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1. CMS did not detect some inappropriate claims for durable medical equipment in nursing facilities

Publication:
[Washington, D.C.] : U.S. Department of Health and Human Services, Office of Inspector General, June 2018
Subject(s):
Durable Medical Equipment -- economics
Insurance, Health, Reimbursement
Medicare -- economics
Skilled Nursing Facilities
Home Care Services -- economics
Insurance Claim Review
Insurance Coverage
Medicaid -- economics
Nursing Homes
Humans
United States
United States. Department of Health and Human Services.
Centers for Medicare & Medicaid Services (U.S.)

3. Beyond fair hearings: how five states help Medicaid managed care beneficiaries resolve disputes with health plans

Author(s):
Stevens, Beth, author
Archibald, Nancy, author
Foster, Leslie, 1968-, author
Publication:
Washington, D.C. : Office of Disability, Aging and Long-Term Care Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, [2001]
Subject(s):
Managed Care Programs -- organization & administration
Medicaid
Dissent and Disputes
Insurance Claim Review
United States

4. Shopping for health care makes "cents" for consumers: estimates of the potential financial benefits to consumers as they shop for elective medical care

Author(s):
Barrette, Eric, author
Publication:
Washington, D.C., : Health Care Cost Institute, February 2015
Subject(s):
Choice Behavior
Community Participation
Delivery of Health Care -- economics
Fees, Medical -- trends
Health Care Costs -- trends
Delivery of Health Care -- statistics & numerical data
Fees, Medical -- statistics & numerical data
Financing, Personal -- statistics & numerical data
Forecasting
Health Benefit Plans, Employee -- statistics & numerical data
Health Care Costs -- statistics & numerical data
Information Services
Insurance Claim Review
Insurance Coverage
Quality of Health Care
Humans
United States

5. Key findings from Children's Health Spending: 2009-2012

Author(s):
Frost, Amanda, author
Hiers, Scott, author
Herrera, Carolina-Nicole, author
Publication:
Washington, D.C., : Health Care Cost Institute, February 2014
Subject(s):
Child Health Services -- economics
Health Expenditures -- trends
Adolescent
Child
Child, Preschool
Forecasting
Health Benefit Plans, Employee
Infant
Infant, Newborn
Insurance Claim Review
Insurance Coverage
Female
Humans
Male
United States

6. Best practices in specialty provider recruitment and retention: challenges and solutions

Publication:
[New York, N.Y.] : Commonwealth Fund, [2005]
Subject(s):
Health Manpower
Interprofessional Relations
Personnel Selection -- organization & administration
Personnel Turnover
Specialization
Communication
Contract Services
Economics, Medical
Insurance Claim Review
Managed Care Programs -- organization & administration
Medicaid -- organization & administration
Organizational Case Studies
Referral and Consultation
Reimbursement Mechanisms
New York
Oregon
Rhode Island
United States
Washington

7. VA disability benefits: additional planning would enhance efforts to improve the timeliness of appeals decisions : report to Congressional addressees

Publication:
Washington, D.C. : U.S. Government Accountability Office, 2017
Subject(s):
Health Manpower
Insurance Claim Review
Veterans Disability Claims
Workload
Disabled Persons
Personnel Staffing and Scheduling
Veterans
Humans
United States
United States. Department of Veterans Affairs.

8. Medicare provider education: oversight of efforts to reduce improper billing needs improvement : report to the Chairman, Committee on Finance, U.S. Senate

Publication:
Washington, D.C. : U.S. Government Accountability Office, March 2017
Subject(s):
Accounts Payable and Receivable
Fraud -- prevention & control
Insurance Claim Review
Medicare -- economics
Contract Services
Insurance, Health, Reimbursement
Humans
United States
United States. Department of Health and Human Services
Centers for Medicare & Medicaid Services (U.S.)

9. How medical claims simplification can impede delivery of child developmental services

Publication:
[New York, N.Y.] : Commonwealth Fund, [2005]
Subject(s):
Child Health Services -- organization & administration
Delivery of Health Care -- organization & administration
Insurance Claim Review
Child
Infant
Insurance Coverage
Insurance, Health, Reimbursement
International Classification of Diseases -- economics
United States
United States.

10. Quarterly update on the Preventing Wrong-Site Surgery Project

Publication:
[Harrisburg, Pa.] : Pennsylvania Patient Safety Authority, c2008
Subject(s):
Insurance Claim Review
Liability, Legal
Medical Errors -- economics
Medical Errors -- legislation & jurisprudence
Medical Errors -- prevention & control
Safety Management -- methods
Surgical Procedures, Operative -- adverse effects
Surgical Procedures, Operative -- statistics & numerical data
Humans
Pennsylvania
United States

11. Gulf War illness: improvements needed for VA to better understand, process, and communicate decisions on claims : report to Congressional requesters

Publication:
Washington, D.C. : U.S. Government Accountability Office, June 2017
Subject(s):
Disability Evaluation
Persian Gulf Syndrome
Veterans
Veterans Disability Claims
Veterans Health
Insurance Claim Review
Humans
United States
United States. Department of Veterans Affairs.

12. Gulf War illness: additional actions needed to improve VA's claims process : testimony before the Subcommittees on Oversight and Investigations and Disability Assistance and Memorial Affairs, Committee on Veterans' Affairs, House of Representatives

Publication:
Washington, D.C. : U.S. Government Accountability Office, July 13, 2017
Subject(s):
Disability Evaluation
Insurance Claim Review
Persian Gulf Syndrome
Veterans Disability Claims
Veterans Health
Humans
United States
United States. Department of Veterans Affairs.

13. Medicare Advantage program integrity: CMS's efforts to ensure proper payments and identify and recover improper payments : testimony before the Subcommittee on Oversight, Committee on Ways and Means, House of Representatives

Publication:
Washington, D.C. : U.S. Government Accountability Office, July 19, 2017
Subject(s):
Financial Audit
Fraud -- prevention & control
Insurance, Health, Reimbursement
Medicare Part C -- economics
Fee-for-Service Plans -- economics
Insurance Claim Review
Humans
United States
Centers for Medicare & Medicaid Services (U.S.)

14. SSA's Compassionate Allowance Initiative: improvements needed to make expedited processing of disability claims more consistent and accurate : report to the Chairman, Subcommittee on Social Security, Committee on Ways and Means, House of Representatives

Publication:
Washington, D.C. : U.S. Government Accountability Office, August 2017
Subject(s):
Disability Evaluation
Eligibility Determination
Insurance Claim Review
Social Security
Humans
United States
United States. Social Security Administration.

15. Medicare: CMS Fraud Prevention System uses claims analysis to address fraud : report to Congressional requesters

Publication:
Washington, D.C. : U.S. Government Accountability Office, August 2017
Subject(s):
Fraud -- prevention & control
Insurance Claim Review
Medicare
Public-Private Sector Partnerships
Contract Services
Data Interpretation, Statistical
Information Dissemination
Insurance, Health, Reimbursement
Humans
United States
Centers for Medicare & Medicaid Services (U.S.)

16. SSA's Compassionate Allowance initiative: actions needed to improve the accuracy and consistency of expedited processing of disability claims : testimony before the Subcommittee on Social Security, Committee on Ways and Means, House of Representatives

Publication:
Washington, D.C. : U.S. Government Accountability Office, September 6, 2017
Subject(s):
Disability Evaluation
Eligibility Determination
Insurance Claim Review
Insurance, Disability
Social Security
Humans
United States
United States. Social Security Administration.

17. Star power: the effect of Angelina Jolie's personal story of BRCA1 mutation on testing rates among commercially insured women

Author(s):
Walker, Lina, author
Morin, Pamela, author
Publication:
Washington, D.C. : AARP Public Policy Institute, February 2015
Subject(s):
BRCA1 Protein -- genetics
Breast Neoplasms -- genetics
Breast Neoplasms -- prevention & control
Famous Persons
Genetic Predisposition to Disease
Genetic Testing -- statistics & numerical data
Genetic Testing -- trends
Health Services Needs and Demand
Mutation -- genetics
Adult
Aged
Elective Surgical Procedures
Health Knowledge, Attitudes, Practice
Insurance Claim Review
Insurance Coverage
Insurance, Health
Mass Media
Mastectomy
Middle Aged
Female
Humans
United States

18. The ABCs of APCDs: how states are using claims data to understand and improve care

Author(s):
Porter, Josephine, author
Love, Denise, author
Publication:
[Oakland, Calif.] : California Health Care Foundation, November 2018
Subject(s):
Databases as Topic
Health Expenditures -- statistics & numerical data
Insurance Claim Review
Chronic Disease -- economics
Cost of Illness
Drug Costs
Health Care Costs
Inappropriate Prescribing -- prevention & control
Opioid-Related Disorders -- economics
Opioid-Related Disorders -- epidemiology
State Government
Humans
California
United States

21. Medicaid information technology: effective CMS oversight and states’ sharing of claims processing and information retrieval systems can reduce costs : report to Congressional requesters

Publication:
Washington, DC : United States Government Accountability Office, September 2020
Subject(s):
Cost Control
Information Systems -- economics
Insurance Claim Review
Medical Informatics
United States
Centers for Medicare & Medicaid Services (U.S.)

22. Department of Health and Human Services: Office of Inspector General’s use of agreements to protect the integrity of federal health care programs : report to Congressional requesters

Publication:
Washington, DC : United States Government Accountability Office, April 2018
Subject(s):
Delivery of Health Care
Fraud -- prevention & control
Government Programs
Insurance Claim Review
United States
United States. Department of Health and Human Services. Office of Inspector General.

26. Private health insurance: Roll out of independent dispute resolution process for out-of-network claims has been challenging : report to congressional committees

Publication:
Washington, DC : United States Government Accountability Office, December 2023
Subject(s):
Dissent and Disputes
Government Regulation
Health Benefit Plans, Employee
Health Expenditures
Insurance Claim Review
Insurance, Health, Reimbursement
Negotiating
United States

27. Assessing the usability of the MAX 2007 inpatient and prescription encounter data for enrollees in comprehensive managed care

Author(s):
Dodd, Allison Hedley, author
Nysenbaum, Jessica, author
Zlatinov, Ashley, author
Publication:
Princeton, N.J. : Mathematica Policy Research, Inc., April 2012
Subject(s):
Databases as Topic -- statistics & numerical data
Insurance Claim Review
Insurance, Pharmaceutical Services -- statistics & numerical data
Managed Care Programs -- statistics & numerical data
Medicaid -- statistics & numerical data
Adult
Child
Disabled Persons
Information Systems -- statistics & numerical data
State Government
Humans
United States