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Validating a Novel Health Insurance Fraud Detection Method
Validating a Novel Health Insurance Fraud Detection Method This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for ...- Authors: Robert D Lieberthal, Elias
- Date: Aug 2018
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Risk Management
- Topics: Economics>Health economics; Enterprise Risk Management; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Public financing - Health & Disability; Modeling & Statistical Methods>Data mining; Predictive Analytics
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Medicaid and the ACA
Medicaid and the ACA Medicaid and the ACA Patient Protection and Affordable Care Act= PPACA=Affordable Care Act;Health care reform;Health insurance;Medical Loss Ratio=MLR;Accountable care ...- Authors: Rebecca Owen
- Date: Aug 2015
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; External Forces & Industry Knowledge>External forces and business performance
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Health & Disability>Public financing - Health & Disability
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Health Watch, February 2018, Issue 85
Health Watch, February 2018, Issue 85 Read the February 2018 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section ...- Authors: Society of Actuaries
- Date: Feb 2018
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Health & Disability>Public financing - Health & Disability
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E&R Sponsored Sessions at the June Health Meeting
E&R Sponsored Sessions at the June Health Meeting By Ian Duncan and Chuck Fuhrer Healthcare Reform;Health Economics;Health Policy By Ian Duncan and Chuck Fuhrer There are a lot of sessions at ...- Authors: Ian G Duncan
- Date: Apr 2017
- Competency: External Forces & Industry Knowledge>Internal forces and business performance; Strategic Insight and Integration>Strategy development
- Publication Name: Expanding Horizons
- Topics: Health & Disability>Public financing - Health & Disability
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Recent Developments in the Health Care Market
Summary of a presentation made by the author to the Government Finance Officer’s Association (GFOA) in New York on December 2018. This included an overview of the health insurance market ...
- Authors: Michael Frank
- Date: Feb 2019
- Competency: Communication; External Forces & Industry Knowledge; Professional Values; Technical Skills & Analytical Problem Solving
- Publication Name: Innovators & Entrepreneurs
- Topics: General Insurance (Property & Casualty)>Claims - General Insurance; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Public financing - Health & Disability; Life Insurance>Claims - Life Insurance; Long-term Care>Public financing - Long-term Care; Health & Disability>Affordable Care Act (ACA)
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The ACA’s Medical Loss Ratio Provisions: Looking Back
The ACA’s Medical Loss Ratio Provisions: Looking Back The ACA’s Medical Loss Ratio Provisions Patient Protection and Affordable Care Act= PPACA=Affordable Care Act;Health care reform;Health ...- Authors: Rowen Bell
- Date: Aug 2015
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; External Forces & Industry Knowledge>External forces and business performance
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Health & Disability>Public financing - Health & Disability
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Prologue
Prologue Introduction to the ACA @ 5 publication Patient Protection and Affordable Care Act= PPACA=Affordable Care Act;Health care reform;Health insurance;Medical Loss Ratio=MLR;Accountable care ...- Authors: Jim Toole
- Date: Aug 2015
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; External Forces & Industry Knowledge>External forces and business performance
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Health & Disability>Public financing - Health & Disability
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Medicare The 1979 Trustees' Report
Medicare The 1979 Trustees' Report Overview of Medicare's 1979 financial projections under optimistic, pessimistic, and intermediate assumptions, for the Hospital Insurance and ...- Authors: Roland E King, David R McKusick
- Date: Oct 1979
- Competency: Communication>Difficult message delivery; Professional Values>Public interest representation; Strategic Insight and Integration>Strategy development
- Publication Name: The Actuary Magazine
- Topics: Health & Disability>Public financing - Health & Disability; Public Policy; Social Insurance>Government-funded healthcare; Social Insurance>Medicare
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Improving Medicare Advantage Star Ratings: An Analytical Framework
Improving Medicare Advantage Star Ratings: An Analytical Framework This paper outlines a framework for assisting a STARS manager in implementing a quantitative approach to prioritize stars ...- Authors: Puneet Budhiraja, Rajesh Munjuluri
- Date: Oct 2018
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Payment models; Health & Disability>Public financing - Health & Disability; Technology & Applications>Analytics and informatics
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Assessing Alternative Financing Methods For The Canadian Health Care System In View of Population Aging
Assessing Alternative Financing Methods For The Canadian Health Care System In View of Population Aging This paper introduces a single measure combining cost and quality of healthcare. This is ...- Authors: Application Administrator
- Date: Jan 2007
- Competency: Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Topics: Health & Disability>Health care quality; Health & Disability>Public financing - Health & Disability