Uncovering Systemic Corruption in the ER: An Empirical Analysis of Motor Vehicle-Related Hospital Bills and their Impact on Insurance Companies

Size: px
Start display at page:

Download "Uncovering Systemic Corruption in the ER: An Empirical Analysis of Motor Vehicle-Related Hospital Bills and their Impact on Insurance Companies"

Transcription

1 Uncovering Systemic Corruption in the ER: An Empirical Analysis of Motor Vehicle-Related Hospital Bills and their Impact on Insurance Companies DRAFT Eileen Lee Advisor: Professor Alain Kornhauser Submitted in partial fulfillment of the requirements for the degree of Bachelor of Science in Engineering Department of Operations Research and Financial Engineering Princeton University June 2014

2 I hereby declare that I am the sole author of this thesis. I authorize Princeton University to lend this thesis to other institutions or individuals for the purpose of scholarly research. Eileen Lee I further authorize Princeton University to reproduce this thesis by photocopying or by other means, in total or in part, at the request of other institutions or individuals for the purpose of scholarly research. Eileen Lee

3 Abstract With the advent of automated and assisted vehicle technology, the prospect of significantly decreasing motor vehicle accidents is imminent. However, accidents resulting in emergency room visits provide revenue for hospitals by charging automobile insurance companies for services to treat injured individuals. Statistical methods are used to investigate discrepancies in charges associated with motor vehicle accident injuries among different payers including: automobile insurance providers, Medicare, Medicaid, self-pay, and others. Charges for treatment of similar injuries with different causes are also evaluated. Results from 2011 data for New Jersey show that patients admitted to the emergency room (ER) after falling or being struck have significantly less expensive medical bills than patients that enter the ER from a motor vehicle accident. Differences in services for treating patients show hospital bias toward automobile insurers who provide generous reimbursements in New Jersey. ii

4 Acknowledgements I would first like to thank my advisor, Professor Kornhauser, for his guidance throughout this process. His ability to answer my incessant questions were truly appreciated, and his humorous comments always made me laugh. This thesis would not have been possible without his support. I would also like to acknowledge Christine O Brien for her assistance in providing a better understanding of automobile insurance coverage and its relationship with hospital care. Without her insight, I would not have been able to fully understand the complexities of these interactions. Our conversation and exchanges inspired my thesis to take on new directions. I would also like to thank my friends for all their constant encouragement, especially in the last few weeks. Finally, I would like to thank my family who supports me in everything I do. I cannot imagine how I could have made it here without them. A special thank you goes to my sister, Jenny, for her contributions during the editing process. iii

5 iv To my loving mother, father, and sister.

6 Contents v

7 List of Tables vi

8 List of Figures vii

9 Chapter 1 Introduction 1.1 Motivation In 2009, there were nearly eleven million motor vehicle accidents (MVA) in the United States, resulting in approximately 36,000 deaths (?). As technology continues to provide safer vehicles on the road, a question remains about the impact these vehicles will have on society. While vehicle manufacturers and policy makers who support safety advancements are motivated to reduce the number of MVA that are so prevalent today, the costs associated with medical care also provide revenue for hospitals treating these patients. With MVA among the leading causes of death in the United States and millions of drivers treated in emergency rooms, medical care expenses are quite significant. Though hospitals are often seen as beneficial institutions that heal injuries and cure diseases, they also represent businesses. As the only business entity that does not provide any prices associated with their services until after the services are performed, hospitals can charge patients inexorably large rates that vary from person to person. With no market pressures to adjust pricing, hospitals have extreme power in requesting unnecessary tests and adding services to increase the bill for patients they know can afford it. Typically in a stressful environment in which people are willing to do anything to help a loved one recover, society is forced to pay such demanding costs. 1

10 CHAPTER 1. INTRODUCTION However, these costs are not typically paid completely out-of-pocket from patients. Rather, insurance companies cover a majority, if not all, of the bill. Since hospitals are aware of limited funding with public insurance programs, it may be advantageous for hospitals to target other payers when possible to maximize their reimbursements. In the case of MVA in New Jersey, automobile insurance companies are the primary responsible party for paying medical expenses associated with accident-related injuries. Distortion of charges and fraudulent behavior is possible amongst hospital administration to maximize revenue. With nearly 300,000 accidents occurring in New Jersey each year, the potential for revenue generating patines is high (?). This thesis evaluates the hypothesized discrepancy in hospital charges related to motor vehicle accident injuries in the state of New Jersey. It uncovers disparities that may occur between payers, particularly looking at the difference in charges between automobile insurance companies and other providers. It also evaluates different causes of the same injuries to understand if automobile insured patients are being overcharge for treatment relative to other patients. As safe driving technology continues to advance, significant reductions in accidents are anticipated. Will hospitals who experience less emergency room patients from MVA be impacted financially in the future? 1.2 Automobile Insurance in New Jersey Automobile insurance liability falls into three different categories: tort, no-fault, and choice. Tort liability states that the at-fault driver is responsible for economic and noneconomic damages inflicted on others, while no-fault allows damages from an accident to be covered by each party s own insurance (?). The choice option allows drivers to decide between tort or no-fault insurance plans. New Jersey is among three states (along with Kentucky and Pennsylvania) that follows a choice car insurance model. The choice system allows drivers to choose between "insurance that puts no limitations on their right to sue for noneconomic damages and a no-fault plan that has a verbal threshold (?). This verbal threshold allows drivers to sue for noneconomic losses only in strictly stipulated circumstances. The default option for drivers who do not specify their preference 2

11 CHAPTER 1. INTRODUCTION is the no-fault coverage, and New Jersey s insurance practices make it effectively a no-fault state. The no-fault system was initially designed to lower legal costs from lawsuits determining liability for certain damages after an accident to ensure all parties involved were reimbursed (?). Since legislation in 1999 tightened the verbal threshold of reasons to sue, savings between $400 and $800 a year have resulted from fewer lawsuit fees and cost-reducing medical treatment regimes (?). Automobile insurance is required for all drivers in New Jersey, and there are several policy options that affect the amount of coverage received. The standard policy includes: bodily injury liability, property damage liability, personal injury protection (PIP), and collision and comprehensive coverage (?). Liability involves claims from accidents that the insured party causes, while collision and comprehensive coverage includes other damages to the insured party s vehicle. Bodily injury insurance and PIP insurance are mandatory portions of the policy. Most relevant is PIP coverage that pays for any injury-related treatment associated with an automobile accident Personal Injury Protection (PIP) Personal Injury Protection is included in all car insurance policies in New Jersey and covers medical expenses associated with an accident. The motivation behind this coverage began in the late 1960 s when automobile lawsuits were used to determine whether medical care of MVA victims should be provided at all (?). It was then decided that all medical bills should be paid upfront by auto insurers, and this coverage became known as PIP. It includes two parts: 1. Medical expense coverage: Cost of treatment from hospitals, doctors, and other medical providers and any medical equipment necessary 2. Reimbursements for other expenses such as lost wages and damages Though NJ drivers are required to purchase medical coverage, the second portion of coverage for reimbursing other expenses is optional. Prior to recent amendments to the policy, PIP provided unlimited medical benefits (?). This meant that PIP paid for 100 percent of medical expenses as a part of automobile insurance coverage. Any services and corresponding charges from hospitals or 3

12 CHAPTER 1. INTRODUCTION other health care providers as a result of an accident were covered, resulting in unlimited potential for excessive treatment and procedures to increase patients bills. This unlimited coverage encouraged providers to maximize their profits because of the unregulated benefits they could receive from medical reimbursements, causing high insurance premiums. Figure 1.1: PIP Costs for Different Auto Insurance Options As seen in the figure, states with no-fault automobile coverage similar to that in New Jersey, have higher PIP costs per vehicle than other options. Between 1980 and 2006, the no-fault PIP policy resulted in an additional $300 in costs compared to states with a mandatory add-on policy, meaning that drivers purchased PIP coverage in addition to the tort liability system (?). Though on a downward decline in recent years, efforts are still being made to decrease costs because reducing PIP coverage costs would help to lower premiums for those insured. Today, New Jersey has a PIP limit defaulted to $250,000 (?). This coverage still includes benefits for all medical expenses related to injuries sustained from the accident along with rehabilitative series and lost income. While an overwhelming majority of drivers have this maximum amount in their insurance plan, there are now lower premium options that reduce coverage from $250,000 to as low as $15,000 (?). It is also possible to place a health insurance provider as the primary payer to further reduce premiums. However, this option is only utilized by approximately 2 to 3 percent 4

13 CHAPTER 1. INTRODUCTION of the population. If medical bills exceed the limit of PIP, additional claims are automatically sent to secondary payers such as the injured party s health insurance or other source of reimbursement including Medicare, Medicaid, or charity care from hospitals. CPT* Hospital Outpatient Department Hospital Outpatient Department HCPCS DESCRIPTION Fees North Fees South INJECTION INTO SKIN LESIONS ADDED SKIN LESIONS INJECTION THERAPY FOR CONTOUR DEFECTS THERAPY FOR CONTOUR DEFECTS INSERT TISSUE EXPANDER(S) 6, , INSERT DRUG IMPLANT DEVICE REMOVE DRUG IMPLANT DEVICE REPAIR SUPERFICIAL WOUND(S) REPAIR SUPERFICIAL WOUND(S) REPAIR SUPERFICIAL WOUND(S) Figure 1.2: Sample of Fee Schedule for PIP Coverage in NJ On January 4, 2013, to combat abuse of the PIP system, fee schedules for certain health care providers treating automobile-related injuries went into effect. These documents list the dollar amount that PIP will reimburse hospitals for a particular service performed on a patient. The schedules include one for Physicians and Ambulatory Surgical Centers (ASC), Dental-associated expenses, and Hospital Outpatient Surgical Facilities (HOSF). The HOSF fee schedule relates particularly to outpatient facilities, such as emergency departments. As seen in??, a hospital outpatient department located in northern New Jersey would receive $247.20, for example, to perform an "injection into skin lesions" (?). Charges not on the fee schedule are paid at the usual, customary, and reasonable (UCR) rates. These UCR rates are the aggregated average amounts that insurance providers are willing to pay for a specific service, and they are often determined by geographic region. With the implementation of the fee schedule, it is anticipated that more reasonable charges will be made from hospitals, particularly in the emergency department where many motor vehicle accident patients are admitted. However, limitations to the fee schedules exist. Currently there is no reimbursement schedule for patients who enter the emergency room and are then admitted to the hospital. Once admitted, the only PIP regulation that limits reimbursements is the standard $250,000 maximum for any treatment associated with injuries sustained from a motor vehicle 5

14 CHAPTER 1. INTRODUCTION accident. 1.3 Hospital Billing Policies Hospital charges represent approximately 31 percent of total national health care expenditure in the United States, the largest single segment among the different types of services (?). Charges associated with hospitals are additional fees beyond physician and clinical services, prescription drugs, and other professional health services The Chargemaster To generate a dollar amount for a specific service provided, each hospital in the United States has its own "chargemaster". This extensive list includes the hospital s prices for every procedure performed and every supply item used to complete them. These chargemasters are updated at least once a year with no structured method to their changes. Because no regulation stipulates a unified approach to pricing, hospitals make ad hoc updates without any constraints. Patients typically see their detailed medical bills with prices listed from the chargemaster. New Jersey hospitals are not required to share their price lists, making the billing process opaque to patients until services are already performed. Hospitals receive approximately 30 percent of net revenues from Medicare, 17 percent from Medicaid, and 33 percent from private insurance (?). Medicare and Medicaid have fee schedules similar to that of the one instituted by PIP to curb costs of reimbursements to hospitals. Payment rates for private health insurers are typically discounted, and these lower prices are negotiated between hospitals and health insurance companies individually. However, automobile insurance companies do not have negotiating powers as significant as that of health insurers. Uninsured patients are even worse off and are often billed the full charges represented on the inflated hospital chargemasters. 6

15 CHAPTER 1. INTRODUCTION Figure 1.3: Sample Charges for Treatment at Bayonne Hospital Center Without regulation for uniform pricing, charges associated with treatment vary significantly between states, regions, and hospitals.?? displays the average charges for the most expensive hospital in the United States, Bayonne Hospital Center, located in northern New Jersey (?). This notoriously high charging hospital has medical bills for treatment of bloodstream infection and congestive heart failure that are significantly higher than the state and national averages. Compared to the average amount that Medicare providers actually pay for these charges, which is less than 10 percent of the amount billed, the chargemaster billing amounts are quite substantially inflated. The billing system of hospitals continues to be unknown and extremely variable for a majority of the population Emergency Room Visits Every visit to the emergency room is categorized under one of five billing codes based on the varying levels of severity and resources required for hospital care. Level 1 code is for minor incidences, while Level 5 code is for more severe problems such as a broken bone. This tiered fee structure is an additional "facility fee" beyond physician fees and charges for medicine and treatment. The payments associated with the different billing codes typically range from $50 to $324, though chargemasters have inflated prices of greater than $2,000 for a Level 5 visit according to the data sets analyzed for the study. 7

16 CHAPTER 1. INTRODUCTION One particular issue with the current billing system is the potential for "upcoding". Because there are not specific guidelines for the level of severity associated with differing billing codes, hospitals can push the limits to bill higher priced-codes for their patients. In fact, hospitals are required to develop their own guidelines for billing codes rather than use a national standard. According to a study performed by the Center for Public Integrity, more than 500 hospitals of the 2,400 in the database billed the two most expensive codes for more than 60 percent of their patients (?). Despite these high charges, hospitals defend their billing procedures and say the increase is a result of sicker patients entering the emergency room and more accurate billing due to the use of electronic medical records (?). However, many experts do not support the claim that patients are becoming sicker. From 2001 to 2008, the ten most common diagnoses were unchanged, but an increase in billing of the most expensive codes were still recorded. Government provided insurance programs, particularly Medicare and Medicaid, have been concerned with the uncertainty of ER billing because of limited funding available. Recently in July 2013, the Centers for Medicare and Medicaid Services (CMS) began seeking potential methods to contain costs, though the new proposal is still in preliminary stages. Rather than continue the tiered billing codes, CMS officials suggest a single flat rate (?). However, this flat rate proposal has resulted in criticisms from hospitals and medical billing experts who state that hospitals who treat patients with minor injuries would gain a significant amount of money, while others that treat more complex conditions in the ER would be at a loss (?). The motivation behind this new policy is to prevent any incentives to increase charges in the emergency room. Along with "upcoding", CMS plans to "remove any incentives hospitals may have to provide medically unnecessary services or expend additional, unnecessary resources to achieve a higher level of visit payment" (?). In an investigative study performed by the Center for Public Integrity, the results showed an increase of more than $1 billion in emergency room facility fees over the last ten years. CMS has also proposed other changes such as bundling rates for several outpatient medical procedures. This would combine drugs, biologics, and tests to reduce the number of individually paid services. However, this change is currently meeting fierce opposition as 8

17 CHAPTER 1. INTRODUCTION specialists stated that bundling payments would make any costly bioengineered products impossible to supply without a loss (?). The current billing process within hospital emergency rooms clearly remains a contentious topic making it difficult to implement changes that are amenable to both hospitals seeking to recover their costs and regulators hoping to decrease expenditures. 9

18 Chapter 2 Literature Review 2.1 Costs Associated with Motor Vehicle-Related Injuries Motor vehicle accidents pose significant costs to the United States. As a proportion of gross national product (GNP), these costs contribute to approximately percent of GNP (?). In 2005, Naumann et al. found that medical costs associated with motor vehicle-related injuries accounted for nearly $100 billion, placing an economic and social burden on the United States (?). The total economic burden of all accidents in 2000 was $230.6 billion for the United States economy. Approximately 75 percent of these costs were not paid by individuals directly involved in these accidents, but rather by society through insurance premiums, taxes, and travel delays. The study also found that the two highest risk groups, young drivers and motorcyclists, contributed to over a third of the economic costs associated with injury and death. Conservative estimates made in the study suggest that each U.S. licensed driver pays almost $500 for medical costs and productivity losses associated with preventable injuries and death from motor vehicle-related accidents. A large portion of medical expenses come from emergency department visits immediately after the accident. Hospitals, therefore, determine the charges that pertain to injuries, which directly contribute to the costs associated with MVA. In considering the expenses related to injuries, payers play a significant role. Typically, hospital fees and claims are paid by various parties includ- 10

19 CHAPTER 2. LITERATURE REVIEW ing: Medicare, Medicaid, private insurance, self-pay, worker s compensation, and others. Within private insurance, health maintenance organizations (HMO) such as Blue Cross Blue Shield, UnitedHealthcare, Aetna, or automobile insurance companies when related to motor vehicle accidents, are typically the primary payers. 2.2 Hospital Costs and Car Insurance Claims In recent years, automobile insurance companies have been experiencing an increase in auto injury claim costs. According to a study from the Insurance Research Council (IRC), hospitals have shifted their costs toward automobile insurance companies due to low reimbursements from public health insurance programs such as Medicare and Medicaid. From IRC estimates, liability claims for Bodily Injury (BI) have resulted in an estimated excess of $1.2 billion in hospital charges (?). This increase in claims costs has resulted in higher scrutiny of hospital bills to negotiate them prior to payment among automobile insurers. To determine excess costs, the IRC used data from more than 42,000 auto injury claims, which involved twenty-two insurers. These insurers represented 58 percent of the private passenger auto insurance market in the United States in After analyzing the data, the IRC developed a statistical model of average hospital charges for auto injury claims in the 38 states that participated in the study. The basis for comparison were the claims from Maryland. In the 1970s, Maryland began regulating hospital reimbursement rates, minimizing the potential for hospitals to shift their costs to auto insurers. In all cases, the average hospital charges in Maryland were lower than other states. The study also found that key predictors of high hospital charges included the percentage of the state s population without health insurance and the percentage of the population covered by Medicaid. The shift in cost burden from public insurance programs to private payers like automobile insurance companies poses an interesting question about the future relationship between payers and hospitals. 11

20 CHAPTER 2. LITERATURE REVIEW Insurance fraud is also a possibility when car accidents occur. As seen in the research, over $1 billion of additional costs are now incurred by auto insurance companies. It is unclear if these additional costs are solely a shift in costs from public insurers or if additional charges are also being made. Currently, detection is difficult. However, preliminary research such as the IRC study helps to uncover possibilities in cost manipulation and the excess burdens on private insurers. Among all states, New Jersey in particular is ranked first for the highest average expenditures for automobile insurance. In 2010, the average cost per person per year was $1, (?). This estimate assumed that all insured vehicles have liability insurance, but not necessarily collision or comprehensive coverage. Though this value shows the amount that consumers pay, the burden of coverage on insurance companies is much larger. The average auto liability claim for BI is $14,653 and the average PIP claim as of 2012 is similar at $14,207 (??). 2.3 Rate Regulatory Reforms in Automobile Insurance Markets This study investigates several states including New Jersey that introduced insurance rate regulation reforms to determine their impact on insurance markets. These reforms reduced the amount of rate regulation by decreasing government oversight. Because automobile insurance markets experience a fair amount of price and product competition, these markets were expected to continue functioning "efficiently and fairly" without regulation (?). The study led to "positive developments" in the automobile insurance market without increasing insurance prices or reducing availability and quality of service. 12

21 CHAPTER 2. LITERATURE REVIEW Figure 2.1: Growth in Premiums in NJ as Presented in IRC Report?? shows the average growth rate of premiums before and after reform in New Jersey compared to the National and Mid-Atlantic rates. It is evident that premium expenditures were on the rise. However, the rate decreased post-reform without sacrificing quality of service. This study shows that the auto insurance market is taking strides in the right direction to minimize cost burdens on drivers. Combining reforms and monitoring of health care provider costs can help to improve the inefficiencies of the market. The study demonstrates that further regulation of the automobile insurance market is not necessary because of competitive environment. However, it does not consider the limitations of the market s relationship with hospitals and health care providers that do not experience such competition. Since the cost of auto insurance premiums are linked to medical expenses, further investigation is necessary to see how health care charges impact costs. This thesis makes strides to address this concern. 13

22 Chapter 3 Data Source 3.1 Healthcare Cost and Utilization Project The data source is from the Healthcare Cost and Utilization Project (HCUP), which includes the largest collection of national and state-specific longitudinal hospital care data in the United States. HCUP is developed through a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality (AHRQ). Particularly of interest is the data associated with emergency department visits in New Jersey, which is included in two databases: State Emergency Department Database (SEDD) and State Inpatient Database (SID). The SEDD captures discharge information for all emergency department visits that do not result in admission into the hospital. These cases only include treat-and-release, or outpatient, visits. To obtain a comprehensive understanding of all visits associated with MVA, the SID is used for records of patients who were admitted to the hospital after being treated in the emergency department. SID patients are, therefore, inpatients. Community and non-community hospitals are included in both databases. Community hospitals represent nonfederal, short-term, general, and other specialty hospitals. They do not include hospital units of institutions. Examples of community hospitals include academic medical centers and specialty hospitals such as obstetrics, orthopedic, and pediatric hospitals. Non-community hos- 14

23 CHAPTER 3. DATA SOURCE pitals include Federal hospitals (ex. Veterans Affairs, Department of Defense), long-term hospitals, treatment facilities, and hospital units within institutions such as prisons (?). All diagnoses in the United States are coded using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). In HCUP, a Clinical Classifications Software (CSS) is used to categorize the ICD-9-CM codes. In order to determine services performed on patients, the Current Procedural Terminology (CPT) code is used. CPT codes are determined by the American Medical Association and describe the medical, surgical, and diagnostic services performed by a medical practitioner. These codes are used by insurers to determine the amount of reimbursement. The use of CPT codes provide a uniform method for analysis. According to a statistical brief released from AHRQ, the most common injuries and procedures associated with MVA throughout the United States in 2006 were investigated. Most frequent injuries include sprains and contusions, which contributed to 78.2 percent of total injuries, as seen in?? (?). Figure 3.1: Most Common Injuries in MVA-Related ED Visits, 2006 The brief also lists the most popular procedures in the emergency room for motor vehicle-related injuries in 2006, which include primarily diagnostic procedures to evaluate the cause of injury, shown in??. 15

24 CHAPTER 3. DATA SOURCE Figure 3.2: Top 10 Procedures in MVA-Related ED Visits, 2006 While these lists show an overview of all MVA occurring in the United States, this thesis focuses on data for the state of New Jersey on the most recently available data in Similar analysis determining the most common injuries and procedures are found. Comparisons between injuries caused by motor vehicle accidents and other factors are also considered. Injury causes that are particularly relevant include: injury from falling and injury from being struck. These two causes result in emergency room visits from injuries most similar to those involved in motor vehicle accidents. Data is separated depending on treat-and-release (outpatients) and admitted (inpatients), who are covered under both databases Data Analysis Tools Data was provided in ASCII format on a CD. To analyze the large set of data, SAS was used to initially load and sort the data. Once this was done, the data was converted to be used in another statistical software, R. In R, the data was manipulated to narrow down important elements relevant in the study and perform analyses. Testing was performed with New Jersey data from a combination of SEDD and SID for the 2011 year. 16

25 CHAPTER 3. DATA SOURCE SEDD The State Emergency Department Database includes all outpatients that visit the emergency room and are released after treatment. The database contains all patients, regardless of payer and includes three different files: a core file, charge file, and diagnosis file. These files are used in combination to extract different information about patients. The core file contains 2,994,439 entries and 393 data elements. It includes the majority of data pertaining to each patient uniquely identified by a key. Basic information about patients such as their age, sex, hospital location, and procedures performed are provided on a high level. The charges file includes every service performed during the 2,994,493 patient visits: a total of 22,349,613 charges. This file includes line item, detailed information about each service along with revenue centers associated with them. Prices billed for these services are also available. These charges are linked to the core patient file using the key. The diagnosis file includes information about diagnoses and injuries associated with patients SID The State Inpatient Database includes all emergency room visits that result in an admission to the hospital. For New Jersey, there are again three relevant files pertaining to the data: a core file, charge file, and diagnosis file. Though inpatient visits account for the majority of revenues in hospitals, there are significantly less inpatient records compared to that of outpatients in New Jersey. The core file contains 1,069,663 patient records and 428 elements. Because these patients have longer hospital stays, the number of charges they accumulate are quite large. There are 18,786,614 charges associated with these visits, nearly the same number of charges as the SEDD with less than half the number of patient discharges Data Dictionary The data dictionary is extensive for both databases but show commonality in the elements per patient. Some data elements include: specific demographic information about the patient, line item 17

State of Colorado. Auto Insurance/Trauma System Study. Final Report. February 18, 2008. Prepared for

State of Colorado. Auto Insurance/Trauma System Study. Final Report. February 18, 2008. Prepared for Final Report February 18, 2008 Auto Insurance/Trauma System Study State of Colorado Prepared for Office of the Governor of Colorado 136 State Capitol Denver, CO 80203-1792 Prepared by BBC Research & Consulting

More information

CHAPTER 2 THE RELATIONSHIP BETWEEN NO-FAULT INSURANCE AND DRIVER BEHAVIOR

CHAPTER 2 THE RELATIONSHIP BETWEEN NO-FAULT INSURANCE AND DRIVER BEHAVIOR -5- CHAPTER 2 THE RELATIONSHIP BETWEEN NO-FAULT INSURANCE AND DRIVER BEHAVIOR Under a traditional tort system, at-fault drivers are liable for the economic and noneconomic damages they inflict on third

More information

THE TOP 10 QUESTIONS YOU SHOULD ASK YOUR CAR ACCIDENT LAWYER

THE TOP 10 QUESTIONS YOU SHOULD ASK YOUR CAR ACCIDENT LAWYER THE TOP 10 QUESTIONS YOU SHOULD ASK YOUR CAR ACCIDENT LAWYER? Introduction After six straight years of decline, the National Highway Traffic Administration (NHTSA) reports that auto accidents, injuries

More information

AUTOMOBILE INSURANCE: THE MINNESOTA NO-FAULT AUTOMOBILE INSURANCE LAW

AUTOMOBILE INSURANCE: THE MINNESOTA NO-FAULT AUTOMOBILE INSURANCE LAW This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp.~l' ''''d:.,j i.;'~\;

More information

WHERE TO GET MORE INFORMATION AND HELP

WHERE TO GET MORE INFORMATION AND HELP WHERE TO GET MORE INFORMATION AND HELP This Buyer's Guide is intended to provide general information to help you make coverage choices. It is not a substitute for the policy language, which governs. Additional

More information

NEW JERSEY AUTO SUPPLEMENT

NEW JERSEY AUTO SUPPLEMENT AGENCY AGENCY CUSTOMER ID: NEW JERSEY AUTO SUPPLEMENT NAMED INSURED(S) POLICY NUMBER EFFECTIVE DATE CARRIER NAIC CODE NEW JERSEY AUTO INSURANCE BUYER'S GUIDE New Jersey Department of Banking and Insurance

More information

TRADITIONPLUS HOSPITAL PROGRAM

TRADITIONPLUS HOSPITAL PROGRAM PO Box 1407, Church Street Station New York, NY 10008-1407 TRADITIONPLUS HOSPITAL PROGRAM PAID-IN-FULL COVERAGE 365 DAYS A YEAR For people who want real value in a hospital program, Empire BlueCross BlueShield

More information

HCUP Methods Series HCUP External Cause of Injury (E Code) Evaluation Report (2001 HCUP Data) Report # 2004-06

HCUP Methods Series HCUP External Cause of Injury (E Code) Evaluation Report (2001 HCUP Data) Report # 2004-06 HCUP Methods Series Contact Information: Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality 540 Gaither Road Rockville, MD 20850 http://www.hcup-us.ahrq.gov For Technical

More information

NO-FAULT INSURANCE IN OTHER STATES

NO-FAULT INSURANCE IN OTHER STATES 79172 Prepared by the North Dakota Legislative Council staff for the Transportation Committee November 2005 NO-FAULT INSURANCE IN OTHER STATES Saskatchewan has had no-fault insurance since 1946 and Puerto

More information

NEW JERSEY AUTO INSURANCE BUYER S GUIDE *C00179480010000001* PL-50074 (03-12) Page 1 of 9 000001/00000 S1347I03 7668 07/23/12

NEW JERSEY AUTO INSURANCE BUYER S GUIDE *C00179480010000001* PL-50074 (03-12) Page 1 of 9 000001/00000 S1347I03 7668 07/23/12 NEW JERSEY AUTO INSURANCE BUYER S GUIDE *C00179480010000001* 000001/00000 S1347I03 7668 07/23/12 PL-50074 (03-12) Page 1 of 9 WHAT S INSIDE WHERE DO I START?... UNDERSTANDING YOUR POLICY... Types of Coverage

More information

COMMERCIAL PPA EDITION

COMMERCIAL PPA EDITION NEW JERSEY AUTO INSURANCE BUYER S GUIDE COMMERCIAL PPA EDITION For Individually Owned Private Passenger Automobiles Written on Commercial Insurance Policies WHAT S INSIDE WHERE DO I START?...PAGE 2 UNDERSTANDING

More information

Changing Tort Reform In Kentucky Christel Siglock. By changing its current No-Fault and Tort law options, Kentucky could; 1) Reduce the

Changing Tort Reform In Kentucky Christel Siglock. By changing its current No-Fault and Tort law options, Kentucky could; 1) Reduce the Changing Tort Reform In Kentucky Christel Siglock By changing its current No-Fault and Tort law options, Kentucky could; 1) Reduce the number of lawsuits filed, 2) Thus reducing insurance company payouts

More information

Analysis of the Costs and Impact of Universal Health Care Coverage Under a Single Payer Model for the State of Vermont

Analysis of the Costs and Impact of Universal Health Care Coverage Under a Single Payer Model for the State of Vermont Analysis of the Costs and Impact of Universal Health Care Coverage Under a Single Payer Model for the State of Vermont Prepared for: The Vermont HRSA State Planning Grant, Office of Vermont Health Access

More information

A Guide for the Utilization of HIRA National Patient Samples. Logyoung Kim, Jee-Ae Kim, Sanghyun Kim. Health Insurance Review and Assessment Service

A Guide for the Utilization of HIRA National Patient Samples. Logyoung Kim, Jee-Ae Kim, Sanghyun Kim. Health Insurance Review and Assessment Service A Guide for the Utilization of HIRA National Patient Samples Logyoung Kim, Jee-Ae Kim, Sanghyun Kim (Health Insurance Review and Assessment Service) Jee-Ae Kim (Corresponding author) Senior Research Fellow

More information

Chapter Objectives. Chapter 13. Property and Liability Insurance. What is risk? How to manage pure risks? What are the fundamental insurance concepts?

Chapter Objectives. Chapter 13. Property and Liability Insurance. What is risk? How to manage pure risks? What are the fundamental insurance concepts? Chapter 13. Property and Liability Insurance Chapter Objectives To understand the foundations of insurance To learn the primary components of the homeowners and auto insurance packages To learn how to

More information

NEW JERSEY AUTO INSURANCE BUYER S GUIDE. Chris Christie Governor. Kim Guadagno Lt. Governor. Commissioner

NEW JERSEY AUTO INSURANCE BUYER S GUIDE. Chris Christie Governor. Kim Guadagno Lt. Governor. Commissioner NEW JERSEY AUTO INSURANCE BUYER S GUIDE Chris Christie Governor Kim Guadagno Lt. Governor Commissioner WHERE DO I START?... 1 UNDERSTANDING YOUR POLICY... 2-6 Types of Coverages Standard and Basic Policies

More information

SYNOPSIS OF HB 03-1321 A BILL FOR AN ACT CONCERNING AUTO INSURANCE

SYNOPSIS OF HB 03-1321 A BILL FOR AN ACT CONCERNING AUTO INSURANCE SYNOPSIS OF HB 03-1321 A BILL FOR AN ACT CONCERNING AUTO INSURANCE HOUSE SPONSORSHIP Wiens, Stafford, Lee, Brophy, Clapp, Coleman, Crane, Lundberg, May M., McCluskey, and Rose SENATE SPONSORSHIP Johnson

More information

D Insurance: City of Detroit Insurance Company Feasibility Study

D Insurance: City of Detroit Insurance Company Feasibility Study D Insurance: City of Detroit Insurance Company Feasibility Study June 8, 2015 Roosevelt C. Mosley, Jr, FCAS, MAAA rmosley@pinnacleactuaries.com 309.807.2330 3109 Cornelius Drive Bloomington, IL 61704 309.807.2300

More information

NEW JERSEY AUTO INSURANCE, BUYER S GUIDE

NEW JERSEY AUTO INSURANCE, BUYER S GUIDE NEW JERSEY AUTO INSURANCE, BUYER S GUIDE BG-NJ (1/14) WHAT'S INSIDE WHEREDOISTART?...1 UNDERSTANDING YOUR POLICY...2 Types of Coverages Standard and Basic Policies What are Limits and Deductibles? UNDERSTANDING

More information

Medical Costs of No-Fault Automobile Insurance

Medical Costs of No-Fault Automobile Insurance Medical Costs of No-Fault Automobile Insurance Jeffrey Guilfoyle, President Nicole Bradshaw, Research Associate Citizens Research Council of Michigan www.crcmich.org Independent Research CRC is a privately

More information

New Jersey AUTO INSURANCE

New Jersey AUTO INSURANCE New Jersey AUTO INSURANCE Buyer s Guide Chris Christie Governor Kim Guadagno Lt. Governor Ken Kobylowski Commissioner NJM Insurance Group offers personal auto insurance in the voluntary market through

More information

NEW JERSEY AUTO INSURANCE

NEW JERSEY AUTO INSURANCE NEW JERSEY AUTO INSURANCE BUYER S GUIDE Chris Christie Governor Kim Guadagno Lt. Governor Richard J. Badolato Acting Commissioner NJM Insurance Group offers personal auto insurance in the voluntary market

More information

NEW JERSEY AUTO INSURANCE BUYER S GUIDE. Jon S. Corzine Governor. Steven M. Goldman Commissioner

NEW JERSEY AUTO INSURANCE BUYER S GUIDE. Jon S. Corzine Governor. Steven M. Goldman Commissioner NEW JERSEY AUTO INSURANCE BUYER S GUIDE Jon S. Corzine Governor Steven M. Goldman Commissioner WHERE DO I START?... 1 UNDERSTANDING YOUR POLICY... 2-6 Types of Coverages Standard and Basic Policies What

More information

NEW JERSEY AUTO INSURANCE BUYER S GUIDE

NEW JERSEY AUTO INSURANCE BUYER S GUIDE NEW JERSEY AUTO INSURANCE BUYER S GUIDE AD9460ARR-0704 American Bankers Insurance Company of Florida American Bankers Insurance Company of Florida 11222 Quail Roost Drive, Miami, FL 33157-6596 NEW JERSEY

More information

NO-FAULT AUTO INSURANCE IN MICHIGAN A Summary of Loss Trends and Estimates of the Benefits of Proposed Reforms

NO-FAULT AUTO INSURANCE IN MICHIGAN A Summary of Loss Trends and Estimates of the Benefits of Proposed Reforms NO-FAULT AUTO INSURANCE IN MICHIGAN A Summary of Loss Trends and Estimates of the Benefits of Proposed Reforms Robert P. Hartwig, Ph.D., CPCU President & Economist Insurance Information Institute James

More information

WORKING P A P E R. Auto Liability in Nevada Compared to Other States. Testimony for Nevada Auto Theft and Insurance Fraud Task Force

WORKING P A P E R. Auto Liability in Nevada Compared to Other States. Testimony for Nevada Auto Theft and Insurance Fraud Task Force WORKING P A P E R Auto Liability in Nevada Compared to Other States Testimony for Nevada Auto Theft and Insurance Fraud Task Force PAUL HEATON, ERIC HELLAND WR-9-NATIFTF July 008 This product is part of

More information

Health Insurance / Learning Targets

Health Insurance / Learning Targets Health Insurance / Learning Targets Compare the basic principles of at least four different health insurance plans Define key terms pertaining to health insurance Health Insurance I have a hospital bill

More information

CHUBB GROUP OF INSURANCE COMPANIES

CHUBB GROUP OF INSURANCE COMPANIES CHUBB GROUP OF INSURANCE COMPANIES Dear Insured, Attached please find an informational letter which is being sent to your treating provider outlining the processes and procedures for Precertification and

More information

Article from: Health Section News. October 2002 Issue No. 44

Article from: Health Section News. October 2002 Issue No. 44 Article from: Health Section News October 2002 Issue No. 44 Outpatient Facility Reimbursement by Brian G. Small Outpatient Charge Levels Today s outpatient care can be every bit as intense and expensive

More information

STATISTICAL BRIEF #23

STATISTICAL BRIEF #23 HEALTHCARE COST AND UTILIZATION PROJECT STATISTICAL BRIEF #23 Agency for Healthcare Research and Quality January 2007 Bariatric Surgery Utilization and Outcomes in 1998 and 2004 Yafu Zhao, M.S. and William

More information

A. CPT Coding System B. CPT Categories, Subcategories, and Headings

A. CPT Coding System B. CPT Categories, Subcategories, and Headings OST 148 MEDICAL CODING, BILLING AND INSURANCE COURSE DESCRIPTION: Prerequisites: None Corequisites: None This course introduces CPT and ICD coding as they apply to medical insurance and billing. Emphasis

More information

Glossary of Frequently Used Billing and Coding Terms

Glossary of Frequently Used Billing and Coding Terms Glossary of Frequently Used Billing and Coding Terms Accountable Care Organization (ACO) Accounts Receivable Reports All Inclusive Fees Allowances and Adjustments Capitation Payments Care Coordination

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES

DEPARTMENT OF HEALTH AND HUMAN SERVICES Minimum Value Calculator Methodology DEPARTMENT OF HEALTH AND HUMAN SERVICES Patient Protection and Affordable Care Act; Minimum Value Calculator Methodology AGENCY: Department of Health and Human Services

More information

Response to the Auto Insurance Working Group s Report

Response to the Auto Insurance Working Group s Report Response to the Auto Insurance Working Group s Report Department of Justice and Attorney General June 2012 Table of Contents Background... 3 Response to Auto Insurance Working Group s Recommendations:

More information

Analysis of National Sales Data of Individual and Family Health Insurance

Analysis of National Sales Data of Individual and Family Health Insurance Analysis of National Sales Data of Individual and Family Health Insurance Implications for Policymakers and the Effectiveness of Health Insurance Tax Credits Vip Patel, Chairman ehealthinsurance June 2001

More information

STATISTICAL BRIEF #93

STATISTICAL BRIEF #93 Agency for Healthcare Medical Expenditure Panel Survey Research and Quality STATISTICAL BRIEF #93 August 2005 Health Care Expenditures for Injury- Related Conditions, 2002 Steven R. Machlin, MS Introduction

More information

University of Mississippi Medical Center. Access Management. Patient Access Specialists II

University of Mississippi Medical Center. Access Management. Patient Access Specialists II Financial Terminology in Access Management University of Mississippi Medical Center Access Management Patient Access Specialists II As a Patient Access Specialist You are the FIRST STAGE in the Revenue

More information

Who will these reforms benefit? Anyone who has auto insurance in Nova Scotia and who has been involved in an automobile accident.

Who will these reforms benefit? Anyone who has auto insurance in Nova Scotia and who has been involved in an automobile accident. Questions and Answers for Consumers Automobile Insurance Reform: Phase 2 General Questions about Phase 2 Reforms Why is the government so interested in reforming auto insurance? Auto insurance had not

More information

Observation Care Evaluation and Management Codes Policy

Observation Care Evaluation and Management Codes Policy Policy Number REIMBURSEMENT POLICY Observation Care Evaluation and Management Codes Policy 2016R0115A Annual Approval Date 3/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT

More information

STATISTICAL BRIEF #8. Conditions Related to Uninsured Hospitalizations, 2003. Highlights. Introduction. Findings. May 2006

STATISTICAL BRIEF #8. Conditions Related to Uninsured Hospitalizations, 2003. Highlights. Introduction. Findings. May 2006 HEALTHCARE COST AND UTILIZATION PROJECT STATISTICAL BRIEF #8 Agency for Healthcare Research and Quality May 2006 Conditions Related to Uninsured Hospitalizations, 2003 Anne Elixhauser, Ph.D. and C. Allison

More information

American Commerce Insurance Company

American Commerce Insurance Company American Commerce Insurance Company INITIAL INFORMATION LETTER TO INSURED/CLAIMANT/PROVIDERS Dear Insured and/or /Eligible Injured Person/Medical Provider: Please read this letter carefully because it

More information

Chapter 11 Auto Insurance in the United States (continued)

Chapter 11 Auto Insurance in the United States (continued) Chapter 11 Auto Insurance in the United States (continued) Overview Compensating innocent motorists who have been injured in auto accidents is an important issue for society. Private insurers are not anxious

More information

Bracing for change Medical professional liability (MPL) insurance costs at a crossroads

Bracing for change Medical professional liability (MPL) insurance costs at a crossroads February 2011 Bracing for change Medical professional liability (MPL) insurance costs at a crossroads At a glance The effects of the healthcare reform law, changing market conditions, emerging societal

More information

Chapter 7 Acute Care Inpatient/Outpatient Hospital Services

Chapter 7 Acute Care Inpatient/Outpatient Hospital Services Chapter 7: Acute Care Inpatient/ Outpatient Hospital Services Executive Summary Description Acute care hospitals are the largest group of enrolled hospital providers. Kansas Medicaid has 144 acute care

More information

KYPHON. Reimbursement Guide. Physician Reimbursement. Balloon Kyphoplasty Procedure. ICD-9-CM Diagnosis Codes. CPT Codes and Payment

KYPHON. Reimbursement Guide. Physician Reimbursement. Balloon Kyphoplasty Procedure. ICD-9-CM Diagnosis Codes. CPT Codes and Payment KYPHON Balloon Kyphoplasty Procedure Reimbursement Guide ICD-9-CM Diagnosis Codes Providers should report the ICD-9-CM diagnosis code that most accurately describes the patient s condition. Please refer

More information

OBSERVATION CARE EVALUATION AND MANAGEMENT CODES

OBSERVATION CARE EVALUATION AND MANAGEMENT CODES REIMBURSEMENT POLICY OBSERVATION CARE EVALUATION AND MANAGEMENT CODES Policy Number: ADMINISTRATIVE 232.8 T0 Effective Date: April, 205 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION...

More information

The Schlitt Law Firm A Consumer Guide to New York No-Fault Auto Insurance

The Schlitt Law Firm A Consumer Guide to New York No-Fault Auto Insurance The Schlitt Law Firm A Consumer Guide to New York No-Fault Auto Insurance The Schlitt Law Firm 79 Wall Street, Huntington, NY 11743 www.schlittlaw.com 631.425.9775 A Consumer Guide An Explanation of New

More information

Medical Reimbursements of America. Get Paid MORE for Accident Claims.

Medical Reimbursements of America. Get Paid MORE for Accident Claims. Medical Reimbursements of America Get Paid MORE for Accident Claims. 1 Now, there s a better way to manage Accident Claims. Accident Claims Management 2 3 Reimbursement Pressure is Accelerating. The Pain

More information

WEEK CHAPTER OBJECTIVES ASSIGNMENTS & TESTS 19-20 6A medical necessity as it ICD-9-CM Coding. relates to reporting diagnosis codes on claims.

WEEK CHAPTER OBJECTIVES ASSIGNMENTS & TESTS 19-20 6A medical necessity as it ICD-9-CM Coding. relates to reporting diagnosis codes on claims. HEALTH INSURANCE & CODING Textbook: Understanding Health Insurance: A Guide to Billing and Reimbursement 11 th edition Website Activities: StudyWARE Online Practice Software linked to the book. SimClam:

More information

Total Cost of Care and Resource Use Frequently Asked Questions (FAQ)

Total Cost of Care and Resource Use Frequently Asked Questions (FAQ) Total Cost of Care and Resource Use Frequently Asked Questions (FAQ) Contact Email: TCOCMeasurement@HealthPartners.com for questions. Contents Attribution Benchmarks Billed vs. Paid Licensing Missing Data

More information

Westchester Medical Center. 2014 Operating Budget

Westchester Medical Center. 2014 Operating Budget Westchester Medical Center 2014 Operating Budget December 4, 2013 WESTCHESTER COUNTY HEALTH CARE CORPORATION Operating Budget 2014 Table of Contents Page Executive Summary 1 Detailed Discussion of Revenue

More information

A Consumer Guide. An Explanation of New York s New York s No-Fault Insurance for Motor Vehicles

A Consumer Guide. An Explanation of New York s New York s No-Fault Insurance for Motor Vehicles 79 Wall Street Huntington, NY 11743 800.660.1466 631.425.9775 718.220.0099 631.415.5004 (fax) A Consumer Guide An Explanation of New York s New York s No-Fault Insurance for Motor Vehicles If you have

More information

Chiropractic Assistants Insurance Verification Training Guide

Chiropractic Assistants Insurance Verification Training Guide Chiropractic Assistants Insurance Verification Training Guide What You Will Learn: How to Obtain Maximum Chiropractic Benefits Tools Needed to Verify Benefits Understanding Why You Are Verifying Understanding

More information

Accident Injuries and Your Car Insurance

Accident Injuries and Your Car Insurance Personal Injury Wrongful Death Slip & Fall Automobile Accidents Trucking Accidents Motorcycle Accidents Medical Malpractice Criminal Defense Accident Injuries and Your Car Insurance Critical Details You

More information

ANALYSIS AS REPORTED FROM COMMITTEE. Senate Bill 288 (Substitute S-3 as reported) Sponsor: Senator Virgil Smith Committee: Insurance

ANALYSIS AS REPORTED FROM COMMITTEE. Senate Bill 288 (Substitute S-3 as reported) Sponsor: Senator Virgil Smith Committee: Insurance LIMITED-BENEFITS NO-FAULT POLICY S.B. 288 (S-3): ANALYSIS AS REPORTED FROM COMMITTEE Senate Bill 288 (Substitute S-3 as reported) Sponsor: Senator Virgil Smith Committee: Insurance Date Completed: 7-20-15

More information

OFFICE OF INSURANCE REGULATION Property and Casualty Product Review

OFFICE OF INSURANCE REGULATION Property and Casualty Product Review OFFICE OF INSURANCE REGULATION Property and Casualty Product Review NOTIFICATION OF PERSONAL INJURY PROTECTION BENEFITS YOUR PERSONAL INJURY PROTECTION RIGHTS AND BENEFITS UNDER THE FLORIDA MOTOR VEHICLE

More information

Glossary. Adults: Individuals ages 19 through 64. Allowed amounts: See prices paid. Allowed costs: See prices paid.

Glossary. Adults: Individuals ages 19 through 64. Allowed amounts: See prices paid. Allowed costs: See prices paid. Glossary Acute inpatient: A subservice category of the inpatient facility clams that have excluded skilled nursing facilities (SNF), hospice, and ungroupable claims. This subcategory was previously known

More information

Cabinet Presentation Personal Injury Protection. August 2011

Cabinet Presentation Personal Injury Protection. August 2011 Cabinet Presentation Personal Injury Protection Tallahassee, Florida August 2011 1 Types of Auto Insurance Systems No Fault 10 States Economic damages from injuries sustained in an auto accident are covered

More information

ACTUARIAL VALUE AND EMPLOYER- SPONSORED INSURANCE

ACTUARIAL VALUE AND EMPLOYER- SPONSORED INSURANCE NOVEMBER 2011 ACTUARIAL VALUE AND EMPLOYER- SPONSORED INSURANCE SUMMARY According to preliminary estimates, the overwhelming majority of employer-sponsored insurance (ESI) plans meets and exceeds an actuarial

More information

CAR ACCIDENT GUIDE TABLE OF CONTENTS

CAR ACCIDENT GUIDE TABLE OF CONTENTS CAR ACCIDENT GUIDE TABLE OF CONTENTS Page Introduction... 1 First Step... 1 Finding and Hiring a Lawyer... 1 Financial Arrangements... 2 Your Claim... 3 Documenting Your Claim... 5 Parties to the Claim...

More information

President Obama Signs the Temporary Payroll Tax Cut Continuation Act of 2011 --New Law Includes Physician Update Fix through February 2012--

President Obama Signs the Temporary Payroll Tax Cut Continuation Act of 2011 --New Law Includes Physician Update Fix through February 2012-- President Obama Signs the Temporary Payroll Tax Cut Continuation Act of 2011 --New Law Includes Physician Update Fix through February 2012-- On Friday, December 23, 2011, President Obama signed into law

More information

Westchester Medical Center. 2015 Operating Budget

Westchester Medical Center. 2015 Operating Budget Westchester Medical Center 2015 Operating Budget December 3, 2014 WESTCHESTER COUNTY HEALTH CARE CORPORATION Operating Budget 2015 Table of Contents Page Executive Summary 1 Detailed Discussion of Revenue

More information

SPECIAL QUESTIONS. August 26, 2014

SPECIAL QUESTIONS. August 26, 2014 August 26, 2014 SPECIAL QUESTIONS Data were collected Aug. 4 7, and 191 Texas business executives responded to the survey. 1. What are your best estimates of the annual percentage change in your firm's

More information

Commonly Used Terms in Auto Accident Cases

Commonly Used Terms in Auto Accident Cases Commonly Used Terms in Auto Accident Cases 117 South Willow Avenue Tampa, Florida 33606 Toll Free: 877-444-2929 Phone: 813-223-2929 Fax: 813-251-6853 Definitions are specific as to Florida Law. Other state

More information

SECTION 4 COSTS FOR INPATIENT HOSPITAL STAYS HIGHLIGHTS

SECTION 4 COSTS FOR INPATIENT HOSPITAL STAYS HIGHLIGHTS SECTION 4 COSTS FOR INPATIENT HOSPITAL STAYS EXHIBIT 4.1 Cost by Principal Diagnosis... 44 EXHIBIT 4.2 Cost Factors Accounting for Growth by Principal Diagnosis... 47 EXHIBIT 4.3 Cost by Age... 49 EXHIBIT

More information

OFFICE OF INSURANCE REGULATION Property and Casualty Product Review

OFFICE OF INSURANCE REGULATION Property and Casualty Product Review OFFICE OF INSURANCE REGULATION Property and Casualty Product Review NOTIFICATION OF PERSONAL INJURY PROTECTION BENEFITS YOUR PERSONAL INJURY PROTECTION RIGHTS AND BENEFITS UNDER THE FLORIDA MOTOR VEHICLE

More information

Use and Integration of Freely Available U.S. Public Use Files to Answer Pharmacoeconomic Questions: Deciphering the Alphabet Soup

Use and Integration of Freely Available U.S. Public Use Files to Answer Pharmacoeconomic Questions: Deciphering the Alphabet Soup Use and Integration of Freely Available U.S. Public Use Files to Answer Pharmacoeconomic Questions: Deciphering the Alphabet Soup Prepared by Ovation Research Group for the National Library of Medicine

More information

EDUCATION AND EXAMINATION COMMITTEE SOCIETY OF ACTUARIES RISK AND INSURANCE. Copyright 2005 by the Society of Actuaries

EDUCATION AND EXAMINATION COMMITTEE SOCIETY OF ACTUARIES RISK AND INSURANCE. Copyright 2005 by the Society of Actuaries EDUCATION AND EXAMINATION COMMITTEE OF THE SOCIET OF ACTUARIES RISK AND INSURANCE by Judy Feldman Anderson, FSA and Robert L. Brown, FSA Copyright 25 by the Society of Actuaries The Education and Examination

More information

PRAETORIAN INSURANCE COMPANY PERSONAL INJURY PROTECTION IMPORTANT NOTICE TO POLICYHOLDERS MEDICAL PROTOCOLS

PRAETORIAN INSURANCE COMPANY PERSONAL INJURY PROTECTION IMPORTANT NOTICE TO POLICYHOLDERS MEDICAL PROTOCOLS PRAETORIAN INSURANCE COMPANY PERSONAL INJURY PROTECTION IMPORTANT NOTICE TO POLICYHOLDERS MEDICAL PROTOCOLS DECISION POINT REVIEW: Pursuant to N.J.A.C. 11:3-4, the New Jersey Department of Banking and

More information

Life & Health Insurance Advisor

Life & Health Insurance Advisor Life & Health Insurance Advisor MRCT Benefits Plus is a comprehensive employee benefits, wellness and Human Resources consulting firm offering a variety of financial services to businesses and individuals

More information

Comparison of the Prospective Payment System Methodologies Currently Utilized in the United States

Comparison of the Prospective Payment System Methodologies Currently Utilized in the United States Comparison of the Prospective Payment System Methodologies Currently Utilized in the United States 1 Can you speak the jargon of Prospective Payment Systems? MS- DRGs APCs IPF-PPS RBRVS HHRGs RUGs MS-LTC

More information

H. The Study Design. William S. Cash and Abigail J. Moss National Center for Health Statistics

H. The Study Design. William S. Cash and Abigail J. Moss National Center for Health Statistics METHODOLOGY STUDY FOR DETERMINING THE OPTIMUM RECALL PERIOD FOR THE REPORTING OF MOTOR VEHICLE ACCIDENTAL INJURIES William S. Cash and Abigail J. Moss National Center for Health Statistics I. Introduction

More information

A CONSUMER'S GUIDE TO AUTOMOBILE INSURANCE IN MARYLAND 1. Peter J. Basile, Shareholder Ferguson, Schetelich & Ballew, P.A.

A CONSUMER'S GUIDE TO AUTOMOBILE INSURANCE IN MARYLAND 1. Peter J. Basile, Shareholder Ferguson, Schetelich & Ballew, P.A. A CONSUMER'S GUIDE TO AUTOMOBILE INSURANCE IN MARYLAND 1 Introduction Peter J. Basile, Shareholder Ferguson, Schetelich & Ballew, P.A. 2011 We represent many clients who have been involved in car accidents,

More information

North Carolina Institute for Early Childhood Professional Development HEALTH INSURANCE: INFORMATION AND TIPS FOR CHILD CARE EMPLOYEES AND EMPLOYERS

North Carolina Institute for Early Childhood Professional Development HEALTH INSURANCE: INFORMATION AND TIPS FOR CHILD CARE EMPLOYEES AND EMPLOYERS North Carolina Institute for Early Childhood Professional Development HEALTH INSURANCE: INFORMATION AND TIPS FOR CHILD CARE EMPLOYEES AND EMPLOYERS Often times in the early care and education field we

More information

FIS-PUB 0077 (6/13) Number of copies printed: 10,000 / Legal authorization to print: PA 145 of 1979 / Printed on recycled paper

FIS-PUB 0077 (6/13) Number of copies printed: 10,000 / Legal authorization to print: PA 145 of 1979 / Printed on recycled paper DIFS is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities. FIS-PUB 0077 (6/13) Number of copies

More information

SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE INSURANCE COVERAGE

SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE INSURANCE COVERAGE SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE INSURANCE COVERAGE 11:3-29.1 Purpose and scope (a) This subchapter implements the provisions

More information

Payor Perspectives on Provider Realignment and ACOs

Payor Perspectives on Provider Realignment and ACOs Payor Perspectives on Provider Realignment and ACOs Joel L. Michaels March 15, 2011 Overview Issues to be addressed Medicare Shared Savings Program overview ACO organization options Health care reform

More information

ARE YOU DRIVING ON THIN ICE : FULL COVERAGE MIGHT NOT BE WHAT YOU THINK IT IS

ARE YOU DRIVING ON THIN ICE : FULL COVERAGE MIGHT NOT BE WHAT YOU THINK IT IS ARE YOU DRIVING ON THIN ICE : FULL COVERAGE MIGHT NOT BE WHAT YOU THINK IT IS By: Jay R. Vaughn, Esq. Schachter, Hendy & Johnson, P.S.C. (859) 578-4444 jvaughn@pschachter.com My practice focuses on personal

More information

Concerning the Cap on Pain and Suffering Awards for Minor Injuries

Concerning the Cap on Pain and Suffering Awards for Minor Injuries Discussion Paper Concerning the Cap on Pain and Suffering Awards for Minor Injuries Office of the Superintendent of Insurance January, 2010 Introduction The Province of Nova Scotia regulates automobile

More information

EXPECTED SOURCE OF PAYMENT Section 97265

EXPECTED SOURCE OF PAYMENT Section 97265 EXPECTED SOURCE OF PAYMENT Section 97265 The patient s expected source of payment, defined as the type of entity or organization which is expected to pay or did pay the greatest share of the patient s

More information

FULL ANALYSIS I. SUBSTANTIVE ANALYSIS

FULL ANALYSIS I. SUBSTANTIVE ANALYSIS HOUSE OF REPRESENTATIVES STAFF ANALYSIS BILL #: CS/CS/HB 659 Automobile Insurance SPONSOR(S): Regulatory Affairs Committee; Insurance & Banking Subcommittee; Santiago TIED BILLS: IDEN./SIM. BILLS: CS/CS/SB

More information

PCI SPECIAL REPORT Oct. 27, 2011

PCI SPECIAL REPORT Oct. 27, 2011 PCI SPECIAL REPORT Oct. 27, 2011 Florida s Automobile No Fault Insurance: A System Under Siege by Fraud and Abuse Executive Summary Over the last several years, pervasive fraud in Florida s no fault auto

More information

UNITED SERVICES AUTOMOBILE ASSOCIATION NEW JERSEY AUTO INSURANCE BUYER'S GUIDE

UNITED SERVICES AUTOMOBILE ASSOCIATION NEW JERSEY AUTO INSURANCE BUYER'S GUIDE UNITED SERVICES AUTOMOBILE ASSOCIATION NEW JERSEY AUTO INSURANCE BUYER'S GUIDE New Jersey Department of Banking and Insurance 999NJ(31) Rev. 6-04 Page 1 of 10 WHAT'S INSIDE WHERE DO I START? PAGE 2 UNDERSTANDING

More information

a consumers guide to No-Fault Automobile Insurance in Michigan

a consumers guide to No-Fault Automobile Insurance in Michigan a consumers guide to No-Fault Automobile Insurance in Michigan No-Fault Automobile Insurance in Michigan The Michigan no-fault system was adopted in 1973 to increase the level of benefits paid to injured

More information

The Factors Fueling Rising Healthcare Costs 2006

The Factors Fueling Rising Healthcare Costs 2006 The Factors Fueling Rising Healthcare Costs 2006 Prepared for America s Health Insurance Plans, January 2006 2006 America s Health Insurance Plans Table of Contents Executive Summary........................................2

More information

Chapter 10 Section 5

Chapter 10 Section 5 Claims Adjustments And Recoupments Chapter 10 Section 5 1.0 GOVERNMENT S RIGHT TO RECOVER MEDICAL COSTS The following statutes provide the basic authority for the recovery of medical costs incurred as

More information

I want a health care plan with all the options.

I want a health care plan with all the options. I want a health care plan with all the options. PERSONAL BLUEPLANS SE These are my plans. Personal BluePlans SM SE PLAN FEATURES Personal Blue BluePlans SE let you build the plan that works for you. The

More information

United States Fire Insurance Company: International Technological University Coverage Period: beginning on or after 9/7/2014

United States Fire Insurance Company: International Technological University Coverage Period: beginning on or after 9/7/2014 or after 9/7/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Plan Type: PPO This is only a summary. If you want more detail about your coverage and

More information

Stopping the Flow of Health Care Fraud with Technology, Data and Analytics

Stopping the Flow of Health Care Fraud with Technology, Data and Analytics White Paper and New Ways to Fight It Stopping the Flow of Health Care Fraud with Technology, Data and Analytics January 2014 Health care costs are rising and everyone is being affected, including patients,

More information

Energy and Commerce Committee Subcommittee on Health Hearing on Examining ICD-10 Implementation February 11, 2015

Energy and Commerce Committee Subcommittee on Health Hearing on Examining ICD-10 Implementation February 11, 2015 3 Energy and Commerce Committee Subcommittee on Health Hearing on Examining ICD-10 Implementation February 11, 2015 Written Statement of Richard F Averill, M.S. Director of Public Policy, 3M Health Information

More information

Florida No-Fault Auto Insurance: A Historical Primer

Florida No-Fault Auto Insurance: A Historical Primer Florida No-Fault Auto Insurance: A Historical Primer Auto Insurance Fraud Strike Force Board Meeting Tallahassee, FL January 24, 2013 Lynne McChristian, Florida Representative Insurance Information Institute

More information

HOUSE DOCKET, NO. 2366 FILED ON: 1/20/2011. HOUSE... No. 2035. The Commonwealth of Massachusetts PRESENTED BY: Garrett J. Bradley

HOUSE DOCKET, NO. 2366 FILED ON: 1/20/2011. HOUSE... No. 2035. The Commonwealth of Massachusetts PRESENTED BY: Garrett J. Bradley HOUSE DOCKET, NO. 2366 FILED ON: 1/20/2011 HOUSE............... No. 2035 The Commonwealth of Massachusetts PRESENTED BY: Garrett J. Bradley To the Honorable Senate and House of Representatives of the Commonwealth

More information

Unified Health One. Guaranteed Issue and Instant Fulfillment

Unified Health One. Guaranteed Issue and Instant Fulfillment Unified Health One Limited Benefit Health Insurance Plans For Individuals and Families 00% Guaranteed Coverage for Individuals and Families Who Cannot Afford or Qualify for Full Comprehensive Medical Plans

More information

B-11-3. Response: Page 1 of 1

B-11-3. Response: Page 1 of 1 Information Request No..1 RR BCCA.BI.1.a-b Dated 04 May 16 March Insurance Corporation of British Columbia B-11-3.1 RR BCCA.BI.1.a-b Reference: Page 5-2, paragraph 6, the first bullet point refers to "An

More information

The Florida Senate POTENTIAL IMPACT OF MANDATING BODILY INJURY LIABILITY INSURANCE FOR MOTOR VEHICLES. Interim Project Summary 98-03 November 1998

The Florida Senate POTENTIAL IMPACT OF MANDATING BODILY INJURY LIABILITY INSURANCE FOR MOTOR VEHICLES. Interim Project Summary 98-03 November 1998 The Florida Senate Interim Project Summary 98-03 November 1998 Committee on Banking and Insurance Senator Mario Diaz-Balart, Chairman POTENTIAL IMPACT OF MANDATING BODILY INJURY LIABILITY INSURANCE FOR

More information

Research. Dental Services: Use, Expenses, and Sources of Payment, 1996-2000

Research. Dental Services: Use, Expenses, and Sources of Payment, 1996-2000 yyyyyyyyy yyyyyyyyy yyyyyyyyy yyyyyyyyy Dental Services: Use, Expenses, and Sources of Payment, 1996-2000 yyyyyyyyy yyyyyyyyy Research yyyyyyyyy yyyyyyyyy #20 Findings yyyyyyyyy yyyyyyyyy U.S. Department

More information

Statistical Modeling and Analysis of Stop- Loss Insurance for Use in NAIC Model Act

Statistical Modeling and Analysis of Stop- Loss Insurance for Use in NAIC Model Act Statistical Modeling and Analysis of Stop- Loss Insurance for Use in NAIC Model Act Prepared for: National Association of Insurance Commissioners Prepared by: Milliman, Inc. James T. O Connor FSA, MAAA

More information

Health Care Utilization and Costs of Full-Pay and Subsidized Enrollees in the Florida KidCare Program: MediKids

Health Care Utilization and Costs of Full-Pay and Subsidized Enrollees in the Florida KidCare Program: MediKids Health Care Utilization and Costs of Full-Pay and Subsidized Enrollees in the Florida KidCare Program: MediKids Prepared for the Florida Healthy Kids Corporation Prepared by Jill Boylston Herndon, Ph.D.

More information