Insurance Claim Reporting

Publication Title: 
Health Progress (Saint Louis, Mo.)

Catholic healthcare should establish comprehensive compliance strategies, beyond following Medicare reimbursement laws, that reflect mission and ethics. A covenant model of business ethics--rather than a self-interest emphasis on contracts--can help organizations develop a creed to focus on obligations and trust in their relationships. The corporate integrity program (CIP) of Mercy Health System Oklahoma promotes its mission and interests, educates and motivates its employees, provides assurance of systemwide commitment, and enforces CIP policies and procedures.

Author(s): 
Tuohey, J. F.
Publication Title: 
Health Affairs (Project Hope)

Communicating openly and honestly with patients and families about unexpected medical events-a policy known as full disclosure-improves outcomes for patients and providers. Although many certification and licensing organizations have declared full disclosure to be imperative, the adoption of and adherence to a full disclosure protocol is not common practice in most clinical settings. We conducted a case study of Ascension Health's implementation of a full disclosure protocol at five labor and delivery demonstration sites.

Author(s): 
Hendrich, Ann
McCoy, Christine Kocot
Gale, Jane
Sparkman, Lora
Santos, Palmira
Publication Title: 
Journal of Dental Education

Dentists and the dental team have been encouraged to become an important part of the effort to curb tobacco use. Many health insurance policies, however, do not cover tobacco cessation programs, especially by dentists. The generosity of insurance for tobacco cessation has been found to influence the use of these programs.

Author(s): 
Damiano, P. C.
Publication Title: 
Health Services Research

OBJECTIVES: To examine the impact of benefit generosity and household health care financial burden on the demand for specialty drugs in the treatment of rheumatoid arthritis (RA). DATA SOURCES/STUDY SETTING: Enrollment, claims, and benefit design information for 35 large private employers during 2000-2005. STUDY DESIGN: We estimated multivariate models of the effects of benefit generosity and household financial burden on initiation and continuation of biologic therapies.

Author(s): 
Karaca-Mandic, Pinar
Joyce, Geoffrey F.
Goldman, Dana P.
Laouri, Marianne
Publication Title: 
The American Journal of Managed Care

BACKGROUND: Since 1996, Washington State law has required that private health insurance cover licensed complementary and alternative medicine (CAM) providers. OBJECTIVE: To evaluate how insured people used CAM providers and what role this played in healthcare utilization and expenditures. STUDY DESIGN: Cross-sectional analysis of insurance enrollees from western Washington in 2002. METHODS: Analysis of insurance demographic data, claims files, benefit information, diagnoses, CAM and conventional provider utilization, and healthcare expenditures for 3 large health insurance companies.

Author(s): 
Lafferty, William E.
Tyree, Patrick T.
Bellas, Allen S.
Watts, Carolyn A.
Lind, Bonnie K.
Sherman, Karen J.
Cherkin, Daniel C.
Grembowski, David E.
Publication Title: 
Maternal and Child Health Journal

This study investigated provider-based complementary/alternative medicine use and its association with receipt of recommended vaccinations by children aged 1-2 years and with acquisition of vaccine-preventable disease by children aged 1-17 years. Results were based on logistic regression analysis of insurance claims for pediatric enrollees covered by two insurance companies in Washington State during 2000-2003. Primary exposures were use of chiropractic, naturopathy, acupuncture, or massage practitioner services by pediatric enrollees or members of their immediate families.

Author(s): 
Downey, Lois
Tyree, Patrick T.
Huebner, Colleen E.
Lafferty, William E.
Publication Title: 
The American Journal of Managed Care

BACKGROUND: Since 1996, Washington State law has required that private health insurance cover licensed complementary and alternative medicine (CAM) providers. OBJECTIVE: To evaluate how insured people used CAM providers and what role this played in healthcare utilization and expenditures. STUDY DESIGN: Cross-sectional analysis of insurance enrollees from western Washington in 2002. METHODS: Analysis of insurance demographic data, claims files, benefit information, diagnoses, CAM and conventional provider utilization, and healthcare expenditures for 3 large health insurance companies.

Author(s): 
Lafferty, William E.
Tyree, Patrick T.
Bellas, Allen S.
Watts, Carolyn A.
Lind, Bonnie K.
Sherman, Karen J.
Cherkin, Daniel C.
Grembowski, David E.
Publication Title: 
American Journal of Medical Quality: The Official Journal of the American College of Medical Quality

Research use of insurance claims data presents unique challenges and requires a series of value judgments that are intended to improve the data quality. In this study, medical insurance claims from 2 large companies were combined to assess utilization of complementary and alternative medicine. Challenges included assessing and improving the quality of data, combining data from 2 different companies with dissimilar coding systems, and determining the most appropriate ways to describe utilization.

Author(s): 
Tyree, Patrick T.
Lind, Bonnie K.
Lafferty, William E.
Publication Title: 
Maternal and Child Health Journal

This study investigated provider-based complementary/alternative medicine use and its association with receipt of recommended vaccinations by children aged 1-2 years and with acquisition of vaccine-preventable disease by children aged 1-17 years. Results were based on logistic regression analysis of insurance claims for pediatric enrollees covered by two insurance companies in Washington State during 2000-2003. Primary exposures were use of chiropractic, naturopathy, acupuncture, or massage practitioner services by pediatric enrollees or members of their immediate families.

Author(s): 
Downey, Lois
Tyree, Patrick T.
Huebner, Colleen E.
Lafferty, William E.
Publication Title: 
Journal of Manipulative and Physiological Therapeutics

OBJECTIVE: The objective of this study was to examine the volume and rate of Medicare Part B claims for chiropractic spinal manipulation longitudinally from 1998 to 2004. METHODS: A descriptive retrospective analysis was performed on Medicare part B claims from 1998 to 2004 using the Medicare Part B Standard Analytical Variable Length File. Using a 5% random sample of Medicare part B claims, the total number of claims were determined for chiropractic spinal manipulation procedures, and the rate of chiropractic spinal manipulation procedures per 1000 beneficiaries.

Author(s): 
Whedon, James M.
Davis, Matthew A.

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