Making a Killing: Hmos and the Threat to Your Health
by Jamie Court (Editor), Francis Smith
Making Them Pay: How to Get the Most from Health Insurance and Managed Care
by Rhonda D. Orin
"Most people don't understand health insurance, and insurance companies know it. Unfair denials, late payments and hopeless confusion are the norm. At last, there is a solution. In eight easy steps, Making Them Pay gives practical advice about the things that drive people crazy. Like:
- Figuring out what health plans really say
- Understanding what benefits they provide
- Finding, and understanding, the exclusions
- Determining what health plans really cost
- How to talk to customer service, and other painful details
- Easy ways to keep good records
- Laws that can change your life - like the mandatory-benefits laws in all 50 states
- How to prepare successful appeals
"Along with this useful advice, Making Them Pay offers a much-needed sense of humor. It's filled with cartoons, sidebars and vignettes that will make you laugh as you learn. Based on Rhonda Orin's extensive experience as a litigator, a journalist and a mother fighting her own family's insurance battles, Making Them Pay is the book your health insurer doesn't want you to read."
The Managed Care Blues and How to Cure Them
by Walter A. Zelman, Robert A. Berenson
From Book News, Inc.
"Zelman (public health, Harvard) and Berenson (an official in the U.S. Department of Health and Human Services) attempt a clear-headed analysis of managed care, both its strengths and weaknesses. They argue that critics of the new system overly romanticize the old one, and disregard the considerable savings that are one result of the change. However, they also suggest needed reforms to improve quality of care and consumer empowerment under the managed care system."
Book News, Inc.®, Portland, OR
Managed Care Contracting: Successful Negotiation Strategies
by Reed TinsleyFor everyone who ever has to deal with health insurance and managed care, it's time to start Making Them Pay.
Managed Care in the Inner City: the Uncertain Promise for Providers, Plans, and Communities
by Dennis P. Andrulis, Betsy Carrier, National Public Health and hospit, Rebecca Gold, Yoku Shaw-Taylor
From Ingram
"This seminal book for managed care and health care executives addresses the issues of managed care among low-income and other vulnerable populations. Andrulis and his colleagues show how we can create programs that succeed, from a policy and a health care management perspective."
Managed Care Pharmacy Practice
by Robert Navarro (Editor)
"This book will be useful for any designing, managing, analyzing, or purchasing a managed care pharmacy benefit. Practical text on the issues critical to the development and operation of a managed care pharmacy program. Covers disease management, formulary management, drug utilization review, benefit design and more. For pharmacists.
DNLM: Pharmaceutical Services--organization & administration."
Managed Care: What It Is and How It Works
by Peter R. Kongstvedt, Wendy Knight
"Here is the exciting new edition everyone has been waiting for!
Look to Managed Care: What It Is and How It Works, Second Edition, to provide you with a solid grounding and clear understanding of managed health care. This completely updated and revised new edition is by the foremost authority in the managed care industry, Dr. Peter Kongstvedt.
"Managed Care: What It Is and How It Works is enhanced with learning objectives at the beginning of every chapter, and an extensive glossary of key managed health care terms. It is written in clear and concise terms that provide basic fundamentals, beginning with an historical overview of managed care, to organizational structures, concepts, and practices of the managed care industry."
The Managed Health Care Handbook
by Peter R. Kongstvedt (Editor)
"Ernst & Young LLP, Washington, D.C. Third edition of a Brandon/Hill Medical List selection. Text on strategical and operational management of managed care plans, for health care administrators. Previous edition 1993. 66 U.S. contributors. DNLM: Managed Care Programs - organization
& administration - United States."
Managing Catastrophic Disaster Risks Using Alternative Risk Financing and Pooled Insurance Structures (World Bank Technical Paper, No. 495)
by John D. Pollner
Managing Health Benefits in Small & Mid-Sized Organizations
by Patricia Halo
"Getting the highest-quality health care at the lowest price is a challenge for any size company. But it's especially difficult for smaller companies that lack the in-house expertise and negotiating muscle of the big corporations.
" With this comprehensive 'how-to-do-it' guide, ANY size organization can design a Fortune 500-style health care plan that offers maximum benefits at minimum costs. Written in plain language and filled with practical cost-containment measures and ready-to-use worksheets, the book explains how to:
- understand insurance principles and legislation
- gather bids on a range of health care services
- compare options, including networks, coverage limitations, and eligibility issues
- lower costs by using wellness and managed care services
- use benchmarking to monitor costs and performance, and more."
Managing Workers' Compensation: A Guide to Injury Reduction and Effective Claim Management
by Keith R. Wertz, James J. Bryant
"Workers' compensation causes headaches throughout all levels of an organization. Injuries affect production, costs, and morale.
Managing Workers' Compensation: A Guide to Injury Reduction and Effective Claim Management lays out - in logical order - management and safety procedures that reduce injuries and the aggravation that follows.
The authors cover hiring, training, and managing employees with injury avoidance in mind. They provide a blueprint for dealing with injured employees and their families, and for determining the correct time for the employee to return to work.The book discusses the all-important issues of fraud, modified duty, substance abuse testing and accident investigations. It also provides guidance for managing your organization's safety efforts in a manner that targets workers' compensation cost control as one of its major objectives. In addition to comprehensive coverage of workers' compensation, the book gives you a thorough explanation of additional sources of assistance, including the availability and utility of Internet safety resources, a complete listing of state workers' compensation agencies, and sample checklists that help you evaluate your workplace. Although workers' compensation laws vary from state-to-state, the principles behind the system and the ability of employers to influence their own premiums remain consistent. By gaining a thorough understanding of these principles and implementing proven cost control strategies, you can realize substantial savings.
Managing Workers' Compensation: A Guide to Injury Reduction and Effective Claim Management explains the process by which premiums are calculated and shows how you can impact - favorably - the amount your organization pays in premiums."
Market-Driven Healthcare: Who Wins, Who Loses in the Transformation of America's Largest Service Industry
by Regina E. Herzlinger
From Midwest Book Review
"How does American business hold lessons for health care management and the health industry? Herzlinger's focus on consumer demands, changing market requirements, and business impacts on health organizations and structures provides an analysis of service provides' business practices, revealing how such providers succeed - and fail - in their jobs."
Marketing Through Advisors: A Toolkit for Life Insurance Professionals
by Russ Alan Prince, Karen Maru File
Mastering Coding: Tools, Techniques, and Practical Applications
by Marsha S. Diamond
"A Worktext provides a solid foundation in basic coding principles with an emphasis on learning through actual physician documentation.
This practical approach prepares students to tackle any coding scenario, from routine to complex. Chapters begin with an emphasis on basic coding documentation and rules to ensure correct coding for ICD-9-CM, CPT-4, and HCPCS. Progressively difficult coding exercises incorporate newly learned skills as readers advance through this worktext. Learning objectives, numerous examples, chapter reviews, and coding reference tools throughout the text provide the necessary pedagogy to fully master basic and advanced coding concepts."
Mastering the Reimbursement Process
by L. Lamar Blount, Joanne M. Waters
"Guide covering insurance basics, types of insurance and third-party payers, coding systems, insurance processing after submission of claims, insurance accounts receivable management, and requests for review and appeals. For personnel in the physician's office."
The Medicaid Planning Handbook: A Guide to Protecting Your Family's Assets from Catastropic Nursing Home Costs (2nd Rev Ed)
by Alexander A., Jr. Bove
From Ingram
"A guide for seniors, disabled individuals, and their families explains how to preserve personal assets while ensuring long-term care, covering such topics as interfamily transfers and trusts."
The Medical Bill Survival Guide: What You Need to Know Before You Pay a Dime
by Pat Palmer, Martha Ellis (Contributor), Christopher Slone (Contributor)
Medical Billing: The Bottom Line - Revised Edition
by Claudia A Yalden
"A comprehensive guide to starting your own home-based medical billing business. Chapters include setting up your home-based medical billing office, starting out, pricing your services, finding clients, marketing examples and strategies, writing a business plan and much more. The revised edition has several new chapters that include: understanding medical billing and what medical billing codes and modifiers mean, legal consideration, life cycle of an insurance claim form and how to fill out an insurance claim form along with examples.
Medical Billing: Dr. Jack Doe Primary Care Physician Full Practice Management Training Book
by Jamie L Rayko
"The Best Hands-On Medical Billing Center and Physician's Office Training Tool. The book consits of one weeks worth of primary care physician billing. It uses real superbills, diagnosis codes, procedure codes, patient information sheets, insurance cards, daily encounter forms, and EOB's (Explanation of Benefits).We have created an actual demo of billing from a real physicians office. The only thing that is pretend about this account is the Patient Names. You will be able to work at your own pace and get hands on experience. This will give you great confidence when scheduling appointments with physicians knowing that you can do this. It is also great for a physician's office that needs to train a new employee on Medical Billing."
The Medicare Answer Book
by Connacht Cash
"User friendly guide for understanding and coping with Medicare.
The book provides definitions of commonly misunderstood terms, useful addresses and phone numbers and extremely practical advice about how to keep from being overwhelmed by the paperwork."
Medicare Made Easy (Serial)
by Charles B. Inlander, Michael A. Donio
Merriam-Webster's Medical Office Handbook
by Joseph Hamburg (Editor)
Modelling Extremal Events for Insurance and Finance (Applications of Mathematics, Vol 33)
by Paul Embrechts, Claudia Kluppelberg, Thomas Mikosch, M. Yor (Editor), I. Karatzas (Editor)
"Both in insurance and finance applications, questions involving extremal events (such as large insurance claims, large fluctuations in financial data, stock market shocks, risk management, . . . ) play an increasingly important role. This book sets out to bridge the gap between the existing theory and practical applications both from a probabilistic as well as from a statistical point of view. Whatever new theory is presented is always motivated by relevant real-life examples. The numerous illustrations and examples, and the extensive bibliography make this book an ideal reference text for students, teachers and users in the industry of extremal event methodology."
Modern Actuarial Theory and Practice
by Philip M. Booth, Robert Chadburn, Deborah Cooper, Steven Haberman, Dewi James, P. H. Booth (Editor)
"In the last two decades, there has been a significant shift in thinking and in the approach taken to actuarial practice: moving from deterministic methods (with implicit or explicit margins to protect against variability) to fully stochastic methods. Important international developments are currently being made in actuarial education, with radical changes being implemented in Australia and North America, and evolutionary changes planned in the UK.At the same time, the Consultative Group of Actuarial Associations within the EU and the International Forum of Actuarial Associations are both actively considering the international harmonization of professional qualifications.Modern Actuarial Theory and Practice matches the philosophy of those international developments, and the manner in which actuarial qualifications are changing and are likely to continue to change. It describes the traditional areas of actuarial activity with an emphasis on the fundamental principles, as well as the economic, financial, and statistical foundations of actuarial theory and practice. Information is presented in five interconnected sections:oInvestmentoLife InsuranceoGeneral InsuranceoPensionsoActuarial Modelswhich can be read separately or taken as part of the integrated whole.This text will be an invaluable aid for final-year undergraduates, MSc students, research students preparing for an MPhil or Ph. D degree, and to student actuaries preparing for the professional actuarial examinations of a number of professional bodies. Practicing actuaries will also find this a useful guide to current methodologies and models."
