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Author: Patricia A. Davis Publisher: ISBN: Category : Languages : en Pages :
Book Description
This report provides a general overview of the Medicare program including descriptions of the program's history, eligibility criteria, covered services, provider payment systems, and program administration and financing.
Author: Patricia A. Davis Publisher: ISBN: Category : Languages : en Pages :
Book Description
This report provides a general overview of the Medicare program including descriptions of the program's history, eligibility criteria, covered services, provider payment systems, and program administration and financing.
Author: Aspen Health Law Center Publisher: ISBN: Category : Business & Economics Languages : en Pages : 156
Book Description
Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.
Author: Sunil Badve Publisher: Springer ISBN: 3319952285 Category : Medical Languages : en Pages : 635
Book Description
“Precision/personalized or stratified medicine” refers to the tailoring of medical treatment or drug administration to the individual characteristics of each patient treatment. It does not literally mean that a pharmaceutical company makes a drug for an individual patient for consumption and treatment but rather means the ability to stratify (or classify) individuals into sub-populations that differ in their responsiveness to a specific drug. A marker that provides information on the likely response to therapy, i.e., either in terms of tumor shrinkage or survival of the patient is termed “predictive biomarker”. Despite their promise in precision medicine and the explosion of knowledge in this area, there is not a single source on this subject that puts all this evidence together in a concise or richly illustrated and easy to understand manner. This book provides a collection of ingeniously organized, well-illustrated and up-to-date authoritative chapters divided into five sections that are clear and easy to understand. Section one provides an overview of biomarkers, introduces the basic terminologies, definitions, technologies, tools and concepts associated with this subject in the form of illustrations/graphics, photographs and concise texts. Several recent biomarker endeavors that have been initiated and funded by the National Cancer Institute, National Institutes of Health, FDA and other International organizations are presented. Section two involves the signaling pathways controlling cell growth and differentiation altered in cancer. This section analyzes how predictive biomarkers are altered (expressed or amplified) across cancer types. Section three explores how predictive biomarkers play a role in patient stratification and tailored treatment in relationship to specific cancers. In addition, it includes discussion on the various precision medicine initiatives that are going on across the globe (e.g. TARGET, NCI-MATCH, BATTLE, SHIVA, etc.). Section four discusses: (a) how pharmaceutical companies validate predictive biomarker assays and accompanying companion diagnostics either internally or externally with partner companies such as central laboratories or clinical research organizations, and (b) how predictive biomarker tests fall under the oversight of US FDA, Centers for Medicare & Medicaid Services (CMS) and state laws. Section five wraps up novel agents and targets that are being used as targets for cancer therapeutics. The biomarkers associated with these protocols will also be presented. Throughout the book, sidebars, special interest boxes and illustrations are used to explain terms that are either newly introduced, uncommon, or specialized. Predictive Biomarkers in Oncology will serve as a definitive guide for practicing pathologists, oncologists, basic researchers, and personnel in the pharmaceutical or diagnostic industry interested in learning how “predictive biomarkers” are used in precision cancer therapy.
Author: Robin L. Linker Publisher: American Medical Association Press ISBN: 9781640160378 Category : Medical Languages : en Pages : 0
Book Description
"Coding with Modifiers, 6th Ed, is the ultimate resource for modifier guidelines. This revised edition provides guidance on how and when to use modifiers in order to avoid costly payment delays and denials. Coding with Modifiers uses real-life modifier scenarios and medical records to guide correct CPT® and HCPCS modifier usage. Modifiers create clear, concise communications between the provider and payer, and are essential to the coding process. Clinical documentation improvement and other pertinent considerations highlight important clinical documentation improvements for each modifier and related best practices to ensure correct modifier usage. Provides guidelines from CPT, CMS, third-party payers, and NCCI to explain how and when to use modifiers to avoid payment delays and denials"--
Author: Adam K. Brooks Publisher: ISBN: 9781611229042 Category : Health care reform Languages : en Pages : 0
Book Description
The Medicare program enables millions of beneficiaries to obtain health care services; however, lacks many of the essential elements of a high-quality, high-value and efficient health system. Program spending and utilisation have increased substantially, without corresponding improvements in beneficiaries' health. This new and important book describes the need for Medicare to move away from payment policies that encourage service volume and are indifferent to quality and toward policies that promote better value for Medicare and its beneficiaries.
Author: James C. Cosgrove Publisher: DIANE Publishing ISBN: 1437921485 Category : Health & Fitness Languages : en Pages : 35
Book Description
Medicare¿s physician fees may not always reflect efficiencies that occur when a physician performs multiple services for the same patient on the same day, and some resources required for these services do not need to be duplicated. This report examined: (1) the Centers for Medicare and Medicaid Services¿ (CMS) efforts to set appropriate fees for services furnished together; and (2) additional opportunities for CMS to avoid excessive payments when services are furnished together. The report examined relevant policies, laws, and regulations; interviewed CMS officials and others; and analyzed claims data to identify opportunities for further savings. Includes recommendations. Charts and tables.
Author: Patricia A. Davis
Author: Patricia A. Davis
Author: Medicare Payment Advisory Commission (U.S.)
Author: United States. Social Security Administration
Author: Beekman Hospital, New York. Bowling Green Division
Author: Aspen Health Law Center
Author: Sunil Badve
Author: Brian Blase
Author: Robin L. Linker
Author: Adam K. Brooks
Author: James C. Cosgrove