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At least 1,459 records · Page 81Linked to original sources
PubMed1994

Medicare program; criteria and standards for evaluating intermediary and carrier performance during FY 1995--HCFA. General notice with comment period.

This notice describes the criteria and standards to be used for evaluating the performance of fiscal intermediaries and carriers in the administration of the Medicare program beginning October 1, 1994. The results of these evaluations are considered whenever HCFA enters into, renews, or terminates an intermediary agreement or carrier contract or takes other contract actions (for example, assigning or reassigning providers of services to an intermediary or designating regional or national intermediaries). This notice is published in accordance with sections 1816(f) and 1842(b)(2) of the Social Security Act. We are publishing for public comment in the Federal Register those criteria and standards against which we evaluate intermediaries and carriers.

Financial Audit↗
PubMed1988

Medicare: criteria and standards for evaluating intermediary and carrier performance during fiscal year 1989--HCFA. General notice with comment period.

This notice describes the criteria and standards to be used for evaluating the performance of fiscal intermediaries and carriers in the administration of the Medicare program for the fiscal year beginning October 1, 1988. The results of these evaluations are considered whenever we enter into, renew, or terminate an intermediary or carrier agreement or take other contract actions; assign or reassign providers of services to an intermediary; or designate regional or national intermediaries. In addition, this notice describes the methodology for identifying contractors with performance over a period of time in the lowest 20th percentile that HCFA may replace using competitive bidding. This notice is published in accordance with sections 1816(f) and 1842(b)(2) of the Social Security Act, which require us to publish for public comment in the Federal Register those criteria and standards against which we evaluate intermediaries and carriers.

Contract Services↗
PubMed1998

DSSNY course bolsters dentists' defenses.

The DSSNY risk management course was born of crisis. Now in its fifth version, the course is credited with increasing competition among malpractice carriers and lowering premium prices.

Education, Dental↗
PubMed1991

Medicare program; standard claim forms for Part B claims completed and submitted by physicians, suppliers and other persons--HCFA. General notice with comment period.

This notice announces that effective April 1, 1992, Medicare carriers will no longer accept nonstandard claims. These are claims accompanied by attachments, in lieu of the biller entering required information in designated blocks of prescribed claims forms. This change is intended to eliminate costly and inefficient claims processing practices for Medicare carriers.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1989

Restructuring the Federal Employees Health Benefits Program: the private sector option.

The Federal Employees Health Benefits Program (FEHBP) needs to contain its costs. This paper recommends reforms of FEHBP that would substantially lower costs. As a first step, FEHBP should offer each employee a high and low option from a single conventional carrier, plus several HMO alternatives. FEHBP's practice of offering employees a choice of conventional carriers is virtually unheard of in the private sector. Cost control is more likely when carriers compete for employment groups rather than for individual employees. In addition, my analysis suggests that FEHBP should self-insure, competitively select third-party administrators (TPAs), one for each region of the country, aggressively manage program costs through preadmission certification and DRGs, and allow Medicare-eligible annuitants to enroll in Medicare HMOs and receive the government contribution. All of these reforms have been successfully implemented elsewhere, either by private employers or state or federal governments. These reforms would yield savings of at least $500 million annually for taxpayers and additional savings for federal employees.

Cost Control↗
PubMed1987

Third-party fee for service in children's mental health: limitation and suggestions.

The current third-party fee-for-service mode of reimbursement for mental health services emphasizes individual, pathology-oriented intervention and thus has disadvantages for clients and carriers. This article focuses on the mode's effects on outpatient services for children, youth, and families. It examines the ways in which common payment modes seriously limit services and create an incentive for psychologists to take a narrow, often nonempirical, perspective. Suggestions that allow for multisystem, ecological skill building hinge on building relationships between psychologists and the carriers. Desired results take two forms: modification of contingencies between providers and carriers and modification of contingency between insured and carrier. Examples of each are presented.

Adolescent↗