insurance claim review
Summary: Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.
Publications224 found, 100 shown here
- Validation of diagnostic codes within medical services claimsMachelle Wilchesky
Department of Epidemiology and Biostatistics, McGill University, Morrice House, 1140 Pine Avenue West, Montreal, QCH3A 1A3, Canada
J Clin Epidemiol 57:131-41. 2004....
- Adherence and dosing frequency of common medications for cardiovascular patientsJay P Bae
College of Pharmacy, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE 68198 6045, USA
Am J Manag Care 18:139-46. 2012..To compare adherence between once-daily (QD) and twice-daily (BID) dosing with chronic-use prescription medications used by patients with cardiovascular disease...
- Comparison of methodologies for calculating quality measures based on administrative data versus clinical data from an electronic health record system: implications for performance measuresPaul C Tang
Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA 94301, USA
J Am Med Inform Assoc 14:10-5. 2007..Using data from EHRs will also leverage their clinical content without adding burden to the care process...
- Medical chart validation of an algorithm for identifying multiple sclerosis relapse in healthcare claimsBenjamin J Chastek
i3 Innovus, Eden Prairie, MN, USA
J Med Econ 13:618-25. 2010..Relapse is a common measure of disease activity in relapsing-remitting multiple sclerosis (MS). The objective of this study was to test the content validity of an operational algorithm for detecting relapse in claims data...
- [Structural differences between health insurance funds and their impact on health services research: results from the Bertelsmann Health-Care Monitor]F Hoffmann
Universitat Bremen, ZeS, Abteilung Gesundheitsökonomie, Gesundheitspolitik und Versorgungsforschung, 28334 Bremen
Gesundheitswesen 74:291-7. 2012....
- A refined comorbidity measurement algorithm for claims-based studies of breast, prostate, colorectal, and lung cancer patientsCarrie N Klabunde
Health Services and Economics Branch, Applied Research Program, National Cancer Institute, Bethesda, MD 20892 7344, USA
Ann Epidemiol 17:584-90. 2007....
- Incidence of and survival after mammary tumors in a population of over 80,000 insured female dogs in Sweden from 1995 to 2002Agneta Egenvall
Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, SE 750 07 Uppsala, Sweden
Prev Vet Med 69:109-27. 2005..At the ages 6, 8 and 10 years, 1%, 6% and 13% respectively, of all females had at least one MT claim. The MT mortality was 6 deaths per 10,000 DYAR and increased with age. The overall-case fatality was 6%...
- Specificity and sensitivity of claims-based algorithms for identifying members of Medicare+Choice health plans that have chronic medical conditionsThomas S Rector
Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN 55417, USA
Health Serv Res 39:1839-57. 2004..To examine the effects of varying diagnostic and pharmaceutical criteria on the performance of claims-based algorithms for identifying beneficiaries with hypertension, heart failure, chronic lung disease, arthritis, glaucoma, and diabetes...
- A statistical analysis of 'rule-out' diagnoses in outpatient health insurance claims in JapanShinichi Tanihara
Department of Hygiene and Preventive Medicine, School of Medicine, Fukuoka University, Fukuoka, Japan
J Eval Clin Pract 17:1070-4. 2011..However, little is known about the statistical profiles of such rule-out diagnoses...
- A comparison of disease-specific medical expenditures in Japan using the principal diagnosis method and the proportional distribution methodShinichi Tanihara
Department of Hygiene and Preventive Medicine, School of Medicine, Fukuoka University, Jonan ku, Fukuoka, Japan
J Eval Clin Pract 18:616-22. 2012..Therefore, conventional methods for estimating disease-specific medical expenditures assume that all medical care expenditures in a given HIC are spent on only one principal diagnosis even when the HIC contains multiple diagnoses...
- Analgesic usage for low back pain: impact on health care costs and service useMolly T Vogt
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Spine (Phila Pa 1976) 30:1075-81. 2005..Cross-sectional analysis of analgesic use by patients with low back pain (LBP)...
- Identification of dementia: agreement among national survey data, medicare claims, and death certificatesTruls Ostbye
Department of Community and Family Medicine, Duke University Center for Health Policy, School of Nursing, Duke University Medical Center, Box 2914 Med Ctr, Durham, NC 27710, USA
Health Serv Res 43:313-26. 2008..To estimate the proportion of seniors with dementia from three independent data sources and their agreement...
- One-year costs of ischemic heart disease among patients with acute coronary syndromes: findings from a multi-employer claims databaseJoseph Menzin
Boston Health Economics, Inc, 20 Fox Road, Waltham, MA 02451, USA
Curr Med Res Opin 24:461-8. 2008..Acute coronary syndromes (ACS) are life-threatening disorders requiring intensive medical management or invasive cardiovascular procedures. Limited data exist on the costs and resource utilization associated with ACS...
- Performance of comorbidity scores to control for confounding in epidemiologic studies using claims dataS Schneeweiss
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women s Hospital and Harvard Medical School, Boston, MA 02115, USA
Am J Epidemiol 154:854-64. 2001..7% and 6.2%, respectively) for predicting mortality. Generalizability of results may be limited to an elderly, predominantly White population with equal access to state-funded health care...
- Incremental third-party costs associated with COPD exacerbations: a retrospective claims analysisAndrew P Yu
Analysis Group Inc, Boston, MA, USA
J Med Econ 14:315-23. 2011..Exacerbations are a major contributor to the large burden of treating chronic obstructive pulmonary disease (COPD). Estimates of exacerbation costs in the United States are limited...
- Developing alternative methods for determining the incidence, prevalence, and cost burden of coronary heart disease in a corporate populationMeghan Short Beckowski
Thomson Reuters, Washington, DC 20008, USA
J Occup Environ Med 54:1026-38. 2012..To determine the most appropriate methods for estimating the prevalence and incidence of coronary heart disease (CHD), the associated risk factors, and health care costs in a corporate setting...
- Claims data linked to hospital registry data enhance evaluation of the quality of care of breast cancerAri Nareg Meguerditchian
Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada
J Surg Oncol 101:593-9. 2010..This study assesses the ability to link private payer claims to the National Cancer Data Base (NCDB) and the extent of additional treatment data identified in claims...
- Frequency and cost of chemotherapy-related serious adverse effects in a population sample of women with breast cancerMichael J Hassett
Center for Outcomes and Policy Research, Dana Farber Cancer Institute, 44 Binney Street, 454 STE 21, Boston, MA 02115 6084, USA
J Natl Cancer Inst 98:1108-17. 2006..The number, nature, and costs of serious adverse effects experienced by younger women receiving chemotherapy for breast cancer outside of clinical trials are unknown...
- [Experience with the linkage of primary and secondary claims data in an intervention trial]E Swart
Institut für Sozialmedizin und Gesundheitsökonomie, Medizinische Fakultät der Otto von Guericke Universität Magdeburg, Magdeburg
Gesundheitswesen 73:e126-32. 2011..Nevertheless a couple of data protection rules have to be followed; the data linkage offers a high knowledge insight to many health and epidemiological research questions and might be the new gold standard for health services research...
- Cost of illness associated with metastatic breast cancerS Rao
Global Health Outcomes Assessment, Wyeth Research, Collegeville, PA 19426 3930, USA
Breast Cancer Res Treat 83:25-32. 2004..Multivariate regression analysis showed that as the age increased, the Medicare costs decreased within the MBC cohorts. Less combination treatments were provided for older MBC patients. Cost of illness was inversely proportional to age...
- Assessing treatment effects of inhaled corticosteroids on medical expenses and exacerbations among COPD patients: longitudinal analysis of managed care claimsManabu Akazawa
Department of Health Policy and Administration, University of North Carolina at Chapel Hill, CB 7411, Chapel Hill, NC 27599 7411, USA
Health Serv Res 43:2164-82. 2008..To assess costs, effectiveness, and cost-effectiveness of inhaled corticosteroids (ICS) augmenting bronchodilator treatment for chronic obstructive pulmonary disease (COPD)...
- Bouncing-back: rehospitalization in patients with complicated transitions in the first thirty days after hospital discharge for acute strokeAmy J H Kind
Department of Population Health Sciences, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Wadison, WI, USA
Home Health Care Serv Q 26:37-55. 2007..Bounce-backs" (movements from a less intensive to a more intensive care setting) soon after hospital discharge are common, but reasons for bouncing-back remain unknown...
- [Garbage in - garbage out? Validity of coded diagnoses from GP claims records]A Erler
Zentrum für Human und Gesundheitswissenschaften, Institut für Gesundheitssystemforschung, Charite Universitatsmedizin Berlin
Gesundheitswesen 71:823-31. 2009..In GP practices in particular, it is questionable whether claims-based diagnoses realistically reflect the health problems of patients treated over a one year period...
- Effect of a retrospective drug utilization review on potentially inappropriate prescribing in the elderlyCatherine I Starner
Prime Therapeutics, Eagan, Minnesota, USA
Am J Geriatr Pharmacother 7:11-9. 2009..Although the literature suggests DAE are associated with negative health outcomes, educational interventions have had a positive impact on inappropriate prescribing...
- All-cause and potentially disease-related health care costs associated with venous thromboembolism in commercial, Medicare, and Medicaid beneficiariesPatrick Lefebvre
Groupe d Analyse, Ltee, 1000 De La Gauchetière Ouest, Bureau 1200, Montreal, QC, Canada
J Manag Care Pharm 18:363-74. 2012..Therefore, formulary/policy decision makers should understand the clinical and economic consequences associated with VTE...
- Agreement between administrative claims and the medical record in identifying patients with a diagnosis of hypertensionMichael F Bullano
HealthCore Inc, Wilmington, Delaware 19801, USA
Med Care 44:486-90. 2006..This study evaluated the accuracy of 2 administrative claims-based selection rules to identify patients with hypertension (HTN) using medical records as the gold standard...
- Evaluation of the Washington state screening, brief intervention, and referral to treatment project: cost outcomes for Medicaid patients screened in hospital emergency departmentsSharon Estee
Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia, WA 98504 5204, USA
Med Care 48:18-24. 2010..We evaluated a screening, brief intervention, and referral to treatment (SBIRT) program, implemented in 9 hospital emergency departments (ED) in Washington State...
- Do women simply complain more? National patient injury claims data show gender and age differencesKarin Pukk
Sodersjukhuset, Stockholm, Sweden
Qual Manag Health Care 12:225-31. 2003..Differences in claims rates have major financial and quality of care implications. Further studies are needed...
- Using claims data to examine mortality trends following hospitalization for heart attack in MedicareArlene S Ash
Health Care Research Unit, Boston University School of Medicine, MA 02118, USA
Health Serv Res 38:1253-62. 2003....
- Job satisfaction and trust in Health Insurance Review Agency among Korean physiciansHoo Yeon Lee
National Cancer Control Research Institute, National Cancer Center, Republic of Korea
Health Policy 87:249-57. 2008..To measure Korean physicians' job satisfaction and to examine the relationship between trust in Health Insurance Review Agency (HIRA) and job satisfaction...
- Development of a comorbidity index using physician claims dataC N Klabunde
Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Executive Plaza North Room 4005, 6130 Executive Boulevard MSC 7344, Bethesda, MD, USA
J Clin Epidemiol 53:1258-67. 2000..The physician claims index can be used in conjunction with a comorbidity index derived from inpatient hospital claims, or employed as a stand-alone measure...
- Agreement of Medicare claims and tumor registry data for assessment of cancer-related treatmentG S Cooper
Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
Med Care 38:411-21. 2000..Although health claims data are increasingly used in evaluating variations in patterns of cancer care and outcomes, little is known about the comparability of these data with tumor registry information...
- Increased expenditures for other health conditions after an incident of low back painAshok Nimgade
Environmental and Occupational Medicine, Harvard School of Public Health, Boston, MA 02446, USA
Spine (Phila Pa 1976) 35:769-77. 2010..We reviewed healthcare expenditures in a random sample of 655 patients from a managed health plan with new onset low back pain (LBP) in 1999...
- Identification and validation of vertebral compression fractures using administrative claims dataJeffrey R Curtis
Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA
Med Care 47:69-72. 2009..Vertebral compression fractures (VCFs) are the most common type of osteoporotic fracture. Administrative claims data might be useful to identify VCFs, but this approach to case finding has received limited evaluation...
- Dementia in community-dwelling elderly patients: A comparison of survey data, medicare claims, cognitive screening, reported symptoms, and activity limitationsJoyce C Pressley
Gertrude H Sergievsky Center, College of Physicians and Surgeons, Columbia University, 722 West 168th Street, New York, NY 10032, USA
J Clin Epidemiol 56:896-905. 2003....
- Workplace health and safety regulations: Impact of enforcement and consultation on workers' compensation claims rates in Washington StateJames Baggs
Safety and Health Assessment and Research for Prevention Program, Washington State Department of Labor and Industries, Olympia, Washington 98504, USA
Am J Ind Med 43:483-94. 2003..To address this, we examined changes in lost time workers compensation claims rates for Washington State employers who had (1) no OSHA State Plan (WISHA) activity, (2) enforcement, (3) consultation, and (4) both types of visits...
- Validation of ICD-9-CM codes to identify gastrointestinal perforation events in administrative claims data among hospitalized rheumatoid arthritis patientsJeffrey R Curtis
Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, FOT 805D, 510 20th Street South, Birmingham, AL 35294, USA
Pharmacoepidemiol Drug Saf 20:1150-8. 2011..To validate, using physician review of abstracted medical chart data as a gold standard, a claims-based algorithm developed to identify gastrointestinal (GI) perforation cases among rheumatoid arthritis (RA) patients...
- Accuracy of prediction models in the context of disease managementGuizhou Hu
BioSignia Inc, 1822 E NC Highway 54, Suite 350, Durham, NC 27713, USA
Dis Manag 8:42-7. 2005..It also introduces a new accuracy parameter termed "cost concentration," which indicates the model accuracy more explicitly in the context of disease management...
- Depression and fibromyalgia: treatment and cost when diagnosed separately or concurrentlyRebecca L Robinson
Eli Lilly and Company, Indianapolis, Indiana 46285, USA
J Rheumatol 31:1621-9. 2004..Both syndromes share common symptoms and impose significant economic burdens. This study compared claims for treatment and costs of FM plus depression with those for FM or depression alone...
- Quantifying morbidities by Adjusted Clinical Group system for a Taiwan population: a nationwide analysisWui Chiang Lee
Department of Medical Affairs and Planning, Taipei Veterans General Hospital, Taipei City, Taiwan
BMC Health Serv Res 8:153. 2008..Therefore, the objective of this study was using the ACG system to quantify morbidities for Taiwanese population and to examine their relationship to ambulatory utilizations and costs...
- Validity of gout diagnoses in administrative dataLeslie R Harrold
Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation, and Fallon Community Health Plan, Worcester, Massachusetts 01655, USA
Arthritis Rheum 57:103-8. 2007..To determine the utility of using administrative data for epidemiologic studies of gout by examining the validity of gout diagnoses in claims data...
- Data sources for measuring comorbidity: a comparison of hospital records and medicare claims for cancer patientsCarrie N Klabunde
Health Services and Economics Branch, Applied Research Program, National Cancer Institute, Bethesda, MD 20892 7344, USA
Med Care 44:921-8. 2006..Identifying appropriate comorbidity data sources is a key consideration in health services and outcomes research...
- Fee code creep among general practitioners and family physicians in Ontario: why does the ratio of intermediate to minor assessments keep climbing?B Chan
Institute for Clinical Evaluative Sciences, Ontario, Toronto
CMAJ 158:749-54. 1998..The authors examine the extent and nature of fee code creep and describe physician characteristics associated with the changes...
- Physician manipulation of reimbursement rules for patients: between a rock and a hard placeM K Wynia
Institute for Ethics, American Medical Association, Chicago, Ill 60610, USA
JAMA 283:1858-65. 2000..Health plan utilization review rules are intended to enforce insurance contracts and can alter and constrain the services that physicians provide to their patients. Physicians can manipulate these rules, but how often they do so is unknown...
- Identification of patients with nonmelanoma skin cancer using health maintenance organization claims dataMelody J Eide
Department of Dermatology, Henry Ford Hospital, 3031 West Grand Boulevard, Suite 800, Detroit, MI 48202, USA
Am J Epidemiol 171:123-8. 2010..7% identified with both codes. HMO administrative data can be used to ascertain NMSC with high positive predictive values with either ICD-9-CM or CPT code, but both codes may be necessary among non-HMO patient populations...
- Consistency of performance ranking of comorbidity adjustment scores in Canadian and U.S. utilization dataSebastian Schneeweiss
Division of Pharmacoepidemiology and Pharmacoeconomics, Gigham and Women s Hospital and Harvard Medical School, Boston, MA 02120, USA
J Gen Intern Med 19:444-50. 2004..We sought to evaluate and rank the performance of comorbidity scores across selected U.S. and Canadian elderly populations using health care utilization databases...
- The impact of value-based benefit design on adherence to diabetes medications: a propensity score-weighted difference in difference evaluationFeng Zeng
MedImpact Healthcare Systems, Inc, San Diego, CA 92131, USA
Value Health 13:846-52. 2010..To evaluate the impact of value-based benefit design (VBBD) on adherence to diabetes medications...
- Patient and hospital characteristics associated with claims and compensations for patient injuries in coronary artery bypass grafting in FinlandJutta Järvelin
Centre for Health Economics CHESS, National Institute for Health and Welfare, Helsinki, Findland
J Health Serv Res Policy 14:150-5. 2009..And to explore whether either hospital productivity or volume of procedures is related to claims and compensation rates...
- The value of specialty oncology drugsDana P Goldman
Schaeffer Center for Health Policy and Economics, Schools of Pharmacy and Policy, Planning, and Development, University of Southern California, Ralph and Goldy Lewis Hall 214, Los Angeles, CA 90089 0626, USA
Health Serv Res 45:115-32. 2010..To estimate patients' elasticity of demand, willingness to pay, and consumer surplus for five high-cost specialty medications treating metastatic disease or hematologic malignancies...
- Claiming behaviour in a no-fault system of medical injury: a descriptive analysis of claimants and non-claimantsMarie M Bismark
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
Med J Aust 185:203-7. 2006....
- Injuries as a result of treatment of tibial fractures in children: Claims for compensation submitted to the Patient Insurance Center in FinlandSauli Palmu
Children s Hospital, Helsinki University Central Hospital, Helsinki, Finland
Acta Orthop 80:78-82. 2009..We analyzed compensation claims concerning treatment of these fractures in Finland. We used this information to determine preventable causes of treatment injuries...
- Validation of physician billing and hospitalization data to identify patients with ischemic heart disease using data from the Electronic Medical Record Administrative data Linked Database (EMRALD)Karen Tu
Department of Family and Community Medicine, University of Toronto, Ontario
Can J Cardiol 26:e225-8. 2010..Reporting of ischemic heart disease (IHD) prevalence in Canada has been based on self-report or patients presenting to hospital. However, IHD often presents and can be managed in the outpatient setting...
- Quality of hysterectomy care in rural Gujarat: the role of community-based health insuranceM Kent Ranson
Self Employed Women s Association, Ahmedabad, India
Reprod Health Matters 10:70-81. 2002..In the case of SEWA, it is most feasible to identify a limited number of hospitals providing better quality care and contract directly with them...
- Challenges and benefits of adding laboratory data to a mortality risk adjustment methodElizabeth McCullough
3M Health Information Systems, Inc, Wallingford, Connecticut 06492, USA
Qual Manag Health Care 20:253-62. 2011....
- [Prognostic impact of Charlson comorbidity index obtained from medical records and claims data on 1-year mortality and length of stay in gastric cancer patients]Min Ho Kyung
Department of Preventive Medicine, College of Medicine, Korea University, Korea
J Prev Med Public Health 42:117-22. 2009..We also attempted to assess the prognostic value of these data for predicting 1-year mortality and length of the hospital stay (length of stay)...
- Impact of change in high-density lipoprotein cholesterol from baseline on risk for major cardiovascular eventsDavid L Laitinen
Global Health Economics and Outcomes Research, Abbott Laboratories, 200 Abbott Park Road, Abbott Park, IL 60064 6145, USA
Adv Ther 27:233-44. 2010....
- Adherence with multiple-combination antihypertensive pharmacotherapies in a US managed care databaseKenneth C Jackson
Clin Ther 30:1558-63. 2008..The aim of this analysis was to assess the impact of multiple combination therapies on medication possession ratios (MPRs) in an antihypertensive naive population...
- An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with heart failureHarlan M Krumholz
Department of Medicine, Yale University School of Medicine, New Haven, CT 06520 8088, USA
Circulation 113:1693-701. 2006..A model using administrative claims data that is suitable for profiling hospital performance for heart failure would be useful in quality assessment and improvement efforts...
- Measuring underuse of necessary care among elderly Medicare beneficiaries using inpatient and outpatient claimsS M Asch
RAND, Santa Monica, CA, USA
JAMA 284:2325-33. 2000..Traditional approaches to measuring underuse have relied on patient surveys and chart reviews, which are expensive, or simple single-condition claims-based indicators, which are not clinically convincing...
- Mortality of Department of Veterans Affairs patients admitted to private sector hospitals for 5 common medical conditionsMary S Vaughan-Sarrazin
Center for Research in the Implementation of Innovative Strategies in Practice CRIISP, Iowa City VA Medical Center, Iowa City, IA 52246, USA
Am J Med Qual 22:186-97. 2007..Results using propensity-matched samples were similar. The use of Veterans Affairs services is not a strong marker of unmeasured severity among patients in private sector hospitals...
- Outcomes of sword swallowing and pharmaceutical step-therapy interventionsFrederic R Curtiss
J Manag Care Pharm 13:284-6. 2007
- Improving the bottom line through a better understanding of rules and statutesDavid M Glaser
Fredrikson and Byron, P A, Suite 4000, 200 South Sixth Street, Minneapolis, MN 55402 1425, USA
J Med Pract Manage 21:80-4. 2005..The authors explain why clinicians may have more recourse than they estimate in appealing Medicare reimbursement rulings...
- Community and ambulatory pharmacy: evaluation of patient care services and billing patterns before implementation of Medicare part DStuart J Beatty
Division of Pharmacy Practice and Administration, College of Pharmacy, The Ohio State University, Columbus, USA
J Am Pharm Assoc (2003) 46:707-14. 2006..To provide a summary of community and ambulatory pharmacy practice and billing patterns for medication therapy management services before implementation of Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA)...
- Medication therapy management programs: when will the outcomes come out?Joshua J Spooner
Clinical and Outcomes Services, Advanced Concepts Institute, University of the Sciences in Philadelphia, PA 19104, USA
J Manag Care Pharm 13:276-7. 2007
- The Medicare Part D doughnut hole: effect on pharmacy utilizationShawn X Sun
Walgreens Health Services, Deerfield, Illinois 60015, USA
Manag Care Interface 20:51-5, 59. 2007..33% (P < .0001). Regular Medicare part D beneficiaries reduced medication utilization after they reached the coverage gap, which raises concerns those beneficiaries may face an increased risk of adverse health events...
- Failure to comply with CMS' new enrollment procedures could impact physicians' cash flowErin M Duffy
Duane Morris LLP, 30 South 17th Street, Philadelphia, PA 19103 4196, USA
J Med Pract Manage 23:37-40. 2007..Therefore, not having an NPI or a Medicare Provider Number can have serious consequences on providers' ability to provide care as well as their bottom line (think cash flow!)...
- Exploring the potential link between Medicaid access restrictions, physician location, and health disparitiesAlvin Headen
Department of Economics, North Carolina State University, Raleigh, NC, USA
Am J Manag Care 11:SP21-6. 2005....
- Actuarial analysis of private payer administrative claims data for women with endometriosisDavid Mirkin
Milliman, Inc, New York, NY 10119, USA
J Manag Care Pharm 13:262-72. 2007..Endometriosis is the most common gynecological cause of chronic pelvic pain, but published information on its associated medical care costs is scarce...
- Medicaid, Medicare, and the Michigan Tumor Registry: a linkage strategyCathy J Bradley
Virginia Commonwealth University, Department of Health Administration and Massey Cancer Center, Grant House, Richmond, VA, USA
Med Decis Making 27:352-63. 2007..This data set serves as a cornerstone of a health outcomes data infrastructure. The methodology described may serve as a model for other researchers seeking to create a similar data set in their state...
- Effects of a step-therapy program for angiotensin receptor blockers on antihypertensive medication utilization patterns and cost of drug therapyKrista Yokoyama
WellPoint NextRx, West Hills, CA 91304, USA
J Manag Care Pharm 13:235-44. 2007..Step therapy for angiotensin receptor blockers (ARBs) requiring prior use of angiotensin-converting enzyme inhibitors (ACEIs) is a common cost-containment intervention in managed care...
- Who will be denied Medicare prescription drug subsidies because of the asset test?Thomas Rice
Department of Health Services, UCLA School of Public Health, 90095 1772, USA
Am J Manag Care 12:46-54. 2006..To determine the number and characteristics of Medicare beneficiaries who will be excluded from low-income prescription drug subsidies because they do not qualify under an asset test...
- Economic burden of atopic manifestations in patients with atopic dermatitis--analysis of administrative claimsDong Churl Suh
Ernest Mario School of Pharmacy, Rutgers University, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA
J Manag Care Pharm 13:778-89. 2007..Atopic dermatitis (AD) has been associated with atopic manifestations (AMs), such as food allergies, asthma, allergic rhinitis, and allergic conjunctivitis...
- Medicare part D data: major changes on the horizonLeslie M Greenwald
RTI International, Baltimore, Maryland, USA
Med Care 45:S9-12. 2007..This paper describes the structure of the Medicare Part D program and the related databases, and discusses their utilization for research purposes...
- Gender differences in healthcare-seeking behavior for urinary incontinence and the impact of socioeconomic status: a study of the Medicare managed care populationYue Li
Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 462 Grider Street, New York, NY 14215, USA
Med Care 45:1116-22. 2007..Despite the gender difference in etiology, prevalence and management of urinary incontinence (UI) among community-living older adults, little is known about the effect of gender on their healthcare-seeking behaviors...
- Descriptive analysis of the direct medical costs of multiple sclerosis in 2004 using administrative claims in a large nationwide databaseJeff D Prescott
Science and Technology, The MCM Group, 108 I Centre Blvd, Marlton, NJ 08053, USA
J Manag Care Pharm 13:44-52. 2007..Multiple sclerosis (MS) is chronic and debilitating, afflicts patients in the prime of their lives, and requires costly, decades-long disease management. MS prevalence is increasing, and treatment with new drug therapies is expensive...
- More on Medicare Part DCathy A Klein
Nurse Pract 32:16. 2007
- Discrepancies in administrative databases: implications for practice and researchRenée J Roberts
Crit Care Med 35:949-50. 2007
- New 2006 physical therapy cap and exception processKathleen D Schaum
Kathleen D Schaum and Associates, Inc, Lake Worth, FL, USA
Adv Skin Wound Care 19:251-4. 2006
- The instrumental variable method to study self-selection mechanism: a case of influenza vaccinationByung Kwang Yoo
Center for Health Policy, Stanford University, Stanford, CA, USA
Value Health 9:114-22. 2006....
- Access to cancer drugs in Medicare Part D: formulary placement and beneficiary cost sharing in 2006Jennifer Bowman
Avalere Health LLC in Washington, DC, USA
Health Aff (Millwood) 25:1240-8. 2006..In addition, many plans charge a relatively low copayment for most cancer drugs. These findings suggest that Part D could greatly expand beneficiaries' access to cancer treatments...
- Health care utilization among Medicare-Medicaid dual eligibles: a count data analysisSangho Moon
Department of Public Administration, Sungkyunkwan University, Seoul, Korea
BMC Public Health 6:88. 2006..The objective of this study is to explore the relationship between dual eligibility and health care utilization among Medicare beneficiaries...
- The use of disease-modifying agents among multiple sclerosis patients enrolled in medicare from 1995 to 2002 and the impact of medicare part D: analysis of claims data from the medicare current beneficiary surveyJason Lundy
University of Arizona, College of Pharmacy, Tucson, Arizona 85721, USA
Clin Ther 28:140-5. 2006....
- Prevalence and cost of nonadherence with antiepileptic drugs in an adult managed care populationKeith L Davis
Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina 27709, USA
Epilepsia 49:446-54. 2008..This study assessed the extent of refill nonadherence with antiepileptic drugs (AEDs) and the potential association between AED nonadherence and health care costs in an adult-managed care population...
- Medicare beneficiaries and the impact of gaining prescription drug coverage on inpatient and physician spendingBecky A Briesacher
Division of Geriatric Medicine, University of Massachusetts Medical School, Worchester, MA 01605, USA
Health Serv Res 40:1279-96. 2005..To assess whether gaining prescription drug coverage produces cost offsets in Medicare spending on inpatient and physician services...
- High-cost users among dual eligibles in three care settingsJudy Yip
CARF International in Tucson, Arizona, USA
J Health Care Poor Underserved 18:950-65. 2007..These findings suggest that policymakers and providers should consider care setting as an important component when designing disease management strategies...
- The use of breast conserving surgery: linking insurance claims with tumor registry dataGertraud Maskarinec
Cancer Research Center of Hawaii, University of Hawaii at Manoa, 1236 Lauhala Street, Honolulu, Hawaii 96813, USA
BMC Cancer 2:3. 2002..The purpose of this study was to use insurance claims and tumor registry data to examine determinants of breast conserving surgery (BCS) in women with early stage breast cancer...
- Clinical Risk Groups (CRGs): a classification system for risk-adjusted capitation-based payment and health care managementJohn S Hughes
Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
Med Care 42:81-90. 2004....
- The top 10 myths about MedicareMarisa A Scala-Foley
Center for Medicare Education in Washington, DC, USA
Am J Nurs 104:34-5, 37. 2004
- The effect of a three-tier formulary on antidepressant utilization and expendituresDominic Hodgkin
Heller School, Brandeis University, Waltham MA 02454 9110, USA
J Ment Health Policy Econ 11:67-77. 2008..The antidepressant class has certain characteristics that may pose problems for implementation of three-tier formularies, such as differences in which medication works for which patient, and high rates of medication discontinuation...
- Long-term resource use and cost of percutaneous transluminal coronary angioplasty versus stenting in the elderly: a retrospective claims data analysisSujha Subramanian
Research Triangle Institute, Waltham, MA 02452, USA
Value Health 6:534-41; discussion 532-3. 2003..The objective of this study was to evaluate the resource use and cost (Medicare payment) of PTCA versus bare stent in actual practice over a 2-year period...
- Are urologists fairly reimbursed for complex procedures: failure of 22 modifier?Yair Lotan
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390 9110, USA
Urology 72:494-7. 2008..The 22 modifier was designed to provide surgeons with additional reimbursement for performing complex procedures. We evaluated whether urologists at a tertiary referral center are reimbursed when using the 22 modifier...
- How to fight bundlingDorothy L Pennachio
Med Econ 80:65-8, 73. 2003
- Group practice contracting with managed care: Part 2Lewis W Mustard
Healthcare Negligence Control, Inc, P O Box 2442, Chapel Hill, NC 27515, USA
J Med Pract Manage 19:45-9. 2003..This article (the second in the series) provides a framework for administrators and practices to consider when approaching negotiations for such contracts...
- Effect of postoperative epidural analgesia on morbidity and mortality after total hip replacement surgery in medicare patientsChristopher L Wu
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Carnegie 280, 600 N Wolfe Street, Baltimore, MD 21287, USA
Reg Anesth Pain Med 28:271-8. 2003..systemic analgesia) on patient outcomes is unclear. Available randomized controlled trials (RCTs) have focused on the intraoperative period and not properly examined the effect of postoperative epidural analgesia (EA) on outcomes...
- Medicare mental health coverageAmy Coviello
Medicare Rights Center, New York, USA
Issue Brief Cent Medicare Educ 4:1-6. 2003..In this brief, we present an overview of mental health coverage and payment policies, including consumers' costs and their rights to appeal denials of payment...
- Managed Medicaid's last standJohn Carroll
Manag Care 12:46A-46B, 46F, 46H. 2003
- Preventing hospital payment errorsStephan D Schroeder
South Dakota Foundation for Medical Care, USA
S D Med 59:481. 2006
- CMS issues updated rules for the Medicare claims appeal processNancy J Davidson
Lash Group Healthcare Consultants, Charlotte, N C, USA
Nephrol News Issues 17:10. 2003..CMS released the draft SOW on Oct. 7, 2002. It is anticipated that the addition of the QICs will provide a more uniform and consistent handling of Medicare appeals on a national level...
- Disease burden profiles: an emerging tool for managing managed careYang Zhao
DxCG, Inc, Boston, MA 02111, USA
Health Care Manag Sci 5:211-9. 2002..We also examine and compare the predictive power of claims-based models within a diabetic cohort...
- The polyp detection rate of colonoscopy: a national study of Medicare beneficiariesGregory S Cooper
Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106 5066, USA
Am J Med 118:1413. 2005..These data may be informative in predicting resource allocation for therapeutic procedures associated with colonoscopy. Future studies should determine the use and yield of serial colonoscopies for polyp surveillance...
- A study on the economic impact of bariatric surgeryPierre Yves Cremieux
Analysis Group, Inc, 111 Huntington Ave, 10th Fl, Boston, MA 02199, USA
Am J Manag Care 14:589-96. 2008..To evaluate the private third-party payer return on investment for bariatric surgery the United States...
- Metabolic Screening: Prioritizing Implementation Strategies for Mental HealthElaine H Morrato; Fiscal Year: 2013....
- Obesity and Surgical OutcomesJeffrey H Silber; Fiscal Year: 2010..The multi-institutional OBSOS study will examine differences in outcomes and treatments between obese and normal weight patients, and in so doing, should make important contributions to the care of these patients. ..
- Clinical Database to Support Comparative Effectiveness Studies of Complex PatientCaroline S Blaum; Fiscal Year: 2010....
- Risk and Recovery in Complex Environments: L&D as a Mod*Marlene Goldman; Fiscal Year: 2003..abstract_text> ..
- Prostate Cancer Education in African American MenSTEPHEN LEPORE; Fiscal Year: 2007....
- PRIVATE AND SOCIAL COST OF SMOKINGFrank Sloan; Fiscal Year: 2001..We will examine implications of our empirical analysis for tort claims brought against tobacco companies and the evolution of legal theories underlying tobacco tort litigation in a law review article. ..
- Determinants and Consequences of Alcohol ConsumptionFrank Sloan; Fiscal Year: 2008..abstract_text> ..
- Visual Impairment, Treatment and Effects on the ElderlyFrank Sloan; Fiscal Year: 2008..Ten papers are anticipated for this four-year study. [unreadable] [unreadable]..
- Cancer-Related Disparities in the Elderly PopulationSiran Koroukian; Fiscal Year: 2007..abstract_text> ..
- Telemonitoring to improve heart failure outcomesHarlan Krumholz; Fiscal Year: 2008..abstract_text> ..
- Strategies to reduce time to reperfusion therapy for MIHarlan Krumholz; Fiscal Year: 2005..Data generated from these studies will guide efforts by clinicians, administrators, researchers, and policy makers to decrease time to reperfusion therapy for patients with STEMI. ..
- HOSPITAL PERFORMANCE & BETA-BLOCKER USE AFTER AMIHarlan Krumholz; Fiscal Year: 2001..abstract_text> ..
- EVALUATING MAMMOGRAPHY CLAIMS DATAJean Freeman; Fiscal Year: 2006..S. radiologists. [unreadable] [unreadable]..
- Adverse Outcomes of Dual Use of Health Systems Among Older Male VeteransFREDRIC WOLINSKY; Fiscal Year: 2006..unreadable] [unreadable] [unreadable] [unreadable]..
- Economics of Formulary Design and Mental Health PolicyHaiden Huskamp; Fiscal Year: 2006..Huskamp the training, mentoring, time and resources to develop the skills that will put her in a position to lead independent research on the economics of pharmaceutical treatment for mental illnesses. ..
- Poisoning Incidence and ED Use/Misuse in Young ChildrenBarbara Polivka; Fiscal Year: 2006..unreadable] [unreadable] [unreadable] [unreadable]..
- National Impact of IT Investments on Hospital QualityStephen Parente; Fiscal Year: 2009..This research represents a collaborative effort of investigators at the University of Minnesota, Carnegie Mellon University, and the Medical University of South Carolina. ..
- Pilot Trial of Peer Support for Bipolar DisorderGregory Simon; Fiscal Year: 2006..abstract_text> ..
- Improving Safety Culture and Outcomes in HealthcareLaurence Baker; Fiscal Year: 2006..abstract_text> ..
- Continuity of Care and Health Outcomes: Does It Really Matter?FREDRIC WOLINSKY; Fiscal Year: 2008..unreadable] [unreadable] [unreadable] [unreadable] [unreadable]..
- Effects of Mental Parity on High-Cost and Severely-Ill IndividualsHaiden A Huskamp; Fiscal Year: 2011..We will estimate a combination of two-part random-effects models for longitudinal data, latent class random-effects models, logistic regression models, Poisson regression models, and hazard models to address these aims. ..
- Financial Incentives and Variations in the Care of Medicare BeneficiariesBruce E Landon; Fiscal Year: 2010..Because patients will be clustered within physicians and physicians clustered within markets, we will use hierarchical analytic methods. ..
- Health and Health Services Use in the HRS/AHEADFREDRIC WOLINSKY; Fiscal Year: 2008..Linear and non-linear regression and random effects models will also be used where appropriate. [unreadable] [unreadable]..
- Can Longitudinal Population-Based Data Help to Personalize Depression Treatment?Gregory E Simon; Fiscal Year: 2010..We propose a set of targeted methodologic studies to prepare for a multi-site research consortium focused on predicting response to specific depression treatments. ..
- The Role of Customization in Psychotropic PrescribingDominic Hodgkin; Fiscal Year: 2009....
- Using Social Risk to Guide Coronary Heart Disease (CHD) Preventive TreatmentKevin Fiscella; Fiscal Year: 2009..Implementation of such a global risk tool could ultimately help justify implementation of more intensive behavioral interventions focusing on diet, exercise, smoking cessation and medication adherence for those at highest social risk. ..
- Modeling Adherence to Psychotherapy for DepressionGregory Simon; Fiscal Year: 2009..The proposed research is one component of an ongoing comprehensive program to understand and increase consumer demand for effective depression treatment. ..
- SCHOOL ENVIRONMENT: EFFECT ON SUICIDE PREVENTION PROGRAMBradley Stein; Fiscal Year: 2004....
- POPULATION-BASED MANAGEMENT OF DEPRESSIONGregory Simon; Fiscal Year: 2003..e. 12-18 mos) Incremental cost and cost-effectiveness of each intervention program compared to care as usual. ..
- MD Group Characteristics and Quality of Care for CHDBruce Landon; Fiscal Year: 2003..abstract_text> ..
- Randomized Control Trial of Mifepristone for FibroidsKevin Fiscella; Fiscal Year: 2004..The study may also offer valuable insight into a mechanism by which mifepristone reduces fibroid size. ..
- Evaluation of Enteral Stent Placement Using Claims DataSujha Subramanian; Fiscal Year: 2004..abstract_text> ..
- Impact of 3 Tier Drug Copays on Use and SpendingDominic Hodgkin; Fiscal Year: 2003..abstract_text> ..
- Do Reporting Biases Mitigate Disparity Estimates?Kevin Fiscella; Fiscal Year: 2004..abstract_text> ..
- The Impact of HMO's on DispartiesKevin Fiscella; Fiscal Year: 2004..If the study hypotheses are confirmed, the findings will underscore the need for HMOs to track and address disparities among their members if the Healthy People 2010 for the elimination of disparities is to be achieved. ..
- Epidemiology and Care of Comorbid Obesity and DepressionGregory Simon; Fiscal Year: 2006..weight loss, nutrient intake, physical activity, depressive symptoms, functional impairment and disability in the two groups of women with comorbid obesity and depression randomly assigned to the two different intervention programs ..
- In-Depth Examination of Disparities in Cancer OutcomesCathy Bradley; Fiscal Year: 2007..abstract_text> ..
- Medication Management Decisions in SchizophreniaMark Olfson; Fiscal Year: 2003..The results will inform quality improvement programs by identifying key modifiable determinants of the quality of medication management in the community treatment of schizophrenia. ..
- Race, Ethnicity and Quality of Health Care for NewbornsLaurence Baker; Fiscal Year: 2005..Our work will focus on Black-White differences, disparities for Hispanics (including subgroups like Mexican and Puerto Rican), and disparities for Asian and Pacific Islanders. ..
- Health Services Research in Under-Served PopulationsJean Freeman; Fiscal Year: 2006..unreadable] b. Develop and implement a Health Services Research selective to introduce School of [unreadable] Medicine students to this area of research. [unreadable] [unreadable] [unreadable]..
- MANAGED CARE AND HEALTH CARE MARKETSLaurence Baker; Fiscal Year: 2003..abstract_text> ..
- Volume-Outcomes in Incontinence SurgeryJennifer Anger; Fiscal Year: 2005..The primary outcome will be re-operation rates, repeat sling procedures (for failures), and other postoperative complications, stratified by high and low volume surgeons and hospitals. ..
- IDENTIFICATION OF CLINICALLY RELEVANT CHANGES IN HRQOLFREDRIC WOLINSKY; Fiscal Year: 2002..abstract_text> ..
- Specialty Mental Health Care--Expanding Access in an HMODominic Hodgkin; Fiscal Year: 2003..The results will inform health plan decision-makers and others as they make utilization management choices that may have a major impact on patients and enrollee populations overall. ..
- LABOR MARKET OUTCOMES OF LONG TERM CANCER SURVIVORSCathy Bradley; Fiscal Year: 2004....
- Alcohol Use and Medical Care Quality among the ElderlyELIZABETH MERRICK; Fiscal Year: 2006..abstract_text> ..
- A Test of the Validity of the "Nursing Home Compare" Measure of Physical FunctionYue Li; Fiscal Year: 2008..unreadable] [unreadable] [unreadable]..
- IS NON-ADHERENCE A REVEALED PREFERENCELeslie Lenert; Fiscal Year: 2003..We will also use an expert panel to assess the clinical match between patients' regimens and their preferences. ..
- PATHOGENESIS OF GLAUCOMATOUS OPTIC NERVE DAMAGEHarry Quigley; Fiscal Year: 2008..Candidate molecules for genetic susceptibility to glaucoma are likely to be identified. ..
- Educational Disparities in Diabetes ComplicationsAndrew Karter; Fiscal Year: 2006..abstract_text> ..
- EPIDEMIC OCCUPATIONAL HEARING LOSS IN WASHINGTON STATEWilliam Daniell; Fiscal Year: 2001..OHL: (a) noise levels that exceed legal standards, (b) under-utilization of feasible noise controls, and (c) hearing conservation programs that are not compliant with legal standards and/or are not optimally effective? ..
- Improving Asthma Communication in Minority FamiliesArlene Butz; Fiscal Year: 2007..abstract_text> ..
- DESIGN AND IMPLEMENTATION OF PHARMACOGENETIC DATABASEPrakash Nadkarni; Fiscal Year: 2002..Informatics assistance will be provided to the individual nodes to assist the task of data exchange, and when necessary, to assist the design of local data collection systems. ..
- ROBUST QUERY OF HETEROGENEOUS CLINICAL DATABASESPrakash Nadkarni; Fiscal Year: 2002..In particular, research will be performed on utilization of newer database technologies, such as new indexing methods, as well as parallel database implementations. ..
- Selection and the Quality Impact of Nursing Home OwnershipDavid C Grabowski; Fiscal Year: 2010..By examining this relationship using a novel empirical strategy, this study provides an opportunity to improve the quality of care for the millions of Americans receiving care in the nursing home setting. ..
- Health and School Performance Among Youth Ages 9-13Christopher Forrest; Fiscal Year: 2009..Our long-term goal for this research is to follow youth into high school and beyond to more fully characterize the evolution of health from childhood to adulthood. ..
- Diabetes and Drug-Associated Hyperkalemia: Effect of Laboratory MonitoringMarsha Raebel; Fiscal Year: 2008..The findings will also assist in developing a framework for future studies to evaluate the effects and costs of medication-laboratory monitoring among patients with diabetes. [unreadable] [unreadable] [unreadable] [unreadable]..
- NEBULIZER INTERVENTION IN MINORITY CHILDREN WITH ASTHMAArlene Butz; Fiscal Year: 2004..Study findings will improve clinical care to this vulnerable population of children and will be if significant use to health care providers, researchers, insurers and policy makers. ..
- Use of GIS in analyzing environmental cancer risks as a*Robin Harris; Fiscal Year: 2003..abstract_text> ..
- Feeding Tube Use Among Persons with Advanced DementiaJoan Teno; Fiscal Year: 2008..Knowledge gained will be used to inform public policy and formulate facility interventions to ensure that FT insertion in persons with severe cognitive impairment is ethically appropriate. [unreadable] [unreadable] [unreadable]..
- Role of Depression in Medicare New Chronic Care Improvement ProgramJurgen Unutzer; Fiscal Year: 2008..Our findings will help CMS strengthen the CCIP and will help public and private policymakers implement effective disease management programs for chronic medical illness and comorbid depression. ..
- Use of Complementary and Alternative Medical (CAM) Providers by Cancer PatientsPaula Diehr; Fiscal Year: 2007..This study will increase the understanding of the role CAM should play in providing supportive care for cancer patients. ..
- OUTCOMES OF OLDER WOMEN WITH EARLY STAGE BREAST CANCERANN NATTINGER; Fiscal Year: 2008..The results will be critical to informing policy initiatives, including determination of how to best reduce socioeconomic disparities in breast cancer outcomes. ..
- HIV Testing and Women's Attitudes on HIV Vaccine TrialsGregory D Zimet; Fiscal Year: 2010..abstract_text> ..
- Values of Families in Guiding End-of-Life CareCharles Gessert; Fiscal Year: 2002..This research will lay the groundwork for two future studies: a survey of values in end-of-life decision-making, and an in depth examination of the role of selected values in decision-making. ..
- Race and Herbal Medications Among Medicare RecipientsWilliam Lafferty; Fiscal Year: 2004..African- Americans already report lower satisfaction with their medical care and frequently leave the doctor's office with unanswered questions, therefore, special educational programs may be useful. ..
- Literacy and Utilization of Maternal Depression CareIan Bennett; Fiscal Year: 2006..This study represents a unique and cost effective opportunity to study patient factors which are obstacles to depression treatment in women with low literacy and inform future interventions. ..
- N O S AND NEUROPATHIC AND ENDOTHELIAL INDUCED EDKevin McVary; Fiscal Year: 2002..Results of this research will aid in the understanding of how diabetic neuropathy contributes to sexual dysfunction and elucidate possible mechanisms to prevent them. ..
- Economic Evaluations of Emerging Genomic Tests for Early Stage Breast CancerYA CHEN SHIH; Fiscal Year: 2008..To estimate the budgetary impact of the emerging pharmacogenomic prognostic and/or predictive tests [unreadable] [unreadable] [unreadable]..
- Valuation of Primary Care-Integrated TelehealthKenneth McConnochie; Fiscal Year: 2006..Direct and indirect costs will be assessed. Study B will assess integration in primary care, for example by measuring impact on continuity of care, adherence to well-child visit schedules and immunization rates. ..
- Molecular Genetics of Inattention in AustraliaTHEODORE CICERO; Fiscal Year: 2009..This will be at a marked cost savings due to the employment of existing well-characterized samples and the long history of collaborative studies between investigators from Australia and the United States. ..