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The Missing 1 Percent
The Missing 1 Percent A discussion of insurance claims processing and payment systems, and how to achieve the minimum possible number of errors. Audits;Claims processing;Claims review;Data ...- Authors: Jim Del Vecchio
- Date: May 2010
- Competency: External Forces & Industry Knowledge>External forces and business performance; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Big picture view; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Long-Term Care News
- Topics: Health & Disability>Health information technology; Health & Disability>Electronic medical record
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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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Medicare Advantage experience data: pitfalls and concerns beyond ASOP #23
Medicare Advantage experience data: pitfalls and concerns beyond ASOP #23 Medicare Advantage Organizations must consider influences both internal and external to the adjudication process as they ...- Authors: Michelle Wahab, Shelby Weber
- Date: Mar 2019
- Competency: Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Health Watch
- Topics: Health & Disability>Health information technology; Social Insurance>Medicare; Technology & Applications>Data warehousing