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Medicare Advantage Hierarchical Condition Categories: Targeting Chart Reviews
Medicare Advantage Hierarchical Condition Categories: Targeting Chart Reviews Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the ...- Authors: Corey Berger, Eric P Goetsch
- Date: Jan 2011
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Demography; Health & Disability>Health risks; Modeling & Statistical Methods>Data mining; Social Insurance>Medicare; Technology & Applications>Analytics and informatics
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Potential Membership Shifts for Medicare Prescription Drug Plans
Potential Membership Shifts for Medicare Prescription Drug Plans Changes in CMS requirements for 2011 Medicare Part D plans aimed at reducing confusion surrounding the PDP selection process by ...- Authors: Shelly Brandel
- Date: Jan 2011
- Competency: External Forces & Industry Knowledge>Actuarial theory in business context; Professional Values>Public interest representation; Strategic Insight and Integration>Big picture view
- Publication Name: Health Watch
- Topics: Public Policy; Social Insurance>Medicare
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How to Survive and Maybe Even Benefit from Medicare Advantage and Prescription Drug Bid Reviews and Audits
How to Survive and Maybe Even Benefit from Medicare Advantage and Prescription Drug Bid Reviews and Audits Background on, and best practices guidelines for dealing with, bid reviews and audits ...- Authors: Michael Cook
- Date: May 2011
- Competency: Communication; Professional Values; Relationship Management>Relationships and trust
- Publication Name: Health Watch
- Topics: Actuarial Profession>Best practices; Social Insurance>Medicare
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Letter from the Editor
Letter from the Editor The editor of Health Watch previews the articles in this issue. Audits;Health care costs;Health care reform;Investment strategy; 9564 05/01/2011 05:00:00 ...- Authors: Mary Kindel Van der Heijde
- Date: May 2011
- Competency: Communication>Written communication; Professional Values>Public interest representation; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Actuarial Profession>Professional associations; Health & Disability; Public Policy
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An Interview with Susan Dentzer
An Interview with Susan Dentzer Susan Dentzer, editor-in-chief of Health Affairs, discusses health care and health policy. Patient Protection and Affordable Care Act= PPACA=Affordable Care Act; ...- Authors: Mary Kindel Van der Heijde, Douglas Norris
- Date: Oct 2011
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Actuarial Profession>Academic partnerships; Health & Disability>Health care
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SOA 2012 Health Meeting Interview with Mary Milla
SOA 2012 Health Meeting Interview with Mary Milla Interview with Mary Milla regarding tips for giving effective presentations. 4294993957 01/01/2013 06:00:00 ...- Authors: Douglas Norris
- Date: Jan 2013
- Publication Name: Health Watch
- Topics: Actuarial Profession>Management skills; Actuarial Profession>Professional development
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Soundbites from the American Academy of Actuaries' Health Practice Council
Soundbites from the American Academy of Actuaries' Health Practice Council News from the American Academy of Actuaries 4294993937 01/01/2013 06:00:00 ...- Authors: Heather E Jerbi
- Date: Jan 2013
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health insurance
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Similarities between Medicare Prescription Drug Plans and Commercial Exchanges
Similarities between Medicare Prescription Drug Plans and Commercial Exchanges This article compares the Prescription Drug Plan (PDP) market to the commercial individual market exchanges included ...- Authors: Shelly Brandel
- Date: Jan 2013
- Competency: Strategic Insight and Integration>Strategy development
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health insurance; Public Policy; Public Policy; Social Insurance>Medicare
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Improving Outcomes Through Incentives: Using a Global Budget with Risk Sharing to Drive Cost Savings and Improved Quality
Improving Outcomes Through Incentives: Using a Global Budget with Risk Sharing to Drive Cost Savings and Improved Quality This article describes the results of three years of work by Blue Shield ...- Authors: Edward Cymerys
- Date: May 2013
- Competency: Relationship Management>Relationships and trust; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Management partnership; Technical Skills & Analytical Problem Solving>Innovative solutions
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health insurance; Health & Disability>Payment models
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Massachusetts Payment Reform from an Actuarial Perspective
Massachusetts Payment Reform from an Actuarial Perspective The article is a case study of various actuarial concepts invovled in the design and implementtion of the AQC - a global budget provider ...- Authors: Matthew Day, Jill Wilson
- Date: May 2013
- Competency: External Forces & Industry Knowledge>Actuarial theory in business context; Strategic Insight and Integration>Big picture view; Technical Skills & Analytical Problem Solving>Innovative solutions
- Publication Name: Health Watch
- Topics: Health & Disability>Payment models; Public Policy