How to complete a medical insurance form

The information submitted is knowledge accumulated over years of experience teaching dentists how to bill medical insurance. This is supplemented with a good number of personal expert witness testimonies in criminal and malpractice insurance cases. The objective is to prevent problems before they start with the prudent use of information. My experience in court testimony on these issues has shown me that there is an army of lawyers, insurance company fraud examiners, and dentists working for the aforementioned, just waiting for you to improperly use this method of insurance reimbursement. Use this only if you understand the nuances of what it is you are doing! For example, any procedure you bill to dental insurance using CDT-2 codes can be billed to medical insurance using medical insurance CPT-95 codes. The difference is that if the procedure is not a covered medical expense, it will not be paid by the medical insurance carrier. I strongly suggest that you do not fall into the trap of obfuscating these codes. There are a number of so-called insurance "gurus" teaching dentists how to write confusing and misleading operative reports so as to obtain reimbursement for procedures that normally would not be covered. I beseech you--please do not do it! The penalties are severe. You will experience a significant increase in payments from the medical insurance when procedures are submitted in the proper manner. More and more computerized dental insurance management programs are offering their clients the ability to automatically cross-code and submit dental/medical insurance claims. It is a recognized ability of dentists to do such. Billing responsibly is of the utmost importance.     

Counseling expectations as a function of fee for service.

Two studies investigated the hypothesis that counseling on a fee-for-service basis might affect client evaluation of counseling, client motivation to change, and client willingness to seek help. In Study 1, 80 male and 80 female undergraduates completed a questionnaire, which required Ss to estimate the probability of their using university counseling-center services for varied concerns, and an expectations-about-counseling questionnaire. Ss were randomly assigned to 1 of 4 experimental conditions representing fee structures: no fee, a modest fee ($5), a modest fee but knowing others pay more for the same services, and a substantial fee ($25). Results show that fee condition did not affect willingness to seek help or counseling expectancies. Although there were some differences between sexes on expectancies, there was no interaction effect for sex and fee condition. In Study 2, 12 male and 31 female 15–54 yr old former clients of a psychology clinic were asked to compare satisfaction under no-fee and fee ($5 and $25) conditions. Again, fees did not affect Ss' evaluations of, expectations for, or willingness to seek counseling. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent pregnancy prevention in managed care

Efforts by the US government, employers, and insurance industry to address women's health issues have neglected the problem of adolescent pregnancy. 30 million of the 37.4 million US adolescents have health insurance coverage and 20-40% of them are enrolled in managed care plans, either through private insurance or Medicaid. Each year, managed care insurance plans pay for 150,000-300,000 adolescent pregnancies, half of which end in a live birth. There are many gaps in current approaches to adolescent health care that can be filled by physicians and managed care organizations. Prevention of adolescent pregnancy would have immediate, cost-effective results. Managed care insurance, with its organizational structure, has the potential to address the traditional obstacles to adolescent reproductive health of lack of confidentiality and difficulties with access. An adolescent health care coordinator could be hired to track teen care within the insurance plan, educate staff, and arrange and enforce protocols. It would be instructive to see whether such case management could achieve reductions in repeat adolescent pregnancies by targeting follow-up activities to this risk group. Finally, managed care organizations should analyze teen pregnancy prevention programs in their own setting and select the most effective interventions on the basis of cost and medical outcome rather than political expediency.     

Satisfaction of active duty U.S. service members with military dental care

This study explores what factors influence whether active duty U.S. military personnel enroll their families in Department of Defense (DoD) or non-DoD dental insurance plans. The data come from a 26-site, cross-sectional survey of U.S. service members conducted from April 1994 to January 1995. A prestratified, randomly selected target sample of 15,915 service members yielded 12,950 respondents (81% response rate); 7,243 of these had insurance-eligible families. Age, gender, ethnicity, education, rank, marital status, branch of service, number of children, number of years of military service, and insurance status of respondents were collected on self-administered questionnaires. We performed stepwise, backward, logistic regression analysis to determine which factors influence a military family's dental insurance status. Results show that enrollment in DoD insurance is influenced by every demographic factor collected; enrollment in non-DoD insurance is influenced by fewer factors. The decision by U.S. service members to enroll their families in dental insurance plans is subject to many and complex influences.     

Quantitative structure-activity relationship studies on some nonbenzodiazepine series of compounds acting at the benzodiazepine receptor

OBJECTIVE: To estimate charges attributable to osteoarthritis (OA) in a managed care organization. METHODS: Longitudinal study based on insurance claims incurred and filed between 1991 and 1993 in a national managed care organization. Patients with claims for OA were randomly sampled to yield 20,000 study subjects. Charges per person-year were determined for these patients and compared to those of comparison subjects matched for age, sex, and insurance plan without claims for OA. RESULTS: Total charges per patient-year adjusted to 1993 dollars for patients with OA <65 and > or =65 years of age were $5,294 and $5,704, respectively, while charges for controls were $2,467 and $3,741, respectively. Thus, charges due to OA were $2,827 and $1,963, accounting for 5% of total plan charges. CONCLUSION: Patients with symptomatic OA incur charges for medical care at about twice the rate of plan enrollees without claims for OA and account for a substantial proportion of total charges in a managed care plan.     

Self-insured employer health plans: prevalence, profile, provisions, and premiums

Data from three recent surveys indicate that about 40 percent of workers with employment-based health insurance are enrolled in plans that their employers self-insure. Despite the considerable differences between federal regulation of these self-insured plans and state regulation of employer plans purchased from an insurance company, we find striking similarities in the populations they serve, the benefits they offer, and their premium costs. Implications for health policy are discussed.     

Impact of employee participation in the development of pay incentive plans: A field experiment.

Ss were part-time workers who clean buildings in the evenings. 3 autonomous work groups with 10, 9, and 8 Ss developed their own pay incentive plans to reward good attendance on the job (Condition A). These plans were then imposed by the company on other work groups with 13 and 26 Ss (Condition B). Of 2 control groups, 1 (N = 17) talked with Es about job attendance problems but received no additional experimental treatment, and the other (N = 34) received no treatment. A significant increase in attendance followed only Condition A. Possible reasons cited: (a) participation caused Ss to be more committed to the plan, (b) Ss who participated in the development of their plan were more knowledgeable about it, and (c) participation increased Ss' trust of the good intentions of management with respect to the plan. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Employee attitudes toward technological change in a medium sized insurance company.

How do office workers react to office automation? "Questionnaires about technological change and the installation of a new electronic computer were administered to all of the employees of a medium sized insurance company." The validity of the questionnaires was not discussed. "Most of the employees welcomed changes in their work… . They believe that machines are replacing workers in office situations but do not feel that they themselves will be replaced. They do not perceive that the introduction of the new technologies has had much effect on the amount of pay they get, their chances for promotion, or the amount of supervision they receive. But they do believe that the new technologies have changed the amount of work that they do and the degree to which there is variety in their work." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of galanin and serotonin on the endocrine response to Hexarelin, a synthetic peptidyl GH-secretagogue, in normal women

BACKGROUND: Lack of information about the effect of insurance coverage on the demand for and use of smoking-cessation services has prevented widescale adoption of coverage for such services. METHODS: In a longitudinal, natural experiment, we compared the use and cost effectiveness of three forms of coverage with those of a standard form of coverage for smoking-cessation services that included a behavioral program and nicotine-replacement therapy. The study involved seven employers and a total of 90,005 adult enrollees. The standard plan offered 50 percent coverage of the behavioral program and full coverage of nicotine-replacement therapy. The other plans offered 50 percent coverage of both the behavioral program and nicotine-replacement therapy (reduced coverage), full coverage of the behavioral program and 50 percent coverage of nicotine-replacement therapy (flipped coverage), or full coverage of both the behavioral program and nicotine-replacement therapy. RESULTS: Estimated annual rates of use of smoking-cessation services ranged from 2.4 percent (among smokers with reduced coverage) to 10 percent (among those with full coverage). Smoking-cessation rates ranged from 28 percent (among users with full coverage) to 38 percent (among those with standard coverage). The estimated percentage of all smokers who would quit smoking per year as a result of using the services ranged from 0.7 percent (with reduced coverage) to 2.8 percent (with full coverage). The average cost to the health plan per user who quit smoking ranged from $797 (with standard coverage) to $1,171 (with full coverage). The annual cost per smoker ranged from $6 (with reduced coverage) to $33 (with full coverage). The annual cost per enrollee ranged from $0.89 (with reduced coverage) to $4.92 (with full coverage). CONCLUSIONS: Use of smoking-cessation services varies according to the extent of coverage, with the highest rates of use among smokers with full coverage. Although the rate of smoking cessation among the benefit users with full coverage was lower than the rates among users with plans requiring copayments, the effect on the overall prevalence of smoking was greater with full coverage than with the cost-sharing plans.     

Solution and solid state conformation of the human EGF receptor transmembrane region

The purpose of this article is to examine 10 steps analyzing the financial impact on a periodontal practice accepting a proposed managed care dental plan. It is emphasized that this analysis should be conducted before formally agreeing to accept the proposed plan. The procedures for examining the 10 steps include the use of hypothetical data for a periodontal practice confronted with a discounted fee plan. Each step is identified, discussed, and the hypothetical data are used to develop results presented in a set of tables. The steps in the analysis process include constructing a practice profit and loss statement and developing a dataset of practice characteristics and productivity measures. Other estimates should be made of covered lives, new patient utilization, existing patient utilization, utilization of non-covered services, estimating other sources of revenue and expense, and the impact on capacity utilization of operatories and practice staff. Results are presented in a set of analysis tables. The importance of multiple analyses is discussed as is the importance of analyzing the impact on results from changing assumptions. Some of the higher risk variables faced by the practitioner are identified for submission to risk evaluation to examine the sensitivity of results. Finally, the relationship between the proposed plan and the additional time required by the periodontist to meet the plan's specifications is examined in light of the data developed in the 10 steps and the results tables.     

Intermediates of prothrombin activation induce intracellular calcium mobilization in rat aortic smooth muscle cells

OBJECTIVES: To determine the diagnostic utility and net cost of magnetic resonance imaging (MRI) in the management of clinically and sonographically inconclusive scrotal lesions. METHODS: A multicenter retrospective review identified 34 patients diagnosed with scrotal MRI following inconclusive clinical and ultrasound (US) evaluation. Final diagnoses were based on surgery (n = 18) or clinical and US follow-up (n = 16). Final diagnoses of 29 testicular lesions were as follows: orchitis (n = 11), infarct (n = 6), neoplasm (n = 6), rupture (n = 3), torsion (n = 2), and radiation fibrosis (n = 1). Final diagnoses of five extratesticular lesions were as follows: epididymitis (n = 2), epididymal abscess (n = 2), and neoplasm (n = 1). Management plans prior to and following MRI findings were formulated by a general urologist and a urologic oncologist. The costs of the pre-MRI and post-MRI management plans were estimated using the Medicare reimbursement schedule. RESULTS: The leading US diagnosis was correct for 10 of 34 patients (29%) and the leading MRI diagnosis was correct for 31 of 34 patients (91%). MRI improved the management plan of the general urologist and urologic oncologist in 19 patients (56%) and 17 patients (50%), respectively. MRI worsened the management plan of both clinicians in 1 patient. Management was unchanged in all other patients. The overall net cost savings were $543 to $730 per patient for the urologic oncologist and the general urologist, respectively, and $3833 per patient originally scheduled for surgery. CONCLUSIONS: Use of MRI after inconclusive clinical and US evaluation of scrotal lesions may improve management, decrease the number of surgical procedures, and result in net cost savings.     

How expensive is unlimited mental health care coverage under managed care?

OBJECTIVES: To study costs, access, and intensity of mental health care under managed care carve-out plans with generous coverage; compare with assumptions used in policy debates; and simulate the consequences of removing coverage limits for mental health care as required by the Mental Health Parity Act. DESIGN: Claims data from 1995 and 1996 for 24 managed care carve-out plans; all plans offered unlimited mental health coverage with minimal co-payments. OUTCOME MEASURES: Probability of care, intensity of care, and total costs broken down by service type and type of enrollee. RESULTS: Assumptions used in last year's policy debate overstate actual managed care costs by a factor of 4 to 8. In the plans studied, costs are lower owing to reduced hospitalization rates, a relative shift to outpatient care, and reduced payments per service. However, access to mental health specialty care increased (7.0% of enrollees) compared with the preceding fee-for-service plans (6.5%) or free care in the RAND Health Insurance Experiment (5.0%). Removing an annual limit of $25000 for mental health care, which is the average among plans currently imposing limits, will increase insurance payments only by about $1 per enrollee per year. Children are the main beneficiaries of expanded benefits. CONCLUSIONS: Concerns about costs have stifled many health system reform proposals. However, policy decisions were often based on incorrect assumptions and outdated data that led to dramatic overestimates. For mental health care, the cost consequences of improved coverage under managed care, which by now accounts for most private insurance, are relatively minor.     

Report on APA's income protection plan: Announcement of higher weekly benefits and of expanded coverage.

Item notes that APA's income protection plan insures APA members against loss of income during periods of total disability, paying benefits when an insured member is unable to work at his regular occupation because of sickness or accident. The present plan provides payments ranging from $25.00 a week to $100.00 a week during periods that an insured member is prevented from working at his regular job because of sickness or accident. Beginning on May 1, 1959, benefits as high as $150.00 a week will be available on certain plans. These provisions are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interaction of the maize and Arabidopsis kinase interaction domains with a subset of receptor-like protein kinases: implications for transmembrane signaling in plants

The American population is aging rapidly and individuals are living longer. Yet Americans are saving less and older workers are leaving the labor force at younger and younger ages. The accelerated drop in labor force participation corresponds roughly to the introduction of Social Security and the adaptation of employer-provided pension plans. I have illustrated that Social Security and employer-provided pension plans provide substantial incentive to leave the labor force early. The quantitative effect of this inducement is illustrated by simulating the effects of changes in pension plan and Social Security provisions on the retirement decisions of employees in a large firm, who are covered by a typical defined benefit pension plan. Scheduled Social Security changes would have little effect on the retirement decisions of employees with a typical defined benefit pension plan like the one considered here. But if the pension plan provisions were changed to correspond to the Social Security changes, the effect would be very large. And, although not contemplated by current legislation; it is clear that an increase in the Social Security early retirement age would have a substantial effect on the early retirement rates of the large number of employees not covered by a pension plan.     

焦炉煤气净化系统工艺优化及填料无污染再生技术研究

通过对焦炉煤气净化系统工艺及填料再生存在问题的分析，对比各种净化填料再生方案的优缺点，选择和实施了使用净化后焦炉煤气再生填料的方案，节约了填料更换费用，同时解决了净化系统填料再生时环境污染问题。     

Developmental eye disease--a genome era paradigm

Usually, the French dental insurance system covers the cost of restorative treatment but does not reimburse the cost of preventive therapies. A French sick-fund covering self-employed persons tested a new dental benefit plan for children intended to provide an incentive to develop office-based preventive activities. The programme, which started in 1992, concerns all 4-year-old children of self-employed workers in a single French region (Auvergne). Participants undergo an annual examination by the dentist of their choice until their 15th birthday. If the child is seen every year, all services related to dental caries (preventive and restorative) are provided free of charge. An ongoing evaluation of the programme was necessary to determine its influence on the development of office-based preventive activities and the dental health of the participants. A cohort of children enrolled in the programme in 1992 was followed over 4 years to examine the patterns of service use. In addition, a cross-sectional study comparing the caries experience of all 8-year-old children participating continuously in the programme (test sample) with that of a sample of control children (n=90) was conducted in 1996. Data from the longitudinal follow-up indicate that 43.37% of the 551 children to whom the programme was offered in 1992 underwent an annual examination in the first year. Of the children enrolled in 1992, 55.2% were still participating in the programme in 1996. Results showed that independent practitioners continued to focus on restorative treatment rather than preventive therapy. Results from the cross-sectional study are in accordance with this trend. The number of caries-free children was identical in test and control samples and the mean dft, DMFT, DT and dt did not vary between the two groups (Student's t-test, P>0.05). However the mean number of filled teeth was significantly higher in the test children than in the controls (P<0.01). For children with caries, the mean dft was 23.5% greater in the test group than in the control group (P<0.05). In Auvergne, a large number of families were not ready to participate in a plan that required them to take their child to the dentist every year. There was not a perceived need for regular preventive dental care, an attitude probably reinforced by the interventionist approach undertaken by the dentists over the survey period. Moreover, the plan did not provide an incentive for dentists to develop office-based preventive activities.     

炼钢-热轧生产计划的优化与协调

炼钢和热轧是钢铁企业的关键工序,它们的生产运行情况影响着整个钢铁企业的效益.随着热送热装技术的普及,现代钢铁企业不仅追求炼钢和热轧生产计划各自的优化,更对它们之间的协调提出了更高的要求.根据最优炉次计划模型和最优轧制计划模型建立了炉次-轧制计划的协调模型,采用禁忌搜索算法对它们进行求解,并对模型和算法进行了仿真验证.     

Unnecessary emergency transport and care of grand mal seizures

Every source quoted in this study has clearly refuted the need for emergency transport and care of an uncomplicated grand mal seizure in a managed epileptic patient. This review of a large patient population has determined that 27% of emergency department seizures were uncomplicated and occurred in patients already under care. This represented 0.25% of all emergency department visits and nearly $200,000 in claims to this managed care entity per year. Taking some statistical liberties, a national health care expenditure of $270,000,000 is suggested for this single abuse. It is hoped that further education of the public, medical community, and epileptic patients will produce a comfort level that permits decisions about emergency transport and care of seizures. These savings could translate into basic health insurance for thousands of our medically deprived citizens.