drug reactions that should have been reported to the Committee on Side Effects in Sweden according to the criteria published by the National Board of Health and Welfare, were actually reported by the responsible doctors. This was found in a prospective study of all adverse reactions established in 1 271 patients at a department of infectious diseases. It was also found in retrospect that only half of the patients affected by complications making them eligible for compensation from the Patients' Insurance Office existing in Sweden actually received compensation, while the Drug Insurance Office was better utilized. Various reasons for these low reporting frequencies are discussed.

Drug-Related Side Effects and Adverse Reactions↗
PubMed1987

Accounting guidelines developed for malpractice claims.

Recently, the AICPA developed a Statement of Position on medical malpractice claims of healthcare providers. The statement was developed to provide guidance and consistency for accounting and reporting practices for healthcare providers. The proper application of the Statement of Position requires a thorough understanding of the provider's claim and incident identification procedures. And this understanding becomes more critical as providers begin to realize the restrictive opportunities of conventional malpractice insurance coverage.

Accounting↗
PubMed1994

A primer on coding and reimbursement for gastrointestinal endoscopy.

The days when a physician could rely solely on "the front office" to deal with coding, billing, and reimbursement have passed. Only the practitioner knows specifically what service or procedure has been performed, and for which diagnosis. There is no substitute for remaining up-to-date on the rules and regulations for coding and payment. The safest approach to reporting services and procedures is to keep abreast of changes and heed the axiom "do what you say and say what you do."

Endoscopy, Digestive System↗
PubMed1987

Medicaid program; identification of third party liability resources for medical assistance--HCFA. Final rule.

This final rule revises regulations governing a Medicaid State agency's responsibility to take reasonable measures to determine the legal liability of third parties to pay for services under the plan. The final regulations require that the agency at a minimum: Obtain certain health insurance information for Medicaid applicants or recipients during the initial application and redetermination processes; conduct, or in some cases attempt to secure agreements to conduct, certain types of data exchanges with specific State and Federal agencies, or in some cases alternate sources, to identify legally liable third parties; conduct diagnosis and trauma code edits to identify third party resources; and follow other specified procedures regarding frequency of conducting the above activities, follow up, safeguarding information obtained and exchanged, and reporting and reimbursement requirements. The objectives of these requirements are to improve State agency performance in the identification of third party resources and to assure the timely incorporation of this resource information into the third party claims payment processing system. This regulation also makes minor technical revisions to the Income and Eligibility Verification System final rule published in the Federal Register on February 28, 1986.

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