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Health Insurance Fraud
Assistant surgeons (billing as if they were the primary surgeon) — Soft Fraud ! Facility charges (for ... might not be direct fraud, it definitely costs your company money when you are the primary payer, and you ...- Authors: JOSEPH HOWARD CAMPBELL
- Date: Apr 2001
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance
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Biosimilars, Part 1: A Brief Introduction
change to the pharmacy benefits status quo. As health care consultants, we have been watching the swell develop ... this primer to help educate and prepare the health care system for the coming changes and opportunities ...- Authors: Gregory Warren, Tony Pistilli
- Date: Sep 2023
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability
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Issue Brief: Changing Financial Risks for Medigap Insurance, Part 2
(snowbirds, for example); and cover their major health care needs without MA’s utilization reviews and the risk ... as well as likely delays in receiving necessary care.[4] Providers may also appreciate Medigap-covered ...
- Date: Mar 2024
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health insurance; Public Policy; Public Policy
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Implementing Parity: Investing in Behavioral Health—Part 1
providers, and consumers of behavioral health care. Part 1 of this article will address implementation ... could impact the busi- ness of behavioral health care and the decisions that follow is of even greater ...- Authors: Stephen P Melek
- Date: May 2010
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Public Policy
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Do Individuals Make Sensible Health Insurance Decisions
office visit copayment levels ($15 for pri- mary care physician (PCP)/$40 for specialist; $25 for PCP/$35 ... School of Business.1 For many Americans, health care spending represents a meaningful portion of their ...- Authors: Alexander Leung, Jonah Yearick, Randy P Herman
- Date: Nov 2016
- Competency: External Forces & Industry Knowledge; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Strategy development
- Publication Name: Health Watch
- Topics: Economics>Behavioral economics; Economics>Health economics; Health & Disability>Health insurance; Technology & Applications>E-commerce
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Leader Interview With Greger J. Vigen
role for CalPERS, a jumbo client that buys health care for more than a million members; and founding chair ... my core expertise of networks and provider-based care began to be used across the country, I became an ...- Authors: Greger J Vigen
- Date: Jun 2020
- Competency: External Forces & Industry Knowledge; Leadership
- Publication Name: Health Watch
- Topics: Health & Disability
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New Assessment Program for PPOs
availability of care, health plan stability, use of services, cost of care, and effectiveness of care. This year ... choice: there are fewer restrictions on specialist care and PPOs offer better out-of- network coverage than ...- Authors: Louis Lana
- Date: Aug 2000
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability>Health care quality
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ASOP 6 and Medicare Payment Projections
facility in excess of $101.50 per day, custodial care, etc. The reimbursement decreases have led to an ... share of the expected future post-retirement health care cost for a plan partici- pant is developed by reducing ...- Authors: Charles Edwards
- Date: Aug 2003
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability
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Issue Brief: Changing Financial Risks for Medigap Insurance, Part 1
patients who deferred certain types of care or simply sought less care than they normally would (or should) ... financial improvements due to delayed and averted care in 2020 and 2021 than did other types of health ...
- Authors: Kristi Bohn
- Date: Mar 2024
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health insurance
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Health Watch, October 2020
23, 2020, the 10th anniversary of the Affordable Care Act (ACA), the Health Section Council released our ... others. • In April, we released our Value-Based Care strategic initiative. More and more we are seeing ...- Authors: Society of Actuaries
- Date: Oct 2020
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability