A comprehensive guide designed to help consumers understand the American health insurance system so that they can obtain the benefits to which they are entitled. Epstein explains the ins and outs of both new and traditional health insurance plans, including traditional individual and group policies, HMOs and other types of managed care plans, self-funded plans, Medicare, Medicare HMOs, Medigap, long-term care, COBRA, CHAMPUS, and Medical Savings Accounts.
Written by a nationally syndicated columnist, this useful volume also deals with special health insurance issues related to children, adults with special needs, and individuals who may need long-term care. In addition, Epstein provides valuable information for individuals who are in the process of changing jobs or making changes in their marital or family status, choosing a health insurance plan, or arranging long-term care-including placement in a nursing home or an assisted-living facility-for an aging parent. The book has a practical focus with a variety of tables and worksheets to help consumers establish a system for preventing health insurance problems, and for dealing with any health insurance problems that may arise. It also contains answers to common questions about health insurance, and provides a list of organizations that offer detailed information and advice in regard to specific health insurance problems.
The book examines how the absence of insurance in the past led to some special maritime liability law principles such as 'general average' (i.e., losses or expenses shared by all the parties to a maritime adventure) and the limitation of shipowners' liability. In the absence of insurance, these principles served the function of insurance mostly for shipowners. As commercial marine insurance is now widely available, these principles have lost their justification and may in fact interfere with the most important goal of liability law i.e., deterrence from negligence. The work thus recommends their abolition. It further argues that when insurance is easily available and affordable to the both parties to a liability claim, the main goal of liability law should be deterrence as opposed to compensation. This is exactly the case with the maritime cargo liability claims where both cargo owners and shipowners are invariably insured. As a result, the sole focus of cargo liability law should be and to a great extent, is deterrence. On the other hand in the vessel-source oil pollution liability setting, pollution victims are not usually insured. Therefore oil pollution liability law has to cater both for compensation and deterrence, the two traditional goals of liability law. The final question the work addresses is whether the deterrent effect of liability law is affected by the availability of liability insurance. Contrary to the popular belief the work attempts to prove that the presence of liability insurance is not necessarily a hindrance but can be a complementary force towards the realization of deterrent goal of liability law.
Understanding Health Insurance: A Guide to Billing and Reimbursement, 8th Edition is a comprehensive source for teaching the subject of health insurance and reimbursement. The book contains chapters on introductory information on the health insurance field, managed health care, legal and regulatory issues, coding systems, reimbursement methodologies, coding for medical necessity, and common health insurance plans. Each chapter contains exercises to illustrate content and reinforce learning. Numerous opportunities are provided throughout the book for manual completion of CMS-1500 claims. A CD-ROM at the back of the book allows for electronic data entry of CMS-1500 claim form information. End of chapter review questions in objective format (e.g., multiple choice) test learners on their understanding of book content. Appendices I and II provide case studies that are also included on the Student Practice CD-ROM. Additional appendices provide instruction in dental claims processing and completion of the UB-92 (claim used for inpatient and outpatient hospital claims). The accompanying workbook provides application based assignments for each chapter, additional content review (multiple choice questions), and additional case studies for practice in completing CMS-1500 claims. This edition of the book contains the most up to date information regarding health insurance claims processing and coding and reimbursement issues.
Written by an internationally-recognized expert in the field of quality management, this book will serve as your guide for planning and implementing a successful quality measurement program in your healthcare facility. It begins by presenting an overview of the context for quality measurement, the forces influencing the demand for quality reform, how to listen to the voice of the customer, and the characteristics of quality that customers value most. Youa (TM)ll also learn how to select and define indicators to collect data and how to organize data into a dashboard that can provide feedback on your progress toward quality measurement. Finally, this book shows you how to analyze your data by detailing how variation lives in your data, and whether this variation is acceptable. Case studies are provided to demonstrate how quality measurement can be applied to clinical as well as operational aspects of healthcare delivery.
Statistics published by the U. S. Department of Commerce (1980) indicate that in 1977 we spent 8. 1% of our gross national product (GNP) on life, health, property-casualty, and other forms of insurance. An additional 5. 7% was used to pay the Social Security tax, which is another form of insurance premium, for a total of 14. 8% of the GNP. Although insurance had its historical origin in marine insurance, it has now developed into one of the major industries of the American economy and extends into many areas of economic activity. One area where growth has been particularly strong is the medical sector. Health insurance is a major institution in all industrialized countries. It became a government responsibility in 1883 when Bismarck intro- duced a compulsory program of health insurance for industrial workers in Germany. Programs for workers in various industrial and income categories soon followed in other European countries-Austria (1888), Hungary (1891), Norway (1909), Servia (1910), Great Britain (1911), and Russia and Romania (1912) (Rubinow, 1913:250). Programs in these countries were extended in subsequent years, and other countries in Europe followed with their own programs. Consequently, today most industrial countries have universal or near-universal health insurance coverage. In the United States the issue of national health insurance has been seriously debated since just prior to World War I, and polling data since the 1930s show that a substantial majority of the public has been supportive of such a program (Erskine, 1975).
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