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Academic Journals
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From:Journal of Risk and Insurance (Vol. 70, Issue 1) Peer-ReviewedABSTRACT Loss functions play an important role in analyzing insurance portfolios. A fundamental issue in the study of loss functions involves the selection of probability models for claim frequencies. In this...
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From:Management Review (Vol. 88, Issue 8) Peer-ReviewedThis article discuses how corporations can expand into related or even unrelated industries with success, thereby leaving the competition behind. Included in this article are accounts of how four companies diversified...
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From:Journal of Risk and Insurance (Vol. 57, Issue 2) Peer-ReviewedABSTRACT The Federal government's Medicare program currently pays on a risk basis to health maintenance organizations (HMOs) and competitive medical plans (CMPS) using an adjusted average per capita cost (AAPCC)...
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From:Physician Executive (Vol. 17, Issue 1) Peer-ReviewedCredentialing, the Most Important Function for Success Recently, I was asked by a managed care physician executive about my choice for the most important component for the containment of medical care costs. I quickly...
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From:Physician Executive (Vol. 17, Issue 1) Peer-ReviewedCoverage, Technology Assessment, and the Courts The role of patient as plaintiff in court challenges to adverse coverage decisions appears to be on the increase. Thus, the courts are increasingly finding themselves...
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From:Health Care Financing Review (Vol. 11, Issue 3) Peer-ReviewedAlternative geographic configurations for Medicare payments to health maintenance organizations Introduction Provisions of the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) authorized that full...
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From:Physician Executive (Vol. 18, Issue 1) Peer-ReviewedIn this era of managed care, the message has been that the health care industry has provided inappropriate or inefficient care, causing the ruination of medicine and ultimately of the U.S. economy. Published research...
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From:Patient Care (Vol. 27, Issue 11) Peer-ReviewedA letter to Hillary Clinton identifies major problems that physicians often encounter when attempting to recover fees for services they provide to Medicare patients. Delays in payment, administrative costs and paperwork...
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From:Health Care Financing Review (Vol. 15, Issue 3) Peer-ReviewedThe following summary is of a report from the Secretary of Health and Human Services released to Congress on March 1, 1994. Legislative Mandate This report was mandated by section 6136 of the Omnibus Budget...
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From:Physician Executive (Vol. 20, Issue 7) Peer-ReviewedThe process of billing an insurance company for health care services has changed radically. In the past few years, the emphasis has been on automation. The change is fueled by the opinion of cst containment experts who...
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From:Hospitals & Health Networks (Vol. 71, Issue 6)Medicare pays more per patient than most private managed care plans in 1997. Managed care fees were below average Medicare fees in 26% of procedure codes in a sample from 1996. This statistic is an increase from 1995...
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From:Journal of Risk and Insurance (Vol. 86, Issue 1) Peer-ReviewedThis research investigates information verification by life insurers with respect to postclaim underwriting through denied and resisted claims. We provide a theoretical model to explore the optimal strategy for insurers...
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From:Florida Bar Journal (Vol. 85, Issue 2)Can an insurer be acting in bad faith for failing to settle a claim when the insured or claimant is deliberately attempting not to settle in order to create a bad faith "refusal to settle" claim against the insurer and...
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From:AAOS NowPeer-ReviewedThe U.S. Department of Health and Human Services (HHS) has announced operating rules for making healthcare claims payments electronically and describing adjustments to claims payments. The new rule builds upon...
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From:AAOS NowPeer-ReviewedBy definition, a "level playing field" is about fairness, a system in which all players abide by the same set of rules. This system requires transparency and consistency of the rules, their definition, and their...
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From:Family Practice News (Vol. 38, Issue 15)In the past 8 years, Medicare has paid more than $76.6 million in durable medical equipment claims that contained the Unique Physician Identification Numbers of dead physicians, according to a congressional subcommittee...
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From:Financial Executive (Vol. 22, Issue 3) Peer-ReviewedLiability is a paramount issue for directors these days, and for good reason. So, perhaps it's surprising that just half of all public and private companies have received directors and officers (D & O) liability...
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From:Health Management Technology (Vol. 28, Issue 9)The diversified information technology company, SSI Group Inc., has released a new service model, ClickON Hosted Claims Management Service. ClickON Hosted Claims Management Service leverages SSI's EHNAC-certified...
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From:Healthcare Financial Management (Vol. 59, Issue 9) Peer-ReviewedIn early 2001, the patient financial services department of The Memorial Hospital in North Conway, N.H., recognized both an increase in registration errors and a developing trend of increased claims denials. These...
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From:Contemporary Urology (Vol. 16, Issue 4) Peer-Reviewed