WorldWideScience

Sample records for reimbursement claims hints

  1. HEALTH INFO SANTÉ – REMINDER ANNUAL DEDUCTIBLE AND REIMBURSEMENT CLAIMS HINTS FOR USE

    CERN Multimedia

    CHIS Board

    2000-01-01

    Information from the CHIS Board and the Human Resources Division:Annual deductible and reimbursement claims: hints for useOne should bear in mind that the annual deductible is an amount (currently CHF 100) charged automatically by the Administrator of the scheme for every adult aged 18 and above. This is what happens: The amount is deducted annually for all medical services received over a calendar year.It is triggered by the date of the treatment and neither by the date of the bill nor that of the reimbursement claim.In other words, if you receive medical treatment in December for the first time in a given year, the CHF 100 will be deducted from the claim for that treatment. So, except for urgent cases, it would be better to wait till the following month, thus avoiding one annual deductible.It is also worth remembering that the cost of processing our reimbursement claims - and there were 54, 000 in 1999 - is part of the cost of our insurance.Help keep administrative costs down: do not submit reimbursement cl...

  2. HEALTH INFO SANTE ANNUAL DEDUCTIBLE AND REIMBURSEMENT CLAIMS: HINTS FOR USE

    CERN Multimedia

    1999-01-01

    Information from the CHIS Board and the Personnel DivisionOne should bear in mind that the annual deductible is an amount (currently CHF 100) charged automatically by the Administrator of the scheme for every adult aged 18 and above. This is what happens: The amount is deducted annually for all medical services received over a calendar year.It is triggered by the date of the treatment and not by the date of the bill nor that of the reimbursement claim.In other words, if you receive medical treatment in December for the first time in a given year, the CHF 100 will be deducted from the claim for that treatment. So, except for urgent cases, it would be better to wait till the following month, thus avoiding one annual deductible.It is also worth remembering that the cost of processing our reimbursement claims - and there were 55, 000 in 1998 - is part of the cost of our insurance.Help keep administrative costs down : do not submit reimbursement claims for amounts less than the annual deductible unless your claims...

  3. CLAIMS FOR REIMBURSEMENT OF EDUCATION FEES

    CERN Multimedia

    Personnel Division

    1999-01-01

    REMINDERYou are reminded that, in accordance with Article R A 8.07 of the Staff Regulations 'the relevant bills shall be grouped so that not more than three claims in respect of each child are submitted in an academic year'.For this purpose:the academic year is defined as the period going from 1st September to 31st August, only paid bills can be subject to reimbursement, a claim for reimbursement of education fees may only include bills for expenses incurred during a given academic year for a given child, bills for one child may be grouped on a claim by periods of term, semester or academic year, the months of July and August should be included in the third term, or the second semester, or the academic year, for each dependent child, a maximum of 3 claims can be submitted for the reimbursement of expenses incurred during one academic year, therefore, any bill submitted for reimbursement after the third claim will not be reimbursed.Please make sure that you have received and paid all bills, including those for...

  4. 44 CFR 295.31 - Reimbursement of claim expenses.

    Science.gov (United States)

    2010-10-01

    ... § 295.31 Reimbursement of claim expenses. (a) FEMA will reimburse Claimants for the reasonable costs they incur in copying documentation requested by OCGFC. FEMA will also reimburse Claimants for the... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement of claim...

  5. 10 CFR 765.21 - Procedures for processing reimbursement claims.

    Science.gov (United States)

    2010-01-01

    ... Department shall complete a final review of all relevant information prior to making a reimbursement decision... 10 Energy 4 2010-01-01 2010-01-01 false Procedures for processing reimbursement claims. 765.21... AND THORIUM PROCESSING SITES Procedures for Submitting and Processing Reimbursement Claims § 765.21...

  6. Proof of payment for all reimbursement claims

    CERN Multimedia

    HR Department

    2006-01-01

    Members of the personnel are kindly requested to note that only documents proving that a payment has been made are accepted as proof of payment for any claims for reimbursement, including specifically the reimbursement of education fees. In particular, the following will be accepted as proof of payment: bank or post office bank statements indicating the name of the institution to which the payment was made; photocopies of cheques made out to the institution to which the payments were made together with bank statements showing the numbers of the relevant cheques; proof of payment in the form of discharged payment slips; invoices with acknowledgement of settlement, receipts, bank statements detailing operations crediting another account or similar documents. As a result, the following documents in particular will no longer be accepted as proof of payment: photocopies of cheques that are not submitted together with bank or post office bank statements showing the numbers of the relevant cheques; details of ...

  7. Rates, Amounts, and Determinants of Ambulatory Blood Pressure Monitoring Claim Reimbursements Among Medicare Beneficiaries

    Science.gov (United States)

    Kent, Shia T.; Shimbo, Daichi; Huang, Lei; Diaz, Keith M.; Viera, Anthony J.; Kilgore, Meredith; Oparil, Suzanne; Muntner, Paul

    2014-01-01

    Ambulatory blood pressure monitoring (ABPM) can be used to identify white coat hypertension and guide hypertensive treatment. We determined the percentage of ABPM claims submitted between 2007–2010 that were reimbursed. Among 1,970 Medicare beneficiaries with submitted claims, ABPM was reimbursed for 93.8% of claims that had an ICD-9 diagnosis code of 796.2 (“elevated blood pressure reading without diagnosis of hypertension”) versus 28.5% of claims without this code. Among claims without an ICD-9 diagnosis code of 796.2 listed, those for the component (e.g., recording, scanning analysis, physician review, reporting) versus full ABPM procedures and performed by institutional versus non-institutional providers were each more than two times as likely to be successfully reimbursed. Of the claims reimbursed, the median payment was $52.01 (25–75th percentiles: $32.95–$64.98). In conclusion, educating providers on the ABPM claims reimbursement process and evaluation of Medicare reimbursement may increase the appropriate use of ABPM and improve patient care. PMID:25492833

  8. REMINDER : deadline for submission of reimbursements claims to UNIQA

    CERN Multimedia

    HR Department

    2011-01-01

    We would like to remind you of the resolution which took effect from 1 June 2010 changing the deadline for submitting a claim from 24 months to 12 months from the invoice date (as opposed to from the time of treatment). As a transitional measure, it is still possible to submit invoices issued prior to 1 June 2010 as long as they do not date back to more than two years (from the invoice date) at the time of submission. The deadline for transitional claims is 31 May 2011. You are advised to check any outstanding submissions that you have since, as from 1 June 2011, no transitional claims will be accepted.  

  9. 41 CFR 301-11.621 - Must I file a claim to be reimbursed for the additional income taxes incurred?

    Science.gov (United States)

    2010-07-01

    ... be reimbursed for the additional income taxes incurred? 301-11.621 Section 301-11.621 Public... ALLOWABLE TRAVEL EXPENSES 11-PER DIEM EXPENSES Income Tax Reimbursement Allowance (ITRA), Tax Years 1995 and Thereafter Employee Responsibilities § 301-11.621 Must I file a claim to be reimbursed for the additional...

  10. 41 CFR 301-11.521 - Must I file a claim to be reimbursed for the additional income taxes incurred?

    Science.gov (United States)

    2010-07-01

    ... be reimbursed for the additional income taxes incurred? 301-11.521 Section 301-11.521 Public... ALLOWABLE TRAVEL EXPENSES 11-PER DIEM EXPENSES Income Tax Reimbursement Allowance (ITRA), Tax Years 1993 and 1994 Employee Responsibilities § 301-11.521 Must I file a claim to be reimbursed for the additional...

  11. 41 CFR 301-52.17 - Within how many calendar days after I submit a proper travel claim must my agency reimburse my...

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Within how many calendar days after I submit a proper travel claim must my agency reimburse my allowable expenses? 301-52.17... REIMBURSEMENT 52-CLAIMING REIMBURSEMENT § 301-52.17 Within how many calendar days after I submit a proper travel...

  12. 41 CFR 301-71.204 - Within how many calendar days after the submission of a proper travel claim must we reimburse the...

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Within how many calendar days after the submission of a proper travel claim must we reimburse the employee's allowable expenses... REQUIREMENTS Travel Claims for Reimbursement § 301-71.204 Within how many calendar days after the submission of...

  13. Sequential Pattern Mining of Electronic Healthcare Reimbursement Claims: Experiences and Challenges in Uncovering How Patients are Treated by Physicians

    Energy Technology Data Exchange (ETDEWEB)

    Pullum, Laura L [ORNL; Ramanathan, Arvind [ORNL; Hobson, Tanner C [ORNL

    2015-01-01

    We examine the use of electronic healthcare reimbursement claims (EHRC) for analyzing healthcare delivery and practice patterns across the United States (US). We show that EHRCs are correlated with disease incidence estimates published by the Centers for Disease Control. Further, by analyzing over 1 billion EHRCs, we track patterns of clinical procedures administered to patients with autism spectrum disorder (ASD), heart disease (HD) and breast cancer (BC) using sequential pattern mining algorithms. Our analyses reveal that in contrast to treating HD and BC, clinical procedures for ASD diagnoses are highly varied leading up to and after the ASD diagnoses. The discovered clinical procedure sequences also reveal significant differences in the overall costs incurred across different parts of the US, indicating a lack of consensus amongst practitioners in treating ASD patients. We show that a data-driven approach to understand clinical trajectories using EHRC can provide quantitative insights into how to better manage and treat patients. Based on our experience, we also discuss emerging challenges in using EHRC datasets for gaining insights into the state of contemporary healthcare delivery and practice in the US.

  14. 44 CFR 208.52 - Reimbursement procedures.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement procedures. 208... Reimbursement Claims and Appeals § 208.52 Reimbursement procedures. (a) General. A Sponsoring Agency must present a claim for reimbursement to DHS in such manner as the Assistant Administrator specifies . (b...

  15. 23 CFR 140.505 - Reimbursable costs.

    Science.gov (United States)

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Reimbursable costs. 140.505 Section 140.505 Highways... Administrative Settlement Costs-Contract Claims § 140.505 Reimbursable costs. (a) Federal funds may participate in administrative settlement costs which are: (1) Incurred after notice of claim, (2) Properly...

  16. 77 FR 3460 - Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    Science.gov (United States)

    2012-01-24

    ... available funding, the approved claim amounts will be reimbursed on a prorated basis. All reimbursements are...., statutory increases in the reimbursement ceilings). Title X requires DOE to reimburse eligible uranium and... DEPARTMENT OF ENERGY Reimbursement for Costs of Remedial Action at Active Uranium and Thorium...

  17. 7 CFR 215.8 - Reimbursement payments.

    Science.gov (United States)

    2010-01-01

    ... reimbursement for each half-pint (236 ml.) of milk served to children exceed the cost of the milk to the school or child care institution. (2) The rate of reimbursement for milk purchased and served free to needy... shall be the average cost of milk, i.e., the total cost of all milk purchased during the claim period...

  18. HINTS Puerto Rico: Final Report

    Science.gov (United States)

    This final report describes HINTS implementation in Puerto Rico. The report addresses sampling; staffing, training and management of data collection; calling protocol; findings from the CATI Operations, and sample weights.

  19. 47 CFR 27.1166 - Reimbursement under the Cost-Sharing Plan.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Reimbursement under the Cost-Sharing Plan. 27... § 27.1166 Reimbursement under the Cost-Sharing Plan. (a) Registration of reimbursement rights. Claims for reimbursement under the cost-sharing plan are limited to relocation expenses incurred on or after...

  20. Active Learning Using Hint Information.

    Science.gov (United States)

    Li, Chun-Liang; Ferng, Chun-Sung; Lin, Hsuan-Tien

    2015-08-01

    The abundance of real-world data and limited labeling budget calls for active learning, an important learning paradigm for reducing human labeling efforts. Many recently developed active learning algorithms consider both uncertainty and representativeness when making querying decisions. However, exploiting representativeness with uncertainty concurrently usually requires tackling sophisticated and challenging learning tasks, such as clustering. In this letter, we propose a new active learning framework, called hinted sampling, which takes both uncertainty and representativeness into account in a simpler way. We design a novel active learning algorithm within the hinted sampling framework with an extended support vector machine. Experimental results validate that the novel active learning algorithm can result in a better and more stable performance than that achieved by state-of-the-art algorithms. We also show that the hinted sampling framework allows improving another active learning algorithm designed from the transductive support vector machine.

  1. 32 CFR 842.95 - Non-assertable claims.

    Science.gov (United States)

    2010-07-01

    ... ADMINISTRATIVE CLAIMS Property Damage Tort Claims in Favor of the United States (31 U.S.C. 3701, 3711-3719) § 842...) Reimbursement for military or civilian employees for their negligence claims paid by the United States. (b) Loss...

  2. Equity in Medicaid Reimbursement for Otolaryngologists.

    Science.gov (United States)

    Conduff, Joseph H; Coelho, Daniel H

    2017-12-01

    Objective To study state Medicaid reimbursement rates for inpatient and outpatient otolaryngology services and to compare with federal Medicare benchmarks. Study Design State and federal database query. Setting Not applicable. Methods Based on Medicare claims data, 26 of the most common Current Procedural Terminology codes reimbursed to otolaryngologists were selected and the payments recorded. These were further divided into outpatient and operative services. Medicaid payment schemes were queried for the same services in 49 states and Washington, DC. The difference in Medicaid and Medicare payment in dollars and percentage was determined and the reimbursement per relative value unit calculated. Medicaid reimbursement differences (by dollar amount and by percentage) were qualified as a shortfall or excess as compared with the Medicare benchmark. Results Marked differences in Medicaid and Medicare reimbursement exist for all services provided by otolaryngologists, most commonly as a substantial shortfall. The Medicaid shortfall varied in amount among states, and great variability in reimbursement exists within and between operative and outpatient services. Operative services were more likely than outpatient services to have a greater Medicaid shortfall. Shortfalls and excesses were not consistent among procedures or states. Conclusions The variation in Medicaid payment models reflects marked differences in the value of the same work provided by otolaryngologists-in many cases, far less than federal benchmarks. These results question the fairness of the Medicaid reimbursement scheme in otolaryngology, with potential serious implications on access to care for this underserved patient population.

  3. Complexity hints for economic policy

    CERN Document Server

    Salzano, Massimo

    2007-01-01

    This volume extends the complexity approach to economics. This complexity approach is not a completely new way of doing economics, and that it is a replacement for existing economics, but rather the integration of some new analytic and computational techniques into economists’ bag of tools. It provides some alternative pattern generators, which can supplement existing approaches by providing an alternative way of finding patterns than be obtained by the traditional scientific approach. On this new kind of policy hints can be obtained. The reason why the complexity approach is taking hold now in economics is because the computing technology has advanced. This advance allows consideration of analytical systems that could not previously be considered by economists. Consideration of these systems suggested that the results of the "control-based" models might not extend easily to more complicated systems, and that we now have a method—piggybacking computer assisted analysis onto analytic methods—to start gen...

  4. Enhancing the Automatic Generation of Hints with Expert Seeding

    Science.gov (United States)

    Stamper, John; Barnes, Tiffany; Croy, Marvin

    2011-01-01

    The Hint Factory is an implementation of our novel method to automatically generate hints using past student data for a logic tutor. One disadvantage of the Hint Factory is the time needed to gather enough data on new problems in order to provide hints. In this paper we describe the use of expert sample solutions to "seed" the hint generation…

  5. 20 CFR 61.102 - Disposition of reimbursement requests.

    Science.gov (United States)

    2010-04-01

    ... STATES CLAIMS FOR COMPENSATION UNDER THE WAR HAZARDS COMPENSATION ACT, AS AMENDED Reimbursement of...' Compensation to the disallowance or reduction of a claim within 60 days of the Office's decision. A carrier outside the United States has six months within which to file objections with the Associate Director. The...

  6. Financial model calibration using consistency hints.

    Science.gov (United States)

    Abu-Mostafa, Y S

    2001-01-01

    We introduce a technique for forcing the calibration of a financial model to produce valid parameters. The technique is based on learning from hints. It converts simple curve fitting into genuine calibration, where broad conclusions can be inferred from parameter values. The technique augments the error function of curve fitting with consistency hint error functions based on the Kullback-Leibler distance. We introduce an efficient EM-type optimization algorithm tailored to this technique. We also introduce other consistency hints, and balance their weights using canonical errors. We calibrate the correlated multifactor Vasicek model of interest rates, and apply it successfully to Japanese Yen swaps market and US dollar yield market.

  7. 41 CFR 301-52.7 - When must I submit my travel claim?

    Science.gov (United States)

    2010-07-01

    ... travel claim? 301-52.7 Section 301-52.7 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES ARRANGING FOR TRAVEL SERVICES, PAYING TRAVEL EXPENSES, AND CLAIMING REIMBURSEMENT 52-CLAIMING REIMBURSEMENT § 301-52.7 When must I submit my travel...

  8. 41 CFR 301-71.207 - What internal policies and procedures must we establish for travel reimbursement?

    Science.gov (United States)

    2010-07-01

    ... AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY REQUIREMENTS Travel Claims for Reimbursement... should submit a travel claim (including whether to use a standard form or an agency form and whether the... and procedures must we establish for travel reimbursement? 301-71.207 Section 301-71.207 Public...

  9. Astrophysical hints of axion-like particles

    Science.gov (United States)

    Roncadelli, M.; Galanti, G.; Tavecchio, F.; Bonnoli, G.

    2015-01-01

    After reviewing three astrophysical hints of the existence of axion-like particles (ALPs), we describe in more detail a new similar hint involving flat spectrum radio quasars (FSRQs). Detection of FSRQs above about 20GeV pose a challenge to very-high-energy (VHE) astrophysics, because at those energies the ultraviolet emission from their broad line region should prevent photons produced by the central engine to leave the source. Although a few astrophysical explanations have been put forward, they are totally ad hoc. We show that a natural explanation instead arises within the conventional models of FSRQs provided that photon-ALP oscillations occur inside the source. Our analysis takes the FSRQ PKR 1222+206 as an example, and it looks tantalizing that basically the same choice of the free model parameters adopted in this case is consistent with those that provide the other three hints of the existence of ALPs.

  10. Reimbursement of school fees

    CERN Multimedia

    2003-01-01

    Members of the personnel are reminded that only school fees from educational establishments recognized by local legislation are reimbursed by the Organization. Human Resources Division Tel. 72862/74474

  11. CLAIMS FOR REINBURSEMENT OF EDUCATION FEES

    CERN Multimedia

    PE-ADS

    1999-01-01

    You are reminded that, in accordance with Article R A 8.07 of the Staff Regulations 'the relevant bills shall be grouped so that not more than three claims in respect of each child are submitted in an academic year'.For this purpose:-\tthe academic year is defined as the period going from 1st September to 31st August,-\tonly paid bills can be subject to reimbursement,-\ta claim for reimbursement of education fees may only include bills for expenses incurred during a given academic year for a given child,-\tbills for one child may be grouped on a claim by periods of term, semester or academic year,-\tthe months of July and August should be included in the third term, or the second semester, or the academic year,-\tfor each dependent child, a maximum of 3 claims can be submitted for the reimbursement of expenses incurred during one academic year, therefore, any bill submitted for reimbursement after the third claim will not be reimbursed.Please make sure that you have receive...

  12. Eating Hints: Before, During, and After Cancer Treatment

    Science.gov (United States)

    ... Publications Reports Eating Hints: Before, during, and after Cancer Treatment Eating Hints is for people who are having or are about to have cancer treatment. Family and friends may also want to read ...

  13. Reimbursement of school fees

    CERN Multimedia

    2003-01-01

    In order to answer regular enquiries on this subject, members of the personnel are reminded that only school fees from educational establishments recognized as such by the competent authorities of the Member State concerned are reimbursed by the Organization. Human Resources Division Tel. 72862/74474

  14. 41 CFR 301-71.205 - Under what circumstances may we disallow a claim for an expense?

    Science.gov (United States)

    2010-07-01

    ... Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY REQUIREMENTS Travel Claims for Reimbursement § 301-71.205 Under what...

  15. 41 CFR 301-52.19 - Will I receive a late payment fee if my agency fails to reimburse me within 30 calendar days...

    Science.gov (United States)

    2010-07-01

    ... payment fee if my agency fails to reimburse me within 30 calendar days after I submit a proper travel claim? 301-52.19 Section 301-52.19 Public Contracts and Property Management Federal Travel Regulation... fails to reimburse me within 30 calendar days after I submit a proper travel claim? Yes, your agency...

  16. Hants Hint - kõigi ihaldatud kaalukeel / Hants Hint ; interv. Erik Gamzejev

    Index Scriptorium Estoniae

    Hint, Hants

    2002-01-01

    Ilmunud ka: Severnoje Poberezhje : Laupäev 26. okt. lk. 3. Res Publica Ida-Viru piirkonna juht Hants Hint: me oleme põhimõtteliselt valmis kõigi poliitiliste jõududega koostööd tegema. Autor: Res Publica

  17. 45 CFR 34.5 - Unallowable claims.

    Science.gov (United States)

    2010-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS FILED UNDER THE MILITARY... as jewelry, cameras, watches, and binoculars when they are shipped with household goods by a moving... exercise due care in protecting his or her property. (10) Sales Tax. Reimbursements for the payment of...

  18. Experimental hint for gravitational CP violation

    Energy Technology Data Exchange (ETDEWEB)

    Gharibyan, Vahagn [Deutsches Elektronen-Synchrotron, Hamburg (Germany). MDI Group

    2016-01-15

    An equality of particle and antiparticle gravitational interactions holds in general relativity and is supported by indirect observations. Gravity dependence on rotation or spin direction is experimentally constrained only at low energies. Here a method based on high energy Compton scattering is developed to measure the gravitational interaction of accelerated charged particles. Within that formalism the Compton spectra measured at HERA rule out the positron's anti-gravity and hint for a gravitational CP violation around 13 GeV energies, at a maximal level of 1.3±0.2% for the charge and 0.68±0.09% for the space parity. A stronger gravitational coupling to left helicity electrons relative to right helicity positrons is detected.

  19. Experimental hint for gravitational CP violation

    International Nuclear Information System (INIS)

    Gharibyan, Vahagn

    2016-01-01

    An equality of particle and antiparticle gravitational interactions holds in general relativity and is supported by indirect observations. Gravity dependence on rotation or spin direction is experimentally constrained only at low energies. Here a method based on high energy Compton scattering is developed to measure the gravitational interaction of accelerated charged particles. Within that formalism the Compton spectra measured at HERA rule out the positron's anti-gravity and hint for a gravitational CP violation around 13 GeV energies, at a maximal level of 1.3±0.2% for the charge and 0.68±0.09% for the space parity. A stronger gravitational coupling to left helicity electrons relative to right helicity positrons is detected.

  20. Increased anxiety-related behaviour in Hint1 knockout mice.

    Science.gov (United States)

    Varadarajulu, Jeeva; Lebar, Maria; Krishnamoorthy, Gurumoorthy; Habelt, Sonja; Lu, Jia; Bernard Weinstein, I; Li, Haiyang; Holsboer, Florian; Turck, Christoph W; Touma, Chadi

    2011-07-07

    Several reports have implicated a role for the histidine triad nucleotide-binding protein-1 (Hint1) in psychiatric disorders. We have studied the emotional behaviour of male Hint1 knockout (Hint1 KO) mice in a battery of tests and performed biochemical analyses on brain tissue. The behavioural analysis revealed that Hint1 KO mice exhibit an increased emotionality phenotype compared to wildtype (WT) mice, while no significant differences in locomotion or general exploratory activity were noted. In the elevated plus-maze (EPM) test, the Hint1 KO animals entered the open arms of the apparatus less often than WT littermates. Similarly, in the dark-light box test, Hint1 KO mice spent less time in the lit compartment and the number of entries were reduced, which further confirmed an increased anxiety-related behaviour. Moreover, the Hint1 KO animals showed significantly more struggling and less floating behaviour in the forced swim test (FST), indicating an increased emotional arousal in aversive situations. Hint1 is known as a protein kinase C (PKC) interacting protein. Western blot analysis showed that PKCγ expression was elevated in Hint1 KO compared to WT mice. Interestingly, PKCγ mRNA levels of the two groups did not show a significant difference, implying a post-transcriptional PKCγ regulation. In addition, PKC enzymatic activity was increased in Hint1 KO compared to WT mice. In summary, our results indicate a role for Hint1 and PKCγ in modulating anxiety-related and stress-coping behaviour in mice. Copyright © 2011 Elsevier B.V. All rights reserved.

  1. 41 CFR 301-71.200 - Who must review and sign travel claims?

    Science.gov (United States)

    2010-07-01

    ... travel claims? 301-71.200 Section 301-71.200 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY REQUIREMENTS Travel Claims for Reimbursement § 301-71.200 Who must review and sign travel claims...

  2. Relating illness complexity to reimbursement in CKD patients.

    Science.gov (United States)

    Bessette, Russell W; Carter, Randy L

    2011-01-01

    Despite significant investments of federal and state dollars to transition patient medical records to an all-electronic system, a chasm still exists between health care quality and payment for it. A major reason for this gap is the difficulty in evaluating health care outcomes based on claims data. Since both payers and patients may not appreciate how illness complexity impacts treatment outcomes, it is difficult to determine fair provider compensation. Chronic kidney disease (CKD) typifies these problems and is often associated with comorbidities that impact cost, health, and work productivity. Thus, the objective of this study was to evaluate an illness complexity score (ICS) based on a linear regression of select blood values that might assist in predicting average monthly reimbursements in CKD patients. A second objective was to compare the results of this ICS prediction to results obtained by prediction of average monthly reimbursement using CKD stage. A third objective was to analyze the relationship between the change in ICS, estimated glomerular filtration rate (eGFR), and CKD stage over time to average monthly reimbursement. We calculated parsimonious values for select variables associated with CKD patients and compared the ICS to ordinal staging of renal disease. Data from 177 de-identified patients over 13 months was collected, which included 15 blood chemistry observations along with complete claims data for all medical expenses. To test for the relationship between average blood chemistry values, stages of CKD, age, and average monthly reimbursement, we modeled an association through a linear regression function of age, eGFR, and the Z-scores calculated from average monthly values of phosphorus, parathyroid hormone, glucose, hemoglobin, bicarbonate, albumin, creatinine, blood urea nitrogen, potassium, calcium, sodium, alkaline phosphatase, alanine aminotransferase, and white blood cells. The results of our study demonstrated that the association

  3. Equal work for unequal pay: the gender reimbursement gap for healthcare providers in the United States.

    Science.gov (United States)

    Desai, Tejas; Ali, Sadeem; Fang, Xiangming; Thompson, Wanda; Jawa, Pankaj; Vachharajani, Tushar

    2016-10-01

    Gender disparities in income continue to exist, and many studies have quantified the gap between male and female workers. These studies paint an incomplete picture of gender income disparity because of their reliance on notoriously inaccurate or incomplete surveys. We quantified gender reimbursement disparity between female and male healthcare providers using objective, non-self-reported data and attempted to adjust the disparity against commonly held beliefs as to why it exists. We analysed over three million publicly available Medicare reimbursement claims for calendar year 2012 and compared the reimbursements received by male and female healthcare providers in 13 medical specialties. We adjusted these reimbursement totals against how hard providers worked, how productive each provider was, and their level of experience. We calculated a reimbursement differential between male and female providers by primary medical specialty. The overall adjusted reimbursement differential against female providers was -US$18 677.23 (95% CI -US$19 301.94 to -US$18 052.53). All 13 specialties displayed a negative reimbursement differential against female providers. Only two specialties had reimbursement differentials that were not statistically significant. After adjustment for how hard a physician works, his/her years of experience and his/her productivity, female healthcare providers are still reimbursed less than male providers. Using objective, non-survey data will provide a more accurate understanding of this reimbursement inequity and perhaps lead the medical profession (as a whole) towards a solution that can reverse this decades-old injustice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. How is intensive care reimbursed?

    DEFF Research Database (Denmark)

    Bittner, Martin-Immanuel; Donnelly, Maria; van Zanten, Arthur Rh

    2013-01-01

    Reimbursement schemes in intensive care are more complex than in other areas of healthcare, due to special procedures and high care needs. Knowledge regarding the principles of functioning in other countries can lead to increased understanding and awareness of potential for improvement. This can...... be achieved through mutual exchange of solutions found in other countries. In this review, experts from eight European countries explain their respective intensive care unit reimbursement schemes. Important conclusions include the apparent differences in the countries' reimbursement schemes---despite all...... of them originating from a DRG system, the high degree of complexity found, and the difficulties faced in several countries when collecting the data for this collaborative work. This review has been designed to help the intensivist clinician and researcher to understanding neighbouring countries...

  5. 78 FR 51061 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

    Science.gov (United States)

    2013-08-20

    ... DEPARTMENT OF DEFENSE 32 CFR Part 199 [DoD-2010-HA-0072] RIN 0720-AB41 TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access Hospitals; Correction... TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access...

  6. Characteristics of otolaryngology claims to Medicare in 2012.

    Science.gov (United States)

    Bhattacharyya, Neil; Lin, Harrison W

    2014-11-01

    The Medicare provider utilization and payment public use datafile for 2012 was analyzed with respect to otolaryngology specialty providers to characterize otolaryngology services billed to and reimbursed by Medicare, both overall and according to provider characteristics. Among 8450 otolaryngology specialty providers submitting claims, the top 5 billed services were (count in millions): 99213 (2.23), 95165 (1.81), 99203 (0.92), 99214 (0.83), and 69210 (0.71), and the top 5 total reimbursed services were (aggregate total reimbursements in millions): 99213 ($114), 99203 ($68), 99214 ($63), 31231 ($60), and 31575 ($47). There was a mean of 1567 services billed per provider with an average (yearly) total reimbursement from Medicare of $76,068 per provider. These data characterize the current level of provision of otolaryngology services to the Medicare population. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2014.

  7. 14 CFR 1214.803 - Reimbursement policy.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Reimbursement policy. 1214.803 Section 1214... Spacelab Services § 1214.803 Reimbursement policy. (a) Reimbursement basis. (1) This policy is established...) Standard flight price. During this phase, customers covered by subpart 1214.1 or subpart 1214.2 shall...

  8. 23 CFR 140.807 - Reimbursable costs.

    Science.gov (United States)

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Reimbursable costs. 140.807 Section 140.807 Highways... Highway Agency Audit Expense § 140.807 Reimbursable costs. (a) Federal funds may be used to reimburse an SHA for the following types of project related audit costs: (1) Salaries, wages, and related costs...

  9. 47 CFR 27.1239 - Reimbursement obligation.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Reimbursement obligation. 27.1239 Section 27... Policies Governing the Transition of the 2500-2690 Mhz Band for Brs and Ebs § 27.1239 Reimbursement obligation. (a) A proponent may request reimbursement from BRS licensees and lessees, EBS lessees, and...

  10. 44 CFR 352.28 - Reimbursement.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement. 352.28 Section... Participation § 352.28 Reimbursement. In accordance with Executive Order 12657, Section 6(d), and to the extent permitted by law, FEMA will coordinate full reimbursement, either jointly or severally, to the agencies...

  11. 50 CFR 37.46 - Cost reimbursement.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Cost reimbursement. 37.46 Section 37.46... NATIONAL WILDLIFE REFUGE, ALASKA General Administration § 37.46 Cost reimbursement. (a) Each applicant for or holder of a special use permit issued under this part shall reimburse the Department for its...

  12. Reimbursement for critical care services in India

    Science.gov (United States)

    Jayaram, Raja; Ramakrishnan, Nagarajan

    2013-01-01

    There are significant variations in critical care practices, costs, and reimbursements in various countries. Of note, there is a paucity of reliable information on remuneration and reimbursement models for intensivists in India. This review article aims to analyze the existing reimbursement models in United States and United Kingdom and propose a frame-work model that may be applicable in India. PMID:23833469

  13. Stratified Medicine and Reimbursement Issues

    Directory of Open Access Journals (Sweden)

    Hans-Joerg eFugel

    2012-10-01

    Full Text Available Stratified Medicine (SM has the potential to target patient populations who will most benefit from a therapy while reducing unnecessary health interventions associated with side effects. The link between clinical biomarkers/diagnostics and therapies provides new opportunities for value creation to strengthen the value proposition to pricing and reimbursement (P&R authorities. However, the introduction of SM challenges current reimbursement schemes in many EU countries and the US as different P&R policies have been adopted for drugs and diagnostics. Also, there is a lack of a consistent process for value assessment of more complex diagnostics in these markets. New, innovative approaches and more flexible P&R systems are needed to reflect the added value of diagnostic tests and to stimulate investments in new technologies. Yet, the framework for access of diagnostic–based therapies still requires further development while setting the right incentives and appropriate align stakeholders interests when realizing long- term patient benefits. This article addresses the reimbursement challenges of SM approaches in several EU countries and the US outlining some options to overcome existing reimbursement barriers for stratified medicine.

  14. An analytical model of the HINT performance metric

    Energy Technology Data Exchange (ETDEWEB)

    Snell, Q.O.; Gustafson, J.L. [Scalable Computing Lab., Ames, IA (United States)

    1996-10-01

    The HINT benchmark was developed to provide a broad-spectrum metric for computers and to measure performance over the full range of memory sizes and time scales. We have extended our understanding of why HINT performance curves look the way they do and can now predict the curves using an analytical model based on simple hardware specifications as input parameters. Conversely, by fitting the experimental curves with the analytical model, hardware specifications such as memory performance can be inferred to provide insight into the nature of a given computer system.

  15. ClaimAssociationService

    Data.gov (United States)

    Department of Veterans Affairs — Retrieves and updates a veteranÆs claim status and claim-rating association (claim association for current rating) from the Corporate database for a claim selected...

  16. Trends in laboratory test volumes for Medicare Part B reimbursements, 2000-2010.

    Science.gov (United States)

    Shahangian, Shahram; Alspach, Todd D; Astles, J Rex; Yesupriya, Ajay; Dettwyler, William K

    2014-02-01

    Changes in reimbursements for clinical laboratory testing may help us assess the effect of various variables, such as testing recommendations, market forces, changes in testing technology, and changes in clinical or laboratory practices, and provide information that can influence health care and public health policy decisions. To date, however, there has been no report, to our knowledge, of longitudinal trends in national laboratory test use. To evaluate Medicare Part B-reimbursed volumes of selected laboratory tests per 10,000 enrollees from 2000 through 2010. Laboratory test reimbursement volumes per 10,000 enrollees in Medicare Part B were obtained from the Centers for Medicare & Medicaid Services (Baltimore, Maryland). The ratio of the most recent (2010) reimbursed test volume per 10,000 Medicare enrollees, divided by the oldest data (usually 2000) during this decade, called the volume ratio, was used to measure trends in test reimbursement. Laboratory tests with a reimbursement claim frequency of at least 10 per 10,000 Medicare enrollees in 2010 were selected, provided there was more than a 50% change in test reimbursement volume during the 2000-2010 decade. We combined the reimbursed test volumes for the few tests that were listed under more than one code in the Current Procedural Terminology (American Medical Association, Chicago, Illinois). A 2-sided Poisson regression, adjusted for potential overdispersion, was used to determine P values for the trend; trends were considered significant at P reimbursement volumes were electrolytes, digoxin, carbamazepine, phenytoin, and lithium, with volume ratios ranging from 0.27 to 0.64 (P reimbursement volumes were meprobamate, opiates, methadone, phencyclidine, amphetamines, cocaine, and vitamin D, with volume ratios ranging from 83 to 1510 (P reimbursement volumes increased for most of the selected tests, other tests exhibited statistically significant downward trends in annual reimbursement volumes. The observed

  17. Claiming Community

    DEFF Research Database (Denmark)

    Jensen, Steffen Bo

    As its point of departure this working paper takes the multitude of different uses and meanings of the concept of community in local politics in Cape Town. Instead of attempting to define it in substantive terms, the paper takes a social constructivist approach to the study of community...... is termed community work. First, the paper explores how community has become a governmental strategy, employed by the apartheid regime as well, although in different ways, as post-apartheid local government. Secondly, the paper explores the ways in which community becomes the means in which local residents...... lay claim on the state, as well as how it enters into local power struggles between different political groups within the township. In the third part, the paper explores how the meanings of community and the struggles to realise it have changed as South Africa, nationally and locally, has become...

  18. New physics hints in B decays and collider outlook

    Indian Academy of Sciences (India)

    There are currently two hints for new physics involving CP violation in → transitions: ≡ - / ≠ 0, and difference in direct CP asymmetry Δ A K π ≡ A K + π 0 − A K + π ≠ 0 . We explore the two scenarious with a large and unique new CP phase in ← tansitions. Motivated by ≠ 0, we update on the ...

  19. Gaze-based hints during child-robot gameplay

    NARCIS (Netherlands)

    Mwangi, E.; Barakova, Emilia I.; Diaz, M.L.Z.; Mallofre, A.C.; Rauterberg, G.W.M.; Kheddar, A.; Yoshida, E.; Sam Ge, S.; Suzuki, K.; Cabibihan, J.J.; Eyssel, F.; He, H.

    2017-01-01

    This paper presents a study that examines whether gaze hints provided by a robot tutor influences the behavior of children in a card matching game. In this regard, we conducted a within-subjects experiment, in which children played a card game “Memory” in the presence of a robot tutor in two

  20. Observational Hints of a Pre--Inflationary Scale?

    CERN Document Server

    Gruppuso, A.

    2015-09-28

    We argue that the lack of power exhibited by cosmic microwave background (CMB) anisotropies at large angular scales might be linked to the onset of inflation. We highlight observational features and theoretical hints that support this view, and present a preliminary estimate of the physical scale that would underlie the phenomenon.

  1. 41 CFR 301-71.203 - Who is responsible for the validity of the travel claim?

    Science.gov (United States)

    2010-07-01

    ... the validity of the travel claim? 301-71.203 Section 301-71.203 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY REQUIREMENTS Travel Claims for Reimbursement § 301-71.203 Who is responsible...

  2. 41 CFR 301-71.206 - What must we do if we disallow a travel claim?

    Science.gov (United States)

    2010-07-01

    ... disallow a travel claim? 301-71.206 Section 301-71.206 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY REQUIREMENTS Travel Claims for Reimbursement § 301-71.206 What must we do if we disallow a travel...

  3. Drivers of Medicare Reimbursement for Thoracolumbar Fusion: An Analysis of Data From The Centers For Medicare and Medicaid Services.

    Science.gov (United States)

    Khanna, Krishn; Padegimas, Eric M; Zmistowski, Benjamin; Howley, Michael; Verma, Kushagra

    2017-11-01

    A retrospective observational study. The purpose of this study is to examine the variation in thoracolumbar fusion (TLF) payment and determine the drivers of this variation. As health care spending continues to increase, variation in surgical procedures reimbursements has come under more scrutiny. TLF is an example of a high-cost, proven-benefit procedure that is often the focus of Centers for Medicare and Medicaid Services (CMS) administrators. There is a wide variation in TLF charges, but the drivers for this variation are not clear. Claims for TLF were identified in the CMS data by analyzing Diagnosis Related Group (DRG) number 460 ("Spinal Fusion Except Cervical without Major Complications or Comorbidities"). Data on factors that may impact cost of care were collected from four sources: the United States Census Bureau, CMS, the Dartmouth Atlas, and WWAMI Rural Health Research Center. These were then grouped into seven categories: quality, supply, demand, substitute treatment availability, patient characteristics, competitive factors, and provider characteristics. Predictive reimbursement models were created from the data using multivariate linear regression to understand the factors that influence TLF reimbursement. There was significant geographic variability in reimbursement. The largest contribution to reimbursement variation came from variables in the demand (ΔR = 13.4%, P reimbursement were provider charges (β = 0.37, P reimbursement in the region (β = 0.19, P reimbursement. There was wide variation in reimbursement for TLF across the U.S. The variables that drive TLF reimbursement variation include supply, demand, and competition. Interestingly, quality of care was not associated with increased TLF reimbursement. N/A.

  4. Covering and Reimbursing Telehealth Services.

    Science.gov (United States)

    Blackman, Kate

    2016-01-01

    Policymakers who are striving to achieve better health care, improved health outcomes and lower costs are considering new strategies and technologies. Telehealth is a tool that uses technology to provide health services remotely, and state leaders are looking to it now more than ever as a way to address workforce gaps and reach underserved patients. Among the challenges facing state lawmakers who are working to introduce or expand telehealth is how to handle covering patients and reimbursing providers.

  5. Relating illness complexity to reimbursement in CKD patients

    Directory of Open Access Journals (Sweden)

    Bessette RW

    2011-09-01

    Full Text Available Russell W Bessette1, Randy L Carter2,3 1Department of Health Sciences, Institute for Healthcare Informatics, 2Department of Biostatistics, 3Population Health Observatory, University at Buffalo, State University of New York, Buffalo, NY, USA Background: Despite significant investments of federal and state dollars to transition patient medical records to an all-electronic system, a chasm still exists between health care quality and payment for it. A major reason for this gap is the difficulty in evaluating health care outcomes based on claims data. Since both payers and patients may not appreciate how illness complexity impacts treatment outcomes, it is difficult to determine fair provider compensation. Objectives: Chronic kidney disease (CKD typifies these problems and is often associated with comorbidities that impact cost, health, and work productivity. Thus, the objective of this study was to evaluate an illness complexity score (ICS based on a linear regression of select blood values that might assist in predicting average monthly reimbursements in CKD patients. A second objective was to compare the results of this ICS prediction to results obtained by prediction of average monthly reimbursement using CKD stage. A third objective was to analyze the relationship between the change in ICS, estimated glomerular filtration rate (eGFR, and CKD stage over time to average monthly reimbursement. Methods: We calculated parsimonious values for select variables associated with CKD patients and compared the ICS to ordinal staging of renal disease. Data from 177 de-identified patients over 13 months was collected, which included 15 blood chemistry observations along with complete claims data for all medical expenses. To test for the relationship between average blood chemistry values, stages of CKD, age, and average monthly reimbursement, we modeled an association through a linear regression function of age, eGFR, and the Z-scores calculated from average

  6. A two-Higgs-doublet model facing experimental hints

    Directory of Open Access Journals (Sweden)

    Crivellin Andreas

    2016-01-01

    Full Text Available Physics beyond the Standard Model has so far eluded our experimental probes. Nevertheless, a number of interesting anomalies have accumulated that can be taken as hints towards new physics: BaBar, Belle, and LHCb have found deviations of approximately 3:8σ in B → Dτν and B → D*τν; the anomalous magnetic moment of the muon differs by about 3σ from the theoretic prediction; the branching ratio for τ → μνν is about 2σ above the Standard Model expectation; and CMS and ATLAS found hints for a non-zero decay rate of h → μτ at 2.6σ. Here we consider these processes within a lepton-specific two-Higgs doublet model with additional non-standard Yukawa couplings and show how (and which of these excesses can be accommodated.

  7. HINT computation of LHD equilibrium with zero rotational transform surface

    International Nuclear Information System (INIS)

    Kanno, Ryutaro; Toi, Kazuo; Watanabe, Kiyomasa; Hayashi, Takaya; Miura, Hideaki; Nakajima, Noriyoshi; Okamoto Masao

    2004-01-01

    A Large Helical Device equilibrium having a zero rotational transform surface is studied by using the three dimensional MHD equilibrium code, HINT. We find existence of the equilibrium but with formation of the two or three n=0 islands composing a homoclinic-type structure near the center, where n is a toroidal mode number. The LHD equilibrium maintains the structure, when the equilibrium beta increases. (author)

  8. Hospitals push back against reimbursement cuts due to Two-Midnight rule.

    Science.gov (United States)

    2016-04-01

    The American Hospital Association (AHA) and other hospitals are suing CMS, challenging the 0.2% cut in Medicare reimbursement that CMS instituted to compensate for the financial effect of the Two-Midnight rule. CMS' actuaries reported that inpatient claims are likely to increase under the rule, resulting in $220 million additional reimbursement for hospitals. Hospitals disagree and a study commissioned by the AHA concluded that the CMS study was based on data not available to the public and that data from the Medicare Provider and Analysis Review (MedPAR) would lead to a different conclusion. The AHA suit asks CMS to rescind the cut, restore the base rate for Medicare payments to its previous level, and reimburse hospitals retroactively for the reductions.

  9. Can medicaid reimbursement help give female condoms a second chance in the United States?

    Science.gov (United States)

    Witte, Susan S; Stefano, Kyle; Hawkins, Courtney

    2010-10-01

    The female condom is the only other barrier contraception method besides the male condom, and it is the only "woman-initiated" device for prevention of sexually transmitted infections. Although studies demonstrate high acceptability and effectiveness for this device, overall use in the United States remains low. The female condom has been available through Medicaid in many states since 1994. We provide the first published summary of data on Medicaid reimbursement for the female condom. Our findings demonstrate low rates of claims for female condoms but high rates of reimbursement. In light of the 2009 approval of a new, cheaper female condom and the recent passage of comprehensive health care reform, we call for research examining how health care providers can best promote consumer use of Medicaid reimbursement to obtain this important infection-prevention device.

  10. Equal Pay for Equal Work: Medicare Procedure Volume and Reimbursement for Male and Female Surgeons Performing Total Knee and Total Hip Arthroplasty.

    Science.gov (United States)

    Holliday, Emma B; Brady, Christina; Pipkin, William C; Somerson, Jeremy S

    2018-02-21

    The observed sex gap in physician salary has been the topic of much recent debate in the United States, but it has not been well-described among orthopaedic surgeons. The objective of this study was to evaluate for sex differences in Medicare claim volume and reimbursement among orthopaedic surgeons. The Medicare Provider Utilization and Payment Public Use File was used to compare claim volume and reimbursement between female and male orthopaedic surgeons in 2013. Data were extracted for each billing code per orthopaedic surgeon in the year 2013 for total claims, surgical claims, total knee arthroplasty (TKA) claims, and total hip arthroplasty (THA) claims. A total of 20,546 orthopaedic surgeons who treated traditional Medicare patients were included in the initial analysis. Claim volume and reimbursement received were approximately twofold higher for all claims and more than threefold higher for surgical claims for male surgeons when compared with female surgeons (p 10 TKAs and THAs, respectively, in 2013 for Medicare patients and were included in the subset analyses. Although male surgeons performed a higher mean number of TKAs than female surgeons (mean and standard deviation, 37 ± 33 compared with 26 ± 17, respectively, p men and women for TKA or THA ($1,135 ± $228 compared with $1,137 ± $184 for TKA, respectively, p = 0.380; $1,049 ± $226 compared with $1,043 ± $266 for THA, respectively, p = 0.310). Female surgeons had a lower number of total claims and reimbursements compared with male surgeons. However, among surgeons who performed >10 THAs and TKAs, there were no sex differences in the mean reimbursement payment per surgeon. The number of women in orthopaedics is rising, and there is much interest in how their productivity and compensation compare with their male counterparts.

  11. 41 CFR 301-71.208 - Within how many calendar days after submission of a proper travel claim must we notify the...

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Within how many calendar days after submission of a proper travel claim must we notify the employee of any errors in the claim... REQUIREMENTS Travel Claims for Reimbursement § 301-71.208 Within how many calendar days after submission of a...

  12. 77 FR 22786 - Privately Owned Vehicle Mileage Reimbursement Rates

    Science.gov (United States)

    2012-04-17

    ... Owned Vehicle Mileage Reimbursement Rates AGENCY: Office of Governmentwide Policy (OGP), General... Privately Owned Vehicle Mileage Reimbursement Rates. SUMMARY: The General Services Administration's (GSA) special review of privately owned vehicle (POV) mileage reimbursement rates has resulted in adjusting the...

  13. 78 FR 46502 - Reimbursed Entertainment Expenses

    Science.gov (United States)

    2013-08-01

    ... is a reimbursement of travel expenses for food and beverages that Y pays in performing services as an... entertainment, amusement, recreation, or travel. * * * * * (f) * * * (2) * * * (iv) Reimbursed entertainment, food, or beverage expenses--(A) Introduction. In the case of any expenditure for entertainment...

  14. [Peripheral vertigo versus central vertigo. Application of the HINTS protocol].

    Science.gov (United States)

    Batuecas-Caletrío, Ángel; Yáñez-González, Raquel; Sánchez-Blanco, Carmen; González-Sánchez, Enrique; Benito, José; Gómez, José Carlos; Santa Cruz-Ruiz, Santiago

    2014-10-16

    One of the most important dilemmas concerning vertigo in emergency departments is its differential diagnosis. There are highly sensitive warning signs in the examination that can put us on the path towards finding ourselves before a case of central vertigo. To determine how effective the application of the HINTS protocol is in the diagnosis of cerebrovascular accidents that mimics peripheral vertigo. We conducted a descriptive observation-based study on patients admitted to hospital with a diagnosis of acute vestibular syndrome in the emergency department. All the patients were monitored on a day-to-day basis until their symptoms improved, with information about nystagmus, the oculocephalic manoeuvre and the skew test. The results from the magnetic resonance imaging study were compared with the alteration of any of those three signs during the time the patient was hospitalised. Altogether 91 patients were examined, with a mean age of 55.8 years. A cerebrovascular accident was observed in eight cases. Of these (mean age: 71 years), in seven of them there were alterations in some of the HINTS signs, and in one case the study was normal (sensitivity: 0.88; specificity: 0.96). All of them had some vascular risk factor. Faced with a patient who visits the emergency department with an acute vestibular syndrome, a suitably directed examination is essential to be able to establish the differential diagnosis between peripheral and central pathology, since some cerebrovascular accidents can present with the appearance of acute vertigo. Applying a protocol like HINTS makes it possible to suspect the central pathology with a high degree of sensitivity and specificity.

  15. 41 CFR 301-75.205 - Is the interviewee required to submit a travel claim to us?

    Science.gov (United States)

    2010-07-01

    ... required to submit a travel claim to us? 301-75.205 Section 301-75.205 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 75... reimbursed, then he or she must submit a travel claim in accordance with your agency procedures in order to...

  16. Medicaid provider reimbursement policy for adult immunizations.

    Science.gov (United States)

    Stewart, Alexandra M; Lindley, Megan C; Cox, Marisa A

    2015-10-26

    State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Observational analysis using document review and a survey. Medicaid administrators in 50 states and the District of Columbia. Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. 32 CFR 536.120 - Claims payable as maritime claims.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Claims payable as maritime claims. 536.120... ACCOUNTS CLAIMS AGAINST THE UNITED STATES Maritime Claims § 536.120 Claims payable as maritime claims. A claim is cognizable under this subpart if it arises in or on a maritime location, involves some...

  18. 7 CFR 1205.520 - Procedure for obtaining reimbursement.

    Science.gov (United States)

    2010-01-01

    ... application forms may be filed. In any such case, the reimbursement application shall show the names... Cotton Board shall make reimbursement to the importer. For joint applications, the reimbursement shall be... procedures prescribed in this section. (a) Application form. An importer shall obtain a reimbursement...

  19. 47 CFR 27.1168 - Triggering a Reimbursement Obligation.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Triggering a Reimbursement Obligation. 27.1168... a Reimbursement Obligation. (a) The clearinghouse will apply the following test to determine when an... reimbursement obligation exists, the clearinghouse will calculate the reimbursement amount in accordance with...

  20. 45 CFR 149.300 - General reimbursement rules.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false General reimbursement rules. 149.300 Section 149... REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reimbursement Methods § 149.300 General reimbursement rules. Reimbursement under this program is conditioned on provision of accurate information by the...

  1. 49 CFR 22.27 - Eligible reimbursements to participating lenders.

    Science.gov (United States)

    2010-10-01

    ... reimbursement. Prior written approval from DOT OSDBU is required. Attorney fees will be reimbursed on a pro-rata... 49 Transportation 1 2010-10-01 2010-10-01 false Eligible reimbursements to participating lenders... PROGRAM (STLP) Participating Lenders § 22.27 Eligible reimbursements to participating lenders...

  2. 76 FR 63844 - Federal Travel Regulation (FTR); Lodging Reimbursement

    Science.gov (United States)

    2011-10-14

    ... lodging I select affect my reimbursement? (a) Your agency will reimburse you for different types of...; Docket Number 2011-0024, Sequence 1] RIN 3090-AJ22 Federal Travel Regulation (FTR); Lodging Reimbursement... (GSA) is amending the Federal Travel Regulation (FTR) regarding reimbursement of lodging per diem...

  3. SyncClaimService

    Data.gov (United States)

    Department of Veterans Affairs — Provides various methods to sync Claim related data for NWQ processing. It includes web operations to get Claims, get Unique Contention Classifications, get Unique...

  4. IBO Claim Taking Project

    Data.gov (United States)

    Social Security Administration — IBO manually tracks all Canadian Claims and DSU claims via this report. It also provides a summary for each region and office of origin that the DSU works with. This...

  5. Workers Compensation Claim Data -

    Data.gov (United States)

    Department of Transportation — This data set contains DOT employee workers compensation claim data for current and past DOT employees. Types of data include claim data consisting of PII data (SSN,...

  6. Medicaid Drug Claims Statistics

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicaid Drug Claims Statistics CD is a useful tool that conveniently breaks up Medicaid claim counts and separates them by quarter and includes an annual count.

  7. 49 CFR 577.11 - Reimbursement notification.

    Science.gov (United States)

    2010-10-01

    ...-notification remedies and identify the type of remedy eligible for reimbursement; (3) Identify any limits on..., and arguments, that all covered vehicles are under warranty or that no person would be eligible for...

  8. HEALTH INSURANCE: FIXED CONTRIBUTION AND REIMBURSEMENT MAXIMA

    CERN Document Server

    Human Resources Division

    2001-01-01

    Affected by the salary adjustments on 1 January 2001 and the evolution of the staff members and fellows population, the average reference salary, which is used as an index for fixed contributions and reimbursement maxima, has changed significantly. An adjustment of the amounts of the reimbursement maxima and the fixed contributions is therefore necessary, as from 1 January 2001. Reimbursement maxima The revised reimbursement maxima will appear on the leaflet summarizing the benefits for the year 2001, which will be sent out with the forthcoming issue of the CHIS Bull'. This leaflet will also be available from the divisional secretariats and from the UNIQA office at CERN. Fixed contributions The fixed contributions, applicable to some categories of voluntarily insured persons, are set as follows (amounts in CHF for monthly contributions) : voluntarily insured member of the personnel, with normal health insurance cover : 910.- (was 815.- in 2000) voluntarily insured member of the personnel, with reduced heal...

  9. HEALTH INSURANCE: CONTRIBUTIONS AND REIMBURSEMENT MAXIMAL

    CERN Document Server

    HR Division

    2000-01-01

    Affected by both the salary adjustment index on 1.1.2000 and the evolution of the staff members and fellows population, the average reference salary, which is used as an index for fixed contributions and reimbursement maximal, has changed significantly. An adjustment of the amounts of the reimbursement maximal and the fixed contributions is therefore necessary, as from 1 January 2000.Reimbursement maximalThe revised reimbursement maximal will appear on the leaflet summarising the benefits for the year 2000, which will soon be available from the divisional secretariats and from the AUSTRIA office at CERN.Fixed contributionsThe fixed contributions, applicable to some categories of voluntarily insured persons, are set as follows (amounts in CHF for monthly contributions):voluntarily insured member of the personnel, with complete coverage:815,- (was 803,- in 1999)voluntarily insured member of the personnel, with reduced coverage:407,- (was 402,- in 1999)voluntarily insured no longer dependent child:326,- (was 321...

  10. United Nations Reimbursements for DOD Troop Contributions

    National Research Council Canada - National Science Library

    1997-01-01

    .... Those rates together with the number of troops provided are used to calculate the level of reimbursement to be made to a participating country for the incremental costs incurred for providing troops...

  11. HINT-KB: The human interactome knowledge base

    KAUST Repository

    Theofilatos, Konstantinos A.

    2012-01-01

    Proteins and their interactions are considered to play a significant role in many cellular processes. The identification of Protein-Protein interactions (PPIs) in human is an open research area. Many Databases, which contain information about experimentally and computationally detected human PPIs as well as their corresponding annotation data, have been developed. However, these databases contain many false positive interactions, are partial and only a few of them incorporate data from various sources. To overcome these limitations, we have developed HINT-KB (http://150.140.142.24:84/Default.aspx) which is a knowledge base that integrates data from various sources, provides a user-friendly interface for their retrieval, estimates a set of features of interest and computes a confidence score for every candidate protein interaction using a modern computational hybrid methodology. © 2012 IFIP International Federation for Information Processing.

  12. Defense Health Care. Reimbursement of Hospitals Not Meeting CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) Copayment Requirements.

    Science.gov (United States)

    1988-06-01

    8217JntedState* General AccouýLg Office __ Rteport to Congmesoa Commitee A,""FILE COPYAD-A197 876 DF7-EANSE HEF.ALTHl L’W Reimbur emen--t Of I...Secretary of Defense grant a waiver from CHAMPUS copayment requirements and be approved, tuader certain criteria, to be reimbursed for care to...that a provider waives patient copayments, it denies the provider’s claim for reimbursement . . In fiscal year 1987, cHAmpus payments to civilian

  13. Reimbursement of analgesics for chronic pain.

    Science.gov (United States)

    Pedersen, Line; Hansen, Anneli Borge; Svendsen, Kristian; Skurtveit, Svetlana; Borchgrevink, Petter C; Fredheim, Olav Magnus S

    2012-11-27

    The prevalence of chronic non-malignant pain in Norway is between 24% and 30%. The proportion of the population using opioids for non-malignant pain on a long-term basis is around 1%. The purpose of our study was to investigate how many were prescribed analgesics on reimbursable prescription under reimbursement code -71 (chronic non-malignant pain) in 2009 and 2010, which analgesics were prescribed and whether prescribing practices were in accordance with national guidelines. We retrieved pseudonymised data from the National Prescription Database on all those who received drugs with reimbursement code -71 in 2009 and 2010. The data contain information on drug, dosage, formulation, reimbursement code and date of issue. 90,731 patients received reimbursement for drugs indicated for chronic non-malignant pain in 2010. Of these, 6,875 were given opioids, 33,242 received paracetamol, 25,865 non-steroid inflammatory drugs (NSAIDs), 20,654 amitryptiline and 16,507 gabapentin. Oxycodone was the most frequently prescribed opioid, followed by buprenorphine, tramadol and codeine/paracetamol. Of those who were prescribed opioids, 4,047 (59%) received mainly slow-release opioids, 2,631 (38%) also received benzodiazepines and 2,418 (35%) received benzodiazepine-like sleep medications. The number of patients who received analgesics and opioids on reimbursable prescriptions was low compared to the proportion of the population with chronic pain and the proportion using opioids long-term. 38% of those reimbursed for opioids also used benzodiazepines, which is contrary to official Norwegian guidelines.

  14. Medicaid provider reimbursement policy for adult immunizations☆

    Science.gov (United States)

    Stewart, Alexandra M.; Lindley, Megan C.; Cox, Marisa A.

    2015-01-01

    Background State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Objective Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Design Observational analysis using document review and a survey. Setting and participants Medicaid administrators in 50 states and the District of Columbia. Measurements Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Results Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Limitations Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Conclusions Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. PMID:26403369

  15. Home Health Chains and Practice Patterns: Evidence of 2008 Medicare Reimbursement Revision.

    Science.gov (United States)

    Huang, Sean Shenghsiu; Kim, Hyunjee

    2017-10-01

    Home health agencies (HHAs) are known to exploit the Medicare reimbursement schedule by targeting a specific number of therapy visits. These targeting behaviors cause unnecessary medical spending. The Centers for Medicare & Medicaid Services estimates that during fiscal year 2015, Medicare made more than $10 billion in improper payments to HHAs. Better understanding of heterogeneous gaming behaviors among HHAs can inform policy makers to more effectively oversee the home health care industry. This article aims to study how home health chains adjust and adopt new targeting behaviors as compared to independent agencies under the new reimbursement schedule. The analytic data are constructed from: (1) 5% randomly sampled Medicare home health claim data, and (2) HHA chain information extracted from the Medicare Cost Report. The study period spans from 2007 to 2010, and the sample includes 7800 unique HHAs and 380,118 treatment episodes. A multivariate regression model is used to determine whether chain and independent agencies change their practice patterns and adopt different targeting strategies after the revision of the reimbursement schedule in 2008. This study finds that independent agencies are more likely to target 6 and 14 visits, while chain agencies are more likely to target 20 visits. Such a change of practice patterns is more significant among for-profit HHAs. The authors expect these findings to inform policy makers that organizational structures, especially the combination of for-profit status and chain affiliation, should be taken into the consideration when detecting medical fraud and designing the reimbursement schedule.

  16. Understanding Attention to Adaptive Hints in Educational Games: An Eye-Tracking Study

    Science.gov (United States)

    Conati, Cristina; Jaques, Natasha; Muir, Mary

    2013-01-01

    This paper presents a user study that investigates the factors affecting student attention to user-adaptive hints during interaction with an educational computer game. The study focuses on Prime Climb, an educational game designed to provide individualized support for learning number factorization skills in the form of textual hints based on a…

  17. Report: Northwest Indian Fisheries Commission Complied With Most Federal Requirements but Claimed Some Unallowable Costs

    Science.gov (United States)

    Report #17-P-0184, April 24, 2017. The vast majority of costs claimed by NWIFC for cooperative agreements PA00J32201 and PA00J91201 were reasonable, allocable and allowable. Only $87,963 of indirect costs reimbursed to SSIT was questioned.

  18. 75 FR 45206 - Proposed Information Collection (Claim, Authorization and Invoice for Prosthetic Items and...

    Science.gov (United States)

    2010-08-02

    ... comments on the collection of information through Federal Docket Management System (FDMS) at http://www...-1394 is used to determine eligibility/entitlement and reimbursement of individual claims for automotive...-2520--700. e. VA Form 10-2914--50,000. f. Form Letter 10-90--8,500. Dated: July 27, 2010. By direction...

  19. Casemix reimbursement: a Singapore Children's Hospital perspective.

    Science.gov (United States)

    Yoong, S L

    2001-07-01

    Casemix reimbursement was introduced to Singapore in October 1999 using the Australian National Diagnosis Related Groups Version 3.1 (AN-DRGs 3.1). The possible impact of this classification system on a Singapore Children's Hospital is discussed. Data on paediatric patients in KK Women's and Children's Hospital (KKH) were drawn from the inhouse Datamart warehouse system, and reviewed with regards to volume of patients, length of stay and charges. Several high cost categories were selected for a more in-depth review and discussed. The classification system and reimbursement method did not take into account the higher cost of treating children, thus penalising the Children's Hospital. The wide variety of cases treated also gave rise to difficulty in obtaining appropriate reimbursement. The lack of severity of illness measures was a drawback in the Diagnosis Related Group (DRG) for ventilated patients. The lack of outcome measures gave rise to potentially inequitable reimbursement in some high cost neonatal DRGs. While Casemix is an improvement over previous methods of providing Government funding in Singapore, particular aspects need to be reviewed, and reimbursement criteria refined to ensure equitable funding to Children's Hospital.

  20. Particle Swarm Optimization algorithms for geophysical inversion, practical hints

    Science.gov (United States)

    Garcia Gonzalo, E.; Fernandez Martinez, J.; Fernandez Alvarez, J.; Kuzma, H.; Menendez Perez, C.

    2008-12-01

    PSO is a stochastic optimization technique that has been successfully used in many different engineering fields. PSO algorithm can be physically interpreted as a stochastic damped mass-spring system (Fernandez Martinez and Garcia Gonzalo 2008). Based on this analogy we present a whole family of PSO algorithms and their respective first order and second order stability regions. Their performance is also checked using synthetic functions (Rosenbrock and Griewank) showing a degree of ill-posedness similar to that found in many geophysical inverse problems. Finally, we present the application of these algorithms to the analysis of a Vertical Electrical Sounding inverse problem associated to a seawater intrusion in a coastal aquifer in South Spain. We analyze the role of PSO parameters (inertia, local and global accelerations and discretization step), both in convergence curves and in the a posteriori sampling of the depth of an intrusion. Comparison is made with binary genetic algorithms and simulated annealing. As result of this analysis, practical hints are given to select the correct algorithm and to tune the corresponding PSO parameters. Fernandez Martinez, J.L., Garcia Gonzalo, E., 2008a. The generalized PSO: a new door to PSO evolution. Journal of Artificial Evolution and Applications. DOI:10.1155/2008/861275.

  1. New physics hints in Β decays and collider outlook

    International Nuclear Information System (INIS)

    Hou, George W.S.

    2006-01-01

    There are currently two hints for new physics involving CP violation in b →s transitions: ΔS ≡ S f - S J/ ψK ≠ 0, and difference in direct CP asymmetry ΔA Kπ ≡ A K + π 0 - A K + π - ≠0. We explore the two scenarios with a large and unique new CP phase in b s transitions. Motivated by ΔS ≠ 0, we update on the right-handed strange beauty squark sb 1R at TeV scale. Motivated by ΔA Kπ ≠ 0, we explore sequential fourth generation t and b quarks. Both scenarios can survive constraints such as SM level b→sγ, sll and Β s mixing, and predict sizable CP violation in Β s mixing. The fourth generation picture predicts sizable K L → π 0 νν. Direct search for sb R , b' and t' at hadronic colliders, such as Tevatron Run II and LHC, can complement further CP violation studies at these machines, as well as at the future Super Β factory. (author)

  2. The fairness of the PPS reimbursement methodology.

    Science.gov (United States)

    Gianfrancesco, F D

    1990-01-01

    In FY 1984 the Medicare program implemented a new method of reimbursing hospitals for inpatient services, the Prospective Payment System (PPS). Under this system, hospitals are paid a predetermined amount per Medicare discharge, which varies according to certain patient and hospital characteristics. This article investigates the presence of systematic biases and other potential imperfections in the PPS reimbursement methodology as revealed by its effects on Medicare operating ratios. The study covers the first three years of the PPS (approximately 1984-1986) and is based on hospital data from the Medicare cost reports and other related sources. Regression techniques were applied to these data to determine how Medicare operating ratios were affected by specific aspects of the reimbursement methodology. Several possible imbalances were detected. The potential undercompensation relating to these can be harmful to certain classes of hospitals and to the Medicare populations that they serve. PMID:2109738

  3. Vertical integration and optimal reimbursement policy.

    Science.gov (United States)

    Afendulis, Christopher C; Kessler, Daniel P

    2011-09-01

    Health care providers may vertically integrate not only to facilitate coordination of care, but also for strategic reasons that may not be in patients' best interests. Optimal Medicare reimbursement policy depends upon the extent to which each of these explanations is correct. To investigate, we compare the consequences of the 1997 adoption of prospective payment for skilled nursing facilities (SNF PPS) in geographic areas with high versus low levels of hospital/SNF integration. We find that SNF PPS decreased spending more in high integration areas, with no measurable consequences for patient health outcomes. Our findings suggest that integrated providers should face higher-powered reimbursement incentives, i.e., less cost-sharing. More generally, we conclude that purchasers of health services (and other services subject to agency problems) should consider the organizational form of their suppliers when choosing a reimbursement mechanism.

  4. 7 CFR 3015.104 - Requesting advances or reimbursements.

    Science.gov (United States)

    2010-01-01

    ... outlays for the month covered. These estimates shall be made on a cash basis, even if the recipient uses an accrual accounting system. (b) Reimbursements. If payments are made through reimbursement or by...

  5. 48 CFR 416.405 - Cost-reimbursement incentive contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 416.405 Section 416.405 Federal Acquisition Regulations System DEPARTMENT OF...-reimbursement incentive contracts. ...

  6. 41 CFR 301-71.209 - Must we pay a late payment fee if we fail to reimburse the employee within 30 calendar days after...

    Science.gov (United States)

    2010-07-01

    ... payment fee if we fail to reimburse the employee within 30 calendar days after receipt of a proper travel claim? 301-71.209 Section 301-71.209 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY...

  7. Formalizing Probabilistic Safety Claims

    Science.gov (United States)

    Herencia-Zapana, Heber; Hagen, George E.; Narkawicz, Anthony J.

    2011-01-01

    A safety claim for a system is a statement that the system, which is subject to hazardous conditions, satisfies a given set of properties. Following work by John Rushby and Bev Littlewood, this paper presents a mathematical framework that can be used to state and formally prove probabilistic safety claims. It also enables hazardous conditions, their uncertainties, and their interactions to be integrated into the safety claim. This framework provides a formal description of the probabilistic composition of an arbitrary number of hazardous conditions and their effects on system behavior. An example is given of a probabilistic safety claim for a conflict detection algorithm for aircraft in a 2D airspace. The motivation for developing this mathematical framework is that it can be used in an automated theorem prover to formally verify safety claims.

  8. Reimbursement of licensed cell and gene therapies across the major European healthcare markets

    Science.gov (United States)

    Jørgensen, Jesper; Kefalas, Panos

    2015-01-01

    Objective The aim of this research is to identify the pricing, reimbursement, and market access (P&R&MA) considerations most relevant to advanced therapy medicinal products (ATMPs) in the Big5EU, and to inform their manufacturers about the key drivers for securing adoption at a commercially viable reimbursed price. Methodology The research was structured following three main steps: 1) Identifying the market access pathways relevant to ATMPs through secondary research; 2) Validating the secondary research findings and addressing any data gaps in primary research, by qualitative interviews with national, regional, and local-level payers and their clinical and economic advisors; 3) Collating of primary and secondary findings to compare results across countries. Results The incremental clinical benefit forms the basis for all P&R&MA processes. Budget impact is a key consideration, regardless of geography. Cost-effectiveness analyses are increasingly applied; however, only the United Kingdom has a defined threshold that links the cost per quality-adjusted life year (QALY) specifically and methodologically to the reimbursed price. Funding mechanisms to enable adoption of new and more expensive therapies exist in all countries, albeit to varying extents. Willingness to pay is typically higher in smaller patient populations, especially in populations with high disease burden. Outcomes modelling and risk-sharing agreements (RSAs) provide strategies to address the data gap and uncertainties often associated with trials in niche populations. Conclusions The high cost of ATMPs, coupled with the uncertainty at launch around their long-term claims, present challenges for their adoption at a commercially viable reimbursed price. Targeting populations of high disease burden and unmet needs may be advantageous, as the potential for improvement in clinical benefit is greater, as well as the potential for capitalising on healthcare cost offsets. Also, targeting small populations can

  9. Impact of a new reimbursement program on hepatitis B antiviral medication cost and utilization in Beijing, China.

    Directory of Open Access Journals (Sweden)

    Qian Qiu

    Full Text Available BACKGROUND: Hepatitis B virus (HBV infection is a significant clinical and financial burden for chronic hepatitis B (CHB patients. In Beijing, China, partial reimbursement on antiviral agents was first implemented for the treatment of CHB patients in July 1, 2011. AIMS: In this study, we describe the medical cost and utilization rates of antiviral therapy for CHB patients to explore the impact of the new partial reimbursement policy on the medical care cost, the composition, and antivirals utilization. METHODS: Clinical and claims data of a retrospective cohort of 92,776 outpatients and 2,774 inpatients with non-cirrhotic CHB were retrieved and analyzed from You'an Hospital, Beijing between February 14, 2008 and December 31, 2012. The propensity score matching was used to adjust factors associated with the annual total cost, including age, gender, medical insurance type and treatment indicator. RESULTS: Compared to patients who paid out-of-pocket, medical cost, especially antiviral costs increased greater among patients with medical insurance after July 1, 2011, the start date of reimbursement policy. Outpatients with medical insurance had 16% more antiviral utilization; usage increased 3% among those who paid out-of-pocket after the new partial reimbursement policy was implemented. CONCLUSIONS: Direct medical costs and antiviral utilization rates of CHB patients with medical insurance were higher than those from paid out-of-pocket payments, even after adjusting for inflation and other factors. Thus, a new partial reimbursement program may positively optimize the cost and standardization of antiviral treatment.

  10. State Medicaid reimbursement for nursing homes, 1978-86

    Science.gov (United States)

    Swan, James H.; Harrington, Charlene; Grant, Leslie A.

    1988-01-01

    State Medicaid reimbursement methods and rates are reported for the period 1978-86 for skilled nursing and intermediate care facilities. A cross-sectional time series regression analysis of Medicaid reimbursement rates on methods showed that States using prospective class reimbursement had significantly lower rates for the period 1982-86. States using prospective facility-specific reimbursement methods had lower rates than retrospective methods in 1983-84. PMID:10312516

  11. Formal reporting of second-opinion CT interpretation: experience and reimbursement in the emergency department setting.

    Science.gov (United States)

    Jeffers, Adam B; Saghir, Amina; Camacho, Marc

    2012-06-01

    The purpose of this study is to describe a system for formally reporting second-opinion interpretations of CT imaging exams accompanying patients transferred emergently to a tertiary care center. Second-opinion interpretations of cross-sectional imaging exams rendered in the emergency department setting over 6 months spanning 22 September 2009 to 22 March 2010 were reviewed and tallied by two radiologists and a research assistant, with a focus on professional fee reimbursement rates. A more in depth review was performed of those exams for which a clinical referral request form was available, detailing such information as the clinical history, content and source of available initial interpretation, and congruity of the initial interpretation with clinical data. Discrepancies between outside and second-opinion interpretations were also assessed. This quality assurance exercise was reviewed by our institutional review board, which waived formal informed consent. Formal second-opinion interpretation was rendered for 370 exams on 198 patients (mean age, 53.5 years; 45.1% female), received from 50 referring facilities. Head CT was the most common imaging exam referred for second opinion. Forty-one of 370 exams (11%) were submitted for self-pay, and 43 (12%) were written off as free care. The remaining 286 exams (77%) were submitted for reimbursement of the professional fee only. Ultimately, of the 286 exams submitted, 260 (91%) were reimbursed for professional fees, 199 (70%) on the initial submission. Of 29 health plans contracted with our facility, 22 ultimately approved all claims made. Three plans denied all claims submitted. The largest payer was Medicare, which reimbursed 88 of 90 submitted claims. Clinical intake forms were available for 184 exams on 107 patients (mean age, 52.7 years, 43.0% female). Trauma was the most common indication, or history, provided (55% of 184 exams, 40% of 107 patients). An outside report of some form was available for 112 of the 184

  12. 47 CFR 97.527 - Reimbursement for expenses.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Reimbursement for expenses. 97.527 Section 97... AMATEUR RADIO SERVICE Qualifying Examination Systems § 97.527 Reimbursement for expenses. VEs and VECs may be reimbursed by examinees for out-of-pocket expenses incurred in preparing, processing...

  13. 45 CFR 149.100 - Amount of reimbursement.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Amount of reimbursement. 149.100 Section 149.100... REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reinsurance Amounts § 149.100 Amount of reimbursement... reimbursement in the amount of 80 percent of the costs for health benefits (net of negotiated price concessions...

  14. 44 CFR 206.8 - Reimbursement of other Federal agencies.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement of other... Reimbursement of other Federal agencies. (a) Assistance furnished under § 206.5 (a) or (b) of this subpart may... Administrator or the Regional Director may not approve reimbursement of costs incurred while performing work...

  15. 47 CFR 27.1184 - Triggering a reimbursement obligation.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Triggering a reimbursement obligation. 27.1184... reimbursement obligation. (a) The clearinghouse will apply the following test to determine when an AWS entity... paragraphs (a)(3)(i) and (ii) of this section, indicates that a reimbursement obligation exists, the...

  16. 48 CFR 52.243-2 - Changes-Cost-Reimbursement.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Changes-Cost-Reimbursement....243-2 Changes—Cost-Reimbursement. As prescribed in 43.205(b)(1), insert the following clause. The 30-day period may be varied according to agency procedures. Changes—Cost-Reimbursement (AUG 1987) (a) The...

  17. 48 CFR 52.249-6 - Termination (Cost-Reimbursement).

    Science.gov (United States)

    2010-10-01

    ...-Reimbursement). 52.249-6 Section 52.249-6 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION....249-6 Termination (Cost-Reimbursement). As prescribed in 49.503(a)(1), insert the following clause: Termination (Cost-Reimbursement) (MAY 2004) (a) The Government may terminate performance of work under this...

  18. 47 CFR 54.407 - Reimbursement for offering Lifeline.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Reimbursement for offering Lifeline. 54.407... (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Low-Income Consumers § 54.407 Reimbursement for... carrier may receive universal service support reimbursement for each qualifying low-income consumer served...

  19. 77 FR 76487 - Privately Owned Vehicle Mileage Reimbursement Rates

    Science.gov (United States)

    2012-12-28

    ... Vehicle Mileage Reimbursement Rates AGENCY: Office of Governmentwide Policy (OGP), General Services... Mileage Reimbursement Rates. SUMMARY: The General Services Administration's annual privately owned vehicle (POV) mileage reimbursement rate reviews have resulted in new CY 2013 rates for the use of privately...

  20. 75 FR 62348 - Reimbursement Offsets for Medical Care or Services

    Science.gov (United States)

    2010-10-08

    ... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN55 Reimbursement Offsets for Medical Care... Veterans Affairs (VA) proposes to amend its regulations concerning the reimbursement of medical care and... situations where third-party payers are required to reimburse VA for costs related to care provided by VA to...

  1. 48 CFR 2052.215-77 - Travel approvals and reimbursement.

    Science.gov (United States)

    2010-10-01

    ... reimbursement. 2052.215-77 Section 2052.215-77 Federal Acquisition Regulations System NUCLEAR REGULATORY....215-77 Travel approvals and reimbursement. As prescribed at 2015.209-70(d), the contracting officer shall insert the following clause in cost reimbursement solicitations and contracts which require travel...

  2. 45 CFR 149.200 - Use of reimbursements.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Use of reimbursements. 149.200 Section 149.200 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Use of Reimbursements § 149.200 Use of reimbursements...

  3. 44 CFR 208.35 - Reimbursement for Advisory.

    Science.gov (United States)

    2010-10-01

    ... Cooperative Agreements § 208.35 Reimbursement for Advisory. DHS will not reimburse costs incurred during an... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for Advisory. 208.35 Section 208.35 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY...

  4. 42 CFR 57.213a - Loan cancellation reimbursement.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Loan cancellation reimbursement. 57.213a Section 57... Professions Student Loans § 57.213a Loan cancellation reimbursement. (a) For loans made prior to October 22... credited to this insurance fund), and used only to reimburse the school for the institutional share of any...

  5. 75 FR 82029 - Privately Owned Vehicle Mileage Reimbursement Rates

    Science.gov (United States)

    2010-12-29

    ... Owned Vehicle Mileage Reimbursement Rates AGENCY: Office of Governmentwide Policy (OGP), General... Owned Vehicle Mileage Reimbursement Rates. SUMMARY: The General Services Administration's (GSA) annual privately owned vehicle (POV) mileage reimbursement rate reviews have resulted in new CY 2011 rates for the...

  6. 44 CFR 208.44 - Reimbursement for other costs.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for other costs... Cooperative Agreements § 208.44 Reimbursement for other costs. (a) Except as allowed under paragraph (b) of this section, DHS will not reimburse other costs incurred preceding, during or upon the conclusion of...

  7. 45 CFR 149.315 - Reimbursement conditioned upon available funds.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Reimbursement conditioned upon available funds... TO HEALTH CARE ACCESS REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reimbursement Methods § 149.315 Reimbursement conditioned upon available funds. Notwithstanding a sponsor's compliance with...

  8. 47 CFR 24.247 - Triggering a reimbursement obligation.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Triggering a reimbursement obligation. 24.247... Mhz Band § 24.247 Triggering a reimbursement obligation. (a) Licensed PCS. The clearinghouse will... the Proximity Threshold test indicates that a reimbursement obligation exists, the clearinghouse will...

  9. 48 CFR 47.104-3 - Cost-reimbursement contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement... CONTRACT MANAGEMENT TRANSPORTATION General 47.104-3 Cost-reimbursement contracts. (a) 49 U.S.C. 10721 and... accrues to the Government, i.e., the Government shall pay the charges or directly and completely reimburse...

  10. 48 CFR 46.305 - Cost-reimbursement service contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement service... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 46.305 Cost-reimbursement service contracts. The contracting officer shall insert the clause at 52.246-5, Inspection of Services—Cost Reimbursement, in...

  11. 48 CFR 16.405 - Cost-reimbursement incentive contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 16.405 Section 16.405 Federal Acquisition Regulations System FEDERAL ACQUISITION...-reimbursement incentive contracts. See 16.301 for requirements applicable to all cost-reimbursement contracts...

  12. 48 CFR 46.303 - Cost-reimbursement supply contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement supply... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 46.303 Cost-reimbursement supply contracts. The contracting officer shall insert the clause at 52.246-3, Inspection of Supplies—Cost-Reimbursement, in...

  13. 45 CFR 703.9 - Reimbursement of members.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Reimbursement of members. 703.9 Section 703.9... AND FUNCTIONS OF STATE ADVISORY COMMITTEES § 703.9 Reimbursement of members. (a) Advisory Committee members may be reimbursed by the Commission by a per diem subsistence allowance and for travel expenses at...

  14. 26 CFR 601.804 - Reimbursements.

    Science.gov (United States)

    2010-04-01

    ... provided for in cooperative agreements, the Internal Revenue Service will provide amounts to program.... Cooperative agreements will establish the items for which reimbursements will be allowed and the method of..., and accounting and financial control systems. (b) Direct, reasonable, and prudent expenses...

  15. Indirect Cost Reimbursement: An Industrial View.

    Science.gov (United States)

    Bolton, Robert

    1987-01-01

    The meaning of indirect costs in an industrial environment is discussed. Other factors considered are corporate policies; nature of work being supported; the uniqueness of the work; who is doing the negotiating for industry; and indirect rates. Suggestions are offered for approaches to indirect cost reimbursement. (Author/MLW)

  16. 24 CFR 5.632 - Utility reimbursements.

    Science.gov (United States)

    2010-04-01

    ... Section 8 Project-Based Assistance Family Payment § 5.632 Utility reimbursements. (a) Applicability. This... the utility supplier to pay the utility bill on behalf of the family. If the PHA elects to pay the utility supplier, the PHA must notify the family of the amount paid to the utility supplier. (3) In the...

  17. 77 FR 38173 - TRICARE Reimbursement Revisions

    Science.gov (United States)

    2012-06-27

    ... specific numeric diagnosis-related group values and replacing them with their narrative description. DATES... reference to specific DRG numbers and descriptions became obsolete, so we are removing the numeric... follows: Sec. 199.14 Provider reimbursement methods. * * * * * (a) * * * (1) * * * (ii) * * * (C) * * * (3...

  18. 14 CFR 1214.202 - Reimbursement policy.

    Science.gov (United States)

    2010-01-01

    ... according to the reimbursement schedule plus short term call-up additional costs. The additional costs will... services. (2) The price will be based on estimated costs. (3) The price will be held constant for flights...) Subsequent to the first three years, the price will be adjusted annually to insure that total operating costs...

  19. 77 FR 45520 - Reimbursed Entertainment Expenses

    Science.gov (United States)

    2012-08-01

    ... as compensation and wages, the employee may be able to deduct the expense as an employee business...(e)(3) has the same meaning as in section 62(2)(A) (dealing with employee business expenses, later... Reimbursed Entertainment Expenses AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of...

  20. SSA Disability Claim Data

    Data.gov (United States)

    Social Security Administration — The dataset includes fiscal year data for initial claims for SSA disability benefits that were referred to a state agency for a disability determination. Specific...

  1. Communication to CHIS members - Attach proof of payment to your claims !

    CERN Multimedia

    HR Department

    2009-01-01

    As it was evident that more and more members were forgetting to attach proof of payment of bills to reimbursement claims, we launched a campaign in the summer, using various means (the CHIS Bull, the web site, adding a reminder on the forms, etc.), to make everyone aware of this obligation. The situation has improved dramatically, and we should like to thank you for your positive response to our reminder. Only a minority of members have not yet got into the habit of attaching proof of payment to their claims. We have asked UNIQA to adhere strictly to the rules and to return every claim which is incomplete. The handling of an initially incomplete claim means extra work for the personnel of UNIQA. Complete claims will be handled first before any incomplete claims are sent back and processed. The reimbursement of a claim, which may include several bills, could be delayed for several weeks, all because there is one proof of payment missing. Thank you in advance for your understanding.

  2. Utilization of travel reimbursement in the Veterans Health Administration.

    Science.gov (United States)

    Nelson, Richard E; Hicken, Bret; Cai, Beilei; Dahal, Arati; West, Alan; Rupper, Randall

    2014-01-01

    To improve access to care, the Veterans Health Administration (VHA) increased its patient travel reimbursement rate from 11 to 28.5 cents per mile on February 1, 2008, and again to 41.5 cents per mile on November 17, 2008. We identified characteristics of veterans more likely to receive travel reimbursements and evaluated the impact of these increases on utilization of the benefit. We examined the likelihood of receiving any reimbursement, number of reimbursements, and dollar amount of reimbursements for VHA patients before and after both reimbursement rate increases. Because of our data's longitudinal nature, we used multivariable generalized estimating equation models for analysis. Rurality and categorical distance from the nearest VHA facility were examined in separate regressions. Our cohort contained 214,376 veterans. During the study period, the average number of reimbursements per veteran was higher for rural patients compared to urban patients, and for those living 50-75 miles from the nearest VHA facility compared to those living closer. Higher reimbursement rates led to more veterans obtaining reimbursement regardless of urban-rural residence or distance traveled to the nearest VHA facility. However, after the rate increases, urban veterans and veterans living reimbursement utilization slightly more than other patients. Our findings suggest an inverted U-shaped relationship between veterans' utilization of the VHA travel reimbursement benefit and travel distance. Both urban and rural veterans responded in roughly equal manner to changes to this benefit. © 2013 National Rural Health Association.

  3. Health Claims Data Warehouse (HCDW)

    Data.gov (United States)

    Office of Personnel Management — The Health Claims Data Warehouse (HCDW) will receive and analyze health claims data to support management and administrative purposes. The Federal Employee Health...

  4. Implementation of the 2011 Reimbursement Act in Poland: Desired and undesired effects of the changes in reimbursement policy.

    Science.gov (United States)

    Kawalec, Paweł; Sagan, Anna; Stawowczyk, Ewa; Kowalska-Bobko, Iwona; Mokrzycka, Anna

    2016-04-01

    The Act of 12 May 2011 on the Reimbursement of Medicines, Foodstuffs Intended for Particular Nutritional Uses and Medical Devices constitutes a major change of the reimbursement policy in Poland. The main aims of this Act were to rationalize the reimbursement policy and to reduce spending on reimbursed drugs. The Act seems to have met these goals: reimbursement policy (including pricing of reimbursed drugs) was overhauled and the expenditure of the National Health Fund on reimbursed drugs saw a significant decrease in the year following the Act's introduction. The annual savings achieved since then (mainly due to the introduction of risk sharing schemes), have made it possible to include new drugs into the reimbursement list and improve access to innovative drugs. However, at the same time, the decrease in prices of reimbursed drugs, that the Act brought about, led to an uncontrolled outflow of some of these drugs abroad and shortages in Poland. This paper analyses the main changes introduced by the Reimbursement Act and their implications. Since the Act came into force relatively recently, its full impact on the reimbursement policy is not yet possible to assess. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  5. The impact of Medicaid-linked reimbursements on revenues of public sexually transmitted disease clinics.

    Science.gov (United States)

    Downey, Lois; Lafferty, William E; Krekeler, Barbara

    2002-02-01

    Public sexually transmitted disease (STD) clinics faced with decreased tax revenue and increased costs must evaluate alternative revenue sources. To report one public STD clinic's Medicaid-linked revenue and discuss the association between system characteristics and reimbursement potential. This was a cross-sectional study of 4208 patients visiting the clinic for new problems during a 6-month period. Of 458 Medicaid-enrolled patients, only 55% acknowledged enrollment at the time of visit. The clinic captured revenue for many of the remaining 45% through a centralized public health information/billing system, which submitted retroactive STD clinic claims when patients self-reported Medicaid enrollment at later visits to other public health clinics. These belated self-reports also contributed to Medicaid administrative-match reimbursements. An estimated $100,000 (31% of the clinic's direct reimbursements for service) would have been lost in 2000, had detection of Medicaid enrollment been based exclusively on patients' self-reports at STD clinic visits.

  6. HinT proteins and their putative interaction partners in Mollicutes and Chlamydiaceae

    Directory of Open Access Journals (Sweden)

    Hegemann Johannes H

    2005-05-01

    Full Text Available Background HinT proteins are found in prokaryotes and eukaryotes and belong to the superfamily of HIT proteins, which are characterized by an histidine-triad sequence motif. While the eukaryotic variants hydrolyze AMP derivates and modulate transcription, the function of prokaryotic HinT proteins is less clearly defined. In Mycoplasma hominis, HinT is concomitantly expressed with the proteins P60 and P80, two domains of a surface exposed membrane complex, and in addition interacts with the P80 moiety. Results An cluster of hitABL genes, similar to that of M. hominis was found in M. pulmonis, M. mycoides subspecies mycoides SC, M. mobile and Mesoplasma florum. RT-PCR analyses provided evidence that the P80, P60 and HinT homologues of M. pulmonis were polycistronically organized, suggesting a genetic and physical interaction between the proteins encoded by these genes in these species. While the hit loci of M. pneumoniae and M. genitalium encoded, in addition to HinT, a protein with several transmembrane segments, the hit locus of Ureaplasma parvum encoded a pore-forming protein, UU270, a P60 homologue, UU271, HinT, UU272, and a membrane protein of unknown function, UU273. Although a full-length mRNA spanning the four genes was not detected, amplification of all intergenic regions from the center of UU270 to the end of UU273 by RT-PCR may be indicative of a common, but unstable mRNA. In Chlamydiaceae the hit gene is flanked upstream by a gene predicted to encode a metal dependent hydrolase and downstream by a gene putatively encoding a protein with ARM-repeats, which are known to be involved in protein-protein interactions. In RT-PCR analyses of C. pneumoniae, regions comprising only two genes, Cp265/Cp266 and Cp266/Cp267 were able to be amplified. In contrast to this in vivo interaction analysis using the yeast two-hybrid system and in vitro immune co-precipitation revealed an interaction between Cp267, which contains the ARM repeats, Cp265, the

  7. 32 CFR 536.129 - Claims cognizable as UCMJ claims.

    Science.gov (United States)

    2010-07-01

    ... Personnel Claims Act and chapter 11 of AR 27-20, which provides compensation only for tangible personal... 32 National Defense 3 2010-07-01 2010-07-01 true Claims cognizable as UCMJ claims. 536.129 Section 536.129 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS...

  8. Physician Reimbursement in Medicare Advantage Compared With Traditional Medicare and Commercial Health Insurance.

    Science.gov (United States)

    Trish, Erin; Ginsburg, Paul; Gascue, Laura; Joyce, Geoffrey

    2017-09-01

    Nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, yet little is known about the prices that MA plans pay for physician services. Medicare Advantage insurers typically also sell commercial plans, and the extent to which MA physician reimbursement reflects traditional Medicare (TM) rates vs negotiated commercial prices is unclear. To compare prices paid for physician and other health care services in MA, traditional Medicare, and commercial plans. Retrospective analysis of claims data evaluating MA prices paid to physicians and for laboratory services and durable medical equipment between 2007 and 2012 in 348 US core-based statistical areas. The study population included all MA and commercial enrollees with a large national health insurer operating in both markets, as well as a 20% sample of TM beneficiaries. Enrollment in an MA plan. Mean reimbursement paid to physicians, laboratories, and durable medical equipment suppliers for MA and commercial enrollees relative to TM rates for 11 Healthcare Common Procedure Coding Systems (HCPCS) codes spanning 7 sites of care. The sample consisted of 144 million claims. Physician reimbursement in MA was more strongly tied to TM rates than commercial prices, although MA plans tended to pay physicians less than TM. For a mid-level office visit with an established patient (Current Procedural Terminology [CPT] code 99213), the mean MA price was 96.9% (95% CI, 96.7%-97.2%) of TM. Across the common physician services we evaluated, mean MA reimbursement ranged from 91.3% of TM for cataract removal in an ambulatory surgery center (CPT 66984; 95% CI, 90.7%-91.9%) to 102.3% of TM for complex evaluation and management of a patient in the emergency department (CPT 99285; 95% CI, 102.1%-102.6%). However, for laboratory services and durable medical equipment, where commercial prices are lower than TM rates, MA plans take advantage of these lower commercial prices, ranging from 67.4% for a walker

  9. Medicaid reimbursement, prenatal care and infant health.

    Science.gov (United States)

    Sonchak, Lyudmyla

    2015-12-01

    This paper evaluates the impact of state-level Medicaid reimbursement rates for obstetric care on prenatal care utilization across demographic groups. It also uses these rates as an instrumental variable to assess the importance of prenatal care on birth weight. The analysis is conducted using a unique dataset of Medicaid reimbursement rates and 2001-2010 Vital Statistics Natality data. Conditional on county fixed effects, the study finds a modest, but statistically significant positive relationship between Medicaid reimbursement rates and the number of prenatal visits obtained by pregnant women. Additionally, higher rates are associated with an increase in the probability of obtaining adequate care, as well as a reduction in the incidence of going without any prenatal care. However, the effect of an additional prenatal visit on birth weight is virtually zero for black disadvantaged mothers, while an additional visit yields a substantial increase in birth weight of over 20 g for white disadvantaged mothers. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. MEDICAID FINANCIAL MANAGEMENT: Better Oversight of State Claims for Federal Reimbursement Needed

    National Research Council Canada - National Science Library

    Calbom, Linda

    2002-01-01

    .... Developing baseline information on Medicaid issues at greatest risk for improper payments and measuring improvements in program management against that baseline is key to achieving effective financial oversight...

  11. 44 CFR 208.39 - Reimbursement for personnel costs incurred during Activation.

    Science.gov (United States)

    2010-10-01

    ...) Reimbursement of additional salary and overtime costs. DHS will reimburse any identified additional salary and...). (g) Reimbursement for Backfill costs upon Activation. DHS will reimburse the cost to Backfill System... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for personnel...

  12. Trends in Medicare Reimbursement for Orthopedic Procedures: 2000 to 2016.

    Science.gov (United States)

    Eltorai, Adam E M; Durand, Wesley M; Haglin, Jack M; Rubin, Lee E; Weiss, Arnold-Peter C; Daniels, Alan H

    2018-03-01

    Understanding trends in reimbursement is critical to the financial sustainability of orthopedic practices. Little research has examined physician fee trends over time for orthopedic procedures. This study evaluated trends in Medicare reimbursements for orthopedic surgical procedures. The Medicare Physician Fee Schedule was examined for Current Procedural Terminology code values for the most common orthopedic and nonorthopedic procedures between 2000 and 2016. Prices were adjusted for inflation to 2016-dollar values. To assess mean growth rate for each procedure and subspecialty, compound annual growth rates were calculated. Year-to-year dollar amount changes were calculated for each procedure and subspecialty. Reimbursement trends for individual procedures and across subspecialties were compared. Between 2000 and 2016, annual reimbursements decreased for all orthopedic procedures examined except removal of orthopedic implant. The orthopedic procedures with the greatest mean annual decreases in reimbursement were shoulder arthroscopy/decompression, total knee replacement, and total hip replacement. The orthopedic procedures with the least annual reimbursement decreases were carpal tunnel release and repair of ankle fracture. Rate of Medicare procedure reimbursement change varied between subspecialties. Trauma had the smallest decrease in annual change compared with spine, sports, and hand. Annual reimbursement decreased at a significantly greater rate for adult reconstruction procedures than for any of the other subspecialties. These findings indicate that reimbursement for procedures has steadily decreased, with the most rapid decrease seen in adult reconstruction. [Orthopedics. 2018; 41(2):95-102.]. Copyright 2018, SLACK Incorporated.

  13. Tuition reimbursement for special education students.

    Science.gov (United States)

    Zirkel, P A

    1997-01-01

    The spring 1996 issue of The Future of Children on special education reviewed the legislative and litigation history of the Individuals with Disabilities Education Act (IDEA). This Revisiting article examines the impact of the two U.S. Supreme Court cases setting forth school districts' responsibility to reimburse parents of students with disabilities for private school tuition under certain circumstances. An extensive examination of published cases reveals that the number of cases litigated has increased but that the courts are no more likely to decide in favor of parents than they were before the Supreme Court rulings.

  14. Reminder : Reimbursement of education fees / accommodation fees

    CERN Multimedia

    2003-01-01

    Your attention is drawn to the 20 km distance limit set in Article R A 8.01 of the Staff Regulations, namely, that only accommodation fees of students attending an educational establishment which is more than 20 km from the place of residence and the duty station of the member of the personnel are reimbursed by the Organization, subject to the percentage rate and maximum amounts set out in this article and in Administrative Circular N° 12. Human Resources Division Tel : 72862 / 74474

  15. Reimbursement of education fees / accommodation fees

    CERN Multimedia

    2003-01-01

    Your attention is drawn to the 20 km distance limit set in Article R A 8.01 of the Staff Regulations, namely, that only accommodation fees of students attending an educational establishment which is more than 20 km from the place of residence and the duty station of the member of the personnel are reimbursed by the Organization, subject to the percentage rate and maximum amounts set out in this article and in Administrative Circular N° 12. Human Resources Division Tel: 72862 / 74474

  16. 7 CFR 400.712 - Research and development reimbursement, maintenance reimbursement, and user fees.

    Science.gov (United States)

    2010-01-01

    ...) Loss adjustment expenses; (vii) Sales commission; (viii) Marketing costs; (ix) Indirect overhead costs..., development, preparation or marketing of the policy; (xiii) Costs of making program changes as a result of any... submission may be eligible for a one-time payment of research and development costs and reimbursement of...

  17. 76 FR 39043 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

    Science.gov (United States)

    2011-07-05

    ...: Federal Docket Management System Office, Room 3C843, 1160 Defense Pentagon, Washington, DC 20301-1160... paid under the Medicare Diagnosis- Related Group (DRG) method for all of that hospital's Medicare... reimbursement is usually substantially greater than what would be paid using the Diagnosis- Related Group (DRG...

  18. BenefitClaimWebServiceBean/BenefitClaimWebService

    Data.gov (United States)

    Department of Veterans Affairs — A formal or informal request for a type of monetary or non-monetary benefit. This service provides benefit claims and benefit claim special issues data, allows the...

  19. Variation in provider vaccine purchase prices and payer reimbursement.

    Science.gov (United States)

    Freed, Gary L; Cowan, Anne E; Gregory, Sashi; Clark, Sarah J

    2009-12-01

    The purpose of this work was to collect data regarding vaccine prices and reimbursements in private practices. Amid reports of physicians losing money on vaccines, there are limited supporting data to show how much private practices are paying for vaccines and how much they are being reimbursed by third-party payers. We conducted a cross-sectional survey of a convenience sample of private practices in 5 states (California, Georgia, Michigan, New York, and Texas) that purchase vaccines for administration to privately insured children/adolescents. Main outcome measures included prices paid to purchase vaccines recommended for children and adolescents and reimbursement from the 3 most common, non-Medicaid payers for vaccine purchase and administration. Detailed price and reimbursement data were provided by 76 practices. There was a considerable difference between the maximum and minimum prices paid by practices, ranging from $4 to more than $30 for specific vaccines. There was also significant variation in insurance reimbursement for vaccine purchase, with maximum and minimum reimbursements for a single vaccine differing from $8 to more than $80. Mean net yield per dose (reimbursement for vaccine purchase minus price paid per dose) varied across vaccines from a low of approximately $3 to more than $24. Reimbursement for the first dose of vaccine administered ranged from $0 to more than $26, with a mean of $16.62. There is a wide range of prices paid by practices for the same vaccine product and in the reimbursement for vaccines and administration fees by payers. This variation highlights the need for individual practices to understand their own costs and reimbursements and to seek opportunities to reduce costs and increase reimbursements.

  20. Legal Services: Claims

    Science.gov (United States)

    1997-12-31

    waive such exemp- tions or privileges and direct release of the protected documents, upon balancing all pertinent factors, including finding that...injury causing death until expiration of decedent’s worklife ex- pectancy. When requested, the previous five years Federal income tax forms must be...knowing at all times how much of the CEA has been obligated, its remaining balance , and assessing each month whether the balance will cover claims

  1. 77 FR 2297 - Office of Asset and Transportation Management; Privately Owned Vehicle Mileage Reimbursement Rates

    Science.gov (United States)

    2012-01-17

    ... of Asset and Transportation Management; Privately Owned Vehicle Mileage Reimbursement Rates AGENCY... Bulletin 12-02, Calendar Year (CY) 2012 Privately Owned Vehicle Mileage Reimbursement Rates. SUMMARY: The General Services Administration's (GSA) annual privately owned vehicle (POV) mileage reimbursement rate...

  2. Hint2, the mitochondrial nucleoside 5'-phosphoramidate hydrolase; properties of the homogeneous protein from sheep (Ovis aries) liver.

    Science.gov (United States)

    Bretes, Ewa; Wojdyła-Mamoń, Anna M; Kowalska, Joanna; Jemielity, Jacek; Kaczmarek, Renata; Baraniak, Janina; Guranowski, Andrzej

    2013-01-01

    Adenosine 5'-phosphoramidate (NH2-pA) is a rare natural nucleotide and its biochemistry and biological functions are poorly recognized. All organisms have proteins that may be involved in the catabolism of NH2-pA. They are members of the HIT protein family and catalyze hydrolytic splitting of NH2-pA to 5'-AMP and ammonia. At least five HIT proteins have been identified in mammals; however, the enzymatic and molecular properties of only Fhit and Hint1 have been comprehensively studied. Our study focuses on the Hint2 protein purified by a simple procedure to homogeneity from sheep liver mitochondrial fraction (OaHint2). Hint1 protein was also prepared from sheep liver (OaHint1) and the molecular and kinetic properties of the two proteins compared. Both function as homodimers and behave as nucleoside 5'-phosphoramidate hydrolases. The molecular mass of the OaHint2 monomer is 16 kDa and that of the OaHint1 monomer 14.9 kDa. Among potential substrates studied, NH2-pA appeared to be the best; the Km and kcat values estimated for this compound are 6.6 μM and 68.3 s⁻¹, and 1.5 μM and 11.0 s⁻¹ per natively functioning dimer of OaHint2 and OaHint1, respectively. Studies of the rates of hydrolysis of different NH2-pA derivatives show that Hint2 is more specific towards compounds with a P-N bond than Hint1. The thermostability of these two proteins is also compared.

  3. 76 FR 19909 - International Terrorism Victim Expense Reimbursement Program

    Science.gov (United States)

    2011-04-11

    ... 1121-AA78 International Terrorism Victim Expense Reimbursement Program AGENCY: Office of Justice... promulgating this interim-final rule for its International Terrorism Victim Expense Reimbursement Program... international terrorism. DATES: Effective date: This interim-final rule is effective April 11, 2011. Comment...

  4. 5 CFR 2634.304 - Gifts and reimbursements.

    Science.gov (United States)

    2010-01-01

    ... manners: (1) If the gift has been newly purchased or is readily available in the market, the value shall... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Gifts and reimbursements. 2634.304....304 Gifts and reimbursements. (a) Gifts. Except as indicated in § 2634.308(b), each financial...

  5. 14 CFR 331.7 - What losses will be reimbursed?

    Science.gov (United States)

    2010-01-01

    ... PROVIDERS IN THE WASHINGTON, DC AREA General Provisions § 331.7 What losses will be reimbursed? (a) You may... which you are or were an operator or provider not been closed as the result of Federal government...-recurring, or unusual adjustments, and capital losses are normally ineligible for reimbursement. If you wish...

  6. Obtaining reimbursement in France and Italy for new diabetes products.

    Science.gov (United States)

    Schaefer, Elmar; Schnell, Gerald; Sonsalla, Jessica

    2015-01-01

    Manufacturers launching next-generation or innovative medical devices in Europe face a very heterogeneous reimbursement landscape, with each country having its own pathways, timing, requirements and success factors. We selected 2 markets for a deeper look into the reimbursement landscape: France, representing a country with central decision making with defined processes, and Italy, which delegates reimbursement decisions to the regional level, resulting in a less transparent approach to reimbursement. Based on our experience in working on various new product launches and analyzing recent reimbursement decisions, we found that payers in both countries do not reward improved next-generation products with incremental reimbursement. Looking at innovations, we observe that manufacturers face a challenging and lengthy process to obtain reimbursement. In addition, requirements and key success factors differ by country: In France, comparative clinical evidence and budget impact very much drive reimbursement decisions in terms of pricing and restrictions, whereas in Italy, regional key opinion leader (KOL) support and additional local observational data are key. © 2015 Diabetes Technology Society.

  7. 48 CFR 1316.405 - Cost-reimbursement incentive contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 1316.405 Section 1316.405 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 1316.405 Cost-reimbursement...

  8. 42 CFR 57.313a - Loan cancellation reimbursement.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Loan cancellation reimbursement. 57.313a Section 57.313a Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR... Loans § 57.313a Loan cancellation reimbursement. In the event that insufficient funds are available to...

  9. 44 CFR 208.42 - Reimbursement for other administrative costs.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for other administrative costs. 208.42 Section 208.42 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... SYSTEM Response Cooperative Agreements § 208.42 Reimbursement for other administrative costs. Costs...

  10. 47 CFR 27.1233 - Reimbursement costs of transitioning.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Reimbursement costs of transitioning. 27.1233 Section 27.1233 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES... Policies Governing the Transition of the 2500-2690 Mhz Band for Brs and Ebs § 27.1233 Reimbursement costs...

  11. 48 CFR 216.405 - Cost-reimbursement incentive contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 216.405 Section 216.405 Federal Acquisition Regulations System DEFENSE ACQUISITION... Contracts 216.405 Cost-reimbursement incentive contracts. ...

  12. 50 CFR 86.71 - How will I be reimbursed?

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false How will I be reimbursed? 86.71 Section 86.71 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR...) PROGRAM How States Manage Grants § 86.71 How will I be reimbursed? For details on how we will pay you...

  13. 44 CFR 63.6 - Reimbursable relocation costs.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursable relocation costs. 63.6 Section 63.6 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... OF SECTION 1306(c) OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 General § 63.6 Reimbursable relocation...

  14. State Variation in Medicaid Reimbursements for Orthopaedic Surgery.

    Science.gov (United States)

    Lalezari, Ramin M; Pozen, Alexis; Dy, Christopher J

    2018-02-07

    Medicaid reimbursements are determined by each state and are subject to variability. We sought to quantify this variation for commonly performed inpatient orthopaedic procedures. The 10 most commonly performed inpatient orthopaedic procedures, as ranked by the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, were identified for study. Medicaid reimbursement amounts for those procedures were benchmarked to state Medicare reimbursement amounts in 3 ways: (1) ratio, (2) dollar difference, and (3) dollar difference divided by the relative value unit (RVU) amount. Variability was quantified by determining the range and coefficient of variation for those reimbursement amounts. The range of variability of Medicaid reimbursements among states exceeded $1,500 for all 10 procedures. The coefficients of variation ranged from 0.32 (hip hemiarthroplasty) to 0.57 (posterior or posterolateral lumbar interbody arthrodesis) (a higher coefficient indicates greater variability), compared with 0.07 for Medicare reimbursements for all 10 procedures. Adjusted as a dollar difference between Medicaid and Medicare per RVU, the median values ranged from -$8/RVU (total knee arthroplasty) to -$17/RVU (open reduction and internal fixation of the femur). Variability of Medicaid reimbursement for inpatient orthopaedic procedures among states is substantial. This variation becomes especially remarkable given recent policy shifts toward focusing reimbursements on value.

  15. 48 CFR 1816.405 - Cost-reimbursement incentive contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Cost-reimbursement incentive contracts. 1816.405 Section 1816.405 Federal Acquisition Regulations System NATIONAL AERONAUTICS... 1816.405 Cost-reimbursement incentive contracts. [62 FR 3478, Jan. 23, 1997. Redesignated at 62 FR...

  16. 48 CFR 916.405 - Cost-reimbursement incentive contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 916.405 Section 916.405 Federal Acquisition Regulations System DEPARTMENT OF ENERGY CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 916.405 Cost-reimbursement...

  17. 36 CFR 64.15 - Financial reporting requirements and reimbursements.

    Science.gov (United States)

    2010-07-01

    ... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Financial reporting requirements and reimbursements. 64.15 Section 64.15 Parks, Forests, and Public Property NATIONAL PARK SERVICE... RIGHTS-OF-WAY § 64.15 Financial reporting requirements and reimbursements. Payments to applicants will...

  18. 78 FR 76626 - Privately Owned Vehicle Mileage Reimbursement Rates

    Science.gov (United States)

    2013-12-18

    ... Procedure GSA posts the POV mileage reimbursement rates, formerly published in 41 CFR Chapter 301, solely on... official travel. Notices published periodically in the Federal Register, such as this one, and the changes... reimbursement rates for Federal agencies. Dated: December 12, 2013. Carolyn Austin-Diggs, Acting Deputy...

  19. Interaction Networks: Generating High Level Hints Based on Network Community Clustering

    Science.gov (United States)

    Eagle, Michael; Johnson, Matthew; Barnes, Tiffany

    2012-01-01

    We introduce a novel data structure, the Interaction Network, for representing interaction-data from open problem solving environment tutors. We show how using network community detecting techniques are used to identify sub-goals in problems in a logic tutor. We then use those community structures to generate high level hints between sub-goals.…

  20. Pigeons (Columba livia) know when they will need hints: prospective metacognition for reference memory?

    Science.gov (United States)

    Iwasaki, Sumie; Watanabe, Sota; Fujita, Kazuo

    2018-03-01

    Despite their impressive cognitive abilities, avian species have shown less evidence for metacognition than mammals. We suspect that commonly used tasks such as matching to sample might be too demanding to allow metacognitive processing within birds' working memory. Here, we examined whether pigeons could control their behavior as a function of knowledge levels on a three-item sequence learning task, a reference memory task supposedly requiring fewer working memory resources. The experiment used two types of lists differing in familiarity. One was familiar to the pigeons through repeated exposure, whereas the other was novel in every new session. In test sessions, pigeons could choose between a trial with a hint specifying the next item to peck and one with no hint. However, successful responses in trials with a hint resulted in lowered rates of primary reinforcement: .60 in the first test and .75 in the second. Results showed that two of four pigeons chose the trial with a hint significantly more often before receiving a novel list than the familiar list in the four sessions of the first test, and three did so in the second test. Impressively, one bird showed robust evidence in the very first sessions in both tests. These results suggest that pigeons may monitor their long-term knowledge states and thereby control their environment before starting to solve a task.

  1. Can children take advantage of nao gaze-based hints during gameplay?

    NARCIS (Netherlands)

    Mwangi, E.N.; Diaz, M.; Barakova, E.I.; Catala, A.; Rauterberg, G.W.M.

    2017-01-01

    This paper presents a study that analyzes the effects of robots' gaze hints on children's performance in a card-matching game. We conducted a within-subjects study, in which children played a card matching game "Memory" in the presence of a robot tutor in two sessions. In one session, the robot gave

  2. Theory of mind in a first-episode psychosis population using the Hinting Task.

    Science.gov (United States)

    Lindgren, Maija; Torniainen-Holm, Minna; Heiskanen, Inkeri; Voutilainen, Greta; Pulkkinen, Ulla; Mehtälä, Tuukka; Jokela, Markus; Kieseppä, Tuula; Suvisaari, Jaana; Therman, Sebastian

    2018-05-01

    Deficiencies in theory of mind (ToM) are common in psychosis and may largely explain impaired social functioning. Currently, it is unclear whether impairments in ToM are explained by the more general cognitive deficits related to psychosis or whether ToM is impaired in psychosis independently of other cognitive deficits. This study examined ToM using the Hinting Task in young adults (n = 66) with first-episode psychosis and matched controls (n = 62). The participants were administered a broad neuropsychological assessment. Participants with psychosis performed worse than controls on the Hinting Task. However, 75% of the variance between the groups was explained by general cognitive deficits, especially impaired processing speed and episodic memory. Hinting Task performance of the best functioning patient group did not differ from that of the control group. When the psychosis group was divided according to diagnosis, the Hinting Task difference between individuals with schizophrenia and controls remained significant even when general cognitive performance was controlled for, suggesting specific verbal ToM deficits in schizophrenia. In contrast, those with other psychotic disorders did not differ from controls. Our results suggest that ToM deficits can be seen in early phases of psychotic disorders, schizophrenia in particular, and are partly independent of other cognitive functions. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. Pedagogical Agent Gestures to Improve Learner Comprehension of Abstract Concepts in Hints

    Science.gov (United States)

    Martins, Igor; de Morais, Felipe; Schaab, Bruno; Jaques, Patricia

    2016-01-01

    In most Intelligent Tutoring Systems, the help messages (hints) are not very clear for students as they are only presented textually and have little connection with the task elements. This can lead to students' undesired behaviors, like gaming the system, associated with low performance. In this paper, the authors aim at evaluating if the gestures…

  4. Res Publicas käärib mäss / Hants Hint

    Index Scriptorium Estoniae

    Hint, Hants

    2002-01-01

    Res Publica eestseisuse liige ja Ida-Viru piirkonna esimees Hants Hint vastab küsimustele Res Publica ja Keskerakonna võimuliidu moodustamisega tekkinud skandaali, Res Publica esimehe Juhan Partsiga kohtumise kohta. Vt. samas: "Korbi toetajaid ootab hukkamõist"

  5. Data-Driven Hint Generation in Vast Solution Spaces: A Self-Improving Python Programming Tutor

    Science.gov (United States)

    Rivers, Kelly; Koedinger, Kenneth R.

    2017-01-01

    To provide personalized help to students who are working on code-writing problems, we introduce a data-driven tutoring system, ITAP (Intelligent Teaching Assistant for Programming). ITAP uses state abstraction, path construction, and state reification to automatically generate personalized hints for students, even when given states that have not…

  6. [Reimbursement of health apps by the German statutory health insurance].

    Science.gov (United States)

    Gregor-Haack, Johanna

    2018-03-01

    reimbursement category for "apps" does not exist in German statutory health insurance. Nevertheless different ways for reimbursement of digital health care products or processes exist. This article provides an overview and a description of the most relevant finance and reimbursement categories for apps in German statutory health insurance. The legal qualifications and preconditions of reimbursement in the context of single contracts with one health insurance fund will be discussed as well as collective contracts with national statutory health insurance funds. The benefit of a general outline appeals especially in respect to the numerous new players and products in the health care market. The article will highlight that health apps can challenge existing legal market access and reimbursement criteria and paths. At the same time, these criteria and paths exist. In terms of a learning system, they need to be met and followed.

  7. Stoic Behavior Hypothesis in Hint Seeking and Development of Reversi Learning Environment as Work Bench for Investigation

    Science.gov (United States)

    Miwa, Kazuhisa; Kojima, Kazuaki; Terai, Hitoshi

    2014-01-01

    Tutoring systems provide students with various types of on-demand and context-sensitive hints. Students are required to consciously adapt their help-seeking behavior, proactively seek help in some situations, and solve problems independently without supports in other situations. We define the latter behavior as stoic behavior in hint seeking. In…

  8. Nursing Home Cost Studies and Reimbursement Issues

    Science.gov (United States)

    Bishop, Christine E.

    1980-01-01

    This review of nursing home cost function research shows that certain provider and service characteristics are systematically associated with differences in the average cost of care. This information can be used to group providers for reasonable cost related rate-setting or to adjust their rates or rate ceilings. However, relationships between average cost and such service characteristics as patient mix, service intensity, and quality of care have not been fully delineated. Therefore, econometric cost functions cannot yet provide rate-setters with predictions about the cost of the efficient provision of nursing home care appropriate to patient needs. In any case, the design of reimbursement systems must be founded not only on technical information but also on public policy goals for long-term care. PMID:10309223

  9. Direct reimbursement. The future for organized dentistry.

    Science.gov (United States)

    Paul, D P

    2001-10-01

    Direct reimbursement, or DR, has been a popular topic in organized dentistry for much of the last decade, and the concept is beginning to be more widely known. This article explores the underpinnings of and future for DR. TYPES OF LITERATURE REVIEWED: This article is based on an online review of the dental, medical and business literature. The author explores the advantages of DR for patients, employers and dentists. He also presents purported disadvantages of DR, and refutes them. Organized dentistry's marketing efforts and the importance of third-party administrators also are examined. During the next several years, DR has the potential to become the vehicle of choice for financing much of the dental care provided in the United States. Dentists need to become more aware of what DR is and what it can offer the public. They then will be better able to promote DR, which is a significantly better payment system for dental care than any other available today.

  10. Nursing home cost studies and reimbursement issues.

    Science.gov (United States)

    Bishop, C E

    1980-01-01

    This review of nursing home cost function research shows that certain provider and service characteristics are systematically associated with differences in the average cost of care. This information can be used to group providers for reasonable cost related rate-setting or to adjust their rates or rate ceilings. However, relationships between average cost and such service characteristics as patient mix, service intensity, and quality of care have not been fully delineated. Therefore, econometric cost functions cannot yet provide rate-setters with predictions about the cost of the efficient provision of nursing home care appropriate to patient needs. In any case, the design of reimbursement systems must be founded not only on technical information but also on public policy goals for long-term care.

  11. Pricing and reimbursement of drugs in Ireland.

    Science.gov (United States)

    Barry, Michael; Tilson, Lesley; Ryan, Máirín

    2004-06-01

    Expenditure on healthcare in Ireland, which is mainly derived from taxation, has increased considerably in recent years to an estimated 9.2 billion euro in 2003. Pharmaceuticals account for approximately 10% of total healthcare expenditure. Approximately one-third of patients receive their medications free of charge whilst the remaining two-thirds are subject to a co-payment threshold of 78 euro per month, i.e. 936 euro per year. The price of medications in Ireland is linked to those of five other member states where the price to the wholesaler of any medication will not exceed the lesser of the currency-adjusted wholesale price in the United Kingdom or the average of wholesale prices in Denmark, France, Germany, The Netherlands and the United Kingdom. A price freeze at the introduction price has been in existence since 1993. Despite the price freeze, expenditure on medicines on the community drugs scheme has increased from 201 million euro in 1993 to 898 million euro in 2002. The two main factors contributing to the increased expenditure on medicines include "product mix", the prescribing of new and more expensive medication, and "volume effect" comprising growth in the number of prescription items. Changing demographics and the extension of the General Medical Services (GMS) Scheme to provide free medicines for all those over the age of 70 years have also contributed. Prior to reimbursement under the community drugs schemes, a medicine must be included in the GMS code book or positive list. A demonstration of cost-effectiveness is not a pre-requisite for reimbursement.

  12. Reimbursement rates and policies for primary molar pit-and-fissure sealants across state Medicaid programs.

    Science.gov (United States)

    Chi, Donald L; Singh, Jennifer

    2013-11-01

    Little is known about Medicaid policies regarding reimbursement for placement of sealants on primary molars. The authors identified Medicaid programs that reimbursed dentists for placing primary molar sealants and hypothesized that these programs had higher reimbursement rates than did state programs that did not reimburse for primary molar sealants. The authors obtained Medicaid reimbursement data from online fee schedules and determined whether each state Medicaid program reimbursed for primary molar sealants (no or yes). The outcome measure was the reimbursement rate for permanent tooth sealants (calculated in 2012 U.S. dollars). The authors compared mean reimbursement rates by using the t test (α = .05). Seventeen Medicaid programs reimbursed dentists for placing primary molar sealants (34 percent), and the mean reimbursement rate was $27.57 (range, $16.00 [Maine] to $49.68 [Alaska]). All 50 programs reimbursed dentists for placement of sealants on permanent teeth. The mean reimbursement for permanent tooth sealants was significantly higher in programs that reimbursed for primary molar sealants than in programs that did not ($28.51 and $23.67, respectively; P = .03). Most state Medicaid programs do not reimburse dentists for placing sealants on primary molars, but programs that do so have significantly higher reimbursement rates. Medicaid reimbursement rates are related to dentists' participation in Medicaid and children's dental care use. Reimbursement for placement of sealants on primary molars is a proxy for Medicaid program generosity.

  13. 78 FR 7750 - Summer Food Service Program; 2013 Reimbursement Rates

    Science.gov (United States)

    2013-02-04

    ...This notice informs the public of the annual adjustments to the reimbursement rates for meals served in the Summer Food Service Program for Children. These adjustments address changes in the Consumer Price Index, as required under the Richard B. Russell National School Lunch Act. The 2013 reimbursement rates are presented as a combined set of rates to highlight simplified cost accounting procedures. The 2013 rates are also presented individually, as separate operating and administrative rates of reimbursement, to show the effect of the Consumer Price Index adjustment on each rate.

  14. 77 FR 5228 - Summer Food Service Program; 2012 Reimbursement Rates

    Science.gov (United States)

    2012-02-02

    ...This notice informs the public of the annual adjustments to the reimbursement rates for meals served in the Summer Food Service Program for Children. These adjustments address changes in the Consumer Price Index, as required under the Richard B. Russell National School Lunch Act. The 2012 reimbursement rates are presented as a combined set of rates to highlight simplified cost accounting procedures. The 2012 rates are also presented individually, as separate operating and administrative rates of reimbursement, to show the effect of the Consumer Price Index adjustment on each rate.

  15. 76 FR 5328 - Summer Food Service Program; 2011 Reimbursement Rates

    Science.gov (United States)

    2011-01-31

    ...This notice informs the public of the annual adjustments to the reimbursement rates for meals served in the Summer Food Service Program for Children. These adjustments address changes in the Consumer Price Index, as required under the Richard B. Russell National School Lunch Act. The 2011 reimbursement rates are presented as a combined set of rates to highlight simplified cost accounting procedures that are extended nationwide by enactment of the Fiscal Year 2008 Consolidated Appropriations Act. The 2011 rates are also presented individually, as separate operating and administrative rates of reimbursement, to show the effect of the Consumer Price Index adjustment on each rate.

  16. 75 FR 3197 - Summer Food Service Program; 2010 Reimbursement Rates

    Science.gov (United States)

    2010-01-20

    ...This notice informs the public of the annual adjustments to the reimbursement rates for meals served in the Summer Food Service Program for Children. These adjustments address changes in the Consumer Price Index, as required under the Richard B. Russell National School Lunch Act. The 2010 reimbursement rates are presented as a combined set of rates to highlight simplified cost accounting procedures that are extended nationwide by enactment of the Fiscal Year 2008 Consolidated Appropriations Act. The 2010 rates are also presented individually, as separate operating and administrative rates of reimbursement, to show the effect of the Consumer Price Index adjustment on each rate.

  17. The Impact of Discharge Disposition on Episode-of-Care Reimbursement After Primary Total Hip Arthroplasty.

    Science.gov (United States)

    Sabeh, Karim G; Rosas, Samuel; Buller, Leonard T; Roche, Martin W; Hernandez, Victor H

    2017-10-01

    Total joint arthroplasty (TJA) accounts for more Medicare expenditure than any other inpatient procedure. The Comprehensive Care for Joint Replacement model was introduced to decrease cost and improve quality in TJA. The largest portion of episode-of-care costs occurs after discharge. This study sought to quantify the cost variation of primary total hip arthroplasty (THA) according to discharge disposition. The Medicare and Humana claims databases were used to extract charges and reimbursements to compare day-of-surgery and 91-day postoperative costs simulating episode-of-care reimbursements. Of the patients who underwent primary THA, 257,120 were identified (204,912 from Medicare and 52,208 from Humana). Patients were stratified by discharge disposition: home with home health, skilled nursing facility, or inpatient rehabilitation facility. There is a significant difference in the episode-of-care costs according to discharge disposition, with discharge to an inpatient rehabilitation facility the most costly and discharge to home the least costly. Postdischarge costs represent a sizeable portion of the overall expense in THA, and optimizing patients to allow safe discharge to home may help reduce the cost of THA. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Contested Property Claims

    DEFF Research Database (Denmark)

    Property relations are such a common feature of social life that we can sometimes forget the immense complexity of the web of laws, practices, and ideas that allow a property regime to function smoothly. But we are quickly reminded of this complexity when social conflict over property erupts. When...... social actors confront a property regime – for example by squatting – they enact what can be called ‘contested property claims’. These confrontations raise crucial issues of social justice and show the ways in which property conflicts often reflect wider social conflicts. Through a series of case studies...... from across the globe, this multidisciplinary anthology exploring contested property claims brings together works from anthropologists, legal scholars, and geographers, who show how disagreements give us a privileged window onto how property regimes function and illustrates the many ways...

  19. Contested Property Claims

    DEFF Research Database (Denmark)

    Property relations are such a common feature of social life that the complexity of the web of laws, practices, and ideas that allow a property regime to function smoothly are often forgotten. But we are quickly reminded of this complexity when conflict over property erupts. When social actors...... confront a property regime – for example by squatting – they enact what can be called ‘contested property claims’. As this book demonstrates, these confrontations raise crucial issues of social justice and show the ways in which property conflicts often reflect wider social conflicts. Through a series...... of case studies from across the globe, this multidisciplinary anthology brings together works from anthropologists, legal scholars, and geographers, who show how exploring contested property claims offers a privileged window onto how property regimes function, as well as an illustration of the many ways...

  20. Claiming health in food products

    DEFF Research Database (Denmark)

    Lähteenmäki, Liisa

    2013-01-01

    Health-related information is increasingly used on food products to convey their benefits. Health claims as a subcategory of these messages link the beneficial component, functions or health outcomes with specific products. For consumers, health claims seem to carry the message of increased...... healthiness, but not necessarily making the product more appealing. The wording of the claim seems to have little impact on claim perception, yet the health image of carrier products is important. From consumer-related factors the relevance and attitudes towards functional foods play a role, whereas socio......-demographic factors have only minor impact and the impact seems to be case-dependent. Familiarity with claims and functional foods increase perceived healthiness and acceptance of these products. Apparently consumers make rather rational interpretations of claims and their benefits when forced to assess...

  1. Claims in civil engineering contracts

    CERN Document Server

    Speirs, N A

    1999-01-01

    This paper considers claims arising during civil engineering construction contracts. The meaning of the word 'claim' is considered and its possible implications for additional cost and time to completion. The conditions of the construction contract selected will influence the risk apportionment between contractor and client and the price offered by the contractor for the work. Competitive bidding constraints and profit margins in the construction industry, however, may also influence the price offered. This in turn can influence the likelihood of claims arising. The client from his point of view is concerned to complete the work within an agreed time and budget. The circumstances under which claims may arise are reviewed in relation to typical conditions of contract. These circumstances are then related to the CERN LHC civil works. Ways of avoiding claims, where this is possible, are considered. Finally, the means of evaluation of claims and their settlement are considered.

  2. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness.

    Science.gov (United States)

    Newman-Toker, David E; Kerber, Kevin A; Hsieh, Yu-Hsiang; Pula, John H; Omron, Rodney; Saber Tehrani, Ali S; Mantokoudis, Georgios; Hanley, Daniel F; Zee, David S; Kattah, Jorge C

    2013-10-01

    Dizziness and vertigo account for about 4 million emergency department (ED) visits annually in the United States, and some 160,000 to 240,000 (4% to 6%) have cerebrovascular causes. Stroke diagnosis in ED patients with vertigo/dizziness is challenging because the majority have no obvious focal neurologic signs at initial presentation. The authors sought to compare the accuracy of two previously published approaches purported to be useful in bedside screening for possible stroke in dizziness: a clinical decision rule (head impulse, nystagmus type, test of skew [HINTS]) and a risk stratification rule (age, blood pressure, clinical features, duration of symptoms, diabetes [ABCD2]). This was a cross-sectional study of high-risk patients (more than one stroke risk factor) with acute vestibular syndrome (AVS; acute, persistent vertigo or dizziness with nystagmus, plus nausea or vomiting, head motion intolerance, and new gait unsteadiness) at a single academic center. All underwent neurootologic examination, neuroimaging (97.4% by magnetic resonance imaging [MRI]), and follow-up. ABCD2 risk scores (0-7 points), using the recommended cutoff of ≥4 for stroke, were compared to a three-component eye movement battery (HINTS). Sensitivity, specificity, and positive and negative likelihood ratios (LR+, LR-) were assessed for stroke and other central causes, and the results were stratified by age. False-negative initial neuroimaging was also assessed. A total of 190 adult AVS patients were assessed (1999-2012). Median age was 60.5 years (range = 18 to 92 years; interquartile range [IQR] = 52.0 to 70.0 years); 60.5% were men. Final diagnoses were vestibular neuritis (34.7%), posterior fossa stroke (59.5% [105 infarctions, eight hemorrhages]), and other central causes (5.8%). Median ABCD2 was 4.0 (range = 2 to 7; IQR = 3.0 to 4.0). ABCD2 ≥ 4 for stroke had sensitivity of 61.1%, specificity of 62.3%, LR+ of 1.62, and LR- of 0.62; sensitivity was lower for those

  3. Capital budgeting and cost reimbursement in investor-owned and not-for-profit hospitals.

    Science.gov (United States)

    Hubbard, C M

    1983-01-01

    Net present value estimates cannot be made in health care finance without the appropriate cost reimbursement adjustments. The results of new regulations could radically alter the effects of reimbursement on capital budgeting. Debates on the effects of cost reimbursement on decision making in hospitals will continue as long as reimbursement exists in a manner that affects operating cash flows or the cost of capital.

  4. 45 CFR 2553.43 - What cost reimbursements are provided to RSVP volunteers?

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false What cost reimbursements are provided to RSVP... Reimbursements and Volunteer Assignments § 2553.43 What cost reimbursements are provided to RSVP volunteers? RSVP volunteers are provided the following cost reimbursements within the limits of the project's available...

  5. 76 FR 30696 - Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    Science.gov (United States)

    2011-05-26

    ... in the reimbursement ceilings). Title X requires DOE to reimburse eligible uranium and thorium... DEPARTMENT OF ENERGY Reimbursement for Costs of Remedial Action at Active Uranium and Thorium... reimbursement under Title X of the Energy Policy Act of 1992. In our Federal Register Notice of November 24...

  6. 45 CFR 2551.46 - What cost reimbursements are provided to Senior Companions?

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false What cost reimbursements are provided to Senior..., and Cost Reimbursements § 2551.46 What cost reimbursements are provided to Senior Companions? Cost reimbursements include: (a) Stipend. Senior Companions who are income eligible will receive a stipend in an...

  7. 76 FR 24871 - Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    Science.gov (United States)

    2011-05-03

    ... in the reimbursement ceilings). Title X requires DOE to reimburse eligible uranium and thorium... DEPARTMENT OF ENERGY Reimbursement for Costs of Remedial Action at Active Uranium and Thorium... reimbursement under Title X of the Energy Policy Act of 1992. DATES: In our Federal Register Notice of November...

  8. 77 FR 12925 - Federal Acquisition Regulation; Proper Use and Management of Cost-Reimbursement Contracts

    Science.gov (United States)

    2012-03-02

    ...-Reimbursement Contracts AGENCIES: Department of Defense (DoD), General Services Administration (GSA), and... addresses the use and management of cost- reimbursement contracts. DATES: Effective Date: April 2, 2012 FOR...-reimbursement contracts in the following three areas: 1. Circumstances when cost-reimbursement contracts are...

  9. 45 CFR 2552.46 - What cost reimbursements are provided to Foster Grandparents?

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false What cost reimbursements are provided to Foster..., Status and Cost Reimbursements § 2552.46 What cost reimbursements are provided to Foster Grandparents? Cost reimbursements include: (a) Stipend. Foster Grandparents who are income eligible will receive a...

  10. 47 CFR 24.245 - Reimbursement under the Cost-Sharing Plan.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Reimbursement under the Cost-Sharing Plan. 24... 1850-1990 Mhz Band § 24.245 Reimbursement under the Cost-Sharing Plan. (a) Registration of reimbursement rights. (1) To obtain reimbursement, a PCS relocator must submit documentation of the relocation...

  11. 44 CFR 208.40 - Reimbursement of fringe benefit costs during Activation.

    Science.gov (United States)

    2010-10-01

    ... reimbursement sought from DHS. (c) DHS will not reimburse the Sponsoring Agency for fringe benefit costs for... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement of fringe... RESCUE RESPONSE SYSTEM Response Cooperative Agreements § 208.40 Reimbursement of fringe benefit costs...

  12. Higgs hints

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1991-10-15

    As well as dominating the news at the recent Joint International Lepton-Photon Symposium and Europhysics Conference on High Energy Physics in Geneva, results from the four big experiments - Aleph , Delphi, L3 and Opal - at CERN's big LEP electron-positron collider had far-reaching implications.

  13. Claim prevention at reactor facilities

    International Nuclear Information System (INIS)

    Colby, B.P.

    1987-01-01

    Why does a radiation worker bring a claim alleging bodily injury from radiation exposure? Natural cancer, fear of radiation induced cancer, financial gain, emotional distress and mental anguish are some reasons for workers' claims. In this paper the author describes what power reactor health physicists are doing to reduce the likelihood of claims by establishing programs which provide sound protection of workers, prevent radiological events, improve workers' knowledge of radiological conditions and provide guidance for radiological incident response

  14. Employing UMLS for generating hints in a tutoring system for medical problem-based learning.

    Science.gov (United States)

    Kazi, Hameedullah; Haddawy, Peter; Suebnukarn, Siriwan

    2012-06-01

    While problem-based learning has become widely popular for imparting clinical reasoning skills, the dynamics of medical PBL require close attention to a small group of students, placing a burden on medical faculty, whose time is over taxed. Intelligent tutoring systems (ITSs) offer an attractive means to increase the amount of facilitated PBL training the students receive. But typical intelligent tutoring system architectures make use of a domain model that provides a limited set of approved solutions to problems presented to students. Student solutions that do not match the approved ones, but are otherwise partially correct, receive little acknowledgement as feedback, stifling broader reasoning. Allowing students to creatively explore the space of possible solutions is exactly one of the attractive features of PBL. This paper provides an alternative to the traditional ITS architecture by using a hint generation strategy that leverages a domain ontology to provide effective feedback. The concept hierarchy and co-occurrence between concepts in the domain ontology are drawn upon to ascertain partial correctness of a solution and guide student reasoning towards a correct solution. We describe the strategy incorporated in METEOR, a tutoring system for medical PBL, wherein the widely available UMLS is deployed and represented as the domain ontology. Evaluation of expert agreement with system generated hints on a 5-point likert scale resulted in an average score of 4.44 (Spearman's ρ=0.80, p<0.01). Hints containing partial correctness feedback scored significantly higher than those without it (Mann Whitney, p<0.001). Hints produced by a human expert received an average score of 4.2 (Spearman's ρ=0.80, p<0.01). Copyright © 2012 Elsevier Inc. All rights reserved.

  15. The Diagnostic Accuracy of Truncal Ataxia and HINTS as Cardinal Signs for Acute Vestibular Syndrome

    Directory of Open Access Journals (Sweden)

    Sergio Carmona

    2016-08-01

    Full Text Available The head impulse, nystagmus type, test of skew (HINTS protocol set a new paradigm to differentiate peripheral vestibular disease from stroke in patients with acute vestibular syndrome (AVS. The relationship between degree of truncal ataxia and stroke has not been systematically studied in patients with AVS. We studied a group of 114 patients who were admitted to a General Hospital due to AVS, 72 of them with vestibular neuritis (based on positive head impulse, abnormal caloric tests and negative MRI, and the rest with Stroke: 32 in the PICA territory (positive HINTS findings, positive MRI and 10 in the AICA territory (variable findings and grade 3 Ataxia, positive MRI. Truncal ataxia was measured by independent observers as grade 1, mild to moderate imbalance with walking independently; grade 2, severe imbalance with standing, but cannot walk without support; and grade 3, falling at upright posture.When we applied the HINTS protocol to our sample, we obtained 100% sensitivity and 94.4% specificity, similar to previously published findings. Only those patients with stroke presented with grade 3 ataxia. Of those with grade 2 ataxia (n = 38, 11 had cerebellar stroke and 28 had vestibular neuritis, not related to the patient's age. Grade 2-3 ataxia was 92.9% sensitive and 61.1% specific to detect AICA/PICA stroke in patients with AVS, with 100% sensitivity to detect AICA stroke. In turn, two signs (nystagmus of central origin and grade 2-3 Ataxia had 100% sensitivity and 61.1% specificity. Ataxia is less sensitive than HINTS but much easier to evaluate.

  16. Anti-depressant and anxiolytic like behaviors in PKCI/HINT1 knockout mice associated with elevated plasma corticosterone level

    Directory of Open Access Journals (Sweden)

    Wang Jia

    2009-11-01

    Full Text Available Abstract Background Protein kinase C interacting protein (PKCI/HINT1 is a small protein belonging to the histidine triad (HIT family proteins. Its brain immunoreactivity is located in neurons and neuronal processes. PKCI/HINT1 gene knockout (KO mice display hyper-locomotion in response to D-amphetamine which is considered a positive symptom of schizophrenia in animal models. Postmortem studies identified PKCI/HINT1 as a candidate molecule for schizophrenia and bipolar disorder. We investigated the hypothesis that the PKCI/HINT1 gene may play an important role in regulating mood function in the CNS. We submitted PKCI/HINT1 KO mice and their wild type (WT littermates to behavioral tests used to study anti-depressant, anxiety like behaviors, and goal-oriented behavior. Additionally, as many mood disorders coincide with modifications of hypothalamic-pituitary-adrenal (HPA axis function, we assessed the HPA activity through measurement of plasma corticosterone levels. Results Compared to the WT controls, KO mice exhibited less immobility in the forced swim (FST and the tail suspension (TST tests. Activity in the TST tended to be attenuated by acute treatment with valproate at 300 mg/kg in KO mice. The PKCI/HINT1 KO mice presented less thigmotaxis in the Morris water maze and spent progressively more time in the lit compartment in the light/dark test. In a place navigation task, KO mice exhibited enhanced acquisition and retention. Furthermore, the afternoon basal plasma corticosterone level in PKCI/HINT1 KO mice was significantly higher than in the WT. Conclusion PKCI/HINT1 KO mice displayed a phenotype of behavioral and endocrine features which indicate changes of mood function, including anxiolytic-like and anti-depressant like behaviors, in conjunction with an elevated corticosterone level in plasma. These results suggest that the PKCI/HINT 1 gene could be important for the mood regulation function in the CNS.

  17. Reimbursement issues facing patients, providers, and payers.

    Science.gov (United States)

    Antman, K

    1993-11-01

    Escalating costs of health care delivery and the current constraints imposed by the federal budget deficit seriously threaten to compromise patient care and innovative biomedical research. Recent third-party refusal to cover some patients treated in protocols has had considerable impact on trial research. In addition, reimbursement for conventional care sometimes has been refused if delivered as part of a study (e.g., MOPP therapy versus ABVD therapy) or for an indication that is not specifically cited on the Food and Drug Administration label. Who should cover the patient care costs of patients participating in clinical trials? One approach would have patients cover these costs themselves. A second approach is the reinstitution of patient care costs into research grants. A third possibility is that the pharmaceutical industry support patient care costs of clinical research. Historically, hospital expenses of patients participating in studies have been paid by health insurance policies. In the absence of a clinical trial, many patients would be treated with Food and Drug Administration-approved therapies despite a lack of substantial benefit. Such marginal treatments are compensated by third-party payers routinely. The current system is arbitrary and expensive, compromises research and development, and equates new treatment with no treatment. By refusing to reimburse the patient care costs of investigational therapy, third-party carriers are, in fact, making medical decisions. There is a growing and legitimate concern that the pace of clinical research will be impeded significantly at a time when many exciting developments will be ready for clinical trials. The molecular steps in carcinogenesis are being documented rapidly for common malignancies, such as colon cancer. Immunologic, biologic, and hormonal approaches, and emerging technologies, such as marrow transplant or antibody toxin conjugates, already are being studied in the clinic. Health policy legislation

  18. 26 CFR 20.2205-1 - Reimbursement out of estate.

    Science.gov (United States)

    2010-04-01

    ... passing to, or in the possession of, any person other than the duly qualified executor or administrator... specific provisions giving the executor the right to reimbursement from life insurance beneficiaries and...

  19. 75 FR 37971 - Providing Stability and Security for Medicare Reimbursements

    Science.gov (United States)

    2010-06-30

    ... Part IV The President Memorandum of June 25, 2010--Providing Stability and Security for Medicare Reimbursements #0; #0; #0; Presidential Documents #0; #0; #0;#0;Federal Register / Vol. 75, No. 125 / Wednesday...

  20. Timing of Clinical Billing Reimbursement for a Local Health Department.

    Science.gov (United States)

    McCullough, J Mac

    2016-01-01

    A major responsibility of a local health department (LHD) is to assure public health service availability throughout its jurisdiction. Many LHDs face expanded service needs and declining budgets, making billing for services an increasingly important strategy for sustaining public health service provision. Yet, little practice-based data exist to guide practitioners on what to expect financially, especially regarding timing of reimbursement receipt. This study provides results from one LHD on the lag from service delivery to reimbursement receipt. Reimbursement records for all transactions at Maricopa County Department of Public Health immunization clinics from January 2013 through June 2014 were compiled and analyzed to determine the duration between service and reimbursement. Outcomes included daily and cumulative revenues received. Time to reimbursement for Medicaid and private payers was also compared. Reimbursement for immunization services was received a median of 68 days after service. Payments were sometimes taken back by payers through credit transactions that occurred a median of 333 days from service. No differences in time to reimbursement between Medicaid and private payers were found. Billing represents an important financial opportunity for LHDs to continue to sustainably assure population health. Yet, the lag from service provision to reimbursement may complicate budgeting, especially in initial years of new billing activities. Special consideration may be necessary to establish flexibility in the budget-setting processes for services with clinical billing revenues, because funds for services delivered in one budget period may not be received in the same period. LHDs may also benefit from exploring strategies used by other delivery organizations to streamline billing processes.

  1. New Drug Reimbursement and Pricing Policy in Taiwan.

    Science.gov (United States)

    Chen, Gau-Tzu; Chang, Shu-Chen; Chang, Chee-Jen

    2018-05-01

    Taiwan has implemented a national health insurance system for more than 20 years now. The benefits of pharmaceutical products and new drug reimbursement scheme are determined by the Expert Advisory Meeting and the Pharmaceutical Benefit and Reimbursement Scheme (PBRS) Joint Committee in Taiwan. To depict the pharmaceutical benefits and reimbursement scheme for new drugs and the role of health technology assessment (HTA) in drug policy in Taiwan. All data were collected from the Expert Advisory Meeting and the PBRS meeting minutes; new drug applications with HTA reports were derived from the National Health Insurance Administration Web site. Descriptive statistics were used to analyze the timeline of a new drug from application submission to reimbursement effective, the distribution of approved price, and the approval rate for a new drug with/without local pharmacoeconomic study. After the second-generation national health insurance system, the timeline for a new drug from submission to reimbursement effective averages at 436 days, and that for an oncology drug reaches an average of 742 days. New drug approval rate is 67% and the effective rate (through the approval of the PBRS Joint Committee and the acceptance of the manufacturer) is 53%. The final approved price is 53.6% of the international median price and 70% of the proposed price by the manufacturer. Out of 95 HTA reports released during the period January 2011 to February 2017, 28 applications (30%) conducted an HTA with a local pharmacoeconomic study, and all (100%) received reimbursement approval. For the remaining 67 applications (70%) for which HTA was conducted without a local pharmacoeconomic analysis, 54 cases (81%) were reimbursed. New drug applications with local pharmacoeconomic studies are more likely to get reimbursement. Copyright © 2018. Published by Elsevier Inc.

  2. Similarities and differences between five European drug reimbursement systems

    OpenAIRE

    Franken, Margreet

    2012-01-01

    3349-357 Objectives: The aim of our study is to compare five European drug reimbursement systems, describe similarities and differences, and obtain insight into their strengths and weaknesses and formulate policy recommendations. Methods: We used the analytical Hutton Framework to assess in detail drug reimbursement systems in Austria, Belgium, France, the Netherlands, and Sweden. We investigated policy documents, explored literature, and conducted fifty-seven interviews with relevant s...

  3. Definition of a prospective payment system to reimburse emergency departments.

    Science.gov (United States)

    Levaggi, Rosella; Montefiori, Marcello

    2013-10-11

    Payers are increasingly turning to Prospective Payment Systems (PPSs) because they incentivize efficiency, but their application to emergency departments (EDs) is difficult because of the high level of uncertainty and variability in the cost of treating each patient.To the best of our knowledge, our work represents the first attempt at defining a PPS for this part of hospital activity. Data were specifically collected for this study and relate to 1011 patients who were triaged at an ED of a major Italian hospital, during 1 week in December 2010.The cost for each patient was analytically estimated by adding up several components: 1) physician and other staff costs that were imputed on the basis of the time each physician claimed to have spent treating the patient; 2) the cost for each test/treatment each patient actually underwent; 3) overhead costs, shared among patients using the time elapsed between first examination and discharge from the ED. The distribution of costs by triage code shows that, although the average cost increases across the four triage groups, the variance within each code is quite high. The maximum cost for a yellow code is €1074.7, compared with €680 for red, the most serious code. Using cluster analysis, the red code cluster is enveloped by yellow, and their costs are therefore indistinguishable, while green codes span all cost groups. This suggests that triage code alone is not a good proxy for the patient cost, and that other cost drivers need to be included. Crude triage codes cannot be used to define PPSs because they are not sufficiently correlated with costs and are characterized by large variances. However, if combined with other information, such as the number of laboratory and non-laboratory tests/examinations, it is possible to define cost groups that are sufficiently homogeneous to be reimbursed prospectively. This should discourage strategic behavior and allow the ED to break even or create profits, which can be reinvested to

  4. Development of an electronic claim system based on an integrated electronic health record platform to guarantee interoperability.

    Science.gov (United States)

    Kim, Hwa Sun; Cho, Hune; Lee, In Keun

    2011-06-01

    We design and develop an electronic claim system based on an integrated electronic health record (EHR) platform. This system is designed to be used for ambulatory care by office-based physicians in the United States. This is achieved by integrating various medical standard technologies for interoperability between heterogeneous information systems. The developed system serves as a simple clinical data repository, it automatically fills out the Centers for Medicare and Medicaid Services (CMS)-1500 form based on information regarding the patients and physicians' clinical activities. It supports electronic insurance claims by creating reimbursement charges. It also contains an HL7 interface engine to exchange clinical messages between heterogeneous devices. The system partially prevents physician malpractice by suggesting proper treatments according to patient diagnoses and supports physicians by easily preparing documents for reimbursement and submitting claim documents to insurance organizations electronically, without additional effort by the user. To show the usability of the developed system, we performed an experiment that compares the time spent filling out the CMS-1500 form directly and time required create electronic claim data using the developed system. From the experimental results, we conclude that the system could save considerable time for physicians in making claim documents. The developed system might be particularly useful for those who need a reimbursement-specialized EHR system, even though the proposed system does not completely satisfy all criteria requested by the CMS and Office of the National Coordinator for Health Information Technology (ONC). This is because the criteria are not sufficient but necessary condition for the implementation of EHR systems. The system will be upgraded continuously to implement the criteria and to offer more stable and transparent transmission of electronic claim data.

  5. Reimbursement for school nursing health care services: position statement.

    Science.gov (United States)

    Lowe, Janet; Cagginello, Joan; Compton, Linda

    2014-09-01

    Children come to school with a variety of health conditions, varying from moderate health issues to multiple, severe chronic health illnesses that have a profound and direct impact on their ability to learn. The registered professional school nurse (hereinafter referred to as school nurse) provides medically necessary services in the school setting to improve health outcomes and promote academic achievement. The nursing services provided are reimbursable services in other health care settings, such as hospitals, clinics, and home care settings. The National Association of School Nurses (NASN) believes that school nursing services that are reimbursable nursing services in other health care systems should also be reimbursable services in the school setting, while maintaining the same high quality care delivery standards. Traditionally, local and state tax revenues targeted to fund education programs have paid for school nursing health services. School nurses are in a strategic position to advocate for improving clinical processes to better fit with community health care providers and to align reimbursements with proposed changes. Restructuring reimbursement programs will enable health care funding streams to assist in paying for school nursing services delivered to students in the school setting. Developing new innovative health financing opportunities will help to increase access, improve quality, and reduce costs. The goal is to promote a comprehensive and cost-effective health care delivery model that integrates schools, families, providers, and communities.

  6. BLM Colorado Mining Claims Closed

    Data.gov (United States)

    Department of the Interior — Shapefile Format –This data set consists of closed mining claim records extracted from BLM’s LR2000 database. These records contain case attributes as well as legal...

  7. BLM Colorado Mining Claims Active

    Data.gov (United States)

    Department of the Interior — Shapefile Format –This data set consists of active mining claim records extracted from BLM’s LR2000 database. These records contain case attributes as well as legal...

  8. Medicare Part D Claims Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — This page contains information on Part D claims data for the purposes of research, analysis, reporting, and public health functions. These data will also be used to...

  9. Neonatal hypoglycaemia: learning from claims

    OpenAIRE

    Hawdon, Jane M; Beer, Jeanette; Sharp, Deborah; Upton, Michele

    2016-01-01

    Objectives Neonatal hypoglycaemia is a potential cause of neonatal morbidity, and on rare but tragic occasions causes long-term neurodevelopmental harm with consequent emotional and practical costs for the family. The organisational cost to the NHS includes the cost of successful litigation claims. The purpose of the review was to identify themes that could alert clinicians to common pitfalls and thus improve patient safety. Design The NHS Litigation Authority (NHS LA) Claims Management Syste...

  10. 32 CFR 536.121 - Claims not payable as maritime claims.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Claims not payable as maritime claims. 536.121... ACCOUNTS CLAIMS AGAINST THE UNITED STATES Maritime Claims § 536.121 Claims not payable as maritime claims... (except at (e) and (k)), and 536.46; (b) Are not maritime in nature; (c) Are not in the best interests of...

  11. Reimbursement of VAT on written-off Receivables

    DEFF Research Database (Denmark)

    Florentsen, Bjarne; Møller, Michael; Nielsen, Niels Chr.

    2003-01-01

    In many OECD countries, a seller has a right to reimbursement of VAT (RVAT) she has paid on goods sold, but for which she has not yet received payment. Such reimbursement of VAT on receivables is economically inefficient. It leads to:@* Distortion of credit markets, by subsidizing direct credit...... at the cost of financial intermediaries.@* Price discrimination, by subsidizing buyers with low creditworthiness.@* A less efficient collection of bad debts, as trade with bad debts is made extremely expensive.The finance literature presents several `good' arguments in favor of trade credits, e.g. transaction...

  12. Trends in Medicaid Reimbursements for Insulin From 1991 Through 2014.

    Science.gov (United States)

    Luo, Jing; Avorn, Jerry; Kesselheim, Aaron S

    2015-10-01

    Insulin is a vital medicine for patients with diabetes mellitus. Newer, more expensive insulin products and the lack of generic insulins in the United States have increased costs for patients and insurers. To examine Medicaid payment trends for insulin products. Cost information is available for all 50 states and has been recorded since the 1990s. A time-series analysis comparing reimbursements and prices. Using state- and national-level Medicaid data from 1991 to 2014, we identified all patients who used 1 or more of the 16 insulin products that were continuously available in the United States between 2006 and 2014. Insulin products were classified into rapid-acting and long-acting analogs, short-acting, intermediate, and premixed insulins based on American Diabetes Association Guidelines. Inflation-adjusted payments made to pharmacies by Medicaid per 1 mL (100 IU) of insulin in 2014 US dollars. Since 1991, Medicaid reimbursement per unit (1 mL) of insulin dispensed has risen steadily. In the 1990s, Medicaid reimbursed pharmacies between $2.36 and $4.43 per unit. By 2014, reimbursement for short-acting insulins increased to $9.64 per unit; intermediate, $9.22; premixed, $14.79; and long-acting, $19.78. Medicaid reimbursement for rapid-acting insulin analogs rose to $19.81 per unit. The rate of increase in reimbursement was higher for insulins with patent protection ($0.20 per quarter) than without ($0.05 per quarter) (Preimbursements peaked at $407.4 million dollars in quarter 2 of 2014. Total volume peaked at 29.9 million units in quarter 4 of 2005 and was 21.2 million units in quarter 2 of 2014. Between 1991 and 2014, there was a near-exponential upward trend in Medicaid payments on a per-unit basis for a wide variety of insulin products regardless of formulation, duration of action, and whether the product was patented. Although reimbursements for newer, patent-protected insulin analogs increased at a faster rate than reimbursements for older insulins, payments

  13. An evaluation of current approaches to nursing home capital reimbursement.

    Science.gov (United States)

    Cohen, J; Holahan, J

    1986-01-01

    One of the more controversial issues in reimbursement policy is how to set the capital cost component of facilities rates. In this article we examine in detail the various approaches used by states to reimburse nursing homes for capital costs. We conclude that newer approaches that recognize the increasing value of nursing home assets over time, commonly called fair rental systems, are preferable to the methodologies that have been used historically in both the Medicare and the Medicaid programs to set capital rates. When properly designed, fair rental systems should provide more rational incentives and less encouragement of property manipulation than do more traditional systems, with little or no increase in state costs.

  14. 78 FR 53507 - Agency Information Collection (Beneficiary Travel Mileage Reimbursement Application Form...

    Science.gov (United States)

    2013-08-29

    ... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-NEW] Agency Information Collection (Beneficiary Travel Mileage Reimbursement Application Form) Activity Under OMB Review AGENCY: Veterans Health... Control No. 2900- NEW (Beneficiary Travel Mileage Reimbursement Application Form)'' in any correspondence...

  15. 48 CFR 428.307 - Insurance under cost-reimbursement contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 428.307 Section 428.307 Federal Acquisition Regulations System DEPARTMENT OF...-reimbursement contracts. ...

  16. 48 CFR 1028.307 - Insurance under cost-reimbursement contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 1028.307 Section 1028.307 Federal Acquisition Regulations System DEPARTMENT OF THE...-reimbursement contracts. ...

  17. Claims for Unabsorbed Overhead on Defense Contracts.

    Science.gov (United States)

    1985-09-01

    coat which, under the provisions of any pertinent law, regulation, or contract, cannot be included in prices, cost reimbureements , or settlements...ruled that the contractor was due some reimbursement . " - Allegheny appealed the contracting officer’s determination a second time questioning how much...amount of reimbursement . The final opinion also added the cost that was substantiated for replacement of operators and make-up pay. Therefore, the

  18. 47 CFR 54.413 - Reimbursement for revenue forgone in offering a Link Up program.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Reimbursement for revenue forgone in offering a... § 54.413 Reimbursement for revenue forgone in offering a Link Up program. (a) Eligible telecommunications carriers may receive universal service support reimbursement for the revenue they forgo in...

  19. 48 CFR 52.246-5 - Inspection of Services-Cost-Reimbursement.

    Science.gov (United States)

    2010-10-01

    ...-Cost-Reimbursement. 52.246-5 Section 52.246-5 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.246-5 Inspection of Services—Cost-Reimbursement. As prescribed in 46.305, insert... furnishing of services, when a cost-reimbursement contract is contemplated: Inspection of Services—Cost...

  20. 75 FR 71677 - Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    Science.gov (United States)

    2010-11-24

    ... DEPARTMENT OF ENERGY Reimbursement for Costs of Remedial Action at Active Uranium and Thorium... in FY 2011 from eligible active uranium and thorium processing site licensees for reimbursement under... approximately $24.3 million of Recovery Act funds available for reimbursement in FY 2011, as well as the $10...

  1. 42 CFR 405.515 - Reimbursement for clinical laboratory services billed by physicians.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Reimbursement for clinical laboratory services... Criteria for Determining Reasonable Charges § 405.515 Reimbursement for clinical laboratory services billed... limitation on reimbursement for markups on clinical laboratory services billed by physicians. If a physician...

  2. Sustainable policy: Higher medication use & adherence during reimbursement of pharmacologic smoking cessation treatments

    NARCIS (Netherlands)

    Van Boven, J.F.; Vemer, P.

    2014-01-01

    Background: The discussion on the reimbursement of Smoking Cessation Treatment (SCT) has known many stages in The Netherlands. From January 2011, SCTs were reimbursed, until January 2012 when the reimbursement of nicotine replacement therapies (NRTs) and pharmacotherapeutic SCT (pSCT) was

  3. 42 CFR 405.1803 - Intermediary determination and notice of amount of program reimbursement.

    Science.gov (United States)

    2010-10-01

    ... program reimbursement. 405.1803 Section 405.1803 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Provider Reimbursement Determinations and Appeals § 405.1803 Intermediary determination and notice of amount of program reimbursement. (a) General requirement. Upon receipt of a provider's cost report, or...

  4. 48 CFR 52.229-8 - Taxes-Foreign Cost-Reimbursement Contracts.

    Science.gov (United States)

    2010-10-01

    ...-Reimbursement Contracts. 52.229-8 Section 52.229-8 Federal Acquisition Regulations System FEDERAL ACQUISITION... Clauses 52.229-8 Taxes—Foreign Cost-Reimbursement Contracts. As prescribed in 29.402-2(a), insert the following clause: Taxes—Foreign Cost-Reimbursement Contracts (MAR 1990) (a) Any tax or duty from which the...

  5. 75 FR 34336 - Reimbursement Transportation Cost Payment Program for Geographically Disadvantaged Farmers and...

    Science.gov (United States)

    2010-06-17

    ... DEPARTMENT OF AGRICULTURE Farm Service Agency 7 CFR Part 755 RIN 0560-AI08 Reimbursement... Reimbursement Transportation Cost Payment (RTCP) Program for geographically disadvantaged farmers and ranchers.... To be eligible for reimbursement, the transportation costs must have been incurred in the FY for...

  6. 48 CFR 2452.232-71 - Voucher submission (cost-reimbursement).

    Science.gov (United States)

    2010-10-01

    ...-reimbursement). 2452.232-71 Section 2452.232-71 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND... Clauses 2452.232-71 Voucher submission (cost-reimbursement). As prescribed in 2432.908(c)(2), insert a clause substantially the same as the following in all cost-reimbursement solicitations and contracts...

  7. 48 CFR 452.232-70 - Reimbursement for Bond Premiums-Fixed-Price Construction Contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Reimbursement for Bond... Provisions and Clauses 452.232-70 Reimbursement for Bond Premiums—Fixed-Price Construction Contracts. As prescribed in 432.111, insert the following clause: Reimbursement for Bond Premiums—Fixed-Price Construction...

  8. 45 CFR 149.610 - Secretary's authority to reopen and revise a reimbursement determination.

    Science.gov (United States)

    2010-10-01

    ... reimbursement determination. 149.610 Section 149.610 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... of Data Inaccuracies § 149.610 Secretary's authority to reopen and revise a reimbursement determination. (a) The Secretary may reopen and revise a reimbursement determination upon the Secretary's own...

  9. 48 CFR 652.232-71 - Voucher Submission (Cost-Reimbursement).

    Science.gov (United States)

    2010-10-01

    ...-Reimbursement). 652.232-71 Section 652.232-71 Federal Acquisition Regulations System DEPARTMENT OF STATE CLAUSES... Voucher Submission (Cost-Reimbursement). As prescribed in 632.908(b), the contracting officer may insert a clause substantially the same as follows: Voucher Submission (Cost-Reimbursement) (AUG 1999) (a) General...

  10. 48 CFR 52.246-3 - Inspection of Supplies-Cost-Reimbursement.

    Science.gov (United States)

    2010-10-01

    ...-Cost-Reimbursement. 52.246-3 Section 52.246-3 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.246-3 Inspection of Supplies—Cost-Reimbursement. As prescribed in 46.303, insert... furnishing of supplies, when a cost-reimbursement contract is contemplated: Inspection of Supplies—Cost...

  11. 48 CFR 1352.228-71 - Deductibles under required insurance coverage-cost reimbursement.

    Science.gov (United States)

    2010-10-01

    ... insurance coverage-cost reimbursement. 1352.228-71 Section 1352.228-71 Federal Acquisition Regulations... Provisions and Clauses 1352.228-71 Deductibles under required insurance coverage—cost reimbursement. As... Coverage—Cost Reimbursement (APR 2010) (a) The contractor is required to present evidence of the amount of...

  12. 48 CFR 52.246-8 - Inspection of Research and Development-Cost-Reimbursement.

    Science.gov (United States)

    2010-10-01

    ... Development-Cost-Reimbursement. 52.246-8 Section 52.246-8 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.246-8 Inspection of Research and Development—Cost-Reimbursement. As prescribed in... (b) a cost-reimbursement contract is contemplated; unless use of the clause is impractical and the...

  13. 48 CFR 252.228-7000 - Reimbursement for war-hazard losses.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Reimbursement for war... CLAUSES Text of Provisions And Clauses 252.228-7000 Reimbursement for war-hazard losses. As prescribed in 228.370(a), use the following clause: Reimbursement for War-Hazard Losses (DEC 1991) (a) Costs for...

  14. 48 CFR 52.229-9 - Taxes-Cost-Reimbursement Contracts With Foreign Governments.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Taxes-Cost-Reimbursement... Provisions and Clauses 52.229-9 Taxes—Cost-Reimbursement Contracts With Foreign Governments. As prescribed in 29.402-2(b), insert the following clause: Taxes—Cost-Reimbursement Contracts With Foreign Governments...

  15. 48 CFR 219.7104 - Developmental assistance costs eligible for reimbursement or credit.

    Science.gov (United States)

    2010-10-01

    ... costs eligible for reimbursement or credit. 219.7104 Section 219.7104 Federal Acquisition Regulations... reimbursement or credit. (a) Developmental assistance provided under an approved mentor-protege agreement is... eligible for reimbursement are set forth in appendix I. (b) Before incurring any costs under the Program...

  16. 48 CFR 1552.211-73 - Level of effort-cost-reimbursement term contract.

    Science.gov (United States)

    2010-10-01

    ...-reimbursement term contract. 1552.211-73 Section 1552.211-73 Federal Acquisition Regulations System... Provisions and Clauses 1552.211-73 Level of effort—cost-reimbursement term contract. As prescribed in 1511.011-73, insert the following contract clause in cost-reimbursement term contracts including cost...

  17. 48 CFR 252.235-7001 - Indemnification under 10 U.S.C. 2354-cost reimbursement.

    Science.gov (United States)

    2010-10-01

    ....S.C. 2354-cost reimbursement. 252.235-7001 Section 252.235-7001 Federal Acquisition Regulations.... 2354—cost reimbursement. As prescribed in 235.070-3, use the following clause: Indemnification Under 10 U.S.C. 2354—Cost Reimbursement (DEC 1991) (a) This clause provides for indemnification under 10 U.S...

  18. 48 CFR 5152.245-9001 - Government property for installation support services (cost-reimbursement contracts).

    Science.gov (United States)

    2010-10-01

    ... installation support services (cost-reimbursement contracts). 5152.245-9001 Section 5152.245-9001 Federal... CONTRACT CLAUSES 5152.245-9001 Government property for installation support services (cost-reimbursement... Installation Support Services (Cost-Reimbursement Contracts) (OCT 1989) (DEV) (a) Government-furnished property...

  19. 44 CFR 208.37 - Reimbursement for equipment and supply costs incurred during Activation.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for equipment... SEARCH AND RESCUE RESPONSE SYSTEM Response Cooperative Agreements § 208.37 Reimbursement for equipment and supply costs incurred during Activation. (a) Allowable costs. DHS will reimburse costs incurred...

  20. 76 FR 14543 - Federal Acquisition Regulation; Proper Use and Management of Cost-Reimbursement Contracts

    Science.gov (United States)

    2011-03-16

    ..., Sequence 1] RIN 9000-AL78 Federal Acquisition Regulation; Proper Use and Management of Cost-Reimbursement... other than firm-fixed-price contracts (e.g., cost-reimbursement, time-and-material, and labor-hour...-reimbursement contracts and identifies the following three areas that the Defense Acquisition Regulation Council...

  1. 48 CFR 831.7001-7 - Reimbursement for other supplies and services.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Reimbursement for other... Principles and Procedures 831.7001-7 Reimbursement for other supplies and services. VA will provide reimbursement for other services and assistance that may be authorized under provisions of applicable Chapter 31...

  2. 47 CFR 64.1170 - Reimbursement procedures where the subscriber has paid charges.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Reimbursement procedures where the subscriber... Preferred Telecommunications Service Providers § 64.1170 Reimbursement procedures where the subscriber has... reimburse the authorized carrier for reasonable expenses. (e) If the authorized carrier has not received...

  3. 48 CFR 49.603-5 - Cost-reimbursement contracts-partial termination.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement....603-5 Cost-reimbursement contracts—partial termination. [Insert the following in Block 14 of SF 30, Amendment of Solicitation/Modification of Contract, for settlement agreements for cost-reimbursement...

  4. 48 CFR 29.402-2 - Foreign cost-reimbursement contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Foreign cost-reimbursement... GENERAL CONTRACTING REQUIREMENTS TAXES Contract Clauses 29.402-2 Foreign cost-reimbursement contracts. (a) The contracting officer shall insert the clause at 52.229-8, Taxes—Foreign Cost-Reimbursement...

  5. 48 CFR 46.308 - Cost-reimbursement research and development contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement... ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 46.308 Cost-reimbursement... of Research and Development—Cost-Reimbursement, in solicitations and contracts for research and...

  6. 48 CFR 28.307 - Insurance under cost-reimbursement contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 28.307 Section 28.307 Federal Acquisition Regulations System FEDERAL ACQUISITION...-reimbursement contracts. Cost-reimbursement contracts (and subcontracts, if the terms of the prime contract are...

  7. 49 CFR 599.303 - Agency disposition of dealer application for reimbursement.

    Science.gov (United States)

    2010-10-01

    ... reimbursement. 599.303 Section 599.303 Transportation Other Regulations Relating to Transportation (Continued... PROCEDURES FOR CONSUMER ASSISTANCE TO RECYCLE AND SAVE ACT PROGRAM Qualifying Transactions and Reimbursement § 599.303 Agency disposition of dealer application for reimbursement. (a) Application review. Upon...

  8. 12 CFR 701.33 - Reimbursement, insurance, and indemnification of officials and employees.

    Science.gov (United States)

    2010-01-01

    ... specifically excludes: (i) Payment (by reimbursement to an official or direct credit union payment to a third... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Reimbursement, insurance, and indemnification... Reimbursement, insurance, and indemnification of officials and employees. (a) Official. An official is a person...

  9. 45 CFR 1609.5 - Acceptance of reimbursement from a client.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Acceptance of reimbursement from a client. 1609.5... CORPORATION FEE-GENERATING CASES § 1609.5 Acceptance of reimbursement from a client. (a) When a case results in recovery of damages or statutory benefits, a recipient may accept reimbursement from the client...

  10. 30 CFR 285.823 - Will MMS reimburse me for my expenses related to inspections?

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Will MMS reimburse me for my expenses related... Conducted Under SAPs, COPs and GAPs Inspections and Assessments § 285.823 Will MMS reimburse me for my expenses related to inspections? Upon request, MMS will reimburse you for food, quarters, and...

  11. 30 CFR 250.133 - Will MMS reimburse me for my expenses related to inspections?

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Will MMS reimburse me for my expenses related... Inspection of Operations § 250.133 Will MMS reimburse me for my expenses related to inspections? Upon request, MMS will reimburse you for food, quarters, and transportation that you provide for MMS representatives...

  12. 76 FR 58567 - Proposed Information Collection (Request for Transportation Expense Reimbursement) Activity...

    Science.gov (United States)

    2011-09-21

    ... (Request for Transportation Expense Reimbursement) Activity; Comment Request AGENCY: Veterans Benefits... needed to determine children with spina bifida eligibility for reimbursement of transportation expenses...: Request for Transportation Expense Reimbursement (38 CFR 21.8370). OMB Control Number: 2900-0580. Type of...

  13. Reimbursement of pharmaceuticals: Reference pricing versus health technology assessment

    NARCIS (Netherlands)

    M. Drummond (Michael); B. Jönsson (Bengt); F.F.H. Rutten (Frans); T. Stargardt (Tom)

    2011-01-01

    textabstractReference pricing and health technology assessment are policies commonly applied in order to obtain more value for money from pharmaceuticals. This study focussed on decisions about the initial price and reimbursement status of innovative drugs and discussed the consequences for market

  14. 41 CFR 101-39.104-2 - Reimbursement.

    Science.gov (United States)

    2010-07-01

    ...-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.1-Establishment, Modification, and Discontinuance of Interagency Fleet... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Reimbursement. 101-39.104-2 Section 101-39.104-2 Public Contracts and Property Management Federal Property Management...

  15. 41 CFR 101-26.506-5 - Reimbursement for services.

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Reimbursement for services. 101-26.506-5 Section 101-26.506-5 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT...

  16. 7 CFR 3015.84 - Request for advance or reimbursement.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Request for advance or reimbursement. 3015.84 Section 3015.84 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER, DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Financial Reporting...

  17. 41 CFR 101-39.207 - Reimbursement for services.

    Science.gov (United States)

    2010-07-01

    ... sufficient to recover applicable costs. Failure by using agencies to reimburse GSA for vehicle services will... or neglect. (e) Agencies may be charged for recovery of expenses for repairs or services to GSA IFMS... services. 101-39.207 Section 101-39.207 Public Contracts and Property Management Federal Property...

  18. 44 CFR 208.36 - Reimbursement for Alert.

    Science.gov (United States)

    2010-10-01

    ... § 208.41 of this part. (4) Food and beverages for Task Force Members and Support Specialists when DHS does not provide meals during the Alert. DHS will limit food and beverage reimbursement to the amount... where such food and beverages were provided, multiplied by the number of personnel who received them. (b...

  19. Governance of conditional reimbursement practices in the Netherlands

    NARCIS (Netherlands)

    Boon, W.P.C.; Martins, Luis; Koopmanschap, Marc

    When entering the market, orphan drugs are associated with substantial prices and a high degree of uncertainty regarding safety and effectiveness. This makes decision making about the reimbursement of these drugs a complex exercise. To advance on this, the Dutch government introduced a conditional

  20. 77 FR 33470 - Reimbursement Rates for Calendar Year 2012

    Science.gov (United States)

    2012-06-06

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2012 AGENCY: Indian Health Service, HHS. ACTION: Notice. SUMMARY: Notice is given that the Director of Indian Health Service (IHS), under the authority of sections 321(a) and 322(b) of the Public...

  1. 75 FR 34147 - Reimbursement Rates for Calendar Year 2010

    Science.gov (United States)

    2010-06-16

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2010 AGENCY: Indian Health Service, HHS. ACTION: Notice. SUMMARY: Notice is given that the Director of Indian Health Service (IHS), under the authority of sections 321(a) and 322(b) of the Public...

  2. 77 FR 37421 - Reimbursement Rates for Calendar Year 2012 Correction

    Science.gov (United States)

    2012-06-21

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2012 Correction AGENCY: Indian Health Service, HHS. ACTION: Notice; correction. SUMMARY: The Indian Health Service published a document in the Federal Register on June 6, 2012, concerning rates for...

  3. 76 FR 24496 - Reimbursement Rates for Calendar Year 2011

    Science.gov (United States)

    2011-05-02

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2011 AGENCY: Indian Health Service, HHS. ACTION: Notice. SUMMARY: Notice is given that the Director of Indian Health Service (IHS), under the authority of sections 321(a) and 322(b) of the Public...

  4. The Case for Insurance Reimbursement of Couple Therapy.

    Science.gov (United States)

    Clawson, Robb E; Davis, Stephanie Y; Miller, Richard B; Webster, Tabitha N

    2017-08-22

    A case is made for why it may now be in the best interest of insurance companies to reimburse for marital therapy to treat marital distress. Relevant literature is reviewed with a considerable focus on the reasons that insurance companies would benefit from reimbursing marital therapy - the high costs of marital distress, the growing link between marital distress and a host of related physical and mental health problems, as well as the availability of empirically supported treatments for marital distress. This is followed by a focus on the major reasons insurance companies cite for not reimbursing marital therapy, along with a discussion of advances in several growing bodies of research to address these concerns. Main arguments include the direct medical offset costs of couple and family therapy (including for high utilizers of health insurance), and the fact that insurance companies already find it cost effective to reimburse for prevention of other health and psychological problems. This is followed by implications for practitioners and researchers. © 2017 American Association for Marriage and Family Therapy.

  5. 78 FR 22890 - Reimbursement Rates for Calendar Year 2013

    Science.gov (United States)

    2013-04-17

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2013 AGENCY: Indian Health Service, HHS. ACTION: Notice. SUMMARY: Notice is given that the Director of the Indian Health Service (IHS), under the authority of sections 321(a) and 322(b) of the...

  6. 42 CFR 413.5 - Cost reimbursement: General.

    Science.gov (United States)

    2010-10-01

    ... and profit-making organizations. (6) That there should be a recognition of the need of hospitals and... fide efforts at collection). (7) Charity and courtesy allowances are not includable, although “fringe... residents in the care of individual patients) furnished in a teaching hospital may be reimbursed as a...

  7. 78 FR 70244 - Electronic Interim Assistance Reimbursement Program

    Science.gov (United States)

    2013-11-25

    ..., Social Security Online, at http://www.socialsecurity.gov . SUPPLEMENTARY INFORMATION: Background To be... SOCIAL SECURITY ADMINISTRATION 20 CFR Part 416 [Docket No. SSA-2011-0104] RIN 0960-AH45 Electronic Interim Assistance Reimbursement Program AGENCY: Social Security Administration. ACTION: Notice of...

  8. 20 CFR 362.12 - Computation of amount of reimbursement.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Computation of amount of reimbursement. 362.12 Section 362.12 Employees' Benefits RAILROAD RETIREMENT BOARD INTERNAL ADMINISTRATION, POLICY AND... the cost of repair is the amount payable. (b) Depreciation in value of an item of personal property is...

  9. 36 CFR 14.22 - Reimbursement of costs.

    Science.gov (United States)

    2010-07-01

    ... acceptable to the authorized officer, by bond, guaranty, cash, certificate of deposit, or other means... acceptable to the authorized officer, by bond, guaranty, cash, certificate of deposit or other means... shall reimburse the United States for costs incurred by the United States in monitoring the construction...

  10. 40 CFR 66.74 - Payment or reimbursement.

    Science.gov (United States)

    2010-07-01

    ....74 Payment or reimbursement. (a) Within thirty days after any adjustment of a noncompliance penalty... timely payment of a deficiency shall pay a nonpayment penalty. The nonpayment penalty shall be calculated as of the due date of the deficiency payment and shall be equal to 20% of the deficiency not paid...

  11. 32 CFR 842.94 - Assertable claims.

    Science.gov (United States)

    2010-07-01

    ..., against a tort-feasor when: (a) Damage results from negligence and the claim is for: (1) More than $100... ADMINISTRATIVE CLAIMS Property Damage Tort Claims in Favor of the United States (31 U.S.C. 3701, 3711-3719) § 842.... (The two claims should be consolidated and processed under subpart N). (d) The Tort-feasor or his...

  12. Exaggerated Claims for Interactive Stories

    Science.gov (United States)

    Thue, David; Bulitko, Vadim; Spetch, Marcia; Webb, Michael

    As advertising becomes more crucial to video games' success, developers risk promoting their products beyond the features that they can actually include. For features of interactive storytelling, the effects of making such exaggerations are not well known, as reports from industry have been anecdotal at best. In this paper, we explore the effects of making exaggerated claims for interactive stories, in the context of the theory of advertising. Results from a human user study show that female players find linear and branching stories to be significantly less enjoyable when they are advertised with exaggerated claims.

  13. Axion-like particles: possible hints and constraints from the high-energy Universe

    International Nuclear Information System (INIS)

    Brun, Pierre

    2013-01-01

    The high-energy Universe is potentially a great laboratory for searching new light bosons such as axion-like particles (ALPs). Cosmic sources are indeed the scene of violent phenomena that involve strong magnetic field and/or very long baselines, where the effects of the mixing of photons with ALPs could lead to observable effects. Two examples are archetypal of this fact, that are the Universe opacity to gamma-rays and the imprints of astrophysical magnetic turbulence in the energy spectra of high-energy sources. In the first case, hints for the existence of ALPs can be proposed whereas the second one is used to put constraints on the ALP mass and coupling to photons

  14. Hint of nonstandard Mikheyev-Smirnov-Wolfenstein dynamics in solar neutrino conversion

    International Nuclear Information System (INIS)

    Palazzo, Antonio

    2011-01-01

    Motivated by the recent low-threshold measurements of the solar 8 B neutrino spectrum performed by Borexino, Super-Kamiokande and the Sudbury Neutrino Observatory--all now monitoring the transition regime between low-energy (vacuumlike) and high-energy (matter-dominated) flavor conversions--we consider the role of subdominant dynamical terms induced by new flavor-changing interactions. We find that the presence of such perturbations with strength ∼10 -1 G F is now favored, offering a better description of the anomalous behavior suggested by the new results, whose spectrum shows no sign of the typical low-energy upturn predicted by the standard Mikheyev-Smirnov-Wolfenstein (MSW) mechanism. Our findings, if interpreted in a 2-flavor scheme, provide a hint of such new interactions at the ∼2σ level, which is rather robust with respect to 3-flavor effects possibly induced by nonzero θ 13 .

  15. Hint of nonstandard Mikheyev-Smirnov-Wolfenstein dynamics in solar neutrino conversion

    Science.gov (United States)

    Palazzo, Antonio

    2011-05-01

    Motivated by the recent low-threshold measurements of the solar B8 neutrino spectrum performed by Borexino, Super-Kamiokande and the Sudbury Neutrino Observatory—all now monitoring the transition regime between low-energy (vacuumlike) and high-energy (matter-dominated) flavor conversions—we consider the role of subdominant dynamical terms induced by new flavor-changing interactions. We find that the presence of such perturbations with strength ˜10-1GF is now favored, offering a better description of the anomalous behavior suggested by the new results, whose spectrum shows no sign of the typical low-energy upturn predicted by the standard Mikheyev-Smirnov-Wolfenstein (MSW) mechanism. Our findings, if interpreted in a 2-flavor scheme, provide a hint of such new interactions at the ˜2σ level, which is rather robust with respect to 3-flavor effects possibly induced by nonzero θ13.

  16. Hints for clarification of influencing factors in case of occupational liver diseases

    Energy Technology Data Exchange (ETDEWEB)

    Zober, A; Raithel, H; Valentin, H

    1981-05-01

    Clarification of influencing factors is of great importance in suspected occupational liver diseases. Hints are given on the basis of the author's own experience and after critical evaluation of the relevant literature. Most important are: 1) Establishment of a comprehensive working anamnesis with special regard to specific features of the job, exposure patterns, and all working materials; 2) assessment of the hepatotoxic potential of the suspected working material according to the present state of knowledge in working medicine and toxicology; 3) objectification and quantification of the suspected noxious substances at the place of work by means of air analysis and analysis of the biological matter; 4) differential diagnosis in view of possible competitive influencing factors.

  17. Hint of a Z' boson from the CERN LEP II data

    International Nuclear Information System (INIS)

    Gulov, A. V.; Skalozub, V. V.

    2007-01-01

    The many-parametric fits of the LEP2 data on e + e - →e + e - , μ + μ - , τ + τ - processes are performed with the goal to estimate the signals of the Abelian Z ' boson. Four independent parameters must be fitted, if the derived already low-energy relations between the Z ' couplings to the standard model fermions are taken into consideration. No signals are found when the complete LEP2 data set for these processes is treated. In the fit of the backward bins, the hint at the 1.3σ confidence level is detected. The Z ' couplings to the vector and axial-vector lepton currents are constrained. The comparisons with the one-parameter fits and with the corresponding LEP1 experiments are fulfilled

  18. Modelling magnetic islands in the H-1NF heliac with the hint code

    International Nuclear Information System (INIS)

    Lloyd, S.S.; Gardner, H.J.

    1999-01-01

    Full text: Recent progress in the theoretical modelling of the effects of plasma pressure on the growth and change in geometry of magnetic islands in the H-1NF Heliac will be reviewed. The HINT magnetohydrodynamic equilibrium code, which has become a standard workhorse in the stellarator community for problems of this type, has been modified to incorporate an interpolation algorithm which significantly accelerates its convergence. This has enabled the critical evaluation of earlier results, and of some conventional wisdom. In many ways the treatment of magnetic islands in low shear fusion reactors, such as H-1NF, is an ideal case study in computational science - the devil is in the details and the devil is important: the existence or otherwise of island self-healing at reactor pressures could significantly affect the design of future experiments. (author)

  19. Reimbursed Price of Orphan Drugs: Current Strategies and Potential Improvements.

    Science.gov (United States)

    Mincarone, Pierpaolo; Leo, Carlo Giacomo; Sabina, Saverio; Sarriá-Santamera, Antonio; Taruscio, Domenica; Serrano-Aguilar, Pedro Guillermo; Kanavos, Panos

    2017-01-01

    The pricing and reimbursement policies for pharmaceuticals are relevant to balance timely and equitable access for all patients, financial sustainability, and reward for valuable innovation. The proliferation of high-cost specialty medicines is particularly true in rare diseases (RDs) where the pricing mechanism is characterised by a lack of transparency. This work provides an overall picture of current strategies for the definition of the reimbursed prices of orphan drugs (ODs) and highlights some potential improvements. Current strategies and suggestions are presented along 4 dimensions: (1) comprehensive value assessment, (2) early dialogs among relevant stakeholders, (3) innovative reimbursement approaches, and (4) societal participation in producing ODs. Comprehensive value assessment could be achieved by clarifying the approach of distributive justice to adopt, ensuring a representative participation of stakeholders, and with a broad consideration of value-bearing factors. With respect to early dialogs, cross-border cooperation can be determinant to companies and agencies. The cost-benefit ratio of early dialogs needs to be demonstrated and the "regulatory capture" effect should be monitored. Innovative reimbursement approaches were developed to balance the need for evidence-based decisions with the timely access to innovative drugs. The societal participation in producing ODs needs to be recognised in a collaborating framework where adaptive agreements can be developed with mutual satisfaction. Such agreements could also impact on coverage and reimbursement decisions as additional elements for the determination of a comprehensive societal value of ODs. Further research is needed to investigate the highlighted open challenges so that RDs will not remain, in practical terms, orphan diseases. © 2017 S. Karger AG, Basel.

  20. An international comparison of reimbursement for DIEAP flap breast reconstruction.

    Science.gov (United States)

    Reid, A W N; Szpalski, C; Sheppard, N N; Morrison, C M; Blondeel, P N

    2015-11-01

    The deep inferior epigastric artery perforator (DIEAP) flap is currently considered the gold standard for autologous breast reconstruction. With the current economic climate and health cutbacks, we decided to survey reimbursement for DIEAP flaps performed at the main international centres in order to assess whether they are funded consistently. Data were collected confidentially from the main international centres by an anonymous questionnaire. Our results illustrate the wide disparity in international DIEAP flap breast reconstruction reimbursement: a unilateral DIEAP flap performed in New York, USA, attracts €20,759, whereas the same operation in Madrid, Spain, will only be reimbursed for €300. Only 35.7% of the surgeons can set up their own fee. Moreover, 85.7% of the participants estimated that the current fees are insufficient, and most of them feel that we are evolving towards an even lower reimbursement rate. In 55.8% of the countries represented, there is no DIEAP-specific coding; in comparison, 74.4% of the represented countries have a specific coding for transverse rectus abdominis (TRAM) flaps. Finally, despite the fact that DIEAP flaps have become the gold standard for breast reconstruction, they comprise only a small percentage of all the total number of breast reconstruction procedures performed (7-15%), with the only exception being Belgium (40%). Our results demonstrate that DIEAP flap breast reconstruction is inconsistently funded. Unfortunately though, it appears that the current reimbursement offered by many countries may dissuade institutions and surgeons from offering this procedure. However, substantial evidence exists supporting the cost-effectiveness of perforator flaps for breast reconstruction, and, in our opinion, the long-term clinical benefits for our patients are so important that this investment of time and money is absolutely essential. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons

  1. The Drug Reimbursement Decision-Making System in Iran.

    Science.gov (United States)

    Ansaripour, Amir; Uyl-de Groot, Carin A; Steenhoek, Adri; Redekop, William K

    2014-05-01

    Previous studies of health policies in Iran have not focused exclusively on the drug reimbursement process. The aim of this study was to describe the entire drug reimbursement process and the stakeholders, and discuss issues faced by policymakers. Review of documents describing the administrative rules and directives of stakeholders, supplemented by published statistics and interviews with experts and policymakers. Iran has a systematic process for the assessment, appraisal, and judgment of drug reimbursements. The two most important organizations in this process are the Food and Drug Organization, which considers clinical effectiveness, safety, and economic issues, and the Supreme Council of Health Insurance, which considers various criteria, including budget impact and cost-effectiveness. Ultimately, the Iranian Cabinet approves a drug and recommends its use to all health insurance organizations. Reimbursed drugs account for about 53.5% of all available drugs and 77.3% of drug expenditures. Despite its strengths, the system faces various issues, including conflicting stakeholder aims, lengthy decision-making duration, limited access to decision-making details, and rigidity in the assessment process. The Iranian drug reimbursement system uses decision-making criteria and a structured approach similar to those in other countries. Important shortcomings in the system include out-of-pocket contributions due to lengthy decision making, lack of transparency, and conflicting interests among stakeholders. Iranian policymakers should consider a number of ways to remedy these problems, such as case studies of individual drugs and closer examination of experiences in other countries. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  2. Reserving by detailed conditioning on individual claim

    Science.gov (United States)

    Kartikasari, Mujiati Dwi; Effendie, Adhitya Ronnie; Wilandari, Yuciana

    2017-03-01

    The estimation of claim reserves is an important activity in insurance companies to fulfill their liabilities. Recently, reserving method of individual claim have attracted a lot of interest in the actuarial science, which overcome some deficiency of aggregated claim method. This paper explores the Reserving by Detailed Conditioning (RDC) method using all of claim information for reserving with individual claim of liability insurance from an Indonesian general insurance company. Furthermore, we compare it to Chain Ladder and Bornhuetter-Ferguson method.

  3. Danish Claims Data Indicators for Electronic Feedback in Oral-Health Care

    DEFF Research Database (Denmark)

    Rosing, Kasper; Christensen, Lisa Bøge; Listl, Stefan

    , as one of several steps in constructing a model on how to promote preventive rather than restorative oral health care. Methods: Danish oral health claims data cover the range of dental care services under the National Health Insurance reimbursement scheme. Demographic and dental claims data on Danish...... adults (age range 18-106 years), who saw a dentist during 2014, n=2,703,442 corresponding to 61% of eligible adults, were obtained from the Danish Health Authority. Approval was granted from the Danish Data Protection Agency. Results: The following indicators of dental clinic service delivery profiles...... health professional, to compare “own” results with relevant groups of dental clinics locally, on a municipality, regional or national level. The indicators may be, to some degree, either individually or combined, considered suitable for comparison in between countries, because of their relatively simple...

  4. Army Blast Claims Evaluation Procedures

    Science.gov (United States)

    1994-03-01

    ATIN: AFZX-JA Building 4551 Fort Polk, LA 71459-5000 Commander U.S. Army Engineer Center and Fort Leonard Wood ATIN: AlZT-JA Building 1706 East...U.S. Armed Forces Claims Service, Korea APO AP 96205-0084 No. of Copies Organization 1 Commander U.S. Army South ATI’N: SOJA Building 154 APO

  5. Nordic scepticism towards health claims

    DEFF Research Database (Denmark)

    Pedersen, Susanne; Grunert, Klaus G.

    2008-01-01

    Imagine that you are shopping in a supermarket and find a package of pork chops labelled "omega-3 added" or that the yogurt "contains phosphatidylserine, which can improve your memory"; would you buy these pork chops or this yogurt? Most Nordic consumers would choose products without health claims....

  6. Entrepreneurial Crowdfunding without Private Claims

    DEFF Research Database (Denmark)

    Boudreau, Kevin J.; Jeppesen, Lars Bo; Reichstein, Toke

    Today's crowdfunding raises funds for tiny, private entrepreneurial ventures without granting funders private claims to a project's future value. Rather than “investments,” these are “contributions.” This paper argues that for such crowdfunding neither producer nor consumer surplus – i.e., project...

  7. Drug reimbursement and GPs' prescribing decisions: a randomized case-vignette study about the pharmacotherapy of obesity associated with type 2 diabetes: how GPs react to drug reimbursement.

    Science.gov (United States)

    Verger, Pierre; Rolland, Sophie; Paraponaris, Alain; Bouvenot, Julien; Ventelou, Bruno

    2010-08-01

    This study sought to identify the effect of drug reimbursability--a decision made in France by the National Authority for Health--on physicians' prescribing practices for a diet drug such as rimonabant, approved for obese or overweight patients with type-2 diabetes. A cross-sectional survey of French general practitioners (GPs) presented a case-vignette about a patient for whom this drug is indicated in two alternative versions, differing only in its reimbursability, to two separate randomized subsamples of GPs in early 2007, before any decision was made about reimbursement. The results indicate that (i) more than 20% of GPs in private practice would be willing to prescribe a non-reimbursed diet drug for patients with obesity complicated by type 2 diabetes; (ii) the number of GPs willing to prescribe it would increase by 47.6% if the drug were reimbursed, and (iii) such a drug would be adopted at a higher rate by GPs who have regular contacts with pharmaceutical sales representatives. In France, unlike most other countries, drug reimbursement status is a signal of quality. However, our results suggest that a significant proportion of GPs would spontaneously adopt anti-obesity drugs even if they were not reimbursed. Decisions about reimbursement of pharmaceutical products should be made taking into account that reimbursement is likely to intensify prescription.

  8. Does a global budget superimposed on fee-for-service payments mitigate hospitals' medical claims in Taiwan?

    Science.gov (United States)

    Hsu, Pi-Fem

    2014-12-01

    Taiwan's global budgeting for hospital health care, in comparison to other countries, assigns a regional budget cap for hospitals' medical benefits claimed on the basis of fee-for-service (FFS) payments. This study uses a stays-hospitals-years database comprising acute myocardial infarction inpatients to examine whether the reimbursement policy mitigates the medical benefits claimed to a third-payer party during 2000-2008. The estimated results of a nested random-effects model showed that hospitals attempted to increase their medical benefit claims under the influence of initial implementation of global budgeting. The magnitudes of hospitals' responses to global budgeting were significantly attributed to hospital ownership, accreditation status, and market competitiveness of a region. The results imply that the regional budget cap superimposed on FFS payments provides only blunt incentive to the hospitals to cooperate to contain medical resource utilization, unless a monitoring mechanism attached with the payment system.

  9. 78 FR 21352 - Update on Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    Science.gov (United States)

    2013-04-10

    ... reimbursement ceilings). Title X requires DOE to reimburse eligible uranium and thorium licensees for certain... DEPARTMENT OF ENERGY Update on Reimbursement for Costs of Remedial Action at Active Uranium and... not currently available for reimbursement for cleanup work performed by licensees at eligible uranium...

  10. Threshold analysis of reimbursing physicians for the application of fluoride varnish in young children.

    Science.gov (United States)

    Hendrix, Kristin S; Downs, Stephen M; Brophy, Ginger; Carney Doebbeling, Caroline; Swigonski, Nancy L

    2013-01-01

    Most state Medicaid programs reimburse physicians for providing fluoride varnish, yet the only published studies of cost-effectiveness do not show cost-savings. Our objective is to apply state-specific claims data to an existing published model to quickly and inexpensively estimate the cost-savings of a policy consideration to better inform decisions - specifically, to assess whether Indiana Medicaid children's restorative service rates met the threshold to generate cost-savings. Threshold analysis was based on the 2006 model by Quiñonez et al. Simple calculations were used to "align" the Indiana Medicaid data with the published model. Quarterly likelihoods that a child would receive treatment for caries were annualized. The probability of a tooth developing a cavitated lesion was multiplied by the probability of using restorative services. Finally, this rate of restorative services given cavitation was multiplied by 1.5 to generate the threshold to attain cost-savings. Restorative services utilization rates, extrapolated from available Indiana Medicaid claims, were compared with these thresholds. For children 1-2 years old, restorative services utilization was 2.6 percent, which was below the 5.8 percent threshold for cost-savings. However, for children 3-5 years of age, restorative services utilization was 23.3 percent, exceeding the 14.5 percent threshold that suggests cost-savings. Combining a published model with state-specific data, we were able to quickly and inexpensively demonstrate that restorative service utilization rates for children 36 months and older in Indiana are high enough that fluoride varnish regularly applied by physicians to children starting at 9 months of age could save Medicaid funds over a 3-year horizon. © 2013 American Association of Public Health Dentistry.

  11. Should the District Courts Have Jurisdiction Over Pre-Award Contract Claims? A Claim for the Claims Court

    National Research Council Canada - National Science Library

    Short, John J

    1987-01-01

    This thesis briefly examines the jurisdiction of the federal district courts and the United States Court of Claims over pre-award contract claims before the Federal Courts Improvement Act of October 1...

  12. Altered Light Conditions Contribute to Abnormalities in Emotion and Cognition Through HINT1 Dysfunction in C57BL/6 Mice

    Directory of Open Access Journals (Sweden)

    Yuan Zhou

    2018-06-01

    Full Text Available In recent years, the environmental impact of artificial light at night has been a rapidly growing global problem, affecting 99% of the population in the US and Europe, and 62% of the world population. The present study utilized a mouse model exposed to long-term artificial light and light deprivation to explore the impact of these conditions on emotion and cognition. Based on the potential links between histidine triad nucleotide binding protein 1 (HINT1 and mood disorders, we also examined the expression of HINT1 and related apoptosis factors in the suprachiasmatic nucleus (SCN, prefrontal cortex (PFC, nucleus accumbens (NAc and hippocampus (Hip. Mice exposed to constant light (CL exhibited depressive- and anxiety-like behaviors, as well as impaired spatial memory, as demonstrated by an increased immobility time in the tail suspension and forced swimming tests, less entries and time spent in the open arms of elevated plus-maze, and less platform site crossings and time spent in the target quadrant in the Morris water maze (MWM. The effects of constant darkness (CD partially coincided with long-term illumination, except that mice in the CD group failed to show anxiety-like behaviors. Furthermore, HINT1 was upregulated in four encephalic regions, indicating that HINT1 may be involved in mood disorders and cognitive impairments due to altered light exposure. The apoptosis-related proteins, BAX and BCL-2, showed the opposite expression pattern, reflecting an activated apoptotic pathway. These findings suggest that exposure to CL and/or darkness can induce significant changes in affective and cognitive responses, possibly through HINT1-induced activation of apoptotic pathways.

  13. Case-mix reimbursement for nursing home services: Simulation approach

    Science.gov (United States)

    Adams, E. Kathleen; Schlenker, Robert E.

    1986-01-01

    Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments. PMID:10311776

  14. Case-mix reimbursement for nursing home services: simulation approach.

    Science.gov (United States)

    Adams, E K; Schlenker, R E

    1986-01-01

    Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments.

  15. Political liberalism and religious claims

    Science.gov (United States)

    2016-01-01

    This article gives an overview of 4 important lacunae in political liberalism and identifies, in a preliminary fashion, some trends in the literature that can come in for support in filling these blind spots, which prevent political liberalism from a correct assessment of the diverse nature of religious claims. Political liberalism operates with implicit assumptions about religious actors being either ‘liberal’ or ‘fundamentalist’ and ignores a third, in-between group, namely traditionalist religious actors and their claims. After having explained what makes traditionalist religious actors different from liberal and fundamentalist religious actors, the author develops 4 areas in which political liberalism should be pushed further theoretically in order to correctly theorize the challenge which traditional religious actors pose to liberal democracy. These 4 areas (blind spots) are: (1) the context of translation; (2) the politics of exemptions; (3) the multivocality of theology; and (4) the transnational nature of norm-contestation. PMID:28344375

  16. Pricing and Reimbursement in U.S. Pharmaceutical Markets

    OpenAIRE

    Newhouse, Joseph Paul; Berndt, Ernst R.

    2010-01-01

    In this survey chapter on pricing and reimbursement in U.S. pharmaceutical markets, we first provide background information on important federal legislation, institutional details regarding distribution channel logistics, definitions of alternative price measures, related historical developments, and reasons why price discrimination is highly prevalent among branded pharmaceuticals. We then present a theoretical framework for the pricing of branded pharmaceuticals, without and then in the pre...

  17. Second WCB claims: who is at risk?

    Science.gov (United States)

    Cherry, Nicola M; Sithole, Fortune; Beach, Jeremy R; Burstyn, Igor

    2010-01-01

    Many workers with one Workers' Compensation Board (WCB) claim make further claims. If the characteristics of the job, initial injury or worker were predictive of an early second claim, interventions at the time of return to work after the first claim might be effective in reducing the burden of work-related injury. This report explores the characteristic of those who make a second claim. Records of all Alberta WCB claims from January 1, 1995, to December 31, 2004, for individuals 18 to claim, sex and age of claimant, type of injury, type of accident, occupation, industry, an indicator of company size, and industry claim rate were extracted, as well as the date of any second claim. The likelihood of second claim and mean time to second claim were estimated. Multivariate analyses were performed using Cox regression. 1,047,828 claims were identified from 490,230 individuals. Of these, 49.2% had at least two claims. In the multivariate model a reduced time to second claim was associated with male sex, younger age and some types of injury and accident. Machining trades were at highest risk of early second claim (hazard ratio [HR] 2.54 compared with administration), and of the industry sectors manufacturing was at highest risk (HR 1.37 compared with business, personal and professional services). Some caution is needed in interpreting these data as they may be affected by under-reporting and job changes between claims. Nonetheless, they suggest that there remains room for interventions to reduce the considerable differences in risk of a second claim among workers, jobs and industries.

  18. Sovereignty Frames and Sovereignty Claims

    OpenAIRE

    Walker, Neil

    2013-01-01

    This essay argues that much of the contemporary confusion and controversy over the meaning and continuing utility of the concept of sovereignty stems from a failure to distinguish between sovereignty as a deep framing device for making sense of the modern legal and political word on the one hand, and the particular claims which are made on behalf of particular institutions, agencies, rules or other entities to possess sovereign authority on the other. The essay begins by providing a basic acc...

  19. HCPCS Coding: An Integral Part of Your Reimbursement Strategy.

    Science.gov (United States)

    Nusgart, Marcia

    2013-12-01

    The first step to a successful reimbursement strategy is to ensure that your wound care product has the most appropriate Healthcare Common Procedure Coding System (HCPCS) code (or billing) for your product. The correct HCPCS code plays an essential role in patient access to new and existing technologies. When devising a strategy to obtain a HCPCS code for its product, companies must consider a number of factors as follows: (1) Has the product gone through the Food and Drug Administration (FDA) regulatory process or does it need to do so? Will the FDA code designation impact which HCPCS code will be assigned to your product? (2) In what "site of service" do you intend to market your product? Where will your customers use the product? Which coding system (CPT ® or HCPCS) applies to your product? (3) Does a HCPCS code for a similar product already exist? Does your product fit under the existing HCPCS code? (4) Does your product need a new HCPCS code? What is the linkage, if any, between coding, payment, and coverage for the product? Researchers and companies need to start early and place the same emphasis on a reimbursement strategy as it does on a regulatory strategy. Your reimbursement strategy staff should be involved early in the process, preferably during product research and development and clinical trial discussions.

  20. Reimbursing Dentists for Smoking Cessation Treatment: Views From Dental Insurers

    Science.gov (United States)

    Wright, Shana; McNeely, Jennifer; Rotrosen, John; Winitzer, Rebecca F.; Pollack, Harold; Abel, Stephen; Metsch, Lisa

    2012-01-01

    Introduction: Screening and delivery of evidence-based interventions by dentists is an effective way to reduce tobacco use. However, dental visits remain an underutilized opportunity for the treatment of tobacco dependence. This is, in part, because the current reimbursement structure does not support expansion of dental providers’ role in this arena. The purpose of this study was to interview dental insurers to assess attitudes toward tobacco use treatment in dental practice, pros and cons of offering dental provider reimbursement, and barriers to instituting a tobacco use treatment-related payment policy for dental providers. Methods: Semi-structured interviews were conducted with 11 dental insurance company executives. Participants were identified using a targeted sampling method and represented viewpoints from a significant share of companies within the dental insurance industry. Results: All insurers believed that screening and intervention for tobacco use was an appropriate part of routine care during a dental visit. Several indicated a need for more evidence of clinical and cost-effectiveness before reimbursement for these services could be actualized. Lack of purchaser demand, questionable returns on investment, and segregation of the medical and dental insurance markets were cited as additional barriers to coverage. Conclusions: Dissemination of findings on efficacy and additional research on financial returns could help to promote uptake of coverage by insurers. Wider issues of integration between dental and medical care and payment systems must be addressed in order to expand opportunities for preventive services in dental care settings. PMID:22387994

  1. Determinants of consumer understanding of health claims

    DEFF Research Database (Denmark)

    Grunert, Klaus G; Scholderer, Joachim; Rogeaux, Michel

    2011-01-01

    as safe, risky or other. In addition to the open questions on claim understanding, respondents rated a number of statements on claim interpretation for agreement and completed scales on interest in healthy eating, attitude to functional foods, and subjective knowledge on food and health. Results showed......The new EU regulation on nutrition and health claims states that claims can be permitted only if they can be expected to be understood by consumers. Investigating determinants of consumer understanding of health claims has therefore become an important topic. Understanding of a health claim...... on a yoghurt product was investigated with a sample of 720 category users in Germany. Health claim understanding was measured using open answers, which were subsequently content analysed and classified by comparison with the scientific dossier of the health claim. Based on this respondents were classified...

  2. Providing Mailing Cost Reimbursements: The Effect on Reporting Timeliness of Sexually Transmitted Diseases in Virginia.

    Science.gov (United States)

    Vasiliu, Oana E; Stover, Jeffrey A; Mays, Marissa J E; Bissette, Jennifer M; Dolan, Carrie B; Sirbu, Corina M

    2009-01-01

    We investigated the effect of providing mailing cost reimbursements to local health departments on the timeliness of the reporting of sexually transmitted diseases (STDs) in Virginia. The Division of Disease Prevention, Virginia Department of Health, provided mailing cost reimbursements to 31 Virginia health districts from October 2002 to December 2004. The difference (in days) between the diagnosis date (or date the STD paperwork was initiated) and the date the case/STD report was entered into the STD surveillance database was used in a negative binomial regression model against time (as divided into three periods-before, during, and after reimbursement) to estimate the effect of providing mailing cost reimbursements on reporting timeliness. We observed significant decreases in the number of days between diagnosis and reporting of a case, which were sustained after the reimbursement period ended, in 25 of the 31 health districts included in the analysis. We observed a significant initial decrease (during the reimbursement period) followed by a significant increase in the after-reimbursement phase in one health district. Two health districts had a significant initial decrease, while one health district had a significant decrease in reporting timeliness in the period after reimbursement. Two health districts showed no significant changes in the number of days to report to the central office. Providing reimbursements for mailing costs was statistically associated with improved STD reporting timeliness in almost all of Virginia's health districts. Sustained improvement after the reimbursement period ended is likely indicative of improved local health department reporting habits.

  3. Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion

    Science.gov (United States)

    Jones, Christine D.; Scott, Serena J.; Anoff, Debra L.; Pierce, Read G.; Glasheen, Jeffrey J.

    2015-01-01

    Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion. PMID:26310500

  4. An Analysis of Medicare Reimbursement to Ophthalmologists: Years 2012 to 2013.

    Science.gov (United States)

    Han, Everett; Baisiwala, Shivani; Jain, Atul; Bundorf, M Kate; Pershing, Suzann

    2017-10-01

    To analyze trends in utilization and payment of ophthalmic services in the Medicare population for years 2012 and 2013. Retrospective, cross-sectional study. A retrospective cross-sectional observational analysis was performed using publicly available Medicare Physician and Other Supplier aggregate file and the Physician and Other Supplier Public Use File. Variables analyzed included aggregate beneficiary demographics, Medicare payments to ophthalmologists, ophthalmic medical services provided, and the most common Medicare-reimbursed ophthalmic services. In 2013, total Medicare Part B reimbursement for ophthalmology was $5.8 billion, an increase of 3.6% from the previous year. From 2012 to 2013, the total number of ophthalmology services rendered increased by 2.2%, while average dollar amount reimbursed per ophthalmic service decreased by 5.4%. The top 5 highest reimbursed services accounted for 85% of total ophthalmic Medicare payments in 2013, an 11% increase from 2012. During 2013, drug reimbursement represented 32.8% of the total Medicare payments to ophthalmologists. Ranibizumab and aflibercept alone accounted for 95% of the entire $1.9 billion in drug reimbursements ophthalmologists in 2013. Medicare Part B reimbursement for ophthalmologists was primarily driven by use of anti-vascular endothelial growth factor (anti-VEGF) injections from 2012 to 2013. Of the total drug payments to ophthalmologists, biologic anti-VEGF agents ranibizumab and aflibercept accounted for 95% of all drug reimbursement. This is in contrast to other specialties, in which drug reimbursement represented only a small portion of Medicare reimbursement. Published by Elsevier Inc.

  5. A Cohort Analysis of Postbariatric Panniculectomy--Current Trends in Surgeon Reimbursement.

    Science.gov (United States)

    Aherrera, Andrew S; Pandya, Sonal N

    2016-01-01

    The overall number of patients undergoing body contouring procedures after massive weight loss (MWL) has progressively increased over the past decade. The purpose of this study was to evaluate the charges and reimbursements for panniculectomy after MWL at a large academic institution in Massachusetts. A retrospective review was performed and included all identifiable panniculectomy procedures performed at our institution between January 2008 and January 2014. The annual number of patients undergoing panniculectomy, the type of insurance coverage and reimbursement method of each patient, and the amounts billed and reimbursed were evaluated. During our study period, 114 patients underwent a medically necessary panniculectomy as a result of MWL. The average surgeon fee billed was $3496 ± $704 and the average amount reimbursed was $1271 ± $589. Ten cases (8.8%) had no reimbursements, 31 cases (21.8%) reimbursed less than $1000, 66 cases (57.9%) reimbursed between $1000 and $2000, and no cases reimbursed the full amount billed. When evaluated by type of insurance coverage, collection ratios were 37.4% ± 17.4% overall, 41.7% ± 16.4% for private insurance, and 24.0% ± 13.0% for Medicare/Medicaid insurance (P Reimbursements for panniculectomy are remarkably low, and in many instances, absent, despite obtaining previous preauthorization of medical necessity. Although panniculectomy is associated with improvements in quality of life and high levels of patient satisfaction, poor physician reimbursement for this labor intensive procedure may preclude access to appropriate care required by the MWL patient population.

  6. Seven Hints for Primordial Black Hole Dark Matter arXiv

    CERN Document Server

    Clesse, Sebastien

    Seven observations point towards the existence of primordial black holes (PBH), constituting the whole or an important fraction of the dark matter in the Universe: the mass and spin of black holes detected by Advanced LIGO/VIRGO, the detection of micro-lensing events of distant quasars and stars in M31, the non-detection of ultra-faint dwarf satellite galaxies with radius below 15 parsecs, evidences for core galactic dark matter profiles, the correlation between X-ray and infrared cosmic backgrounds, and the existence of super-massive black holes very early in the Universe's history. Some of these hints are newly identified and they are all intriguingly compatible with the re-constructed broad PBH mass distribution from LIGO events, peaking on PBH mass $m_{\\rm PBH} \\approx 3 M_\\odot$ and passing all other constraints on PBH abundances. PBH dark matter also provides a new mechanism to explain the mass-to-light ratios of dwarf galaxies, including the recent detection of a diffuse galaxy not dominated by dark ma...

  7. 40 CFR 35.6600 - Contractor claims.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Contractor claims. 35.6600 Section 35... Actions Procurement Requirements Under A Cooperative Agreement § 35.6600 Contractor claims. (a) General... prepared by the contractor to support a claim against the recipient; and (4) The award official determines...

  8. An Individual Claims History Simulation Machine

    Directory of Open Access Journals (Sweden)

    Andrea Gabrielli

    2018-03-01

    Full Text Available The aim of this project is to develop a stochastic simulation machine that generates individual claims histories of non-life insurance claims. This simulation machine is based on neural networks to incorporate individual claims feature information. We provide a fully calibrated stochastic scenario generator that is based on real non-life insurance data. This stochastic simulation machine allows everyone to simulate their own synthetic insurance portfolio of individual claims histories and back-test thier preferred claims reserving method.

  9. International comparison of the factors influencing reimbursement of targeted anti-cancer drugs.

    Science.gov (United States)

    Lim, Carol Sunghye; Lee, Yun-Gyoo; Koh, Youngil; Heo, Dae Seog

    2014-11-29

    Reimbursement policies for anti-cancer drugs vary among countries even though they rely on the same clinical evidence. We compared the pattern of publicly funded drug programs and analyzed major factors influencing the differences. We investigated reimbursement policies for 19 indications with targeted anti-cancer drugs that are used variably across ten countries. The available incremental cost-effectiveness ratio (ICER) data were retrieved for each indication. Based on the comparison between actual reimbursement decisions and the ICERs, we formulated a reimbursement adequacy index (RAI): calculating the proportion of cost-effective decisions, either reimbursement of cost-effective indications or non-reimbursement of cost-ineffective indications, out of the total number of indications for each country. The relationship between RAI and other indices were analyzed, including governmental dependency on health technology assessment, as well as other parameters for health expenditure. All the data used in this study were gathered from sources publicly available online. Japan and France were the most likely to reimburse indications (16/19), whereas Sweden and the United Kingdom were the least likely to reimburse them (5/19 and 6/19, respectively). Indications with high cost-effectiveness values were more likely to be reimbursed (ρ = -0.68, P = 0.001). The three countries with high RAI scores each had a healthcare system that was financed by general taxation. Although reimbursement policies for anti-cancer drugs vary among countries, we found a strong correlation of reimbursements for those indications with lower ICERs. Countries with healthcare systems financed by general taxation demonstrated greater cost-effectiveness as evidenced by reimbursement decisions of anti-cancer drugs.

  10. Capital cost reimbursement to community hospitals under Federal health insurance programs.

    Science.gov (United States)

    Kinney, E D; Lefkowitz, B

    1982-01-01

    Issues in current capital cost reimbursement to community hospitals by Medicare and Medicaid are described, and options for change analyzed. Major reforms in the way the federal government pays for capital costs--in particular substitution of other methods of payment for existing depreciation reimbursement--could have significant impact on the structure of the health care system and on government expenditures. While such reforms are likely to engender substantial political opposition, they may be facilitated by broader changes in the reimbursement system.

  11. Development and Validation of a Novel Generic Health-related Quality of Life Instrument With 20 Items (HINT-20

    Directory of Open Access Journals (Sweden)

    Min-Woo Jo

    2017-01-01

    Full Text Available Objectives Few attempts have been made to develop a generic health-related quality of life (HRQoL instrument and to examine its validity and reliability in Korea. We aimed to do this in our present study. Methods After a literature review of existing generic HRQoL instruments, a focus group discussion, in-depth interviews, and expert consultations, we selected 30 tentative items for a new HRQoL measure. These items were evaluated by assessing their ceiling effects, difficulty, and redundancy in the first survey. To validate the HRQoL instrument that was developed, known-groups validity and convergent/discriminant validity were evaluated and its test-retest reliability was examined in the second survey. Results Of the 30 items originally assessed for the HRQoL instrument, four were excluded due to high ceiling effects and six were removed due to redundancy. We ultimately developed a HRQoL instrument with a reduced number of 20 items, known as the Health-related Quality of Life Instrument with 20 items (HINT-20, incorporating physical, mental, social, and positive health dimensions. The results of the HINT-20 for known-groups validity were poorer in women, the elderly, and those with a low income. For convergent/discriminant validity, the correlation coefficients of items (except vitality in the physical health dimension with the physical component summary of the Short Form 36 version 2 (SF-36v2 were generally higher than the correlations of those items with the mental component summary of the SF-36v2, and vice versa. Regarding test-retest reliability, the intraclass correlation coefficient of the total HINT-20 score was 0.813 (p<0.001. Conclusions A novel generic HRQoL instrument, the HINT-20, was developed for the Korean general population and showed acceptable validity and reliability.

  12. Reimbursed drugs in patients with sleep-disordered breathing: A static-charge-sensitive bed study.

    Science.gov (United States)

    Anttalainen, Ulla; Polo, Olli; Vahlberg, Tero; Saaresranta, Tarja

    2010-01-01

    Co-morbidities in men and women with sleep-disordered breathing (SDB) were compared retrospectively to an age-standardized, general Finnish population. The prevalence of diseases was based on the reimbursement refunds of medications. Two hundred thirty-three age- and BMI-matched male-female pairs and 368 consecutive women identified from our sleep recording database were included. Data on medication were gathered from the National Agency for Medicines and Social Insurance Institution database. Men with SDB had three-fold prevalence of reimbursed medication for diabetes and two-fold prevalence of reimbursed medication for chronic arrhythmia. Women with SDB had three-fold prevalence of reimbursed medication for thyroid insufficiency, and postmenopausal women had two-fold prevalence of reimbursed medication for psychosis. BMI and age did not explain prevalence of reimbursed medications for chronic arrhythmia or psychosis. In both genders with SDB, prevalence of reimbursed medications compared to the general population was two-fold for hypertension and seven-fold for asthma and/or chronic obstructive pulmonary disease (COPD). Partial upper airway obstruction was associated with three-fold prevalence of reimbursed medication for asthma and/or COPD in both genders and 60% reduced prevalence of reimbursed medication for hypertension in females matched for age and BMI. Co-morbidity profile differed between genders. Our results emphasize the importance of diagnosis and treatment of co-morbidities and partial upper airway obstruction. Copyright 2009 Elsevier B.V. All rights reserved.

  13. Changing patient classification system for hospital reimbursement in Romania.

    Science.gov (United States)

    Radu, Ciprian-Paul; Chiriac, Delia Nona; Vladescu, Cristian

    2010-06-01

    To evaluate the effects of the change in the diagnosis-related group (DRG) system on patient morbidity and hospital financial performance in the Romanian public health care system. Three variables were assessed before and after the classification switch in July 2007: clinical outcomes, the case mix index, and hospital budgets, using the database of the National School of Public Health and Health Services Management, which contains data regularly received from hospitals reimbursed through the Romanian DRG scheme (291 in 2009). The lack of a Romanian system for the calculation of cost-weights imposed the necessity to use an imported system, which was criticized by some clinicians for not accurately reflecting resource consumption in Romanian hospitals. The new DRG classification system allowed a more accurate clinical classification. However, it also exposed a lack of physicians' knowledge on diagnosing and coding procedures, which led to incorrect coding. Consequently, the reported hospital morbidity changed after the DRG switch, reflecting an increase in the national case-mix index of 25% in 2009 (compared with 2007). Since hospitals received the same reimbursement over the first two years after the classification switch, the new DRG system led them sometimes to change patients' diagnoses in order to receive more funding. Lack of oversight of hospital coding and reporting to the national reimbursement scheme allowed the increase in the case-mix index. The complexity of the new classification system requires more resources (human and financial), better monitoring and evaluation, and improved legislation in order to achieve better hospital resource allocation and more efficient patient care.

  14. Variation in Health Technology Assessment and Reimbursement Processes in Europe.

    Science.gov (United States)

    Akehurst, Ronald L; Abadie, Eric; Renaudin, Noël; Sarkozy, François

    2017-01-01

    It has been suggested that differences in health technology assessment (HTA) processes among countries, particularly within Europe, have led to inequity in patient access to new medicines. To provide an up-to-date snapshot analysis of the present status of HTA and reimbursement systems in select European countries, and to investigate the implications of these processes, especially with regard to delays in market and patient access. HTA and reimbursement processes were assessed through a review of published and gray literature, and through a series of interviews with HTA experts. To quantify the impact of differences among countries, we conducted case studies of 12 products introduced since 2009, including 10 cancer drugs. In addition to the differences in HTA and reimbursement processes among countries, the influence of particular sources of information differs among HTA bodies. The variation in the time from the authorization by the European Medicines Agency to the publication of HTA decisions was considerable, both within and among countries, with a general lack of transparency as to why some assessments take longer than others. In most countries, market access for oncology products can occur outside the HTA process, with sales often preceding HTA decisions. It is challenging even for those with considerable personal experience in European HTA processes to establish what is really happening in market access for new drugs. We recommend that efforts should be directed toward improving transparency in HTA, which should, in turn, lead to more effective processes. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  15. Reimbursement of care for severe trauma under SwissDRG.

    Science.gov (United States)

    Moos, Rudolf M; Sprengel, Kai; Jensen, Kai Oliver; Jentzsch, Thorsten; Simmen, Hans-Peter; Seifert, Burkhardt; Ciritsis, Bernhard; Neuhaus, Valentin; Volbracht, Jörk; Mehra, Tarun

    2016-01-01

    Treatment of patients with severe injuries is costly, with best results achieved in specialised care centres. However, diagnosis-related group (DRG)-based prospective payment systems have difficulties in depicting treatment costs for specialised care. We analysed reimbursement of care for severe trauma in the first 3 years after the introduction of the Swiss DRG reimbursement system (2012-2014). The study included all patients with solely basic insurance, hospital admission after 01.01.2011 and discharge in 2011 or 2012, who were admitted to the resuscitation room of the University Hospital of Zurich, aged ≥16 years and with an injury severity score (ISS) ≥16 (n = 364). Clinical, financial and administrative data were extracted from the electronic medical records. All cases were grouped into DRGs according to different SwissDRG versions. We considered results to be significant if p ≤0.002. The mean deficit decreased from 12 065 CHF under SwissDRG 1.0 (2012) to 2 902 CHF under SwissDRG 3.0 (2014). The main reason for the reduction of average deficits was a refinement of the DRG algorithm with a regrouping of 23 cases with an ISS ≥16 from MDC 01 to DRGs within MDC21A. Predictors of an increased total loss per case could be identified: for example, high total number of surgical interventions, surgeries on multiple anatomical regions or operations on the pelvis (p ≤0.002). Psychiatric diagnoses in general were also significant predictors of deficit per case (p<0.001). The reimbursement for care of severely injured patients needs further improvement. Cost neutral treatment was not possible under the first three versions of SwissDRG.

  16. Proton Therapy Expansion Under Current United States Reimbursement Models

    Energy Technology Data Exchange (ETDEWEB)

    Kerstiens, John [Indiana University Health Proton Therapy Center, Bloomington, Indiana (United States); Johnstone, Peter A.S., E-mail: pajohnst@iupui.edu [Indiana University Health Proton Therapy Center, Bloomington, Indiana (United States); Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana (United States)

    2014-06-01

    Purpose: To determine whether all the existing and planned proton beam therapy (PBT) centers in the United States can survive on a local patient mix that is dictated by insurers, not by number of patients. Methods and Materials: We determined current and projected cancer rates for 10 major US metropolitan areas. Using published utilization rates, we calculated patient percentages who are candidates for PBT. Then, on the basis of current published insurer coverage policies, we applied our experience of what would be covered to determine the net number of patients for whom reimbursement is expected. Having determined the net number of covered patients, we applied our average beam delivery times to determine the total number of minutes needed to treat that patient over the course of their treatment. We then calculated our expected annual patient capacity per treatment room to determine the appropriate number of treatment rooms for the area. Results: The population of patients who will be both PBT candidates and will have treatments reimbursed by insurance is significantly smaller than the population who should receive PBT. Coverage decisions made by insurers reduce the number of PBT rooms that are economically viable. Conclusions: The expansion of PBT centers in the US is not sustainable under the current reimbursement model. Viability of new centers will be limited to those operating in larger regional metropolitan areas, and few metropolitan areas in the US can support multiple centers. In general, 1-room centers require captive (non–PBT-served) populations of approximately 1,000,000 lives to be economically viable, and a large center will require a population of >4,000,000 lives. In areas with smaller populations or where or a PBT center already exists, new centers require subsidy.

  17. SOCIAL ACCOUNTING ASPECTS IN THE PREUNIVERSITY LEVEL REIMBURSEMENT OF STUDENTS

    Directory of Open Access Journals (Sweden)

    CENAR IULIANA

    2016-12-01

    Full Text Available The specific accounting approaches in preuniversity accounting are reduced, including the segment accounted for the reimbursementof students travel expenses and other benefits. This paper aims to outline an image of the social aspects of education in the preuniversity public education, represented by reimbursement to the beneficiaries of education, how they are reflected in accounting through the budget classification and disclosed to users via public media. Specifically, our approach refers to scholarships provided by the local administration to support learning, professionalscholarships, as well as various support programs for students who come from families with material difficulties, whose financial backer is the state through school inspectorates.

  18. Hospital payroll costs, productivity, and employment under prospective reimbursement.

    Science.gov (United States)

    Kidder, D; Sullivan, D

    1982-12-01

    This paper reports preliminary findings from the National Hospital Rate-Setting Study regarding the effects of State prospective reimbursement (PR) programs on measures of payroll costs and employment in hospitals. PR effects were estimated through reduced-form equations, using American Hospital Association Annual Survey data on over 2,700 hospitals from 1969 through 1978. These tests suggest that hospitals responded to PR by lowering payroll expenditures. PR also seems to have been associated with reductions in full-time equivalent staff per adjusted inpatient day. However, tests did not confirm the hypothesis that hospitals reduce payroll per full-time equivalent staff as a result of PR.

  19. Warranty claim analysis considering human factors

    International Nuclear Information System (INIS)

    Wu Shaomin

    2011-01-01

    Warranty claims are not always due to product failures. They can also be caused by two types of human factors. On the one hand, consumers might claim warranty due to misuse and/or failures caused by various human factors. Such claims might account for more than 10% of all reported claims. On the other hand, consumers might not be bothered to claim warranty for failed items that are still under warranty, or they may claim warranty after they have experienced several intermittent failures. These two types of human factors can affect warranty claim costs. However, research in this area has received rather little attention. In this paper, we propose three models to estimate the expected warranty cost when the two types of human factors are included. We consider two types of failures: intermittent and fatal failures, which might result in different claim patterns. Consumers might report claims after a fatal failure has occurred, and upon intermittent failures they might report claims after a number of failures have occurred. Numerical examples are given to validate the results derived.

  20. Questioning the claims from Kaiser.

    Science.gov (United States)

    Talbot-Smith, Alison; Gnani, Shamini; Pollock, Allyson M; Gray, Denis Pereira

    2004-06-01

    The article by Feachem et al, published in the BMJ in 2002, claimed to show that, compared with the United Kingdom (UK) National Health Service (NHS), the Kaiser Permanente healthcare system in the United States (US) has similar healthcare costs per capita, and performance that is considerably better in certain respects. To assess the accuracy of Feachem et al's comparison and conclusions. Detailed re-examination of the data and methods used and consideration of the 82 letters responding to the article. Analyses revealed four main areas in which Feachem et al's methodology was flawed. Firstly, the populations of patients served by Kaiser Permanente and by the NHS are fundamentally different. Kaiser's patients are mainly employed, significantly younger, and significantly less socially deprived and so are healthier. Feachem et al fail to adjust adequately for these factors. Secondly, Feachem et al have wrongly inflated NHS costs by omitting substantial user charges payable by Kaiser members for care, excluding the costs of marketing and administration, and deducting the surplus from Kaiser's costs while underestimating the capital charge element of the NHS budget and other costs. They also used two methods of converting currency, the currency rate and a health purchasing power parity conversion. This is double counting. Feachem et al reported that NHS costs were 10% less per head than Kaiser. Correcting for the double currency conversion gives the NHS a 40% cost advantage such that per capita costs are 1161 dollars and 1951 dollars for the NHS and Kaiser, respectively. Thirdly, Feachem et al use non-standardised data for NHS bed days from the Organisation for Economic Cooperation and Development, rather than official Department of Health bed availability and activity statistics for England. Leaving aside the non-comparability of the population and lack of standardisation of the data, the result is to inflate NHS acute bed use and underestimate the efficiency of

  1. 32 CFR 842.129 - Settlement of claims against NAFIs.

    Science.gov (United States)

    2010-07-01

    ... LITIGATION ADMINISTRATIVE CLAIMS Nonappropriated Fund Claims § 842.129 Settlement of claims against NAFIs. (a) This subpart does not establish legal theories for adjudication of claims. Refer to the appropriate...

  2. [Health claims for medical foods].

    Science.gov (United States)

    Katan, Martijn B

    2013-01-01

    Souvenaid (Nutricia, Zoetermeer, the Netherlands) is a medical food for the dietary management of early Alzheimer's disease. The mix of nutrients in this drink is suggested to have a beneficial effect on cognitive function; such implicit health claims for medical foods are not checked by government agencies. Souvenaid has been investigated in three clinical trials. The first trial showed that Souvenaid produced a significant improvement in delayed verbal recall, but not in other psychological tests. The second and largest trial showed no effect on any outcome. The third trial showed no significant effect at 12 or 24 weeks, but a significant difference in the 24-week time course of the composite memory score. None of these outcomes was clearly specified as a primary outcome at trial registration. In conclusion, there is no convincing proof that Souvenaid benefits cognitive function. Better scrutiny of the efficacy of medical foods is warranted.

  3. CLAIMS OF SUSTAINABLE FACILITIES MANAGEMENT

    DEFF Research Database (Denmark)

    Nielsen, Susanne Balslev

    Purpose: The purpose of the paper is to provide an overview of current practices within the emergent management discipline: Sustainable Facilities Management (SFM). Background: To develop a sustainable society, facilities managers must become change agents for sustainability in the built...... environment. Facilities Management (FM) is contributing to the environmental, social and economical problems, but can at the same time also be a part of the solution. However, to integrate sustainability in FM is still an emergent niche within FM, and the examples of SFM so far seems to come out of very......-creating of new socio-technical services and technologies These SFM understandings are concluded to be coexisting claims of SFM definitions. Practical Implications: Facilities managers will be able to identify the mindset behind different services and technologies that are promoted as SFM. But maybe just...

  4. 3rd Circuit hints it may reconsider McNemar reasoning.

    Science.gov (United States)

    1997-10-17

    The [name removed] v. The Disney Store ruling is under criticism and the 3rd U.S. Circuit Court of Appeals may reconsider its 1996 decision to not allow employees who receive disability benefits to sue under the Americans with Disabilities Act (ADA). A panel of 3rd Circuit judges, working on [name removed] v. American Sterilizer Co., asserts that the [name removed] decision should not be used to assume that an individual's ADA claims are barred because of prior representations of disability. [Name removed] is suing American Sterilizer under the retaliation provisions of the ADA. Other courts are criticizing the [name removed] decision, including the District of Columbia Court in [name removed] v. Washington Metropolitan Area Transit Authority. The [name removed] court assets that a statement made in the context of a disability application does not preclude an ADA claim brought by a worker for illegal discrimination because the ADA and the Social Security Act differ in their statutory intent. AIDS advocates state that the [name removed] decision places a plaintiff in the position of having to choose between asserting a legal right or maintaining an income. Alan Epstein, who represented [name removed], is pleased by the criticism but explains that [name removed], who died this summer, will not be vindicated.

  5. Reimbursement of pharmaceuticals: reference pricing versus health technology assessment.

    Science.gov (United States)

    Drummond, Michael; Jönsson, Bengt; Rutten, Frans; Stargardt, Tom

    2011-06-01

    Reference pricing and health technology assessment are policies commonly applied in order to obtain more value for money from pharmaceuticals. This study focussed on decisions about the initial price and reimbursement status of innovative drugs and discussed the consequences for market access and cost. Four countries were studied: Germany, The Netherlands, Sweden and the United Kingdom. These countries have operated one, or both, of the two policies at certain points in time, sometimes in parallel. Drugs in four groups were considered: cholesterol-lowering agents, insulin analogues, biologic drugs for rheumatoid arthritis and "atypical" drugs for schizophrenia. Compared with HTA, reference pricing is a relatively blunt instrument for obtaining value for money from pharmaceuticals. Thus, its role in making reimbursement decisions should be limited to drugs which are therapeutically equivalent. HTA is a superior strategy for obtaining value for money because it addresses not only price but also the appropriate indications for the use of the drug and the relation between additional value and additional costs. However, given the relatively higher costs of conducting HTAs, the most efficient approach might be a combination of both policies.

  6. Did recent changes in Medicare reimbursement hit teaching hospitals harder?

    Science.gov (United States)

    Konetzka, R Tamara; Zhu, Jingsan; Volpp, Kevin G

    2005-11-01

    To inform the policy debate on Medicare reimbursement by examining the financial effects of the Balanced Budget Act of 1997 (BBA) and subsequent adjustments on major academic medical centers, minor teaching hospitals, and nonteaching hospitals. The authors simulated the impacts of BBA and subsequent BBA adjustments to predict the independent effects of changes in Medicare reimbursement on hospital revenues using 1997-2001 Medicare Cost Reports for all short-term acute-care hospitals in the United States. The authors also calculated actual (nonsimulated) operating and total margins among major teaching, minor teaching, and nonteaching hospitals to account for hospital response to the changes. The BBA and subsequent refinements reduced Medicare revenues to a greater degree in major teaching hospitals, but the fact that such hospitals had a smaller proportion of Medicare patients meant that the BBA reduced overall revenues by similar percentages across major, minor, and nonteaching hospitals. Consistently lower margins may have made teaching hospitals more vulnerable to cuts in Medicare support. Recent Medicare changes affected revenues at teaching and nonteaching hospitals more similarly than is commonly believed. However, the Medicare cuts under the BBA probably exacerbated preexisting financial strain on major teaching hospitals, and increased Medicare funding may not suffice to eliminate the strain. This report's findings are consistent with recent calls to support needed services of teaching hospitals through all-payer or general funds.

  7. Hint from the interfamily mass hierarchy: Two vectorlike families in the TeV range

    Science.gov (United States)

    Babu, K. S.; Pati, Jogesh C.; Stremnitzer, Hanns

    1995-03-01

    Two vectorlike familes QL,R=(U, D, N, E)L,R and Q'L,R=(U', D', N', E')L,R with masses of order 1 TeV, one of which is a doublet of SU(2)L and the other a doublet of SU(2)R, have been predicted to exist, together with the three observed chiral families, in the context of a viable and economical SUSY preon model. The model itself possesses many attractive features which include explanations of the origins of (i) diverse mass scales, (ii) family replication, (iii) protection of the masses of the composite quarks and leptons compared to their compositeness scales, and (iv) interfamily mass hierarchy. The existence of the two vectorlike familes, a prediction of the model, turns out to be crucial especially for an explanation of the interfamily mass hierarchy (IFMH). Given the simplicity of the explanation, the observed IFMH in turn appears to us to be a strong hint in favor of the existence of the two vectorlike families. This paper is devoted to a detailed study of the expected masses, mixings and decay modes of the fermions belonging to the two vectorlike families, in the context of the SUSY preon model, with the inclusion of the renormalization effects due to the standard model gauge interactions. Including QCQ renormalization effects, the masses of the vectorlike quarks are expected to lie in the range of 500 GeV to about 2.5 TeV, while those of the vectorlike leptons are expected to be in the range of 200 GeV to 1 TeV. Their mass pattern and decay modes exhibit certain distinguishing features and characteristic signals. For example, when the CERN LHC and, possibly a future version of the SSC are built, pair production of the vectorlike quarks would lead to systems such as (bb¯+4Z+W+W-) and (bb¯+2Z+W+W-), while an e-e+ linear collider (NLC) of suitable energy can produce appreciably a single neutral heavy lepton N together, with ντ, followed by the decay of N into (Z+ντ)-->(e-e+)+ντ. This last signal may conceivably materialize even at CERN LEP 200 if N is

  8. Smartphone Ownership Among US Adult Cigarette Smokers: 2014 Health Information National Trends Survey (HINTS) Data.

    Science.gov (United States)

    Heffner, Jaimee L; Mull, Kristin E

    2017-08-31

    Despite increasing interest in smartphone apps as a platform for delivery of tobacco cessation interventions, no previous studies have evaluated the prevalence and characteristics of smokers who can access smartphone-delivered interventions. To guide treatment development in this new platform and to evaluate disparities in access to smartphone-delivered interventions, we examined associations of smartphone ownership with demographics, tobacco use and thoughts about quitting, other health behaviors, physical and mental health, health care access, and Internet and technology utilization using a nationally representative sample of US adult smokers. Data were from the National Cancer Institute's 2014 Health Information National Trends Survey 4 (HINTS 4), Cycle 4. This mailed survey targeted noninstitutionalized individuals aged 18 years or older using two-stage stratified random sampling. For this analysis, we restricted the sample to current smokers with complete data on smartphone ownership (n=479). Nearly two-thirds (weighted percent=63.8%, 248/479) of smokers reported owning a smartphone. Those who were younger (P<.001), employed (P=.002), never married (P=.002), and had higher education (P=.002) and income (P<.001) had the highest rates of ownership. Smartphone owners did not differ from nonowners on frequency of smoking, recent quit attempts, or future plans to quit smoking, although they reported greater belief in the benefits of quitting (P=.04). Despite being equally likely to be overweight or obese, smartphone owners reported greater fruit and vegetable consumption (P=.03) and were more likely to report past-year efforts to increase exercise (P=.001) and to lose weight (P=.02). No differences in health care access and utilization were found. Smartphone owners reported better physical and mental health in several domains and higher access to and utilization of technology and the Internet, including for health reasons. Smartphone ownership among smokers mirrors

  9. 37 CFR 360.12 - Form and content of claims.

    Science.gov (United States)

    2010-07-01

    ... SUBMISSION OF ROYALTY CLAIMS FILING OF CLAIMS TO ROYALTY FEES COLLECTED UNDER COMPULSORY LICENSE Satellite Claims § 360.12 Form and content of claims. (a) Forms. (1) Each claim to compulsory license royalty fees... owner entitled to claim the royalty fees. (ii) A general statement of the nature of the copyright owner...

  10. 37 CFR 360.3 - Form and content of claims.

    Science.gov (United States)

    2010-07-01

    ... SUBMISSION OF ROYALTY CLAIMS FILING OF CLAIMS TO ROYALTY FEES COLLECTED UNDER COMPULSORY LICENSE Cable Claims § 360.3 Form and content of claims. (a) Forms. (1) Each claim to cable compulsory license royalty fees... copyright owner entitled to claim the royalty fees. (ii) A general statement of the nature of the copyright...

  11. 32 CFR 842.110 - Claims not payable.

    Science.gov (United States)

    2010-07-01

    ...) Claims for a maritime occurrence covered under U.S. admiralty laws. (o) Claims for: (1) Any tax or... International Agreements Claims Act. (4) The Air Force Admiralty Claims Act and the Admiralty Extensions Act. (5...) Claims from the combat activities of the armed forces during war or armed conflict. (c) Claims for...

  12. [Reimbursement of opiate substitution drugs to militaries in 2007].

    Science.gov (United States)

    d'Argouges, F; Desjeux, G; Marsan, P; Thevenin-Garron, V

    2012-09-01

    The use of psychoactive drugs by militaries is not compatible with the analytical skills and self-control required by their jobs. Military physicians take this problem into consideration by organising systematic drugs screening in the French forces. However, for technical reasons, opiates are not concerned by this screening with the agreement of the people concerned. The estimated number of militaries who use an opiate substitute may be an approach of heroin consumption in the French forces. This study describes buprenorphine and methadone reimbursements made during 2007 by the national military healthcare centre to French militaries. Each French soldier is affiliated to a special health insurance. The national military healthcare centre has in its information system, all the data concerning drug reimbursement made to French military personnel. This is a retrospective study of buprenorphine and methadone reimbursements made during 2007 by the military healthcare centre, to militaries from the three sectors of the French forces, and from the gendarmerie and joint forces. Only one reimbursement of one of these two drugs during this period allowed the patient to be included in our study. Daily drug dose and treatment steadiness profile have been calculated according to the criteria of the French monitoring centre for drugs and drug addiction. The criteria of the National guidelines against frauds have been used to identify misuse of these drugs. Doctors' shopping behaviour has also been studied. Finally, the nature of the prescriber and the consumption of other drugs in combination with opiate substitute have been analysed. One hundred and eighty-one military consumers of opiate substitute drugs (167 men and 14 women) participated. This sample included people from the three sectors of the French forces as well as from the gendarmerie and from the joint forces. The average age of the consumers was 26.6 years (20-42 years). The average length of service was 6.1 years

  13. Operating room fires: a closed claims analysis.

    Science.gov (United States)

    Mehta, Sonya P; Bhananker, Sanjay M; Posner, Karen L; Domino, Karen B

    2013-05-01

    To assess patterns of injury and liability associated with operating room (OR) fires, closed malpractice claims in the American Society of Anesthesiologists Closed Claims Database since 1985 were reviewed. All claims related to fires in the OR were compared with nonfire-related surgical anesthesia claims. An analysis of fire-related claims was performed to identify causative factors. There were 103 OR fire claims (1.9% of 5,297 surgical claims). Electrocautery was the ignition source in 90% of fire claims. OR fire claims more frequently involved older outpatients compared with other surgical anesthesia claims (P fire claims (P fires (n = 93) increased over time (P fires occurred during head, neck, or upper chest procedures (high-fire-risk procedures). Oxygen served as the oxidizer in 95% of electrocautery-induced OR fires (84% with open delivery system). Most electrocautery-induced fires (n = 75, 81%) occurred during monitored anesthesia care. Oxygen was administered via an open delivery system in all high-risk procedures during monitored anesthesia care. In contrast, alcohol-containing prep solutions and volatile compounds were present in only 15% of OR fires during monitored anesthesia care. Electrocautery-induced fires during monitored anesthesia care were the most common cause of OR fires claims. Recognition of the fire triad (oxidizer, fuel, and ignition source), particularly the critical role of supplemental oxygen by an open delivery system during use of the electrocautery, is crucial to prevent OR fires. Continuing education and communication among OR personnel along with fire prevention protocols in high-fire-risk procedures may reduce the occurrence of OR fires.

  14. The Role of Documentation Quality in Anesthesia-Related Closed Claims: A Descriptive Qualitative Study.

    Science.gov (United States)

    Wilbanks, Bryan A; Geisz-Everson, Marjorie; Boust, Rebecca R

    2016-09-01

    Clinical documentation is a critical tool in supporting care provided to patients. Sound documentation provides a picture of clinical events that can be used to improve patient care. However, many other uses for clinical documentation are equally important. Such documentation informs clinical decision support tools, creates a legal record of patient care, assists in financial reimbursement of services, and serves as a repository for secondary data analysis. Conversely, poor documentation can impair patient safety and increase malpractice risk exposure by reflecting poor or inaccurate information that ultimately may guide patient care decisions.Through an examination of anesthesia-related closed claims, a descriptive qualitative study emerged, which explored the antecedents and consequences of documentation quality in the claims reviewed. A secondary data analysis utilized a database generated by the American Association of Nurse Anesthetists Foundation closed claim review team. Four major themes emerged from the analysis. Themes 1, 2, and 4 primarily describe how poor documentation quality can have negative consequences for clinicians. The third theme primarily describes how poor documentation quality that can negatively affect patient safety.

  15. Radiation injury claims: an overview and update

    International Nuclear Information System (INIS)

    Schaffer, W.G.

    1984-01-01

    The author reviews the radiation injury claims problem and summarizes the legal framework in which the claims are presently brought. Two cases are reviewed in which the decisions are troubling. The implications of these decisions are discussed in the overall radiation injury claims problem. The author notes that in the largest radiation injury case tried in the United States, the court was unable to resolve the claims within the confines of the existing law. The disregard for established norms of adjudication and the resultant decline in predictability of outcome portends grave consequences, not only for the nuclear industry but for other industries involved with potentially toxic substances

  16. Survey of malpractice claims in dermatology

    International Nuclear Information System (INIS)

    Altman, J.

    1975-01-01

    A statistical survey of malpractice claims asserted against dermatologists was made. The subject matter of the claims was divided into eight major categories: drug reactions, x-ray burns, poor cosmetic result following surgery, poor cosmetic result following medication, failure to diagnose cancer, improper diagnosis, infection from treatment, and miscellaneous. The study showed that a group of ''serious'' damage cases, which accounted for 34 percent of total claims, generated 94 percent of total dollar losses. The problem areas for malpractice claims appeared to be drug reactions, cosmetic chemosurgery, and failure to diagnose cancer. (U.S.)

  17. 42 CFR 489.34 - Allowable charges: Hospitals participating in State reimbursement control systems or...

    Science.gov (United States)

    2010-10-01

    ... reimbursement control systems or demonstration projects. 489.34 Section 489.34 Public Health CENTERS FOR... CERTIFICATION PROVIDER AGREEMENTS AND SUPPLIER APPROVAL Allowable Charges § 489.34 Allowable charges: Hospitals participating in State reimbursement control systems or demonstration projects. A hospital receiving payment for...

  18. Recruitment in a Monopsonistic Labour Market: Will Travel Costs be reimbursed?

    NARCIS (Netherlands)

    Rouwendal, Jan; Ommeren, van Jos

    2007-01-01

    Reimbursement of commuting costs by employers has attracted little attention from economists. We develop a theoretical model of a monopsonistic employer who determines an optimal recruitment policy in a spatial labour market with search frictions and show that partial reimbursement of commuting cost

  19. 42 CFR 403.822 - Reimbursement of transitional assistance and associated sponsor requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Reimbursement of transitional assistance and associated sponsor requirements. 403.822 Section 403.822 Public Health CENTERS FOR MEDICARE & MEDICAID... Prescription Drug Discount Card and Transitional Assistance Program § 403.822 Reimbursement of transitional...

  20. 48 CFR 228.307 - Insurance under cost-reimbursement contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 228.307 Section 228.307 Federal Acquisition Regulations System DEFENSE ACQUISITION....307 Insurance under cost-reimbursement contracts. ...

  1. 48 CFR 53.301-1437 - Settlement Proposal for Cost-Reimbursement Type Contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Settlement Proposal for Cost-Reimbursement Type Contracts. 53.301-1437 Section 53.301-1437 Federal Acquisition Regulations...-1437 Settlement Proposal for Cost-Reimbursement Type Contracts. ER09DE97.012 [62 FR 64951, Dec. 9, 1997] ...

  2. 48 CFR 2052.215-78 - Travel approvals and reimbursement-Alternate 1.

    Science.gov (United States)

    2010-10-01

    ... reimbursement-Alternate 1. 2052.215-78 Section 2052.215-78 Federal Acquisition Regulations System NUCLEAR... Clauses 2052.215-78 Travel approvals and reimbursement—Alternate 1. As prescribed in 2015.209-70(d), the contracting officer shall insert the following clause in cost reimbursement solicitations and contracts which...

  3. 42 CFR 447.257 - FFP: Conditions relating to institutional reimbursement.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false FFP: Conditions relating to institutional reimbursement. 447.257 Section 447.257 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...: Conditions relating to institutional reimbursement. FFP is not available for a State's expenditures for...

  4. 48 CFR 245.608-7 - Reimbursement of cost for transfer of contractor inventory.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Reimbursement of cost for transfer of contractor inventory. 245.608-7 Section 245.608-7 Federal Acquisition Regulations System... Reporting, Redistribution, and Disposal of Contractor Inventory 245.608-7 Reimbursement of cost for transfer...

  5. 48 CFR 3028.307 - Insurance under cost-reimbursement contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 3028.307 Section 3028.307 Federal Acquisition Regulations System DEPARTMENT OF HOMELAND... Insurance 3028.307 Insurance under cost-reimbursement contracts. ...

  6. 78 FR 40507 - Appendix B Guidelines for Reviewing Applications for Compensation and Reimbursement of Expenses...

    Science.gov (United States)

    2013-07-05

    ... DEPARTMENT OF JUSTICE Appendix B Guidelines for Reviewing Applications for Compensation and Reimbursement of Expenses Filed Under United States Code by Attorneys in Larger Chapter 11 Cases; Correction... reviewing applications for compensation and reimbursement of expenses filed by attorneys in larger chapter...

  7. 78 FR 56719 - Challenging Regulatory and Reimbursement Paradigms for Medical Devices in the Treatment of...

    Science.gov (United States)

    2013-09-13

    ...] Challenging Regulatory and Reimbursement Paradigms for Medical Devices in the Treatment of Metabolic Diseases... announcing a public workshop entitled ``Changing Regulatory and Reimbursement Paradigms for Medical Devices... registration information on the AGA Web site. If you need special accommodations due to a disability, please...

  8. 78 FR 69694 - Changing Regulatory and Reimbursement Paradigms for Medical Devices in the Treatment of Obesity...

    Science.gov (United States)

    2013-11-20

    ...] Changing Regulatory and Reimbursement Paradigms for Medical Devices in the Treatment of Obesity and... Administration (FDA) is announcing a public workshop entitled ``Changing Regulatory and Reimbursement Paradigms... information on the AGA Web site. If you need special accommodations due to a disability, please contact...

  9. Primary Care Physician and Patient Perceptions of Reimbursement for Total Knee and Hip Replacement.

    Science.gov (United States)

    Wiznia, Daniel H; Kim, Chang-Yeon; Wang, Yuexin; Swami, Nishwant; Pelker, Richard R

    2016-07-01

    The opinions of nonspecialists and patients will be important to determining reimbursements for specialists such as orthopedic surgeons. In addition, primary care physician (PCP) perceptions of reimbursements may affect utilization of orthopedic services. We distributed a web-based survey to PCPs, asking how much they believed orthopedic surgeons were reimbursed for total hip arthroplasty (THA) and total knee arthroplasty (TKA). We also proctored a paper-based survey to postoperative patients, asking how much orthopedic surgeons should be reimbursed. There was a significant difference between perceived and actual reimbursement values for THA and TKA. Hospital-affiliated PCPs estimated higher reimbursements for both THA ($1657 vs $838, P < .0001 for Medicaid and $2246 vs $1515, P = .018 for Medicare) and TKA ($1260 vs $903, P = .052 for Medicaid and $2022 vs $1514, P = .049 for Medicare). Similarly, larger practices estimated higher reimbursements for both THA ($1861 vs $838, P < .0001 for Medicaid and $2635 vs $1515, P = .004 for Medicare) and TKA ($1583 vs $903, P = .005 for Medicaid and $2380 vs $1514, P = .011 for Medicare). Compared to PCPs, patients estimated that orthopedic surgeons should be paid 4 times higher for both THA ($9787 vs $2235, P < .0001) and TKA ($9088 vs $2134, P < .0001). PCPs believe that reimbursements for orthopedic procedures are higher than actual values. The effect that these perceptions will have on efforts at cost reform and utilization of orthopedic services requires further study. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. 76 FR 73020 - Agency Information Collection (Request for Transportation Expense Reimbursement): Activity Under...

    Science.gov (United States)

    2011-11-28

    ... for Transportation Expense Reimbursement): Activity Under OMB Review AGENCY: Veterans Benefits... for Transportation Expense Reimbursement (38 CFR 21.8370). OMB Control Number: 2900-0580. Type of... transportation expenses. To be eligible, the child must provide supportive documentation of actual expenses...

  11. Using 'big data' to validate claims made in the pharmaceutical approval process.

    Science.gov (United States)

    Wasser, Thomas; Haynes, Kevin; Barron, John; Cziraky, Mark

    2015-01-01

    Big Data in the healthcare setting refers to the storage, assimilation, and analysis of large quantities of information regarding patient care. These data can be collected and stored in a wide variety of ways including electronic medical records collected at the patient bedside, or through medical records that are coded and passed to insurance companies for reimbursement. When these data are processed it is possible to validate claims as a part of the regulatory review process regarding the anticipated performance of medications and devices. In order to analyze properly claims by manufacturers and others, there is a need to express claims in terms that are testable in a timeframe that is useful and meaningful to formulary committees. Claims for the comparative benefits and costs, including budget impact, of products and devices need to be expressed in measurable terms, ideally in the context of submission or validation protocols. Claims should be either consistent with accessible Big Data or able to support observational studies where Big Data identifies target populations. Protocols should identify, in disaggregated terms, key variables that would lead to direct or proxy validation. Once these variables are identified, Big Data can be used to query massive quantities of data in the validation process. Research can be passive or active in nature. Passive, where the data are collected retrospectively; active where the researcher is prospectively looking for indicators of co-morbid conditions, side-effects or adverse events, testing these indicators to determine if claims are within desired ranges set forth by the manufacturer. Additionally, Big Data can be used to assess the effectiveness of therapy through health insurance records. This, for example, could indicate that disease or co-morbid conditions cease to be treated. Understanding the basic strengths and weaknesses of Big Data in the claim validation process provides a glimpse of the value that this research

  12. Effects of expiring reimbursability of pentaerythrityl tetranitrate (PETN, pentalong®) on anti-anginal therapy: an observational study.

    Science.gov (United States)

    Grimmsmann, Thomas; Chenot, Jean-François; Angelow, Aniela

    2015-08-01

    Pentaerythrityl tetranitrate (PETN) was the most commonly prescribed long-acting nitrate in Germany. We aimed to assess whether the discontinuation of PETN reimbursability in 2011 resulted in alternative prescriptions of anti-anginal medications or in a discontinuation of anti-anginal therapy. This is an observational study using health claims data from one German federal state analysing all patients discontinuing a PETN treatment. Patients starting a new alternative anti-anginal treatment (long-acting nitrates, molsidome, ivabradine and ranolazine) were compared with patients without a new anti-anginal treatment with respect to use of short-acting nitrates, beta blockers (BBs) and calcium channel blockers (CCBs). Out of 12,909 patients, 12,763 (99%) discontinued PETN until 12/2012. Of these, 52% started an alternative anti-anginal treatment, 43% did not receive any alternative treatment and 5% were excluded from analysis. Before termination of PETN reimbursability, 65% of patients received BBs, 29% CCBs and 10% short-acting nitrates. In patients started on alternative anti-anginal treatment, prescription rates for short-acting nitrates, BBs and CCBs remained constant after discontinuing PETN. In patients without any alternative anti-anginal treatment, prescription rates for BBs and CCBs did not change meaningfully (<3%), and prescription rates for short-acting nitrates decreased from 9% to 6%. Half of the patients discontinued PETN without alternative. This did not lead to increased prescription rates of standard IHD medications or total medication number indicating that there might still be a high percentage of ischaemic heart disease patients treated unnecessarily with long-acting nitrates. The undertreatment with prognostically relevant first-line medications indicates a need for better guideline implementation activities. Copyright © 2015 John Wiley & Sons, Ltd.

  13. 48 CFR 1428.311 - Solicitation provision and contract clause on liability insurance under cost-reimbursement...

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Solicitation provision and contract clause on liability insurance under cost-reimbursement contracts. 1428.311 Section 1428.311... under cost-reimbursement contracts. ...

  14. 48 CFR 528.311 - Solicitation provision and contract clause on liability insurance under cost-reimbursement...

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Solicitation provision and contract clause on liability insurance under cost-reimbursement contracts. 528.311 Section 528.311 Federal...-reimbursement contracts. ...

  15. 48 CFR 28.311 - Solicitation provision and contract clause on liability insurance under cost-reimbursement...

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Solicitation provision and contract clause on liability insurance under cost-reimbursement contracts. 28.311 Section 28.311 Federal...-reimbursement contracts. ...

  16. PsHint1, associated with the G-protein α subunit PsGPA1, is required for the chemotaxis and pathogenicity of Phytophthora sojae.

    Science.gov (United States)

    Zhang, Xin; Zhai, Chunhua; Hua, Chenlei; Qiu, Min; Hao, Yujuan; Nie, Pingping; Ye, Wenwu; Wang, Yuanchao

    2016-02-01

    Zoospore chemotaxis to soybean isoflavones is essential in the early stages of infection by the oomycete pathogen Phytophthora sojae. Previously, we have identified a G-protein α subunit encoded by PsGPA1 which regulates the chemotaxis and pathogenicity of P. sojae. In the present study, we used affinity purification to identify PsGPA1-interacting proteins, including PsHint1, a histidine triad (HIT) domain-containing protein orthologous to human HIT nucleotide-binding protein 1 (HINT1). PsHint1 interacted with both the guanosine triphosphate (GTP)- and guanosine diphosphate (GDP)-bound forms of PsGPA1. An analysis of the gene-silenced transformants revealed that PsHint1 was involved in the chemotropic response of zoospores to the isoflavone daidzein. During interaction with a susceptible soybean cultivar, PsHint1-silenced transformants displayed significantly reduced infectious hyphal extension and caused a strong cell death in plants. In addition, the transformants displayed defective cyst germination, forming abnormal germ tubes that were highly branched and exhibited apical swelling. These results suggest that PsHint1 not only regulates chemotaxis by interacting with PsGPA1, but also participates in a Gα-independent pathway involved in the pathogenicity of P. sojae. © 2015 BSPP AND JOHN WILEY & SONS LTD.

  17. The Status of Billing and Reimbursement in Pediatric Obesity Treatment Programs

    Science.gov (United States)

    Gray, Jane Simpson; Filigno, Stephanie Spear; Santos, Melissa; Ward, Wendy L.; Davis, Ann M.

    2014-01-01

    Pediatric psychologists provide behavioral health services to children and adolescents diagnosed with medical conditions. Billing and reimbursement have been problematic throughout the history of pediatric psychology, and pediatric obesity is no exception. The challenges and practices of pediatric psychologists working with obesity are not well understood. Health and behavior codes were developed as one potential solution to aid in the reimbursement of pediatric psychologists who treat the behavioral health needs of children with medical conditions. This commentary discusses the current state of billing and reimbursement in pediatric obesity treatment programs and presents themes that have emerged from discussions with colleagues. These themes include variability in billing practices from program to program, challenges with specific billing codes, variability in reimbursement from state to state and insurance plan to insurance plan, and a general lack of practitioner awareness of code issues or reimbursement rates. Implications and future directions are discussed in terms of research, training, and clinical service. PMID:23224661

  18. The status of billing and reimbursement in pediatric obesity treatment programs.

    Science.gov (United States)

    Gray, Jane Simpson; Spear Filigno, Stephanie; Santos, Melissa; Ward, Wendy L; Davis, Ann M

    2013-07-01

    Pediatric psychologists provide behavioral health services to children and adolescents diagnosed with medical conditions. Billing and reimbursement have been problematic throughout the history of pediatric psychology, and pediatric obesity is no exception. The challenges and practices of pediatric psychologists working with obesity are not well understood. Health and behavior codes were developed as one potential solution to aid in the reimbursement of pediatric psychologists who treat the behavioral health needs of children with medical conditions. This commentary discusses the current state of billing and reimbursement in pediatric obesity treatment programs and presents themes that have emerged from discussions with colleagues. These themes include variability in billing practices from program to program, challenges with specific billing codes, variability in reimbursement from state to state and insurance plan to insurance plan, and a general lack of practitioner awareness of code issues or reimbursement rates. Implications and future directions are discussed in terms of research, training, and clinical service.

  19. A comparison of patient-centered and case-mix reimbursement for nursing home care.

    Science.gov (United States)

    Willemain, T R

    1980-01-01

    The trend in payment for nursing home services has been toward making finer distinctions amont patients and the rates at which their care is reimbursed. The ultimate in differentiation is patient-centered reimbursement, whereas each patient's rate is individually determined. This paper introduces a model of overpayment and under-payment for comparing the potential performance of alternative reimbursement schemes. The model is used in comparing the patient-centered approach with case-mix reimbursement, which assigns a single rate to all patients in a nursing home on the basis of the facility's case mix. Roughly speaking, the case-mix approach is preferable whenever the differences between patient's needs are smaller than the errors in needs assessment. Since this condition appears to hold in practice today, case-mix reimbursement seems preferable for the short term.

  20. Medicare payment data for spine reimbursement; important but flawed data for evaluating utilization of resources.

    Science.gov (United States)

    Menger, Richard P; Wolf, Michael E; Kukreja, Sunil; Sin, Anthony; Nanda, Anil

    2015-01-01

    Medicare data showing physician-specific reimbursement for 2012 were recently made public in the mainstream media. Given the ongoing interest in containing healthcare costs, we analyze these data in the context of the delivery of spinal surgery. Demographics of 206 leading surgeons were extracted including state, geographic area, residency training program, fellowship training, and academic affiliation. Using current procedural terminology (CPT) codes, information was evaluated regarding the number of lumbar laminectomies, lumbar fusions, add-on laminectomy levels, and anterior cervical fusions reimbursed by Medicare in 2012. In 2012 Medicare reimbursed the average neurosurgeon slightly more than an orthopedic surgeon for all procedures ($142,075 vs. $110,920), but this was not found to be statistically significant (P = 0.218). Orthopedic surgeons had a statistical trend illustrating increased reimbursement for lumbar fusions specifically, $1187 versus $1073 (P = 0.07). Fellowship trained spinal surgeons also, on average, received more from Medicare ($125,407 vs. $76,551), but again this was not statistically significant (P = 0.112). A surgeon in private practice, on average, was reimbursed $137,495 while their academic counterparts were reimbursed $103,144 (P = 0.127). Surgeons performing cervical fusions in the Centers for Disease Control West Region did receive statistically significantly less reimbursement for that procedure then those surgeons in other parts of the country (P = 0.015). Surgeons in the West were reimbursed on average $849 for CPT code 22,551 while those in the Midwest received $1475 per procedure. Medicare reimbursement data are fundamentally flawed in determining healthcare expenditure as it shows a bias toward delivery of care in specific patient demographics. However, neurosurgeons, not just policy makers, must take ownership to analyze, investigate, and interpret these data as it will affect healthcare reimbursement and delivery moving

  1. What are estimated reimbursements for lower extremity prostheses capable of surgical and nonsurgical lengthening?

    Science.gov (United States)

    Henderson, Eric R; Pepper, Andrew M; Letson, G Douglas

    2012-04-01

    Growing prostheses accommodate skeletally immature patients with bone tumors undergoing limb-preserving surgery. Early devices required surgical procedures for lengthening; recent devices lengthen without surgery. Expenses for newer expandable devices that lengthen without surgery are more than for their predecessors but overall reimbursement amounts are not known. We sought to determine reimbursement amounts associated with lengthening of growing prostheses requiring surgical and nonsurgical lengthening. We retrospectively reviewed 17 patients with growing prostheses requiring surgical expansion and eight patients with prostheses capable of nonsurgical expansion. Insurance documents were reviewed to determine the reimbursement for implantation, lengthening, and complications. Growth data were obtained from the literature. Mean reimbursement amounts of surgical and nonsurgical lengthenings were $9950 and $272, respectively. Estimated reimbursements associated with implantation of a growing prosthesis varied depending on age, sex, and location. The largest difference was found for 4-year-old boys with distal femoral replacement where reimbursement for expansion to maturity for surgical and nonsurgical lengthening prostheses would be $379,000 and $208,000, respectively. For children requiring more than one surgical expansion, net reimbursements were lower when a noninvasive lengthening device was used. Annual per-prosthesis maintenance reimbursements to address complications for surgical and nonsurgical lengthening prostheses were $3386 and $1856, respectively. This study showed that reimbursements for lengthening of growing endoprostheses capable of nonsurgical expansion may be less expensive in younger patients, particularly male patients undergoing distal femur replacement, than endoprostheses requiring surgical lengthening. Longer outcomes studies are required to see if reimbursements for complications differ between devices. Level III, economic and decision

  2. Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion

    Directory of Open Access Journals (Sweden)

    Christine D. Jones MD, MS

    2015-08-01

    Full Text Available Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P < .001, uninsured encounters decreased (18.4% to 6.3%, P < 0.001, and private payer encounters also decreased (14.1% to 13.3%, P = .001. The median reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P < .001. In a sensitivity analysis, changes in length of stay, proportions in encounter type by payer, payer mix, and reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion.

  3. 30 CFR 229.109 - Reimbursement for costs incurred by a State under the delegation of authority.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Reimbursement for costs incurred by a State... Administration of Delegations § 229.109 Reimbursement for costs incurred by a State under the delegation of..., on a quarterly basis, a summary of costs incurred for which the State is seeking reimbursement. Only...

  4. 10 CFR 765.30 - Reimbursement of costs incurred in accordance with a plan for subsequent remedial action.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Reimbursement of costs incurred in accordance with a plan... Procedures § 765.30 Reimbursement of costs incurred in accordance with a plan for subsequent remedial action. (a) This section establishes procedures governing reimbursements of costs of remedial action incurred...

  5. 76 FR 79067 - Payment or Reimbursement for Emergency Treatment Furnished by Non-VA Providers in Non-VA...

    Science.gov (United States)

    2011-12-21

    ... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN49 Payment or Reimbursement for Emergency..., authorize the Secretary of Veterans Affairs to reimburse eligible veterans for costs related to non-VA.... Specifically, section 1725 authorizes reimbursement for emergency treatment for eligible veterans with...

  6. 42 CFR 411.22 - Reimbursement obligations of primary payers and entities that received payment from primary payers.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Reimbursement obligations of primary payers and... Provisions § 411.22 Reimbursement obligations of primary payers and entities that received payment from... reimburse CMS for any payment if it is demonstrated that the primary payer has or had a responsibility to...

  7. 43 CFR 404.36 - Will Reclamation reimburse me for the cost of an appraisal investigation or a feasibility study...

    Science.gov (United States)

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Will Reclamation reimburse me for the cost... Reclamation reimburse me for the cost of an appraisal investigation or a feasibility study that was not...) or (b). Reclamation will not reimburse you or provide program funding for any expenses related to an...

  8. 42 CFR 23.10 - Under what circumstances may a National Health Service Corps site's reimbursement obligation to...

    Science.gov (United States)

    2010-10-01

    ... Service Corps site's reimbursement obligation to the Federal Government be waived? 23.10 Section 23.10... National Health Service Corps site's reimbursement obligation to the Federal Government be waived? (a) The Secretary may waive in whole or in part the reimbursement requirements of section 334(a)(3) of the Act if he...

  9. 42 CFR 137.336 - What is the difference between fixed-price and cost-reimbursement agreements?

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false What is the difference between fixed-price and cost-reimbursement agreements? 137.336 Section 137.336 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND...-reimbursement agreements? (a) Cost-reimbursement agreements generally have one or more of the following...

  10. 76 FR 30598 - Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA...

    Science.gov (United States)

    2011-05-26

    ... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN86 Payment or Reimbursement for Emergency...) ``Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities... Reimbursement Act. Some of the revisions in this proposed rule are purely technical, matching the language of...

  11. 48 CFR 49.603-3 - Cost-reimbursement contracts-complete termination, if settlement includes cost.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement... Termination Forms and Formats 49.603-3 Cost-reimbursement contracts—complete termination, if settlement includes cost. [Insert the following in Block 14 of SF 30 for settlement of cost-reimbursement contracts...

  12. When Stepfathers Claim Stepchildren: A Conceptual Analysis

    Science.gov (United States)

    Marsiglio, William

    2004-01-01

    Abstract Guided by social constructionist and symbolic interactionist perspectives and a grounded theory method, my conceptual analysis explores stepfathers experiences with claiming stepchildren as their own. Using indepth interviews with a diverse sample of 36 stepfathers, my analysis focuses on paternal claiming as a core category and generates…

  13. 49 CFR 22.69 - Claim process.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Claim process. 22.69 Section 22.69 Transportation Office of the Secretary of Transportation SHORT-TERM LENDING PROGRAM (STLP) Loan Administration § 22.69 Claim process. After reasonable efforts have been exhausted to collect on a delinquent debt, the...

  14. The Indirect Empathic Approach to Claim Letters.

    Science.gov (United States)

    Bell, James D.

    1985-01-01

    In discussing letter-writing methods for business communication classes, the article explains that claim letter formats other than the direct approach are not only legitimate, but also effective, and suggests that the approach selected should depend upon the circumstances surrounding the claim. (CT)

  15. 16 CFR 460.22 - Tax claims.

    Science.gov (United States)

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Tax claims. 460.22 Section 460.22 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES LABELING AND ADVERTISING OF HOME INSULATION § 460.22 Tax claims. Do not say or imply that your product qualifies for a tax benefit unless it is true. ...

  16. 20 CFR 410.705 - Duplicate claims.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Duplicate claims. 410.705 Section 410.705 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Rules for the Review of Denied and Pending Claims Under the Black Lung...

  17. 78 FR 75944 - Commencement of Claims Program

    Science.gov (United States)

    2013-12-13

    ... Agreement Between the United States of America and the Great Socialist People's Libyan Arab Jamahiriya.... Simkin, Chief Counsel, Foreign Claims Settlement Commission of the United States, 600 E Street NW., Room... provided that (1) the claim was set forth by a claimant named in Abbott et al. v. Socialist People's Libyan...

  18. 76 FR 3156 - Alaska Native Claims Selection

    Science.gov (United States)

    2011-01-19

    ... located in: Seward Meridian, Alaska T. 26 N., R. 47 W., Sec. 3, those lands formerly within mining claim... claim recordation AA- 32365. Containing approximately 155 acres. T. 27 N., R. 47 W., Sec. 34, those... e-mail at ak[email protected] , or by telecommunication device (TTD) through the Federal...

  19. 32 CFR 842.31 - Claims payable.

    Science.gov (United States)

    2010-07-01

    ... which last for an extended period of time. The claimant must be free of negligence. (i) Claims for... hazards may be negligence. These types of claims would include pitted windshields, dents, chipped paint on..., or power outages which last for an extended period of time. The claimant must be free of negligence...

  20. Moral Minimalism in American Indian Land Claims

    Science.gov (United States)

    Hendrix, Burke A.

    2005-01-01

    This is an essay about Indian claims for the return of historically stolen lands, written from the perspective of a "Western" academic moral philosopher. I want to try to outline points of agreement and disagreement between Indian and Western moral conceptions and to seek common ground on which land claims can be more clearly evaluated…

  1. 32 CFR 536.77 - Applicable law for claims under the Military Claims Act.

    Science.gov (United States)

    2010-07-01

    ... contributory negligence be interpreted and applied according to the law of the place of the occurrence... 32 National Defense 3 2010-07-01 2010-07-01 true Applicable law for claims under the Military... Act § 536.77 Applicable law for claims under the Military Claims Act. (a) General principles—(1) Tort...

  2. Pricing and reimbursement of drugs and medical devices in Hungary.

    Science.gov (United States)

    Gulácsi, L; Dávid, T; Dózsa, Cs

    2002-01-01

    Similarly to other countries of Central and Eastern Europe, Hungary has witnessed massive diffusion of healthcare technology such as drugs and medical devices since 1990. While substantial new pharmaceuticals, medical devices, and procedures have been liberalized, there has been no proper evaluation or training in their use. Healthcare providers have come to find themselves as entrepreneurs in private practice, while patients are acquiring an increasing awareness as customers of healthcare,demanding services in return for their taxes and contributions. This has led to extremely irrational patterns of investment in technology, with most an obvious waste of resources, while leaving basic needs unmet. Both the National Health Insurance Fund and the Ministry of Finance believe that the current pharmaceutical and medical device bill is too high. However, introducing a more transparent and flexible pricing and reimbursement framework may enable a more efficient allocation of the limited resources to be achieved.

  3. Extracorporeal membrane oxygenation: current clinical practice, coding, and reimbursement.

    Science.gov (United States)

    Schuerer, Douglas J E; Kolovos, Nikoleta S; Boyd, Kayla V; Coopersmith, Craig M

    2008-07-01

    Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support for patients experiencing both pulmonary and cardiac failure by maintaining oxygenation and perfusion until native organ function is restored. ECMO is used routinely at many specialized hospitals for infants and less commonly for children with respiratory or cardiac failure from a variety of causes. Its usage is more controversial in adults, but select medical centers have reported favorable findings in patients with ARDS and other causes of severe pulmonary failure. ECMO is also rarely used as a rescue therapy in a small subset of adult patients with cardiac failure. This article will review the current uses and techniques of ECMO in the critical care setting as well as the evidence supporting its usage. In addition, current practice management related to coding and reimbursement for this intensive therapy will be discussed.

  4. Perception of health claims among Nordic consumers

    DEFF Research Database (Denmark)

    Grunert, Klaus G.; Lähteenmäki, Liisa; Boztug, Yasemin

    2009-01-01

    . Claims were constructed from an underlying universe combining different active ingredients (familiar, unfamiliar), type of claim (combination of information about ingredient, physiological function and health benefit), framing (positive, negative) and use of qualifier (with, without 'may'). Across pairs...... of active ingredient, physiological function and health benefit, whereas the other prefers 'short' claims consisting of the health benefit only. Results also showed that the familiar ingredient is preferred to the unfamiliar one, whereas effects of positive vs. negative framing depended on the type......Health claim perception was investigated by a web-based instrument with a sample of 4612 respondents in the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden). Respondents decided which of a pair of claims sounded better, was easier to understand, and was more convincing in their opinion...

  5. Pricing and Reimbursement of Biosimilars in Central and Eastern European Countries

    Science.gov (United States)

    Kawalec, Paweł; Stawowczyk, Ewa; Tesar, Tomas; Skoupa, Jana; Turcu-Stiolica, Adina; Dimitrova, Maria; Petrova, Guenka I.; Rugaja, Zinta; Männik, Agnes; Harsanyi, Andras; Draganic, Pero

    2017-01-01

    Objectives: The aim of this study was to review the requirements for the reimbursement of biosimilars and to compare the reimbursement status, market share, and reimbursement costs of biosimilars in selected Central and Eastern European (CEE) countries. Methods: A questionnaire-based survey was conducted between November 2016 and January 2017 among experts from the following CEE countries: Bulgaria, Czech Republic, Croatia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Romania. The requirements for the pricing and reimbursement of biosimilars were reviewed for each country. Data on the extent of reimbursement of biologic drugs (separately for original products and biosimilars) in the years 2014 and 2015 were also collected for each country, along with data on the total pharmaceutical and total public health care budgets. Results: Our survey revealed that no specific criteria were applied for the pricing and reimbursement of biosimilars in the selected CEE countries; the price of biosimilars was usually reduced compared with original drugs and specific price discounts were common. Substitution and interchangeability were generally allowed, although in most countries they were at the discretion of the physician after a clinical assessment. Original biologic drugs and the corresponding biosimilars were usually in the same homogeneous group, and internal reference pricing was usually employed. The reimbursement rate of biosimilars in the majority of the countries was the same and amounted to 100%. Generally, the higher shares of expenditures were shown for the reimbursement of original drugs than for biosimilars, except for filgrastim, somatropin, and epoetin (alfa and zeta). The shares of expenditures on the reimbursement of biosimilar products ranged from 8.0% in Estonia in 2014 to 32.4% in Lithuania in 2015, and generally increased in 2015. The share of expenditures on reimbursement of biosimilars in the total pharmaceutical budget differed between the

  6. Reimbursement for Supportive Cancer Medications Through Private Insurance in Saskatchewan

    Science.gov (United States)

    Forte, Lindy; Olson, Colleen; Atchison, Carolyn; Gesy, Kathy

    2009-01-01

    Background: As demand for cancer treatment grows, and newer, more expensive drugs become available, public payers in Canada are finding it increasingly difficult to fund the full range of available cancer drugs. Objective: To determine the extent of private drug coverage for supportive cancer treatments in Saskatchewan, preparatory to exploring the potential for cost-sharing. Methods: Patients who presented for chemotherapy and who provided informed consent for participation were surveyed regarding their access to private insurance. Insurers were contacted to verify patients' level of coverage for supportive cancer medications. Groups with specified types of insurance were compared statistically in terms of age, income bracket, time required to assess insurance status, and amount of deductible. Logistic regression was used to determine the effect of patients' age and income on the probability of having insurance. Results: Of 169 patients approached to participate, 156 provided consent and completed the survey. Their mean age was 58.5 years. About two-fifths of all patients (64 or 41%) were in the lowest income bracket (up to $30 000). Sixty-three (40%) of the patients had private insurance for drugs, and 36 (57%) of these plans included reimbursement for supportive cancer medications. A deductible was in effect in 31 (49%) of the plans, a copayment in 28 (44%), and a maximum payment in 8 (13%). Income over $50 000 was a significant predictor of access to drug insurance (p = 0.003), but age was not significantly related to insurance status. Conclusions: A substantial proportion of cancer patients in this study had access to private insurance for supportive cancer drugs for which reimbursement is currently provided by the Saskatchewan Cancer Agency. Cost-sharing and optimal utilization of the multipayer environment might offer a greater opportunity for public payers to cover future innovative and supportive therapies for cancer, but further study is required to

  7. 38 CFR 21.4153 - Reimbursement of expenses.

    Science.gov (United States)

    2010-07-01

    ..., such as social security, retirement, and health, accident, or life insurance, that are payable to all... of a contract must be supported by factual vouchers and all transportation allowances must be supported by detailed claims which can be checked against work assignments in the office of the State...

  8. Defining hip fracture with claims data: outpatient and provider claims matter.

    Science.gov (United States)

    Berry, S D; Zullo, A R; McConeghy, K; Lee, Y; Daiello, L; Kiel, D P

    2017-07-01

    Medicare claims are commonly used to identify hip fractures, but there is no universally accepted definition. We found that a definition using inpatient claims identified fewer fractures than a definition including outpatient and provider claims. Few additional fractures were identified by including inconsistent diagnostic and procedural codes at contiguous sites. Medicare claims data is commonly used in research studies to identify hip fractures, but there is no universally accepted definition of fracture. Our purpose was to describe potential misclassification when hip fractures are defined using Medicare Part A (inpatient) claims without considering Part B (outpatient and provider) claims and when inconsistent diagnostic and procedural codes occur at contiguous fracture sites (e.g., femoral shaft or pelvic). Participants included all long-stay nursing home residents enrolled in Medicare Parts A and B fee-for-service between 1/1/2008 and 12/31/2009 with follow-up through 12/31/2011. We compared the number of hip fractures identified using only Part A claims to (1) Part A plus Part B claims and (2) Part A and Part B claims plus discordant codes at contiguous fracture sites. Among 1,257,279 long-stay residents, 40,932 (3.2%) met the definition of hip fracture using Part A claims, and 41,687 residents (3.3%) met the definition using Part B claims. 4566 hip fractures identified using Part B claims would not have been captured using Part A claims. An additional 227 hip fractures were identified after considering contiguous fracture sites. When ascertaining hip fractures, a definition using outpatient and provider claims identified 11% more fractures than a definition with only inpatient claims. Future studies should publish their definition of fracture and specify if diagnostic codes from contiguous fracture sites were used.

  9. PRICING, REIMBURSEMENT, AND HEALTH TECHNOLOGY ASSESSMENT OF MEDICINAL PRODUCTS IN BULGARIA.

    Science.gov (United States)

    Benisheva-Dimitrova, Tatyana; Sidjimova, Dobriana; Cherneva, Daniela; Kralimarkov, Nikolay

    2017-01-01

    The aim of this study was to investigate the analysis, discussion, and challenges of the price and reimbursement process of medicinal products in Bulgaria in the period 2000-15 and health technology assessment (HTA) role in these processes. The dynamics of the reform, with respect to the healthcare and pharmaceutical sectors, are tracked by documentary review of regulations, articles, and reports in the European Union (EU), as well as analytical and historical analysis. Pricing and reimbursement processes have passed through a variety of committees between 2003 and 2012. Separate units for pricing and reimbursement of medicinal products were established in Bulgaria for the first time, in 2013, when an independent body, the National Council at Prices and Reimbursement of Medicinal Products, was set up to approve medicinal products with new international nonproprietary names (INN) for reimbursement in Bulgaria. Over the course of 2 years (2013-14), thirty-three new INNs were approved for reimbursement. In December 2015, a new HTA body was introduced, and assigned to the National Centre for Public Health and Analyses. Although Bulgaria has current legislation on pricing and reimbursement which is in accordance with the EU rules, there is no mechanism for reporting and monitoring these processes or the financial resources annually, so as to provide an overall objective assessment and analysis by year. Therefore, this financial assessment should become a national policy objective for the future.

  10. Florida's model of nursing home Medicaid reimbursement for disaster-related expenses.

    Science.gov (United States)

    Thomas, Kali S; Hyer, Kathryn; Brown, Lisa M; Polivka-West, LuMarie; Branch, Laurence G

    2010-04-01

    This study describes Florida's model of Medicaid nursing home (NH) reimbursement to compensate NHs for disaster-related expenses incurred as a result of 8 hurricanes within a 2-year period. This Florida model can serve as a demonstration for a national model for disaster-related reimbursement. Florida reimburses NHs for approved disaster-related costs through hurricane interim rate requests (IRRs). The state developed its unique Medicaid per diem rate temporary add-on by adapting its standard rate-setting reimbursement methodology. To understand the payment mechanisms and the costs that facilities incurred as a result of natural disasters, we examined the IRRs and cost reports for facilities requesting and receiving reimbursement. Cost reports and IRR applications indicated that Florida Medicaid spent close to $16 million to pay for hurricane-related costs to NHs. Without Florida's Hurricane IRR program, many facilities would have not been reimbursed for their hurricane-related costs. Florida's model is one that Medicare and other states should consider adopting to ensure that NHs receive adequate reimbursement for disaster-related expenses, including tornadoes, earthquakes, floods, blizzards, and other catastrophic events.

  11. The 22-Modifier in Reimbursement for Orthopedic Procedures: Hip Arthroplasty and Obesity Are Worth the Effort.

    Science.gov (United States)

    Smith, Eric L; Tybor, David J; Daniell, Hayley D; Naccarato, Laura A; Pevear, Mary E; Cassidy, Charles

    2018-02-21

    Orthopedic surgeons utilize the 22-modifier when billing for complex procedures under the American Medical Association's Current Procedural Terminology (CPT) for reasons such as excessive blood loss, anatomic abnormality, and morbid obesity, cases that would ideally be reimbursed at a higher rate to compensate for additional physician work and time. We investigated how the 22-modifier affects physician reimbursement in knee and hip arthroplasty. We queried hospital billing data from 2009 to 2016, identifying all cases performed at our urban tertiary care orthopedic center for knee arthroplasty (CPT codes 27438, 27447, 27487, and 27488) and hip arthroplasty (CPT codes 27130, 27132, 27134, 27236). We extracted patient insurance status and reimbursement data to compare the average reimbursement between cases with and without the 22-modifier. We analyzed data from 2605 procedures performed by 10 providers. There were 136 cases with 22-modifiers. For knee arthroplasty (n = 1323), the 22-modifier did not significantly increase reimbursement after adjusting for insurer, provider, and fiscal year (4.2% dollars higher on average, P = .159). For hip arthroplasty (n = 1282), cases with a 22-modifier had significantly higher reimbursement than those without the 22-modifier (6.2% dollars more, P = .049). For hip arthroplasty cases with a 22-modifier, those noting morbid obesity were reimbursed 29% higher than those cases with other etiology. The effect of the 22-modifier on reimbursement amount is differential between knee and hip arthroplasty. Hip arthroplasty procedures coded as 22-modifier are reimbursed more than those without the 22-modifier. Providers should consider these potential returns when considering submitting a 22-modifier. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. Registry and health insurance claims data in vascular research and quality improvement.

    Science.gov (United States)

    Behrendt, Christian-Alexander; Heidemann, Franziska; Rieß, Henrik Christian; Stoberock, Konstanze; Debus, Sebastian Eike

    2017-01-01

    The expansion of procedures in multidisciplinary vascular medicine has sparked a controversy regarding measures of quality improvement. In addition to primary registries, the use of health insurance claims data is becoming of increasing importance. However, due to the fact that health insurance claims data are not collected for scientific evaluation but rather for reimbursement purposes, meticulous validation is necessary before and during usage in research and quality improvement matters. This review highlights the advantages and disadvantages of such data sources. A recent comprehensive expert opinion panel examined the use of health insurance claims data and other administrative data sources in medicine. Results from several studies concerning the validity of administrative data varied significantly. Validity of these data sources depends on the clinical relevance of the diagnoses considered. The rate of implausible information was 0.04 %, while the validity of the considered diagnoses varied between 80 and 97 % across multiple validation studies. A matching study between health insurance claims data of the third-largest German health insurance provider, DAK-Gesundheit, and a prospective primary registry of the German Society for Vascular Surgery demonstrated a good level of validity regarding the mortality of endovascular and open surgical treatment of abdominal aortic aneurysm in German hospitals. In addition, a large-scale international comparison of administrative data for the same disorder presented important results in treatment reality, which differed from those from earlier randomized controlled trials. The importance of administrative data for research and quality improvement will continue to increase in the future. When discussing the internal and external validity of this data source, one has to distinguish not only between its intended usage (research vs. quality improvement), but also between the included diseases and/or treatment procedures

  13. 37 CFR 360.25 - Copies of claims.

    Science.gov (United States)

    2010-07-01

    ... Section 360.25 Patents, Trademarks, and Copyrights COPYRIGHT ROYALTY BOARD, LIBRARY OF CONGRESS SUBMISSION OF ROYALTY CLAIMS FILING OF CLAIMS TO ROYALTY FEES COLLECTED UNDER COMPULSORY LICENSE Digital Audio Recording Devices and Media Royalty Claims § 360.25 Copies of claims. A claimant shall, for each claim...

  14. 32 CFR 536.117 - Statutory authority for maritime claims.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Statutory authority for maritime claims. 536.117... ACCOUNTS CLAIMS AGAINST THE UNITED STATES Maritime Claims § 536.117 Statutory authority for maritime claims. The Army Maritime Claims Settlement Act (AMCSA) (10 U.S.C. 4801-04, 4806, as amended) authorizes the...

  15. 12 CFR 627.2750 - Priority of claims-banks.

    Science.gov (United States)

    2010-01-01

    ...) All claims for taxes. (f) All claims of creditors which are secured by specific assets or equities of... accordance with priorities of applicable Federal or State law. (g) All claims of holders of bonds issued by... claims of holders of consolidated and System-wide bonds and all claims of the other Farm Credit banks...

  16. Encouraging smokers to quit: the cost effectiveness of reimbursing the costs of smoking cessation treatment.

    Science.gov (United States)

    Kaper, Janneke; Wagena, Edwin J; van Schayck, Constant P; Severens, Johan L

    2006-01-01

    Smoking cessation should be encouraged in order to increase life expectancy and reduce smoking-related healthcare costs. Results of a randomised trial suggested that reimbursing the costs of smoking cessation treatment (SCT) may lead to an increased use of SCT and an increased number of quitters versus no reimbursement. To assess whether reimbursement for SCT is a cost-effective intervention (from the Dutch societal perspective), we calculated the incremental costs per quitter and extrapolated this outcome to incremental costs per QALY saved versus no reimbursement. In the reimbursement trial, 1266 Dutch smokers were randomly assigned to the intervention or control group using a randomised double consent design. Reimbursement for SCT was offered to the intervention group for a period of 6 months. No reimbursement was offered to the control group. Prolonged abstinence from smoking was determined 6 months after the end of the reimbursement period. The QALYs gained from quitting were calculated until 80 years of age using data from the US. Costs (year 2002 values) were determined from the societal perspective during the reimbursement period (May-November 2002). Benefits were discounted at 4% per annum. The uncertainty of the incremental cost-effectiveness ratios was estimated using non-parametric bootstrapping. Eighteen participants in the control group (2.8%) and 35 participants in the intervention group (5.5%) successfully quit smoking. The costs per participant were 291 euro and 322 euro, respectively. If society is willing to pay 1000 euro or 10,000 euro for an additional 12-month quitter, the probability that reimbursement for SCT would be cost effective was 50% or 95%, respectively. If society is willing to pay 18,000 euro for a QALY, the probability that reimbursement for SCT would be cost effective was 95%. However, the external validity of the extrapolation from quitters to QALYs is uncertain and several assumptions had to be made. Reimbursement for SCT may

  17. Value-Based Reimbursement: Impact of Curtailing Physician Autonomy in Medical Decision Making.

    Science.gov (United States)

    Gupta, Dipti; Karst, Ingolf; Mendelson, Ellen B

    2016-02-01

    In this article, we define value in the context of reimbursement and explore the effect of shifting reimbursement paradigms on the decision-making autonomy of a women's imaging radiologist. The current metrics used for value-based reimbursement such as report turnaround time are surrogate measures that do not measure value directly. The true measure of a physician's value in medicine is accomplishment of better health outcomes, which, in breast imaging, are best achieved with a physician-patient relationship. Complying with evidence-based medicine, which includes data-driven best clinical practices, a physician's clinical expertise, and the patient's values, will improve our science and preserve the art of medicine.

  18. The importance of subjective claims management.

    Science.gov (United States)

    Beger, C S

    1997-01-01

    This article discusses the causes and effects of "subjective disability" on today's workforce and employers. As employees feel out of control with both their careers and demands placed upon them, the number of claims characterized by self-reported symptoms are increasing. Subjective disabilities include chronic syndrome, fibromyalgia, psychiatric claims and chronic pain. The author discusses creative strategies in case studies that have helped employers contain the costs of disability claims, while empowering the employee to take control of their own situation and return to work sooner.

  19. Health Information National Trends Survey in American Sign Language (HINTS-ASL): Protocol for the Cultural Adaptation and Linguistic Validation of a National Survey.

    Science.gov (United States)

    Kushalnagar, Poorna; Harris, Raychelle; Paludneviciene, Raylene; Hoglind, TraciAnn

    2017-09-13

    The Health Information National Trends Survey (HINTS) collects nationally representative data about the American's public use of health-related information. This survey is available in English and Spanish, but not in American Sign Language (ASL). Thus, the exclusion of ASL users from these national health information survey studies has led to a significant gap in knowledge of Internet usage for health information access in this underserved and understudied population. The objectives of this study are (1) to culturally adapt and linguistically translate the HINTS items to ASL (HINTS-ASL); and (2) to gather information about deaf people's health information seeking behaviors across technology-mediated platforms. We modified the standard procedures developed at the US National Center for Health Statistics Cognitive Survey Laboratory to culturally adapt and translate HINTS items to ASL. Cognitive interviews were conducted to assess clarity and delivery of these HINTS-ASL items. Final ASL video items were uploaded to a protected online survey website. The HINTS-ASL online survey has been administered to over 1350 deaf adults (ages 18 to 90 and up) who use ASL. Data collection is ongoing and includes deaf adult signers across the United States. Some items from HINTS item bank required cultural adaptation for use with deaf people who use accessible services or technology. A separate item bank for deaf-related experiences was created, reflecting deaf-specific technology such as sharing health-related ASL videos through social network sites and using video remote interpreting services in health settings. After data collection is complete, we will conduct a series of analyses on deaf people's health information seeking behaviors across technology-mediated platforms. HINTS-ASL is an accessible health information national trends survey, which includes a culturally appropriate set of items that are relevant to the experiences of deaf people who use ASL. The final HINTS

  20. Association of tinnitus and electromagnetic hypersensitivity: hints for a shared pathophysiology?

    Directory of Open Access Journals (Sweden)

    Michael Landgrebe

    Full Text Available BACKGROUND: Tinnitus is a frequent condition with high morbidity and impairment in quality of life. The pathophysiology is still incompletely understood. Electromagnetic fields are discussed to be involved in the multi-factorial pathogenesis of tinnitus, but data proofing this relationship are very limited. Potential health hazards of electromagnetic fields (EMF have been under discussion for long. Especially, individuals claiming themselves to be electromagnetic hypersensitive suffer from a variety of unspecific symptoms, which they attribute to EMF-exposure. The aim of the study was to elucidate the relationship between EMF-exposure, electromagnetic hypersensitivity and tinnitus using a case-control design. METHODOLOGY: Tinnitus occurrence and tinnitus severity were assessed by questionnaires in 89 electromagnetic hypersensitive patients and 107 controls matched for age-, gender, living surroundings and workplace. Using a logistic regression approach, potential risk factors for the development of tinnitus were evaluated. FINDINGS: Tinnitus was significantly more frequent in the electromagnetic hypersensitive group (50.72% vs. 17.5% whereas tinnitus duration and severity did not differ between groups. Electromagnetic hypersensitivity and tinnitus were independent risk factors for sleep disturbances. However, measures of individual EMF-exposure like e.g. cell phone use did not show any association with tinnitus. CONCLUSIONS: Our data indicate that tinnitus is associated with subjective electromagnetic hypersensitivity. An individual vulnerability probably due to an over activated cortical distress network seems to be responsible for, both, electromagnetic hypersensitivity and tinnitus. Hence, therapeutic efforts should focus on treatment strategies (e.g. cognitive behavioral therapy aiming at normalizing this dysfunctional distress network.

  1. Basic Stand Alone Medicare Inpatient Claims PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Inpatient Public Use Files (PUF) named CMS 2008 BSA Inpatient Claims PUF with information from 2008 Medicare...

  2. 5 CFR 180.107 - Claims procedure.

    Science.gov (United States)

    2010-01-01

    ... General Counsel, Office of Personnel Management, 1900 E Street NW., Washington, DC 20415. Claims shall be... the performance of official business at the request of, or with the knowledge and consent of, superior...

  3. 49 CFR 1018.7 - Conversion claims.

    Science.gov (United States)

    2010-10-01

    ... Conversion claims. These procedures are directed primarily to the recovery of money on behalf of the Government. The Board may demand: (a) The return of specific property; or (b) Either the return of property or the payment of its value. ...

  4. Must Metaethical Realism Make a Semantic Claim?

    Science.gov (United States)

    Kahane, Guy

    2013-02-01

    Mackie drew attention to the distinct semantic and metaphysical claims made by meta ethical realists, arguing that although our evaluative discourse is cognitive and objective, there are no objective evaluative facts. This distinction, however, also opens up a reverse possibility: that our evaluative discourse is antirealist, yet objective values do exist. I suggest that this seemingly far-fetched possibility merits serious attention; realism seems com mitted to its intelligibility, and, despite appearances, it isn't incoherent, ineffable, inherently implausible or impossible to defend. I argue that reflection on this possibility should lead us to revise our understanding of the debate between realists and antirealists. It is not only that the realist's semantic claim is insufficient for realism to be true, as Mackie argued; it's not even necessary. Robust metaethical realism is best understood as making a purely metaphysical claim. It is thus not enough for antirealists to show that our discourse is antirealist. They must directly attack the realist's metaphysical claim.

  5. [Impact Reimbursement Act on the pharmaceutical market in Poland].

    Science.gov (United States)

    Giermaziak, Wojciech

    2014-04-01

    According to 12 may 2011 Reimbursement Act, the new regulations were introduced related to changes in so far in force rules on refunds of official prices and margins for drugs, foodstuffs of special purpose and medical products. After year of functioning of this regulation, in evaluation of the government, law gave measurable financial effects for public payer, sometimes through drastic actions, connected the of reduction of existing profits of manufacturers sector and importers drugs, as well wholesale and retail, both in treatment open and closed. Parallel to research and analysis of effects introduction in life act refund, conducted by government, to target current regulation possible negative phenomena can to be after-effects to regulation, systematically there are conducted analogous study to reputable companies specialized in evaluation and updating market Polish pharmaceutical, such as IMS Health Polska, Pharma Expert, Kamsoft, WHO and European a law firm. In their opinion to reimbursement act is the most serious regulation control system to introduced into Polish order legal, and first time for many years on such a large scale. Thoroughly changed policy of drugs State have important influence for all participants Polish pharmaceutical market, both those directly related to the drug trade, as the functioning doctors and health condition and financial Polish patient. Change in the way prices of drugs is determined as flexible to price formation mechanism, combining drugs similar profile pharmacological in so group limits and dependence of the level of refunds from application drug accordingly characteristics medicinal product, adaptation solutions to new law refund to the existing law about health services, gave measurable financial effect for the public payer. Rationalization expenses to NFZ, as main premise introduction refund act, created to broader than so far possibility to use new molecules of drugs, and the latest medical technology, even if in the

  6. 29 CFR 15.26 - Claims procedures.

    Science.gov (United States)

    2010-07-01

    ... forth in § 15.21(d) will be accepted and considered a claim under the Act if it constitutes a demand for compensation from the Department. A demand is not required to be for a specific sum of money. (c) Notification... 29 Labor 1 2010-07-01 2010-07-01 true Claims procedures. 15.26 Section 15.26 Labor Office of the...

  7. 46 CFR 327.4 - Claim requirements.

    Science.gov (United States)

    2010-10-01

    ... statements made in the claim are subject to the provision of 18 U.S.C. 287 and 1001 and all other penalty... Admiralty Act, as amended by Public Law 877, 81st Congress (64 Stat. 1112; 46 app. U.S.C. 745), shall not be... physicians and hospitals related to a seaman's claim for injury, illness, or death shall be attached. If the...

  8. 40 CFR 1620.2 - Administrative claim; when presented.

    Science.gov (United States)

    2010-07-01

    ... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.2 Administrative claim; when presented. (a... negligence or wrongful act or omission of the CSB or its employees must be mailed or delivered to the Office...

  9. 49 CFR 350.311 - What specific items are eligible for reimbursement under the MCSAP?

    Science.gov (United States)

    2010-10-01

    ... for reimbursement: (a) Personnel expenses, including recruitment and screening, training, salaries and..., special inspection equipment, vehicle maintenance, fuel, and oil. (c) Indirect expenses for facilities... data acquisition, storage, and analysis that are specifically identifiable as program-related to...

  10. Logistics Civil Augmentation Program Task Orders 130 and 151: Program Management, Reimbursement, and Transition

    National Research Council Canada - National Science Library

    Keays, Walt; Furbish, Glenn D

    2007-01-01

    .... Task orders under this contract can be either fixed price or cost reimbursable. In Iraq, the total cost of all 149 task orders issued under the LOGCAP contract as of March 4, 2007, is approximately $22.5 billion...

  11. 11 CFR 9004.6 - Expenditures for transportation and services made available to media personnel; reimbursements.

    Science.gov (United States)

    2010-01-01

    ... CANDIDATES TO PAYMENTS; USE OF PAYMENTS § 9004.6 Expenditures for transportation and services made available... by independent contractors. (d) Disposal of excess reimbursements. If the committee receives...

  12. 40 CFR 310.15 - How do I apply for reimbursement?

    Science.gov (United States)

    2010-07-01

    ... RESPONSE TO HAZARDOUS SUBSTANCE RELEASES Provisions How to Get Reimbursed § 310.15 How do I apply for... Management, Office of Solid Waste and Emergency Response, Environmental Protection Agency, 1200 Pennsylvania...

  13. 7 CFR 1710.109 - Reimbursement of general funds and interim financing.

    Science.gov (United States)

    2010-01-01

    ... LOANS AND GUARANTEES Loan Purposes and Basic Policies § 1710.109 Reimbursement of general funds and... replace interim financing used to finance equipment and facilities that were included in an RUS-approved...

  14. Financial Management: Accounting for Reimbursable Work Orders at Defense Finance and Accounting Service Charleston

    National Research Council Canada - National Science Library

    2003-01-01

    .... DFAS Charleston account managers who are responsible for managing reimbursable work orders for Navy, and DFAS Cleveland accountants who rely on the data could also benefit from the information in the report...

  15. Insurer views on reimbursement of preventive services in the dental setting: results from a qualitative study.

    Science.gov (United States)

    Feinstein-Winitzer, Rebecca T; Pollack, Harold A; Parish, Carrigan L; Pereyra, Margaret R; Abel, Stephen N; Metsch, Lisa R

    2014-05-01

    We explored insurers' perceptions regarding barriers to reimbursement for oral rapid HIV testing and other preventive screenings during dental care. We conducted semistructured interviews between April and October 2010 with a targeted sample of 13 dental insurance company executives and consultants, whose firms' cumulative market share exceeded 50% of US employer-based dental insurance markets. Participants represented viewpoints from a significant share of the dental insurance industry. Some preventive screenings, such as for oral cancer, received widespread insurer support and reimbursement. Others, such as population-based HIV screening, appeared to face many barriers to insurance reimbursement. The principal barriers were minimal employer demand, limited evidence of effectiveness and return on investment specific to dental settings, implementation and organizational constraints, lack of provider training, and perceived lack of patient acceptance. The dental setting is a promising venue for preventive screenings, and addressing barriers to insurance reimbursement for such services is a key challenge for public health policy.

  16. The impact of the fee-for-service reimbursement system on the ...

    African Journals Online (AJOL)

    The impact of the fee-for-service reimbursement system on the utilisation of health services: Part III. A comparison of caesarean section rates in white nulliparous women in the private and public sectors.

  17. CERN Health Insurance Scheme (CHIS) – Reimbursement of contraception and sterilisation

    CERN Multimedia

    HR Department

    2016-01-01

    In line with the practice in many Member States and in other international organisations based in Geneva, the CHIS will, as of 1 March 2016, reimburse upon presentation of a medical prescription:   contraceptive medicine (e.g. oral medicine or implant); intrauterine contraceptive devices; and medical sterilisation operations (vasectomy, tubal ligations). These methods of contraception will be considered as pharmaceutical costs or medical treatments, to which the reimbursement rate according to the general rule and the reimbursement bonus apply. Treatment undertaken, or paid for, before March 2016 will not be reimbursed. For more information, do not hesitate to contact the third-party administrator of the CHIS: UNIQA (Tel.: 72730 / uniqa-assurance@cern.ch).

  18. ALGUNAS PAUTAS PARA LA ESCRITURA DE ARTÍCULOS CIENTÍFICOS SOME HINTS FOR WRITING SCIENTIFIC PAPERS

    Directory of Open Access Journals (Sweden)

    Carlos M Zapata

    2008-06-01

    Full Text Available El objetivo de este artículo es presentar, a aquellos investigadores neófitos, una serie de pautas que faciliten los procesos de escritura y publicación de manuscritos en revistas científicas de corriente principal. En la comunidad científica, una investigación sólo se completa cuando los resultados se socializan a través de artículos en revistas arbitradas que garanticen la originalidad, importancia y validez científica de los hallazgos reportados. Consecuentemente, es necesario que los investigadores desarrollen destrezas y habilidades en la escritura científica. Sin embargo, el proceso de preparación de un manuscrito, desde su fase inicial hasta su publicación final, suele ser largo y difícil, debido a algunos factores clave que tienen influencia sobre su calidad. Este artículo, suministra lineamientos generales sobre la preparación de manuscritos y entrega, también, pautas alrededor de las buenas prácticas de escritura de artículos con miras a facilitar la revisión por parte de los árbitros. En este sentido, este trabajo constituye aporte para quienes se inician en la difusión de la investigación científica.The objective of this paper is to present, to those neophyte researchers, a set of hints that facilitate manuscript writing and publishing processes needed for high class scientific journals. In the scientific community, a research would only be completed when the results are shared through papers in peer-reviewed journals that guarantees the originality, importance and scientific validation of reported contributions. Consequently, researchers have the necessity to develop skills and abilities in scientific writing. However, the manuscript preparation process from the initial phase to the final publication is usually slow and difficult, due to some key factors having influence over its quality. In this paper, we present general guidelines about manuscript preparation and we give some hints about good scientific

  19. Looking at learning communities with the appropriate glasses: hints and ideas from network sciences

    Directory of Open Access Journals (Sweden)

    Fabio Nascimbeni

    2013-02-01

    Full Text Available 0 0 1 229 1263 USAL 10 2 1490 14.0 Normal 0 21 false false false ES JA X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-ansi-language:ES; mso-fareast-language:EN-US;} The level of network thinking within education – intended as the capacity to look at learning systems and communities by focussing on the relations among the involved actors (primarily teachers and learners and not only on the actors characteristics – is growing, with different speeds depending on the educational sector, but not at the pace needed to keep up with the increasingly network nature of our societies. We claim that educational research and practices should increase their capacity to look at learning communities through appropriate “networking-sensitive” glasses, and get equipped with tools and methods – such as Social network Analysis - to properly understand and support these networks. The application of Social Network Analysis to education, especially in the case of distance learning, can allow understanding the patterns of interactions between teachers and learners, and can facilitate the consolidation of new approaches to understand collaboration mechanisms. The paper presents and discusses - from a learning viewpoint - a brief overview of the main theoretical and practical contributions coming from Social Network Analysis – such as the “random graphs”, the “small-worlds” or the “weak-ties” theories – together with some general

  20. Consumer understanding of sugars claims on food and drink products

    OpenAIRE

    Patterson, N J; Sadler, M J; Cooper, J M

    2012-01-01

    Consumer understanding of nutrition and health claims is a key aspect of current regulations in the European Union (EU). In view of this, qualitative and quantitative research techniques were used to investigate consumer awareness and understanding of product claims in the UK, focusing particularly on nutrition claims relating to sugars. Both research methods identified a good awareness of product claims. No added sugars claims were generally preferred to reduced sugars claims, and there was ...

  1. Toward a new payment system for inpatient rehabilitation. Part II: Reimbursing providers.

    Science.gov (United States)

    Saitto, Carlo; Marino, Claudia; Fusco, Danilo; Arcà, Massimo; Perucci, Carlo A

    2005-09-01

    The major fault with existing reimbursement systems lies in their failure to discriminate for the effectiveness of stay, both when paying per day and when paying per episode of treatment. We sought to define an average length of effective stay and recovery trends by impairment category, to design a prospective payment system that takes into account costs and expected recovery trends, and to compare the calculated reimbursement with the predicted costs estimated in a previous study (Saitto C, Marino C, Fusco D, et al. A new prospective payment system for inpatient rehabilitation. Part I: predicting resource consumption. Med Care. 2005;43:844-855). We considered all rehabilitation admissions from 5 Italian inpatient facilities during a 12-month period for which total cost of care had already been estimated and daily cost predicted through regression model. We ascertained recovery trends by impairment category through repeated MDS-PAC schedules and factorial analysis of functional status. We defined effective stay and daily resource consumption by impairment category and used these parameters to calculate reimbursement for the admission. We compared our reimbursement with predicted cost through regression analysis and evaluated the goodness of fit through residual analysis. We calculated reimbursement for 2079 admissions. The r(2) values for the reimbursement to cost correlation ranged from 0.54 in the whole population to 0.56 for "multiple trauma" to 0.85 for "other medical disorders." The best fit was found in the central quintiles of the cost and severity distributions. For each impairment category, we determined the number of days of effective hospital stay and the trends of functional gain. We demonstrated, at least within the Italian health care system, the feasibility of a reimbursement system that matches costs with functional recovery. By linking reimbursement to effective stay adjusted for trends of functional gain, we suggest it is possible to avoid both

  2. Restructuring in response to case mix reimbursement in nursing homes: a contingency approach.

    Science.gov (United States)

    Zinn, Jacqueline; Feng, Zhanlian; Mor, Vincent; Intrator, Orna; Grabowski, David

    2008-01-01

    Resident-based case mix reimbursement has become the dominant mechanism for publicly funded nursing home care. In 1998 skilled nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients. In addition, as of 2004, 35 state Medicaid programs had implemented some form of case mix reimbursement. The purpose of the study is to determine if the implementation of Medicare and Medicaid case mix reimbursement increased the administrative burden on nursing homes, as evidenced by increased levels of nurses in administrative functions. The primary data for this study come from the Centers for Medicare and Medicaid Services Online Survey Certification and Reporting database from 1997 through 2004, a national nursing home database containing aggregated facility-level information, including staffing, organizational characteristics and resident conditions, on all Medicare/Medicaid certified nursing facilities in the country. We conducted multivariate regression analyses using a facility fixed-effects model to examine the effects of the implementation of Medicaid case mix reimbursement and Medicare Prospective Payment System on changes in the level of total administrative nurse staffing in nursing homes. Both Medicaid case mix reimbursement and Medicare Prospective Payment System increased the level of administrative nurse staffing, on average by 5.5% and 4.0% respectively. However, lack of evidence for a substitution effect suggests that any decline in direct care staffing after the introduction of case mix reimbursement is not attributable to a shift from clinical nursing resources to administrative functions. Our findings indicate that the administrative burden posed by case mix reimbursement has resource implications for all freestanding facilities. At the margin, the increased administrative burden imposed by case mix may

  3. The Effect of Tuition Reimbursement on Turnover: A Case Study Analysis

    OpenAIRE

    Colleen N. Flaherty

    2007-01-01

    Tuition reimbursement programs provide financial assistance for direct costs of education and are a type of general skills training program commonly offered by employers in the United States. Standard human capital theory argues that investment in firm-specific skills reduces turnover, while investment in general skills training could result in increased turnover. However, firms cite increased retention as a motivation for offering tuition reimbursement programs. This rationale for offering t...

  4. Health care information systems and formula-based reimbursement: an empirical study.

    Science.gov (United States)

    Palley, M A; Conger, S

    1995-01-01

    Current initiatives in health care administration use formula-based approaches to reimbursement. Examples of such approaches include capitation and diagnosis related groups (DRGs). These approaches seek to contain medical costs and to facilitate managerial control over scarce health care resources. This article considers various characteristics of formula-based reimbursement, their operationalization on hospital information systems, and how these relate to hospital compliance costs.

  5. Many southwest hosptials will receive decreased CMS reimbursement

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2013-11-01

    Full Text Available No abstract available. Article truncated at 150 words. More hospitals are receiving penalties than bonuses in the second year of the Centers for Medicare and Medicaid Services’ (CMS quality incentive program, and the average penalty is steeper than last year according to a report from Jordan Rau in Kaiser Health News (1. Southwest hospitals reflect that trend with New Mexico and Arizona exceeding the US average both in percentage of hospitals receiving penalties and the average size of the penalty (Table 1. Colorado approximated the national averages (Table 1. Most hospitals are gaining or losing <0.2% but in some instances the penalties are substantial. Gallup Indian Medical Center in New Mexico, a federal government hospital on the border of the Navajo Reservation, will be paid 1.14 percent less for each patient and New Mexico’s average of a -0.31% decline in reimbursement are the largest changes nationally. “This program is driving what we want in health care,” said Dr. …

  6. Nursing home reimbursement and the allocation of rehabilitation therapy resources.

    Science.gov (United States)

    Murtaugh, C M; Cooney, L M; DerSimonian, R R; Smits, H L; Fetter, R B

    1988-10-01

    Most public funding methods for long-term care do not adequately match payment rates with patient need for services. Case-mix payment systems are designed to encourage a more efficient and equitable allocation of limited health care resources. Even nursing home case-mix payment systems, however, do not currently provide the proper incentives to match rehabilitation therapy resources to a patient's needs. We were able to determine by a review of over 8,500 patients in 65 nursing homes that certain diagnoses, partial dependence in activities of daily living (ADLs), clear mental status, and improving medical status are associated with the provision of rehabilitation services to nursing home residents. These patient characteristics are clinically reasonable predictors of the need for therapy and should be considered for use in nursing home case-mix reimbursement systems. Primary payment source also was associated with the provision of rehabilitation services even after taking into account significant patient characteristics. It is unclear how much of the variation in service use across payers is due to differences in patient need as opposed to differences in the financial incentives associated with current payment methods.

  7. 20 CFR 429.103 - Who may file my claim?

    Science.gov (United States)

    2010-04-01

    ... authorized agent, or your legal representative may file the claim. (c) Claims based on death. The executor or... behalf as agent, executor, administrator, parent, guardian or other representative. ...

  8. From Value Assessment to Value Cocreation: Informing Clinical Decision-Making with Medical Claims Data.

    Science.gov (United States)

    Thompson, Steven; Varvel, Stephen; Sasinowski, Maciek; Burke, James P

    2016-09-01

    Big data and advances in analytical processes represent an opportunity for the healthcare industry to make better evidence-based decisions on the value generated by various tests, procedures, and interventions. Value-based reimbursement is the process of identifying and compensating healthcare providers based on whether their services improve quality of care without increasing cost of care or maintain quality of care while decreasing costs. In this article, we motivate and illustrate the potential opportunities for payers and providers to collaborate and evaluate the clinical and economic efficacy of different healthcare services. We conduct a case study of a firm that offers advanced biomarker and disease state management services for cardiovascular and cardiometabolic conditions. A value-based analysis that comprised a retrospective case/control cohort design was conducted, and claims data for over 7000 subjects who received these services were compared to a matched control cohort. Study subjects were commercial and Medicare Advantage enrollees with evidence of CHD, diabetes, or a related condition. Analysis of medical claims data showed a lower proportion of patients who received biomarker testing and disease state management services experienced a MI (p companies have in terms of identifying value-creating healthcare interventions. However, payers and providers also need to pursue system integration efforts to further automate the identification and dissemination of clinically and economically efficacious treatment plans to ensure at-risk patients receive the treatments and interventions that will benefit them the most.

  9. Comparing pharmaceutical pricing and reimbursement policies in Croatia to the European Union Member States

    Science.gov (United States)

    Vogler, Sabine; Habl, Claudia; Bogut, Martina; Vončina, Luka

    2011-01-01

    Aim To perform a comparative analysis of the pharmaceutical pricing and reimbursement systems in Croatia and the 27 European Union (EU) Member States. Methods Knowledge about the pharmaceutical systems in Croatia and the 27 EU Member States was acquired by literature review and primary research with stakeholders. Results Pharmaceutical prices are controlled at all levels in Croatia, which is also the case in 21 EU Member States. Like many EU countries, Croatia also applies external price referencing, ie, compares prices with other countries. While the wholesale remuneration by a statutorily regulated linear mark-up is applied in Croatia and in several EU countries, the pharmacy compensation for dispensing reimbursable medicines in the form of a flat rate service fee in Croatia is rare among EU countries, which usually apply a linear or regressive pharmacy mark-up scheme. Like in most EU countries, the Croatian Social Insurance reimburses specific medicines at 100%, whereas patients are charged co-payments for other reimbursable medicines. Criteria for reimbursement include the medicine’s importance from the public health perspective, its therapeutic value, and relative effectiveness. In Croatia and in many EU Member States, reimbursement is based on a reference price system. Conclusion The Croatian pharmaceutical system is similar to those in the EU Member States. Key policies, like external price referencing and reference price systems, which have increasingly been introduced in EU countries are also applied in Croatia and serve the same purpose: to ensure access to medicines while containing public pharmaceutical expenditure. PMID:21495202

  10. Medicaid payment rates, case-mix reimbursement, and nursing home staffing--1996-2004.

    Science.gov (United States)

    Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Zinn, Jacqueline; Mor, Vincent

    2008-01-01

    We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes. We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according to expert recommended thresholds, and examined in a multinomial logistic regression model. Facility fixed-effects models were estimated separately for Registered Nurse (RN), Licensed Practical Nurse (LPN), and Certified Nurse Aide (CNA) staffing levels measured as average hours per resident day. Higher Medicaid payment rates were associated with increases in total staffing levels to meet a higher recommended threshold. However, these gains in overall staffing were accompanied by a reduction of RN staffing and an increase in both LPN and CNA staffing levels. Under case-mix reimbursement, the likelihood of nursing homes achieving higher recommended staffing thresholds decreased, as did levels of professional staffing. Independent of the effects of state, market, and facility characteristics, there was a significant downward trend in RN staffing and an upward trend in both LPN and CNA staffing. Although overall staffing may increase in response to more generous Medicaid reimbursement, it may not translate into improvements in the skill mix of staff. Adjusting for reimbursement levels and resident acuity, total staffing has not increased after the implementation of case-mix reimbursement.

  11. Regularities of Formation of the Labour Reimbursement Institute in the Market Economy

    Directory of Open Access Journals (Sweden)

    Povoroznyuk Inna M.

    2013-11-01

    Full Text Available The article considers theoretical issues of formation of the labour reimbursement institute in the market economy. It proves that functioning of the labour reimbursement institute identifies proportions of distribution of the total amount of expenditures on labour reimbursement between different professional and qualification groups of workers. Also, functioning of the labour reimbursement institute significantly influences proportions of distribution of income between owners of the means of production and hired labour, although, to a big extent, this institute is adapted, on the one hand, to the existing in the society forms of resolution of contradictions, inherent in means of production ownership relations, and, on the other hand, to the situation in a relevant labour market segment. However, the labour reimbursement institute itself significantly influences realisation of interests of employees and employers. The article states that wages in the modern economy should be understood as an incomplete labour reimbursement – the entrepreneur spends on an employee not only the sum of wages, but also uses other forms of resource provision of the processes of acquisition of certain benefits by the enterprise employees.

  12. Factors associated with non-reimbursable activity on an inpatient pediatric consultation-liaison service.

    Science.gov (United States)

    Bierenbaum, Melanie L; Katsikas, Steven; Furr, Allen; Carter, Bryan D

    2013-12-01

    The aim of this study was to identify factors contributing to clinician time spent in non-reimbursable activity on an inpatient pediatric consultation-liaison (C-L) service. A retrospective study was conducted using inpatient C-L service data on 1,246 consecutive referrals. For this patient population, the strongest predictor of level of non-reimbursable clinical activity was illness chronicity and the number of contacts with C-L service clinicians during their hospital stay. Patients with acute life-threatening illnesses required the highest mean amount of non-reimbursable service activity. On average, 28 % of total clinician time in completing a hospital consultation was spent in non-reimbursable activity. Effective C-L services require a proportion of time spent in non-reimbursable clinical activity, such as liaison and coordinating care with other providers. Identifying referral and systemic factors contributing to non-reimbursable activity can provide insight into budgeting/negotiating for institutional support for essential clinical and non-clinical functions in providing competent quality patient care.

  13. Medical Comorbidities Impact the Episode-of-Care Reimbursements of Total Hip Arthroplasty.

    Science.gov (United States)

    Rosas, Samuel; Sabeh, Karim G; Buller, Leonard T; Law, Tsun Yee; Roche, Martin W; Hernandez, Victor H

    2017-07-01

    Total hip arthroplasty (THA) costs are a source of great interest in the currently evolving health care market. The initiation of a bundled payment system has led to further research into costs drivers of this commonly performed procedure. One aspect that has not been well studied is the effect of comorbidities on the reimbursements of THA. The purpose of this study was to determine if common medical comorbidities affect these reimbursements. A retrospective, level of evidence III study was performed using the PearlDiver supercomputer to identify patients who underwent primary THA between 2007 and 2015. Patients were stratified by medical comorbidities and compared using the analysis of variance for reimbursements of the day of surgery, and over the 90-day postoperative period. A cohort of 250,343 patients was identified. Greatest reimbursements on the day of surgery were found among patients with a history of cirrhosis, morbid obesity, obesity, chronic kidney disease (CKD) and hepatitis C. Patients with cirrhosis, hepatitis C, chronic obstructive pulmonary disease, atrial fibrillation, and CKD incurred in the greatest reimbursements over the 90-day period after surgery. Medical comorbidities significantly impact reimbursements, and inferentially costs, after THA. The most costly comorbidities at 90 days include cirrhosis, hepatitis C, chronic obstructive pulmonary disease, atrial fibrillation, and CKD. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. School-located influenza vaccination with third-party billing: outcomes, cost, and reimbursement.

    Science.gov (United States)

    Kempe, Allison; Daley, Matthew F; Pyrzanowski, Jennifer; Vogt, Tara; Fang, Hai; Rinehart, Deborah J; Morgan, Nicole; Riis, Mette; Rodgers, Sarah; McCormick, Emily; Hammer, Anne; Campagna, Elizabeth J; Kile, Deidre; Dickinson, Miriam; Hambidge, Simon J; Shlay, Judith C

    2014-01-01

    To assess rates of immunization; costs of conducting clinics; and reimbursements for a school-located influenza vaccination (SLIV) program that billed third-party payers. SLIV clinics were conducted in 19 elementary schools in the Denver Public School district (September 2010 to February 2011). School personnel obtained parental consent, and a community vaccinator conducted clinics and performed billing. Vaccines For Children vaccine was available for eligible students. Parents were not billed for any fees. Data were collected regarding implementation costs and vaccine cost was calculated using published private sector prices. Reimbursement amounts were compared to costs. Overall, 30% of students (2784 of 9295) received ≥1 influenza vaccine; 39% (1079 of 2784) needed 2 doses and 80% received both. Excluding vaccine costs, implementation costs were $24.69 per vaccination. The percentage of vaccine costs reimbursed was 62% overall (82% from State Child Health Insurance Program (SCHIP), 50% from private insurance). The percentage of implementation costs reimbursed was 19% overall (23% from private, 27% from Medicaid, 29% from SCHIP and 0% among uninsured). Overall, 25% of total costs (implementation plus vaccine) were reimbursed. A SLIV program resulted in vaccination of nearly one third of elementary students. Reimbursement rates were limited by 1) school restrictions on charging parents fees, 2) low payments for vaccine administration from public payers and 3) high rates of denials from private insurers. Some of these problems might be reduced by provisions in the Affordable Care Act. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  15. Comparing pharmaceutical pricing and reimbursement policies in Croatia to the European Union Member States.

    Science.gov (United States)

    Vogler, Sabine; Habl, Claudia; Bogut, Martina; Voncina, Luka

    2011-04-15

    To perform a comparative analysis of the pharmaceutical pricing and reimbursement systems in Croatia and the 27 European Union (EU) Member States. Knowledge about the pharmaceutical systems in Croatia and the 27 EU Member States was acquired by literature review and primary research with stakeholders. Pharmaceutical prices are controlled at all levels in Croatia, which is also the case in 21 EU Member States. Like many EU countries, Croatia also applies external price referencing, i.e., compares prices with other countries. While the wholesale remuneration by a statutorily regulated linear mark-up is applied in Croatia and in several EU countries, the pharmacy compensation for dispensing reimbursable medicines in the form of a flat rate service fee in Croatia is rare among EU countries, which usually apply a linear or regressive pharmacy mark-up scheme. Like in most EU countries, the Croatian Social Insurance reimburses specific medicines at 100%, whereas patients are charged co-payments for other reimbursable medicines. Criteria for reimbursement include the medicine's importance from the public health perspective, its therapeutic value, and relative effectiveness. In Croatia and in many EU Member States, reimbursement is based on a reference price system. The Croatian pharmaceutical system is similar to those in the EU Member States. Key policies, like external price referencing and reference price systems, which have increasingly been introduced in EU countries are also applied in Croatia and serve the same purpose: to ensure access to medicines while containing public pharmaceutical expenditure.

  16. Do financial incentives of introducing case mix reimbursement increase feeding tube use in nursing home residents?

    Science.gov (United States)

    Teno, Joan M; Feng, Zhanlian; Mitchell, Susan L; Kuo, Sylvia; Intrator, Orna; Mor, Vincent

    2008-05-01

    To determine whether adoption of Medicaid case mix reimbursement is associated with greater prevalence of feeding tube use in nursing home (NH) residents. Secondary analysis of longitudinal administrative data about the prevalence of feeding tube insertion and surveys of states' adoption of case mix reimbursement. NHs in the United States. NH residents at the time of NH inspection between 1993 and 2004. Facility prevalence of feeding tubes reported at the state inspection of NHs reported in the Online Survey, Certification and Reporting database and interviews with state policy makers regarding the adoption of case mix reimbursement. Between 1993 and 2004, 16 states adopted Resource Utilization Group case mix reimbursement. States varied in the prevalence of feeding tubes in their NHs. Although the use of feeding tube increased substantially over the years of the study, once temporal trends and facility fixed effects were accounted for, case mix reimbursement was not associated with greater prevalence of feeding tube use. The adoption of Medicaid case mix reimbursement was not associated with an increase in the prevalence of feeding tube use.

  17. Framing and Claiming: How Information-Framing Affects Expected Social Security Claiming Behavior

    Science.gov (United States)

    Brown, Jeffrey R.; Kapteyn, Arie; Mitchell, Olivia S.

    2017-01-01

    This paper provides evidence that Social Security benefit claiming decisions are strongly affected by framing and are thus inconsistent with expected utility theory. Using a randomized experiment that controls for both observable and unobservable differences across individuals, we find that the use of a “breakeven analysis” encourages early claiming. Respondents are more likely to delay when later claiming is framed as a gain, and the claiming age is anchored at older ages. Additionally, the financially less literate, individuals with credit card debt, and those with lower earnings are more influenced by framing than others. PMID:28579641

  18. Framing and Claiming: How Information-Framing Affects Expected Social Security Claiming Behavior.

    Science.gov (United States)

    Brown, Jeffrey R; Kapteyn, Arie; Mitchell, Olivia S

    2016-03-01

    This paper provides evidence that Social Security benefit claiming decisions are strongly affected by framing and are thus inconsistent with expected utility theory. Using a randomized experiment that controls for both observable and unobservable differences across individuals, we find that the use of a "breakeven analysis" encourages early claiming. Respondents are more likely to delay when later claiming is framed as a gain, and the claiming age is anchored at older ages. Additionally, the financially less literate, individuals with credit card debt, and those with lower earnings are more influenced by framing than others.

  19. Reimbursing live organ donors for incurred non-medical expenses: a global perspective on policies and programs.

    Science.gov (United States)

    Sickand, M; Cuerden, M S; Klarenbach, S W; Ojo, A O; Parikh, C R; Boudville, N; Garg, A X

    2009-12-01

    Methods to reimburse living organ donors for the non-medical expenses they incur have been implemented in some jurisdictions and are being considered in others. A global understanding of existing legislation and programs would help decision makers implement and optimize policies and programs. We searched for and collected data from countries that practice living organ donation. We examined legislation and programs that facilitate reimbursement, focusing on policy mechanisms, eligibility criteria, program duration and types of expenses reimbursed. Of 40 countries, reimbursement is expressly legal in 16, unclear in 18, unspecified in 6 and expressly prohibited in 1. Donor reimbursement programs exist in 21 countries; 6 have been enacted in the last 5 years. Lost income is reimbursed in 17 countries, while travel, accommodation, meal and childcare costs are reimbursed in 12 to 19 countries. Ten countries have comprehensive programs, where all major cost categories are reimbursed to some extent. Out-of-country donors are reimbursed in 10 jurisdictions. Reimbursement is conditional on donor income in 7 countries, and recipient income in 2 countries. Many nations have programs that help living donors with their financial costs. These programs differ in operation and scope. Donors in other regions of the world are without support.

  20. Reimbursing Live Organ Donors for Incurred Non-Medical Expenses: A Global Perspective on Policies and Programs

    Science.gov (United States)

    Sickand, M.; Cuerden, M. S.; Klarenbach, S. W.; Ojo, A. O.; Parikh, C. R.; Boudville, N.; Garg, A. X.

    2015-01-01

    Methods to reimburse living organ donors for the non-medical expenses they incur have been implemented in some jurisdictions and are being considered in others. A global understanding of existing legislation and programs would help decision makers implement and optimize policies and programs. We searched for and collected data from countries that practice living organ donation. We examined legislation and programs that facilitate reimbursement, focusing on policy mechanisms, eligibility criteria, program duration and types of expenses reimbursed. Of 40 countries, reimbursement is expressly legal in 16, unclear in 18, unspecified in 6 and expressly prohibited in 1. Donor reimbursement programs exist in 21 countries; 6 have been enacted in the last 5 years. Lost income is reimbursed in 17 countries, while travel, accommodation, meal and childcare costs are reimbursed in 12 to 19 countries. Ten countries have comprehensive programs, where all major cost categories are reimbursed to some extent. Out-of-country donors are reimbursed in 10 jurisdictions. Reimbursement is conditional on donor income in 7 countries, and recipient income in 2 countries. Many nations have programs that help living donors with their financial costs. These programs differ in operation and scope. Donors in other regions of the world are without support. PMID:19788503

  1. W7-X vacuum and finite-β magnetic field structure resolved with the HINT 3D equilibrium code

    International Nuclear Information System (INIS)

    Hayashi, T.; Merkel, P.; Nuehrenberg, J.; Schwenn, U.

    1994-01-01

    The 3D equilibrium code HINT allows the direct investigation of finite-β effects on sizes and phases of islands in genuinely 3D configurations like the W7-X stellarator planned by the Max-Planck-Institut fuer Plasmaphysik in Germany. The code does not require the existence of nested flux surfaces. This, in contrast to the inverse formulation used in the VMEC code, leads to a considerably more complex computational goal. The HINT code combines some crucial features reducing the numerical problems and the computational effort to such an extent as to allow computation of 3D equilibria at finite-β with magnetic islands. The code is based on a two-step procedure: Starting from a given B and an initial pressure, the iteration technique for the pressure advancement is differencing in an artificial time with an explicit 4th order scheme, or - alternatively for resolving the island topology - field lines starting from all gridpoints are followed long enough to allow pressure equalization along these. B.∇p 0, for fixed B. In a second step, p is kept fixed and B is advanced with an artificial time for solving ∇p - jxB = 0 under the constraint of vanishing toroidal current J. The differential equations are discretized in space with 4th order difference approximations on an Eulerian grid spanned by a rectangular box whose toroidal rotation law follows the W7-X geometry. The two sub-iteration steps are repeated until the force balance is satisfied to an appropriate accuracy. The boundaries (where the boundary conditions are prescribed) are far enough away from the last closed magnetic surface, thus guaranteeing the motion of the plasma column not being constrained by the boundary conditions. Due to the stellarator symmetry in the toroidal direction only half of an equilibrium period is computed, using modified periodic boundary conditions guaranteeing the 4th order of the spatial discretization. (author) 5 refs., 4 figs

  2. Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims

    International Nuclear Information System (INIS)

    Breen, Micheal A.; Taylor, George A.; Dwyer, Kathy; Yu-Moe, Winnie

    2017-01-01

    Medical malpractice is the primary method by which people who believe they have suffered an injury in the course of medical care seek compensation in the United States and Canada. An increasing body of research demonstrates that failure to correctly diagnose is the most common allegation made in malpractice claims against radiologists. Since the 1994 survey by the Society of Chairmen of Radiology in Children's Hospitals (SCORCH), no other published studies have specifically examined the frequency or clinical context of malpractice claims against pediatric radiologists or arising from pediatric imaging interpretation. We hypothesize that the frequency, character and outcome of malpractice claims made against pediatric radiologists differ from those seen in general radiology practice. We searched the Controlled Risk Insurance Co. (CRICO) Strategies' Comparative Benchmarking System (CBS), a private repository of approximately 350,000 open and closed medical malpractice claims in the United States, for claims related to pediatric radiology. We further queried these cases for the major allegation, the clinical environment in which the claim arose, the clinical severity of the alleged injury, indemnity paid (if payment was made), primary imaging modality involved (if applicable) and primary International Classification of Diseases, 9th revision (ICD-9) diagnosis underlying the claim. There were a total of 27,056 fully coded claims of medical malpractice in the CBS database in the 5-year period between Jan. 1, 2010, and Dec. 31, 2014. Of these, 1,472 cases (5.4%) involved patients younger than 18 years. Radiology was the primary service responsible for 71/1,472 (4.8%) pediatric cases. There were statistically significant differences in average payout for pediatric radiology claims ($314,671) compared to adult radiology claims ($174,033). The allegations were primarily diagnosis-related in 70% of pediatric radiology claims. The most common imaging modality implicated in

  3. Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims

    Energy Technology Data Exchange (ETDEWEB)

    Breen, Micheal A.; Taylor, George A. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Dwyer, Kathy; Yu-Moe, Winnie [CRICO Risk Management Foundation, Boston, MA (United States)

    2017-06-15

    Medical malpractice is the primary method by which people who believe they have suffered an injury in the course of medical care seek compensation in the United States and Canada. An increasing body of research demonstrates that failure to correctly diagnose is the most common allegation made in malpractice claims against radiologists. Since the 1994 survey by the Society of Chairmen of Radiology in Children's Hospitals (SCORCH), no other published studies have specifically examined the frequency or clinical context of malpractice claims against pediatric radiologists or arising from pediatric imaging interpretation. We hypothesize that the frequency, character and outcome of malpractice claims made against pediatric radiologists differ from those seen in general radiology practice. We searched the Controlled Risk Insurance Co. (CRICO) Strategies' Comparative Benchmarking System (CBS), a private repository of approximately 350,000 open and closed medical malpractice claims in the United States, for claims related to pediatric radiology. We further queried these cases for the major allegation, the clinical environment in which the claim arose, the clinical severity of the alleged injury, indemnity paid (if payment was made), primary imaging modality involved (if applicable) and primary International Classification of Diseases, 9th revision (ICD-9) diagnosis underlying the claim. There were a total of 27,056 fully coded claims of medical malpractice in the CBS database in the 5-year period between Jan. 1, 2010, and Dec. 31, 2014. Of these, 1,472 cases (5.4%) involved patients younger than 18 years. Radiology was the primary service responsible for 71/1,472 (4.8%) pediatric cases. There were statistically significant differences in average payout for pediatric radiology claims ($314,671) compared to adult radiology claims ($174,033). The allegations were primarily diagnosis-related in 70% of pediatric radiology claims. The most common imaging modality

  4. Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims.

    Science.gov (United States)

    Breen, Micheál A; Dwyer, Kathy; Yu-Moe, Winnie; Taylor, George A

    2017-06-01

    Medical malpractice is the primary method by which people who believe they have suffered an injury in the course of medical care seek compensation in the United States and Canada. An increasing body of research demonstrates that failure to correctly diagnose is the most common allegation made in malpractice claims against radiologists. Since the 1994 survey by the Society of Chairmen of Radiology in Children's Hospitals (SCORCH), no other published studies have specifically examined the frequency or clinical context of malpractice claims against pediatric radiologists or arising from pediatric imaging interpretation. We hypothesize that the frequency, character and outcome of malpractice claims made against pediatric radiologists differ from those seen in general radiology practice. We searched the Controlled Risk Insurance Co. (CRICO) Strategies' Comparative Benchmarking System (CBS), a private repository of approximately 350,000 open and closed medical malpractice claims in the United States, for claims related to pediatric radiology. We further queried these cases for the major allegation, the clinical environment in which the claim arose, the clinical severity of the alleged injury, indemnity paid (if payment was made), primary imaging modality involved (if applicable) and primary International Classification of Diseases, 9th revision (ICD-9) diagnosis underlying the claim. There were a total of 27,056 fully coded claims of medical malpractice in the CBS database in the 5-year period between Jan. 1, 2010, and Dec. 31, 2014. Of these, 1,472 cases (5.4%) involved patients younger than 18 years. Radiology was the primary service responsible for 71/1,472 (4.8%) pediatric cases. There were statistically significant differences in average payout for pediatric radiology claims ($314,671) compared to adult radiology claims ($174,033). The allegations were primarily diagnosis-related in 70% of pediatric radiology claims. The most common imaging modality implicated in

  5. A Comparison of Reimbursement Recommendations by European HTA Agencies: Is There Opportunity for Further Alignment?

    Directory of Open Access Journals (Sweden)

    Nicola Allen

    2017-06-01

    Full Text Available Introduction: In Europe and beyond, the rising costs of healthcare and limited healthcare resources have resulted in the implementation of health technology assessment (HTA to inform health policy and reimbursement decision-making. European legislation has provided a harmonized route for the regulatory process with the European Medicines Agency, but reimbursement decision-making still remains the responsibility of each country. There is a recognized need to move toward a more objective and collaborative reimbursement environment for new medicines in Europe. Therefore, the aim of this study was to objectively assess and compare the national reimbursement recommendations of 9 European jurisdictions following European Medicines Agency (EMA recommendation for centralized marketing authorization.Methods: Using publicly available data and newly developed classification tools, this study appraised 9 European reimbursement systems by assessing HTA processes and the relationship between the regulatory, HTA and decision-making organizations. Each national HTA agency was classified according to two novel taxonomies. The System taxonomy, focuses on the position of the HTA agency within the national reimbursement system according to the relationship between the regulator, the HTA-performing agency, and the reimbursement decision-making coverage body. The HTA Process taxonomy distinguishes between the individual HTA agency's approach to economic and therapeutic evaluation and the inclusion of an independent appraisal step. The taxonomic groups were subsequently compared with national HTA recommendations.Results: This study identified European national reimbursement recommendations for 102 new active substances (NASs approved by the EMA from 2008 to 2012. These reimbursement recommendations were compared using a novel classification tool and identified alignment between the organizational structure of reimbursement systems (System taxonomy and HTA

  6. Everyday Citizenship: Identity Claims and Their Reception

    Directory of Open Access Journals (Sweden)

    Nick Hopkins

    2015-10-01

    Full Text Available Citizenship involves being able to speak and be heard as a member of the community. This can be a formal right (e.g., a right to vote. It can also be something experienced in everyday life. However, the criteria for being judged a fellow member of the community are multiple and accorded different weights by different people. Thus, although one may self-define alongside one’s fellows, the degree to which these others reciprocate depends on the weight they give to various membership criteria. This suggests we approach everyday community membership in terms of an identity claims-making process in which first, an individual claims membership through invoking certain criteria of belonging, and second, others evaluate that claim. Pursuing this logic we report three experiments investigating the reception of such identity-claims. Study 1 showed that in Scotland a claim to membership of the national ingroup was accepted more if couched in terms of place of birth and ancestry rather than just in terms of one’s subjective identification. Studies 2 and 3 showed that this differential acceptance mattered for the claimant’s ability to be heard as a community member. We discuss the implications of these studies for the conceptualization of community membership and the realization of everyday citizenship rights.

  7. 76 FR 36176 - Fully Developed Claim (Fully Developed Claims-Applications for Compensation, Pension, DIC, Death...

    Science.gov (United States)

    2011-06-21

    ... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0747] Fully Developed Claim (Fully Developed Claims--Applications for Compensation, Pension, DIC, Death Pension, and/or Accrued Benefits); Correction AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice; correction...

  8. BEACON: A Summary Framework to Overcome Potential Reimbursement Hurdles.

    Science.gov (United States)

    Dunlop, William C N; Mullins, C Daniel; Pirk, Olaf; Goeree, Ron; Postma, Maarten J; Enstone, Ashley; Heron, Louise

    2016-10-01

    To provide a framework for addressing payers' criteria during the development of pharmaceuticals. A conceptual framework was presented to an international health economic expert panel for discussion. A structured literature search (from 2010 to May 2015), using the following databases in Ovid: Medline(®) and Medline(®) In-Process (PubMed), Embase (Ovid), EconLit (EBSCOhost) and the National Health Service Economic Evaluation Database (NHS EED), and a 'grey literature' search, were conducted to identify existing criteria from the payer perspective. The criteria assessed by existing frameworks and guidelines were collated; the most commonly reported criteria were considered for inclusion in the framework. A mnemonic was conceived as a memory aide to summarise these criteria. Overall, 41 publications were identified as potentially relevant to the objective. Following further screening, 26 were excluded upon full-text review on the basis of no framework presented (n = 13), redundancy (n = 11) or abstract only (n = 2). Frameworks that captured criteria developed for or utilised by the pharmaceutical industry (n = 5) and reimbursement guidance (n = 10) were reviewed. The most commonly identified criteria-unmet need/patient burden, safety, efficacy, quality-of-life outcomes, environment, evidence quality, budget impact and comparator-were incorporated into the summary framework. For ease of communication, the following mnemonic was developed: BEACON (Burden/target population, Environment, Affordability/value, Comparator, Outcomes, Number of studies/quality of evidence). The BEACON framework aims to capture the 'essence' of payer requirements by addressing the most commonly described criteria requested by payers regarding the introduction of a new pharmaceutical.

  9. Rumours about blood and reimbursements in a microbicide gel trial.

    Science.gov (United States)

    Stadler, Jonathan; Saethre, Eirik

    2010-12-01

    A rumour that emerged during a microbicide gel trial tells the tale of clinic staff purchasing trial participants' blood. This paper documents the rumour and explores its divergent interpretations and meanings in relation to the context of the trial and the social and economic setting at two of the trial sites (Soweto and Orange Farm) in South Africa. The article is based on qualitative research conducted during the Microbicides Development Programme (MDP) 301 trial to evaluate a microbicide vaginal gel for HIV prevention in women. The research incorporated in-depth interviews with female trial participants and their male partners, focus group discussions with male and female community members, and participant observation in the trial clinic and community setting at the two sites. The article analyses the different perspectives among the clinic staff, community and trial participants in terms of which the rumour about the exchange of blood for cash is seen as: 1) the result of ignorance of the clinical trial procedures; 2) the exploitation of poor and vulnerable women; 3) an example of young women's desire for material gain; and 4) a reciprocal exchange of 'clean blood' for cash between women trial participants and the health services. We suggest that the rumours about selling blood verbalise notions of gender and morality while also providing an appraisal of the behaviour of young women and a critique of social relationships between foreign researchers and local participants. Through stories about the clinical trial procedures and its potential reimbursements, the participants were creating and reconfiguring social relationships. Ultimately, rumours are one way in which foreign enterprises such as a clinical trial are rendered local.

  10. Pricing and reimbursement of orphan drugs: the need for more transparency

    Directory of Open Access Journals (Sweden)

    Simoens Steven

    2011-06-01

    Full Text Available Abstract Pricing and reimbursement of orphan drugs are an issue of high priority for policy makers, legislators, health care professionals, industry leaders, academics and patients. This study aims to conduct a literature review to provide insight into the drivers of orphan drug pricing and reimbursement. Although orphan drug pricing follows the same economic logic as drug pricing in general, the monopolistic power of orphan drugs results in high prices: a orphan drugs benefit from a period of marketing exclusivity; b few alternative health technologies are available; c third-party payers and patients have limited negotiating power; d manufacturers attempt to maximise orphan drug prices within the constraints of domestic pricing and reimbursement policies; and e substantial R&D costs need to be recouped from a small number of patients. Although these conditions apply to some orphan drugs, they do not apply to all orphan drugs. Indeed, the small number of patients treated with an orphan drug and the limited economic viability of orphan drugs can be questioned in a number of cases. Additionally, manufacturers have an incentive to game the system by artificially creating monopolistic market conditions. Given their high price for an often modest effectiveness, orphan drugs are unlikely to provide value for money. However, additional criteria are used to inform reimbursement decisions in some countries. These criteria may include: the seriousness of the disease; the availability of other therapies to treat the disease; and the cost to the patient if the medicine is not reimbursed. Therefore, the maximum cost per unit of outcome that a health care payer is willing to pay for a drug could be set higher for orphan drugs to which society attaches a high social value. There is a need for a transparent and evidence-based approach towards orphan drug pricing and reimbursement. Such an approach should be targeted at demonstrating the relative effectiveness

  11. Pricing and reimbursement of orphan drugs: the need for more transparency.

    Science.gov (United States)

    Simoens, Steven

    2011-06-17

    Pricing and reimbursement of orphan drugs are an issue of high priority for policy makers, legislators, health care professionals, industry leaders, academics and patients. This study aims to conduct a literature review to provide insight into the drivers of orphan drug pricing and reimbursement. Although orphan drug pricing follows the same economic logic as drug pricing in general, the monopolistic power of orphan drugs results in high prices: a) orphan drugs benefit from a period of marketing exclusivity; b) few alternative health technologies are available; c) third-party payers and patients have limited negotiating power; d) manufacturers attempt to maximise orphan drug prices within the constraints of domestic pricing and reimbursement policies; and e) substantial R&D costs need to be recouped from a small number of patients. Although these conditions apply to some orphan drugs, they do not apply to all orphan drugs. Indeed, the small number of patients treated with an orphan drug and the limited economic viability of orphan drugs can be questioned in a number of cases. Additionally, manufacturers have an incentive to game the system by artificially creating monopolistic market conditions. Given their high price for an often modest effectiveness, orphan drugs are unlikely to provide value for money. However, additional criteria are used to inform reimbursement decisions in some countries. These criteria may include: the seriousness of the disease; the availability of other therapies to treat the disease; and the cost to the patient if the medicine is not reimbursed. Therefore, the maximum cost per unit of outcome that a health care payer is willing to pay for a drug could be set higher for orphan drugs to which society attaches a high social value. There is a need for a transparent and evidence-based approach towards orphan drug pricing and reimbursement. Such an approach should be targeted at demonstrating the relative effectiveness, cost-effectiveness and

  12. Billing for pharmacists' cognitive services in physicians' offices: multiple methods of reimbursement.

    Science.gov (United States)

    Scott, Mollie Ashe; Hitch, William J; Wilson, Courtenay Gilmore; Lugo, Amy M

    2012-01-01

    To evaluate the charges and reimbursement for pharmacist services using multiple methods of billing and determine the number of patients that must be managed by a pharmacist to cover the cost of salary and fringe benefits. Large teaching ambulatory clinic in North Carolina. Annual charges and reimbursement, patient no-show rate, clinic capacity, number of patients seen monthly and annually, and number of patients that must be seen to pay for a pharmacist's salary and benefits. A total of 6,930 patient encounters were documented during the study period. Four different clinics were managed by the pharmacists, including anticoagulation, pharmacotherapy, osteoporosis, and wellness clinics. "Incident to" level 1 billing was used for the anticoagulation and pharmacotherapy clinics, whereas level 4 codes were used for the osteoporosis clinic. The wellness clinic utilized a negotiated fee-for-service model. Mean annual charges were $65,022, and the mean reimbursement rate was 47%. The mean charge and collection per encounter were $41 and $19, respectively. Eleven encounters per day were necessary to generate enough charges to pay for the cost of the pharmacist. Considering actual reimbursement rates, the number of patient encounters necessary increased to 24 per day. "What if" sensitivity analysis indicated that billing at the level of service provided instead of level 1 decreased the number of patients needed to be seen daily. Billing a level 4 visit necessitated that five patients would need to be seen daily to generate adequate charges. Taking into account the 47% reimbursement rate, 10 level 4 encounters per day were necessary to generate appropriate reimbursement to pay for the pharmacist. Unique opportunities for pharmacists to provide direct patient care in the ambulatory setting continue to develop. Use of a combination of billing methods resulted in sustainable reimbursement. The ability to bill at the level of service provided instead of a level 1 visit would

  13. Anticipated changes in reimbursements for US outpatient emergency department encounters after health reform.

    Science.gov (United States)

    Galarraga, Jessica E; Pines, Jesse M

    2014-04-01

    We study how reimbursements to emergency departments (EDs) for outpatient visits may be affected by the insurance coverage expansion of the Patient Protection and Affordable Care Act as previously uninsured patients gain coverage either through the Medicaid expansion or through health insurance exchanges. We conducted a secondary analysis of data (2005 to 2010) from the Medical Expenditure Panel Survey. We specified multiple linear regression models to examine differences in the payments, charges, and reimbursement ratios by insurance category. Comparisons were made between 2 groups to reflect likely movements in insurance status after the Patient Protection and Affordable Care Act implementation: (1) the uninsured who will be Medicaid eligible afterward versus Medicaid insured, and (2) the uninsured who will be Medicaid ineligible afterward versus the privately insured. From 2005 to 2010, as a percentage of total ED charges, outpatient ED encounters for Medicaid beneficiaries reimbursed 17% more than for uninsured individuals who will become Medicaid eligible after Patient Protection and Affordable Care Act implementation: 40.0% versus 34.0%, mean absolute difference=5.9%, 95% confidence interval 5.7% to 6.2%. During the same period, the privately insured reimbursed 39% more than for uninsured individuals who will not be Medicaid eligible after Patient Protection and Affordable Care Act implementation: 54.0% versus 38.8%, mean absolute difference=15.2%, 95% confidence interval 12.8% to 17.6%. Assuming historical reimbursement patterns remain after Patient Protection and Affordable Care Act implementation, outpatient ED encounters could reimburse considerably more for both the previously uninsured patients who will obtain Medicaid insurance and for those who move into private insurance products through health insurance exchanges. Although our study does provide insight into the future, multiple factors will ultimately influence reimbursements after implementation

  14. Quantitative evaluation of radiation oncologists' adaptability to lower reimbursing treatment programs.

    Science.gov (United States)

    Gill, Beant S; Beriwal, Sushil; Rajagopalan, Malolan S; Wang, Hong; Hodges, Kimberly; Greenberger, Joel S

    2015-01-01

    Rapid development of sophisticated modalities has challenged radiation oncologists to evaluate workflow and care delivery processes. Our study assesses treatment modality use and willingness to alter management with anticipated limitations in reimbursement and resources. A web-based survey was sent to 43 radiation oncologists in a National Cancer Institute-designated comprehensive cancer center network. The survey contained 7 clinical cases with various acceptable treatment options based on our institutional clinical pathways. Each case was presented in 3 modules with varying situations: (1) unlimited resources with current reimbursement, (2) restricted reimbursement (bundled payment), and (3) both restricted reimbursement and resources. Reimbursement rates were based on the 2013 Medicare fee schedule. Adoption of lower reimbursing options (LROs) was defined as the percentage of scenarios in which a respondent selected an LRO compared with baseline. Forty-three physicians completed the survey, 11 (26%) at academic and 32 (74%) at community facilities. When bundled payment was imposed (module 1 vs 2), an increase in willingness to adopt LROs was observed (median 11.1%). When physicians were limited to both bundled payment and resource restriction, adoption of LROs was more pronounced (module 1 vs 3; median 22.2%, P 25 years, P = .02). Radiation oncologists were more likely to choose lower reimbursing treatment options when both resource restriction and bundled payment were presented. Those with fewer years of clinical practice were less inclined to alter management, perhaps reflecting modern residency training. Future cost-utility analyses may help to better guide radiation oncologists in selection of LROs. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  15. 31 CFR 361.8 - Claim for replacement.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Claim for replacement. 361.8 Section... § 361.8 Claim for replacement. Claim for replacement shall be made in writing to the Secretary, to the..., Parkersburg, WV 26106-1328. The claim, accompanied by a recommendation regarding the manner of replacement...

  16. 32 CFR Appendix to Part 281 - Claims Description

    Science.gov (United States)

    2010-07-01

    ... advance decision functions for claims under the following statutes: (a) 31 U.S.C. 3702, concerning claims... SETTLING PERSONNEL AND GENERAL CLAIMS AND PROCESSING ADVANCE DECISION REQUESTS Pt. 281, App. Appendix to... Personnel Management performs these functions for claims involving civilian employees' compensation and...

  17. 32 CFR Appendix B to Part 282 - Claims Description

    Science.gov (United States)

    2010-07-01

    ... perform the claims settlement and advance decision functions for claims under the following statutes: (a...) MISCELLANEOUS PROCEDURES FOR SETTLING PERSONNEL AND GENERAL CLAIMS AND PROCESSING ADVANCE DECISION REQUESTS Pt... Director of the Office of Personnel Management performs these functions for claims involving civilian...

  18. 37 CFR 7.12 - Claim of color.

    Science.gov (United States)

    2010-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Claim of color. 7.12 Section... § 7.12 Claim of color. (a) If color is claimed as a feature of the mark in the basic application and/or registration, the international application must include a statement that color is claimed as a...

  19. 38 CFR 3.160 - Status of claims.

    Science.gov (United States)

    2010-07-01

    ..., Compensation, and Dependency and Indemnity Compensation Claims § 3.160 Status of claims. The following definitions are applicable to claims for pension, compensation, and dependency and indemnity compensation. (a... for a benefit received after final disallowance of an earlier claim, or any application based on...

  20. 40 CFR 14.12 - Principal types of unallowable claims.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Principal types of unallowable claims... PERSONAL PROPERTY CLAIMS § 14.12 Principal types of unallowable claims. Claims that ordinarily will not be... valid appraisal or authentication with the carrier prior to shipment of the item; (d) Loss of bankbooks...

  1. 37 CFR 360.5 - Copies of claims.

    Science.gov (United States)

    2010-07-01

    ... Section 360.5 Patents, Trademarks, and Copyrights COPYRIGHT ROYALTY BOARD, LIBRARY OF CONGRESS SUBMISSION OF ROYALTY CLAIMS FILING OF CLAIMS TO ROYALTY FEES COLLECTED UNDER COMPULSORY LICENSE Cable Claims... hand delivery or by mail, file an original and one copy of the claim to cable royalty fees. ...

  2. 37 CFR 360.22 - Form and content of claims.

    Science.gov (United States)

    2010-07-01

    .... 360.22 Section 360.22 Patents, Trademarks, and Copyrights COPYRIGHT ROYALTY BOARD, LIBRARY OF CONGRESS SUBMISSION OF ROYALTY CLAIMS FILING OF CLAIMS TO ROYALTY FEES COLLECTED UNDER COMPULSORY LICENSE Digital Audio Recording Devices and Media Royalty Claims § 360.22 Form and content of claims. (a) Forms. (1...

  3. 20 CFR 410.232 - Withdrawal of a claim.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Withdrawal of a claim. 410.232 Section 410.232 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969... Claims and Evidence § 410.232 Withdrawal of a claim. (a) Before adjudication of claim. A claimant (or an...

  4. 49 CFR 1021.4 - Notice of claim and demand.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Notice of claim and demand. 1021.4 Section 1021.4... § 1021.4 Notice of claim and demand. Initiation of administrative collection of enforcement claims will be commenced by the enforcement collection designee mailing a letter of notice of claim and demand to...

  5. 32 CFR 536.19 - Disaster claims planning.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Disaster claims planning. 536.19 Section 536.19... AGAINST THE UNITED STATES The Army Claims System § 536.19 Disaster claims planning. All ACOs will prepare... requirements related to disaster claims planning. ...

  6. 32 CFR 842.43 - Filing a claim.

    Science.gov (United States)

    2010-07-01

    ... completed Standard Form 95 or other signed and written demand for money damages in a sum certain. A claim... Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION ADMINISTRATIVE... amend a claim at any time prior to final action. To amend a claim, the claimant or his or her authorized...

  7. 32 CFR 536.118 - Related statutes for maritime claims.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Related statutes for maritime claims. 536.118... ACCOUNTS CLAIMS AGAINST THE UNITED STATES Maritime Claims § 536.118 Related statutes for maritime claims... under the AMCSA is not mandatory for causes of action as it is for the SIAA or PVA. (b) Similar maritime...

  8. 32 CFR 537.16 - Scope for maritime claims.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Scope for maritime claims. 537.16 Section 537.16... BEHALF OF THE UNITED STATES § 537.16 Scope for maritime claims. The Army Maritime Claims Settlement Act... claims for damage to: (1) DA-accountable properties of a kind that are within the federal maritime...

  9. 32 CFR 537.19 - Demands arising from maritime claims.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Demands arising from maritime claims. 537.19 Section 537.19 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS ON BEHALF OF THE UNITED STATES § 537.19 Demands arising from maritime claims. (a) It is...

  10. 32 CFR 536.119 - Scope for maritime claims.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Scope for maritime claims. 536.119 Section 536... CLAIMS AGAINST THE UNITED STATES Maritime Claims § 536.119 Scope for maritime claims. The AMCSA applies...) Damage that is maritime in nature and caused by tortious conduct of U.S. military personnel or federal...

  11. 32 CFR 536.124 - Settlement authority for maritime claims.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Settlement authority for maritime claims. 536.124 Section 536.124 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES Maritime Claims § 536.124 Settlement authority for maritime...

  12. 32 CFR 537.18 - Settlement authority for maritime claims.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Settlement authority for maritime claims. 537.18 Section 537.18 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS ON BEHALF OF THE UNITED STATES § 537.18 Settlement authority for maritime claims. (a) The...

  13. 32 CFR 536.29 - Revision of filed claims.

    Science.gov (United States)

    2010-07-01

    ... AGAINST THE UNITED STATES Investigation and Processing of Claims § 536.29 Revision of filed claims. (a... the writing alleges a new theory of liability, a new tortfeasor, a new party claimant, a different... amendment, not a new claim. Similarly, the addition of required information not on the original claim...

  14. Worst-Case-Optimal Dynamic Reinsurance for Large Claims

    DEFF Research Database (Denmark)

    Korn, Ralf; Menkens, Olaf; Steffensen, Mogens

    2012-01-01

    We control the surplus process of a non-life insurance company by dynamic proportional reinsurance. The objective is to maximize expected (utility of the) surplus under the worst-case claim development. In the large claim case with a worst-case upper limit on claim numbers and claim sizes, we fin...

  15. 42 CFR 456.722 - Electronic claims management system.

    Science.gov (United States)

    2010-10-01

    ... Electronic Claims Management System for Outpatient Drug Claims § 456.722 Electronic claims management system...'s Medicaid Management Information System (MMIS) applicable to prescription drugs. (ii) Notifying the... 42 Public Health 4 2010-10-01 2010-10-01 false Electronic claims management system. 456.722...

  16. 28 CFR 32.32 - Time for filing claim.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Time for filing claim. 32.32 Section 32.32 Judicial Administration DEPARTMENT OF JUSTICE PUBLIC SAFETY OFFICERS' DEATH, DISABILITY, AND EDUCATIONAL ASSISTANCE BENEFIT CLAIMS Educational Assistance Benefit Claims § 32.32 Time for filing claim. (a...

  17. 7 CFR 220.14 - Claims against school food authorities.

    Science.gov (United States)

    2010-01-01

    ..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.14 Claims against school food authorities. (a) State agencies shall disallow any portion of a claim and recover any payment made... FNSRO, when FNSRO disallows a claim or a portion of a claim, or makes a demand for refund of an alleged...

  18. Reimbursement-Based Economics--What Is It and How Can We Use It to Inform Drug Policy Reform?

    Science.gov (United States)

    Coyle, Doug; Lee, Karen M; Mamdani, Muhammad; Sabarre, Kelley-Anne; Tingley, Kylie

    2015-01-01

    In Ontario, approximately $3.8 billion is spent annually on publicly funded drug programs. The annual growth in Ontario Public Drug Program (OPDP) expenditure has been limited to 1.2% over the course of 3 years. Concurrently, the Ontario Drug Policy Research Network (ODPRN) was appointed to conduct drug class review research relating to formulary modernization within the OPDP. Drug class reviews by ODPRN incorporate a novel methodological technique called reimbursement-based economics, which focuses on reimbursement strategies and may be particularly relevant for policy-makers. To describe the reimbursement-based economics approach. Reimbursement-based economics aims to identify the optimal reimbursement strategy for drug classes by incorporating a review of economic literature, comprehensive budget impact analyses, and consideration of cost-effectiveness. This 3-step approach is novel in its focus on the economic impact of alternate reimbursement strategies rather than individual therapies. The methods involved within the reimbursement-based approach are detailed. To facilitate the description, summary methods and findings from a recent application to formulary modernization with respect to the drug class tryptamine-based selective serotonin receptor agonists (triptans) used to treat migraine headaches are presented. The application of reimbursement-based economics in drug policy reforms allows policy-makers to consider the cost-effectiveness and budget impact of different reimbursement strategies allowing consideration of the trade-off between potential cost savings vs increased access to cost-effective treatments. © 2015 American Headache Society.

  19. 32 CFR 537.15 - Statutory authority for maritime claims and claims involving civil works of a maritime nature.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Statutory authority for maritime claims and claims involving civil works of a maritime nature. 537.15 Section 537.15 National Defense Department of....15 Statutory authority for maritime claims and claims involving civil works of a maritime nature. (a...

  20. Criteria for Drug Reimbursement Decision-Making: An Emerging Public Health Challenge in Bulgaria

    Directory of Open Access Journals (Sweden)

    Georgi Iskrov

    2016-02-01

    Full Text Available Background: During times of fiscal austerity, means of reimbursement decision-making are of particular interest for public health theory and practice. Introduction of advanced health technologies, growing health expenditures and increased public scrutiny over drug reimbursement decisions have pushed governments to consider mechanisms that promote the use of effective health technologies, while constraining costs. Aims: The study’s aim was to explore the current rationale of the drug reimbursement decision-making framework in Bulgaria. Our pilot research focused on one particular component of this process – the criteria used – because of the critical role that criteria are known to have in setting budgets and priorities in the field of public health. The analysis pursued two objectives: to identify important criteria relevant to drug reimbursement decision-making and to unveil relationships between theory and practice. Study Design: Cross-sectional study. Methods: The study was realized through a closed-ended survey on reimbursement criteria among four major public health stakeholders – medical professionals, patients, health authorities, and industry. Empirical outcomes were then cross-compared with the theoretical framework, as defined by current Bulgarian public health legislation. Analysis outlined what is done and what needs to be done in the field of public health reimbursement decision-making. Results: Bulgarian public health stakeholders agreed on 15 criteria to form a tentative optimal framework for drug reimbursement decision-making. The most apparent gap between the empirically found preferences and the official legislation is the lack of consideration for the strength of evidence in reimbursement decisions. Conclusion: Bulgarian policy makers need to address specific gaps, such as formal consideration for strength of evidence, explicit role of efficiency criteria, and means to effectively empower patient and citizen