Gain Efficiency Through Claims Investigation Services

Importance of Claims Investigation

Underwriting and claims investigations are the two most imperative perspectives in the working of an insurance company. In the current commercial environment where competitiveness and financial gains stand as vital business cornerstones, claims investigation can serve as a market differentiator that puts insurance agencies at the front line of industry leadership and innovation.

To be effective, insurers need to enhance the operational productivity of their claims processing and assemble a working model that can minimize claims costs and also dispense the unnecessary expense associated with managing real as well as fraudulent claims.

Numerous insurance providers have varied claims operations, personnel and units that concentrate on the products and services (non-life and life) they offer to people or on various business sectors. This model frequently brings about gigantic claims operations with notable unit designs, system infrastructure and procedures for every market or line of business. In addition, in high-volume or exceptionally complex operations, fraud, waste and abuse claims are the ones that distress the insurance companies the most. It is here that the process of claims investigation works wonders, and helps insurers gain efficiency in their day-to-day operations.

Understanding Claims Investigation

The Claims Investigations process is one in which Insurance Companies, Insurance Examiners, or Investigators get data to assess a claim. Thus, it might require examining documents, finding witnesses, going talking with individuals, assessing property, for example, vehicles, accident sites to give some examples. Further, these investigations may lead to taking photographs, video, finding witnesses, talking with the victims, claims managers and much more. In doing so, insurance companies are looking for able partners that can deliver all the services of the claims investigation process, and this leads to the need of a Third Party Administrator who can work in tandem with the insurance providers to settle the claims and give valuable suggestions.

Various Forms Of A Potentially Fraud Claim

Fraud is a general term used to portray an act of deceit by an individual or group. This act of deceit can come in various configurations. For instance, insurance investigators attempt to uncover the individuals who make false claims with a specific end goal to get insurance money. Likewise, intellectual fraud occurs when fake items are passed off or sold as originals. Mortgage fraud happens when some person has adulterated the paperwork to ensure a loan goes through. Since each of the aforementioned claims fall in the fraudulent claims category, then having a certified claims investigation agency can only gain efficiency in each and every step of claims adjudication.

As you must be aware of the fact that fraud is a gigantic issue that costs insurance companies billions of dollars each year. In such a scenario having a trusted insurance claims investigation partner can very well leverage the workload of in-house working staff of an insurance company. And with integrated platforms and digitized reports can present you with real-time information on every claim investigated.

Following these points can help evaluate the claims investigation service quality parameters, and check how well it suits your business.



Source by Harshal K

So, What IS The Best Insurance For Sailing Clubs?

I’ve been providing insurance programmes to marine-based clubs for over 19 years. If I were to ask that very question to a room full of insurers and insurance brokers who operate in this specialist segment I am quite certain that there would be a deafening clamour as each sought to affirm that their own pet policy or scheme was the very best insurance option for sailing, yachting, cruising and any other marine-based club. An array of whistles, bells and other rinky-dinks would be paraded in great detail, no doubt represented from the point of view of the provider rather than a sailing club. After all, sales people have something to sell and rarely are they able to resist the opportunity to get selling – even when odds as fearsome as this demand selling of heroic proportions – which usually means shouting even louder.

It’s pretty much the same scenario when it comes to insurance marketing in this specialist part of the Marine Leisure Industry. There’s lots of noise from an increasing number of participants with each trying to gain attention by being noisier than everyone else. Lots of noise but very little in the way of differentiation and everyone offering “bespoke” cover with plenty of “unique” features. How on Earth is a sailing club committee to decide exactly what the best option is for their club and its members?

It is against this backdrop that in April this year the Royal Yachting Association (RYA) announced changes to the insurance requirements for their approved training centres: Public Liability (PL) to be increased to a minimum indemnity limit of £3,000,000 and, of greater interest, Approved Centres would need to carry £500,000 of Professional Indemnity (PI) cover in respect of their training activities.

Prima Facie this appeared to be a sensible move. First and foremost, although a trend of “indemnity creep” has seen PL limits nudge upwards in the last few years, a PL limit of £3,000,000 is currently seen as the sensible minimum to carry. Secondly, professional services, including “advice”, are specifically excluded under normal PL Insurance wordings (including marine leisure policies) where it is provided for a fee and, obviously, where training is being delivered for a fee, one would expect some advice to be imparted by an instructor. Training and advice, therefore, is normally insured on a PI policy which is why the new requirement appeared to be a sensible move.

One can only speculate how the announcement of the new requirements was received by training centres – particularly the grass roots not-for-profit sailing clubs for whom every pound counts. An uplift in PL Insurance to a £3m limit would probably not break the bank but PI might, perhaps, be a different matter altogether. Firstly, PI in the Marine Sector can be expensive, even for relatively low limits of cover due to a limited Market appetite. Secondly, where children and/or vulnerable adults are involved in activities, the Market appetite diminishes even more creating further scarcity that could lead to even higher prices.

If the clubs received the news less than enthusiastically, one wonders how certain insurers and insurance brokers might have reacted at the prospect of what appeared to be something of a game changer being announced – for precisely the same reasons as above. Insurers because PI is an anathema to many of them and, brokers, because accessing a market prepared to offer palatable rates in return for the required scope of cover would not be easy.

No doubt everyone breathed a huge sigh of relief then when, just 5 months later, in September, the RYA announced that Professional Indemnity Insurance would not be a requirement after all just so long as a centre’s Public Liability insurance carried an extension that covered their training activities including indemnity for bodily injury to participants.

Cue a meticulous scanning of small print in policy wordings by interested parties to ensure they met the following requirements which are to be implemented by 1 February 2016:

“The purpose of public liability insurance is to indemnify the RTC and its instructors where a third party (which could be a student, customer or a member of the public) suffers personal injury or damage to their property as a result of the RTC’s or instructor’s negligent acts or omissions, and the RTC and/or its instructors is/are required to defend and/or pay damages to the injured party. The RTC must therefore ensure that any instructors employed or engaged directly by the RTC are covered by the RTC’s public liability insurance policy. The RTC’s public liability insurance must extend to indemnify the RTC and its instructors where negligent advice or instruction given by the RTC or its instructors causes personal injury or other damage or loss and the RTC and/or its instructors is/are required to defend the claim and/or pay damages” (RYA Training Notice TN 07-15 dated 7 September 2015).

Helpfully, the statement tells everybody precisely what the purpose of the PL cover is. How then, do we square this with the exclusions regarding training and advice? Well, insurers have addressed this in various ways. One, for example, maintains that as long as they state “Training” within in the business description on their schedule of cover then the explicit exclusion in their policy wording would not apply to the club or centre concerned. Another applies what I consider to be a “safer” option for the club by providing a specific endorsement that confirms tuition is covered.

So, everything’s okay: the centre is indemnified in the event of injury to third parties caused by negligent acts or omissions on the part of their instructors in respect of the advice and instruction provided. Yes? Well, actually, not necessarily.

Remember all those insurers and insurance brokers earlier who were shouting about who had the best features and benefits? Well it’s time to grit your teeth and listen to what some of them have got to say, particularly about “Bodily Injury”. One insurer defines bodily injury as including “Death, Illness, Disease or Nervous Shock”. Another defines it as including simply “Death, Injury or Disease” Still a third as “All physical injury to a Third Party including death, sickness, disease, mental injury, anguish or shock resulting from such physical injury”.

If you haven’t nodded off you might see the [not so] subtle differences between the 3 definitions. The first includes Nervous Shock but what exactly is that? Well, the legal definition of Nervous Shock is a mental condition that extends beyond grief or emotional distress to a recognised mental illness. This contrasts with the third example which includes mental injury, anguish or shock which are not conditions as advanced as Nervous Shock and so potentially provide a better scope of cover as if any of the conditions described did progress to a mental illness then the cover would still be effective. Conversely, the first does not state that Nervous Shock must result from a physical injury whereas the third example will only cover the mental injury, anguish or shock (and sickness or disease) if it results from physical injury. The second definition provides no scope of cover for any form of mental anguish or illness.

So, which option would you prefer or does it even matter to you, your club or your members? At the end of the day all of them appear to “tick the box” as far as what the RYA’s intention is.

However, we must consider what the intention of the insurance is. Is it to indemnify the club, centre and instructors in the event of injury arising during the course of the training itself – ie during actual instruction on and off the water – or something more? What about the efficacy of the training? What if somebody suffers an injury or damage several months after training and alleges it was as a result of an error or omission during training? In this scenario the club or centre would almost certainly have no protection from their Public Liability Insurance.

Furthermore, the extract from RYA Training Notice TN 07-15 (above) calls for cover in respect of “other damage or loss”. Whilst damage to third party property would normally be met, “other loss” presumably means some form of loss (eg. purely financial) other than injury or damage which, in fact would not be covered under the PL Section and would normally require a PI policy to protect this kind of liability.

Let’s have a look at a couple of other scenarios that could affect clubs and their committees:

Imagine there’s an incident at a club or centre where somebody under instruction is severely injured and the centre is prosecuted by the Health & Safety Executive (HSE). What if the PL cover you thought would cover you for £3m has an inner limit of £50,000 in respect of legal fees for HSE prosecutions and doesn’t cover any awards? £50,000 soon gets eaten up in legal fees. But, hey – the cover “ticks the box”.

Furthermore, following the incident the HSE don’t just prosecute the legal entity that is the training centre they also prosecute the directors and/or officers of the club itself. There is no protection for them whatsoever under their PL Insurance, not even for legal expenses.

A club committee decides to take the step to expel a member who subsequently decides to take legal action against the club; a club volunteer or employee sues the club for harassment or discrimination, a group of members decide to take legal action against a club’s officers because they feel the officers have not acted in the best interest of the club or its members. Here we see further examples where there is no protection for the club or its officers under the club’s PL Insurance – but it “ticks the box”.

Insurance that “ticks the box” can be low in price – often a driver for a club looking for an economic solution – but will not offer the bespoke gap-free protection that club officers might want in the 21st Century.

5 Questions Sailing Club Trustees and Officers Should Ask Themselves Before Deciding Which is the Best Insurance for Sailing Clubs

1. What are the long-term objectives of my club and the members?

2. If the club was prosecuted how would it fund its defence?

3. If the club had compensation awards made against it outside the scope of its Public Liability Insurance how would it meet those awards?

4. How would I defend allegations and charges made against me for decisions, errors and omissions made in my capacity as a club officer?

5. Do I want to put my personal assets at risk, either during my tenure as a club officer or after I have stood down?

These are just a handful of questions you can ask yourself as a club officer that will help determine what scope of protection you might wish to invest in to meet the objectives of your club, its members and, indeed, yourself. For some these issues will be important, others will consider them irrelevant and if they are important then the concept of value will often override that of bottom-line price.

Value, of course, is in the eye of the beholder but, even so, I would hazard that the “Best Value” solution is a programme that is fully aligned to your objectives, underwritten by good security and delivered at the best available premium – in other words, the best insurance for your sailing club. The differences in definitions in policy wordings as well as the variance in scope of cover outlined above suggest that a single “off-the-peg” policy offering a one-size-fits-all solution that is anything but bespoke may not necessarily be the best option for your club or centre.



Source by Mark Elcocks

Medical Coding – Introduction and Importance

The medical industry is growing extremely. As it grows, increases the demand of medical services. Medical services are very much required to run the medical practice smoothly. Medical coding is one of highly required services among the other services. Without this, doctors can’t get reimbursement from insurance companies.

Medical coding is a process of assigning standardized code to the patient’s diagnostic and procedural information. This coding is used to generate accurate billing for insurance companies or government organizations. This medical coding process requires great attention to each and every detail to ensure accuracy. Because it is related to thousands of dollars, coding is highly synchronized and strongly controlled activity.

Certified medical coder is doing such type of coding very swiftly with more accuracy. They help the healthcare practitioner for health record documentation. They play vital role in healthcare information system.

Here are some points that show importance of medical coding.

Universal Acceptance: Medical coding is required because it contains so much information about medical procedures and medications on which the rates can be decided. Coding is now universal standardized and required to claim for reimbursement.

Accurate Billing: Wrong coding leads you to the wrong medical billing that will result into wrong charged amount. So it is very important that professional coder will do the coding. They will offer you accurate coding and on that basis billing specialist generates accurate bill.

Quick Reimbursement: Quick reimbursement is the need for every medical practitioner to maintain the good financial condition. Without accurate and prompt coding, no practitioner gets the reimbursement. This situation increases the financial disabilities. At the end, only debt remains. To avoid such situation, you can hire a good coding company/coder who manages you coding requirement and deliver the accurate and prompt result.

That’s how important medical coding is. It is base and most important step for every medical practitioner to get the reimbursement from insurance company or government organization.



Source by Ray Charles

Your Boat Insurance – Key Considerations

Sailing off into the distant blue, has the favorable effect of blowing away your life’s strains and cares with the blowing wind. Yet, before you voyage off in your attractive boat, take five and think about the merits of these questions. Do you have marine or boat insurance in place? Even when the response that that is ‘Yes’ at that point are you confident your insurance essentials are being fulfilled?

Marine insurance groups crafts according to a kind of dimensions. "Boats" are described as measuring anywhere between 16 feet and 25 feet 11 inches in length. Under that size then you are catalogued as small boat namely dinghies, personal watercraft and so forth. If your boat is 26 feet and above in size then you may most likely need expert insurance. Right now let’s check out some of the ins and outs as applied to regular boat insurance policies.

Physical damage insurance coverage

The insurance company reimburses you for the replacement or recondition of your boat, resulting from the following conditions: boating mishap, vandalism, fire, burglary, lightning, hurricanes or tornadoes. Incorporated in this policy are the watercraft itself, its power train or outboard motor and your trailer. Normally the following items are omitted from the dinghy insurance coverage, as they are not thought of as being a part of your boat’s operations: clothes, video or camera equipment, precious jewelry or fashion adornments, cell phones, beverages and food items, diving gear and portable electronics such as TV set, hi-fi equipment or laptops. You may discover they are included on your normal house insurance coverage or you may ask for separate insurance coverage for some of these.

Tip: I know it’s a pain but – always study the fine print at the bottom. Then you will realize what restrictions have been placed on your protection. Can you boat be kept at your home? Otherwise, should the boat be at your vacation place? Where does the protection start and end on the waters you can make use of? A few policies specifically list the assumptions and restrict the use of your craft.

Individual Liability Coverage

We hope you will never ever need to find out how important this coverage is. Typical marine boat insurance cover here ranges upwards from $ 3 million and may compensate you when there’s a collision and your boat is held responsible for harming another property, boat or injury.

Uninsured Boat Protection

This is known as the marine insurance equivalent to the road vehicle’s uninsured motorist insurance coverage. For instance, in the circumstance that the proprietor of a boat who damages yours has run out insurance coverage or worse yet, does not have the money, your boat’s repairs will certainly nonetheless be paid for.

Passenger Health Insurance coverage

This insurance coverage will pay for the medical expenses sustained by any people carried on your boat. You will definitely discover that generally there is one more provision on your policy regulating the quantity of individuals who can be aboard at any one time– make sure you do not bring more as the insurance will at that point be invalid.

Help & Towing Protection

This component of your insurance coverage will recompense you for the costs sustained should you have the requirement to call on the emergency services. You might have motor breakdown or additional mechanical failure or damage your boat on stones requiring a tow back to dock.

What’s the base line to all of this? Be insurance conscious in advance of you start your boating season. Take a while to get hands-on and acquaint yourself with understanding so you can easily decide on the right insurance option, terms and coverage which your boat insurance should include. Then you can set off into the blue knowing you are effectively prepared for any scenario.

To Your Boating Enjoyment!



Source by Tony Lord

Medigap Comparison

The importance of Medigap comparison prior to selecting the right supplemental medical insurance for you or someone in your family can not be overstated. With medical costs going through the roof in the last few years, it is very important to find a plan that suits your needs at a competitive price. The make-or-break moment happens during the plan selection process where prospective policy owners need to consider all the important aspects in order to come up with the best offer that works for them.

The best Medigap comparison strategies take the following into consideration as primary basis for determining on the best supplementary insurance policy currently on the market:

– Scope. The reason why prospective policy owners consider getting Medigap in the first place is because their basic Medicare is most likely not sufficient to cover all their medical needs. The best Medigap plan, therefore, has to fill the areas where Medicare is not adequate. This requires understanding the exact services and benefits contained in specific Medigap offers and then using those details to make an informed exercise in Medigap comparison. When looking at the specific scope of the offers, the most comprehensive does not need to become the most ideal. The goal is to be able to match the scope of the offer to the specific needs of the policy owner in order to maximize the policy benefits without having to get a plan beyond what one needs.

– Price. Different companies have different methods of defying the price for Medigap plans. The first basis is the scope of the plan; a plan with a limited scope of benefits is more likely to be priced lower than a more comprehensive plan. When engaging in Medigap comparison, it is best to compare the price of plans with the same scope from different providers because that serves as the perfect apple-to-apple comparison as opposed to comparing Plan A from Provider A and Plan B from Provider B. This also serves to highlight the importance of knowing the specific needs of the policy owner prior to comparing different Medigap plans.

– The Price Ladder. The price on Day 1 of any Medigap plan is not likely to remain the same over the lifetime of the policy. Many policy holders make the mistake of solely looking at the price on Day 1 when doing their Medigap comparison, only to later realize that the rate at which the price climbs every year squeezes their financial resources beyond what is tolerable. Conversely, there are plans that may cost higher on Day 1 but have a more gradual price jump over the years. Proper Medigap comparison should be able to factor these considerations as a basis for determining the suitability of any policy.

– Customer Service and Company Policies. The last thing a policy holder needs is to deal with a company that does not seem to put the best interest of the clients at heart, and there are more than a few out there. If filing for a claim makes you feel like you are asking for something special, a cheaper price can not compensate for bad service. Do not ever forget to read reviews when doing your Medigap comparison as this can help you see the companies in consideration from the perspective of other clients and their experiences.

A Medigap comparison exercise will help prevent any surprises over the course of a policy's life and given the needs and considerations of those in their late 60s to early 70s, nothing else should be expected. Take the time to compare the different Medigap plans and Medigap cost offered on the market using the considerations outlined above so you can fleece out the appropriate details that will help you come to an informed decision about the best plan for you or for a recognized family member .



Source by Robert N. Perry

Why Invest In Cargo Insurance Today

The risks associated with conducting trade around the world have pre-occupied the minds of most merchants for centuries. Whenever goods move, they are indeed subjected to risk and their value might be partially or totally lost because of different reasons. As a business owner, this can be very critical to your enterprise.

3 Main Types Of Risk

  • Loss
  • Damage
  • Delay

3 Cargo Clauses (A,B and C)

A – This is considered the most comprehensive type of all risks policies which protect you from the effects of most problems, with the exception of strikes and wars. Be reminded that when you are dealing with a dangerous zone during the transit of your vessel, piracy is actually considered an act of war. If you want to minimize this, consider taking out specific cover.

B – This will cover several common risks on a reasonable attributable basis. Be aware that it is actually possible to attribute responsibility or perhaps even blame between different parties to a transaction.

C – This is the most restricted type of policy. It might only cover accidental damage, for instance.

Other Classifications Of Insurance Policies

Marine – This will apply to air and sea freight. It covers loading/unloading, weather issues, and problems with the vessel or airplane.

Truck Cargo – This will cover theft while a vehicle is unattended along with damage to the goods because of movement or collisions.

Voyage – Traders who are not frequently engaging in a trade might opt for specific cover with a policy which sets out the places of origin and destination. When the goods have arrived already, the policy expires. Hence, you need to do it all again the next time you need such coverage.

Open Cargo – This is the best option for regular exporters or importers. This is for an agreed timescale or total value, or both. Thus, if you must export thousands of goods in the next 6 months, you can actually cover such value. The service provider does not need to know where or when the goods are moving.

Tips For Choosing The Best Provider

Begin by approaching a general-purpose company to get a quote. You can actually ask for referral or recommendations from reputable businesses that frequently use this service. Be reminded though that marine freight insurance is a specialist area. So if you need such, it would be wise for you to seek for an expert.

To guarantee a competitive deal, it is advised that you test the market at renewal from time to time. More information mentioned here.



Source by Marcus L Jimenez

Medical Billing – Fraud

Nobody wants to talk about it, but not talking about it is not going to make it go away. It is more common and more cost than most people want to admit to. It is one of the major contributing factors to our rising health care costs. It is very hard to prove and it is even harder to identify when it does happen because the people doing it have gotten very good at it. If you're wondering what we're talking about, it's medical billing and fraud. We're going to take just a brief look at the problem, as this is a topic that you could write books about.

Probably the most disheartening thing about medical billing fraud is that in order for it to be successful, in most cases anyway, more than one party has to be aware that it is going on. While we're not pointing any fingers, this has become a joint effort. The best way to explain exactly what is going on and how this is a coordinated effort, is with an example, albeit a fictitious one.

A patient sufferers an injury on January 1, 2006. The injury, because of the circumstances, is not covered. Maybe it was the patient's own neglect. The reasons do not matter. The injury is not covered under insurance so the patient just let's it slide by. Six months later, the patient is involved in a car accident. While there are no injuries sustained in the accident, the original injury is aggravated and the patient can now claim that the injury that they sustained in January of that year actually took place six months later while in the auto accident. All they need is a doctor's say so.

This is where things get sticky. Yes, we can argue that the doctor is only human and can only go by what the patient tells him. But surely, with today's technology, the doctor should easily be able to tell if the injury the patient sustained happened yesterday or six months ago. The problem is that the tests that would need to be performed, in some cases, would be too costly to do. It's just a lot easier to do a preliminary exam and certify that the injury must have occurred during the accident. The doctor then treats the patient for the injury, wrists up his bill and sends it along to the insurance carrier. The claim is then paid for something that should not have been covered in the first place. Yes, perhaps the injury was worsened by the accident, but if it had not been sustained in the first place, the resulting injury may have not been as bad.

Splitting hairs? Maybe. But this is a borderline case. There are many cases of medical billing where the patient and doctor are both more than aware that this item should probably not be billed and hold their breath hoping that the insurance carrier will not smell something funny and reject the claim. If you think this sort of thing does not go on, spend a day at one of our courts and listen to all the cases of fraud going up before the judge. It's enough to make you sick to your stomach for real.

The solution? For people to be honest. Is this going to happen? Well, we can always check with the courts six months from today.



Source by Michael Russell

Renting a Car – The Merits

In modern times cars are more of a necessity than luxury. With people opting for a fast pace of life, everyone is always on the go, and thus the necessity of the car saves time and traveling expenses in many scenarios. Though owning a car is a necessity, yet hiring a car is a better option considering the vagaries associated with risking a personal car for long distance travel involving a few days.

There are several advantages for economy car hire. These include:

1. Different models of car may be rented at different points of time according to individual preference.

2. Unlike private cars they don’t require any maintenance cost on the part of the person renting a car.

3. In case you are dissatisfied with a rented car you may get it replaced with a satisfactory one.

4. Discounts may be availed on low demand car models.

5. The helpful nature of vehicle agencies makes car renting a pleasurable experience when in a new town with a personal car.

6. Rental agencies provide great options to choose from, that include cars that are expensive, basic, small, minivans, caravans or even trucks.

7. There are no security concerns associated with a rented car as during a breakdown the rental company makes sure to supply with a new automobile on the way.

8. Compared to other modes of transports, rental vehicles offer a greater degree of flexibility to travel and pause according to your preference.

9. Being clean, shiny and fresh-smelling rental vehicles provide better comfort for a smooth travel.

10. Rented cars allow you to choose cars according to suitability of the occasions without having to purchase a new car.

Criteria for renting a vehicle

While renting a vehicle it is essential to approach the right agency offering the most suitable deals. Hence, it’s better to check out with many companies before subscribing to one. Studying the background and market standings gives a clear idea regarding the hire rates of each company.

While choosing a vehicle for hire, go for a car with a good engine condition instead of just being flattered by the outer looks. For availing a car on rent you should possess a valid driver’s license, credit card, life insurance and aged 25 years or above. An advance fee is also required to be paid before you start using the car.

Rental cars are not just for the travelers

Apart from being the best alternative for long-distance transportation, rental cars also serve other purposes. Families getting ready to buy new cars often want to experience the actual merits and demerits of their selected cars by renting the same and using it for a week or so of purchase rent different preferred models of car.

An increasing number of individuals are renting latest varieties of cars for short trips and weekend getaways, high school reunions, or any other special invitation. With aid from the car-renting agencies, new models may be hired for every occasion without having to use the same old private car.



Source by Jacob Bass

Dental Insurance Covers for Your Worries

Dental treatments can put a serious dent on your finances, and it's but fitting that you take advantage of every opportunity to finance it through insurance coverage. The problem with this option is its limitations; cosmetic dental procedures are severely covered by insurance, if at all, and you're often required to pay for the treatment and professional fees out of your own pocket. The next time you consider teeth whitening or porcelain veneers, think of the cost first, if you're able and willing to commit. Some treatments also come with a significant upkeep. Dental implant placements require multiple sessions, and the cost of the procedure is placed on each tooth, depending on the placement area.

Make sure your dental treatments are covered as far as your plan will accommodate, and your dentist should always be aware that you prefer subsidized treatment. The cost is always determined during the consultations, and it helps if you're up front with your dentist. In this way, all cost-efficient alternatives are considered, and you can choose which one you're willing to settle for. You'll spread yourself the problem of paying for the treatment after the fact. Delayed gratification is always the better option. Some treatments require recovery periods, and you do not want to add the costs of the procedure to the workdays you'll lose recovering from it.

The rates also vary between states, and you're better off familiar with the average costs of procedures. Finding out estimates is easy enough, just check out your local dental association's website, enter your zip code, and confirm the going rates. Your dentist can not contest this, but you should not settle for surprises just the same. Negotiate the price until you're comfortable or satisfied, lawyers will accommodate requests by reducing the professional and laboratory fees. Your bargaining skills will pay off, in the hundreds or thousands dollars.

An alternative to dental insurance you can consider is a discount plan, and it also varies between states. These depend on the participating dentists and clinics and your area, but you can avail as much as 60% discount on certain dental procedures, a significant lop-off of your treatment's cost. Dental coverage is usually voided in discounted treatments, but consider yourself fortunate if your clinician accommodates compound savings. If you're really desperate about cheap savings, then you can sign up for treatments at dental schools instead. Students welcome volunteer to participate in their practicums, and the treatments are absolutely free. The only tradeoff: students have yet to earn their license, so there's a risk your treatment could turn for the worse.



Source by Isabella D Johnson

Statutes in U.S. Healthcare System

The healthcare field is the subject of a host of federal statutes, regulations, guidelines, interpretive information, and model guidance. There are a considerable number of statutes and regulations that have an impact on the delivery of healthcare services. A statute is legislative enactment that has been signed into law. A statute either directs someone to take action, grants authority to act in certain situations, or to refrain from doing so. Statutes are not self-enforcing. Someone must be authorized to do so to take action. A statute may authorize the Department of Health and Human Services to take action, and it is up to the department to implement the law. Regulations, or rules, are made by administrative personnel to whom legislatures have delegated such responsibilities. It is a tool for developing policies, procedures, and practice routines that track the expectations of regulatory agencies and departments. The statutory and regulatory requirements are subject to judicial interpretation.

A very important element of healthcare management is to understand the key regulatory environment. One government statute that effects patient healthcare is the Anti-Kickback Statute. The Medicare and Medicaid Patient Protection Act of 1987 (the “Anti-Kickback Statute”), has been enacted to prevent healthcare providers from inappropriately profiting from referrals. The government regards any type of incentive for a referral as a potential violation of this law because the opportunity to reap financial benefits may tempt providers to make referrals that are not medically necessary, thereby driving up healthcare costs and potentially putting patient’s health at risk. The Anti-Kickback statute is a criminal statute. Originally enacted almost 30 years ago, the statute prohibits any knowing or willful solicitation or acceptance of any type of remuneration to induce referrals for health services that are reimbursable by the Federal government. For example, a provider may not routinely waive a patient’s co-payment or deductible. The government would view this as an inducement for the patient to choose the provider for reasons other than medical benefit. While these prohibitions originally were limited to services reimbursed by the Medicare or Medicaid programs, recent legislation expanded the statute’s reach to any Federal healthcare program. Because the Anti-Kickback statute is a criminal statute, violations of it are considered felonies, with criminal penalties of up to $25,000 in fines and five years in prison. Routinely waiving copayments and deductibles violates the statute and ordinarily results in a sanction. However, a safe harbor has been created wherein a provider granting such a waiver based on a patient’s financial need would not be sanctioned. The enactment of the 1996 Health Insurance Portability and Accountability Act (HIPAA) added another level of complexity to the Anti-Kickback statute and its accompanying safe harbors. HIPAA mandated that the OIG (Office of Inspector General) furnish advisory opinions to requesting providers that are either in an arrangement or contemplating an arrangement that may not fit squarely within the law. For a fee, the OIG would analyze the arrangement and determine whether it could violate the law and whether the OIG would impose sanctions on the arrangement. In many of its advisory opinions published over the past few years, the OIG has stated that it would not impose sanctions, even though it found that the arrangement in question could violate the statute. A common reason the OIG has given for not imposing sanctions has been that the arrangement provides an overall benefit to the community. Healthcare finance professionals need to ensure that all business transactions comply with the Anti-Kickback statute.

The Anti-Kickback statute effects the patient. The main aim of this statute is to improve patient safety, provide satisfaction and avoid risk. The result of the acquisition of a physician’s practice would serve to interfere with the physician’s subsequent judgment of what is the most appropriate care for a patient. It would also interfere with a beneficiary’s freedom of choice of providers.

Physicians have direct patient care responsibilities. Any incentive payments to such physicians that are either tied to overall costs of patient treatment or based on a patient’s length of stay could reduce patient services. Also, the profits generated by cost savings may induce investor-physicians to reduce services to patients. Health care programs operate on the good faith and honesty of health care providers. It is important to ensure that quality services are provided at the hospital. The Anti-Kickback statute helps the government not to tolerate misuse of the reimbursement systems for financial gain and hold the responsible parties accountable for their conduct. Such conducts can also prompt patient complaints. The hospitals and physicians who are interested in structuring gainsharing arrangements might adversely affect patient care.

The Anti-Kickback statute creates a protective umbrella, a zone in which patients are protected so that the best health care is provided. This statute helps to improve efficiency, improve quality of care, and provide better information for patients and physicians. The Anti-Kickback statute is not only a criminal prohibition against payments made purposefully to induce or reward the referral or generation of Federal health care business, it also addresses the offer or payment of anything of value in return for purchasing, leasing, ordering of any item or service reimbursable in whole or part by a Federal health care program. It helps to promote quality and efficient delivery of health care transparency regarding health care quality and price.

There are millions of uninsured patients who are unable to pay their hospital bills. Giving a discount on hospital charges to an uninsured patient does not implicate the Federal Anti-Kickback statute. Most need-based discounting policies are aimed at making health care more affordable for the millions of uninsured citizens who are not referral sources for the hospital. For discounts offered to these uninsured patients, the Anti-Kickback statute simply does not apply. It is fully supported that a patient’s financial need is not a barrier to health care. Furthermore, OIG legal authorities permit hospitals and others to offer bonafide discounts to uninsured patients and to Medicare or Medicaid beneficiaries who cannot afford their health care bills. The Anti-Kickback statute is concerned about improper financial incentives that often lead to abuses, such as overutilization, increased program costs, corruption of medical-decision making, and unfair competition.

There are risk management implications of this statute. There are risks associated with the Anti-Kickback statute and its good to prevent them. Rather than be an imposing and daunting challenge to understand, the outcome can be development of risk management systems to guide the delivery of health care. This fact is recognized that such statutes are an important attribute of the risk management professional. For example there are potential risks under the Anti-Kickback statute arising from hospital relationships. In case of joint ventures there has been a long-standing concern about arrangements between those in a position to refer or generate Federal health care program business and those providing items or services reimbursable by Federal health care programs. In the context of joint ventures, the chief concern is that remuneration from a joint venture might be a disguised payment for past or future referrals to the venture or to one or more of its participants. The risk management should be done by having a knowledge of the manner in which joint venture participants are selected and retained, the manner in which the joint venture is structured and the manner in which the investments are financed and profits are distributed. Another area of risk is the hospital’s compensation arrangements with physicians. Although many compensation arrangements are legitimate business arrangements, but may violate the Anti-Kickback statute if one purpose of the arrangement is to compensate physicians for past or future referrals. Risk management is to follow the general rule of thumb that any remuneration flowing between hospitals and physicians should be at fair market value for actual and necessary items furnished or services.

Risk management is also needed in entities such as in cases where a hospital is the referral source for other providers or suppliers. It would be prudent for the hospital to scrutinize carefully any remuneration flowing to the hospital from the provider or supplier to ensure compliance with the Anti-Kickback statute. Also, many hospitals provide incentives to recruit a physician or other health care professional to join the hospital’s medical staff and provide medical services to the surrounding community. When used to bring needed physicians to an underserved community, these arrangements can benefit patients. However, recruitment arrangements pose substantial fraud and abuse risk. This can be prevented by having knowledge of the size and value of the recruitment benefit, the duration of payout of the recruitment benefit, the practice of the existing physician and the need for the recruitment. Another area where risk management is to be applied is when the discounts are given. The Anti-Kickback statute contains an exception for discounts offered to customers that submit claims to the Federal health care programs. The discounts should be properly disclosed and accurately reported. The regulation provides that the discount must be given at the time of sale or, in certain cases, it should be set at the time of sale. This will help in risk management. It is also needed in medical staff credentialing and malpractice insurance subsidies.

The key areas of potential risk under the Federal Anti-Kickback statute also arise from pharmaceutical manufacturer relationships with 3 groups: purchasers, physicians or other health care professionals, and sales agents. Activities that pose potential risk include discounts and other terms of sale offered to purchasers, product conversion, consulting and advisory payments. The pharmaceutical manufacturers and their employees and agents should be aware of the constraints the Anti-Kickback statute places on the marketing and promoting of products paid for by federal and state health care programs. To that end, the draft guidance recommends pharmaceutical manufacturers ensure that such activities fit squarely within one of the safe harbors under the Anti-Kickback statute. The Department of Health and Human Services has promulgated safe harbor regulations that protect certain specified arrangements from prosecution under the Anti-Kickback Statute.

Healthcare being one the most regulated of all sectors of commerce, it is important that all facts and circumstances with respect to the statutes and regulations are evaluated.



Source by Meenu Arora Kapur