Medicare Administrative Costs: Hearings Before the Subcommittee on Oversight of the Committee on Ways and Means, House of Representatives, Ninety-fourth Congress, Second Session, August 2 and 27, 1976U.S. Government Printing Office, 1976 - 239 pages |
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Page 19
... utilization review visits . They have to monitor the plans , not annually but quarterly sometimes . Even monthly they make these visits . That is part of the reason why some of this travel varies between these plans , even though the ...
... utilization review visits . They have to monitor the plans , not annually but quarterly sometimes . Even monthly they make these visits . That is part of the reason why some of this travel varies between these plans , even though the ...
Page 25
... utilization of covered services . These are functions performed by the Social Security field organization and the Central Data Proces- sing Center in Baltimore . We have better than 1,200 or 1,300 , I guess - district offices around the ...
... utilization of covered services . These are functions performed by the Social Security field organization and the Central Data Proces- sing Center in Baltimore . We have better than 1,200 or 1,300 , I guess - district offices around the ...
Page 62
... utilization . The only way to know is to look at each individual plan . I believe all of this simply underscores the need for a publicly administered health program . The Civil Service , whatever its problems , at least provides uniform ...
... utilization . The only way to know is to look at each individual plan . I believe all of this simply underscores the need for a publicly administered health program . The Civil Service , whatever its problems , at least provides uniform ...
Page 67
... utilization process . In your opinion , how well do you think the Blue Cross programs- the Blues , I guess , I should refer to them - provide this utilization review ? How effective are they ? Professor Law . Utilization reviews is a ...
... utilization process . In your opinion , how well do you think the Blue Cross programs- the Blues , I guess , I should refer to them - provide this utilization review ? How effective are they ? Professor Law . Utilization reviews is a ...
Page 68
... utilization review programs that actually go into hospitals and try to teach doctors to review each other's work . I am very skeptical that you can take that kind of broad data and draw much in the way of a conclusion from it ...
... utilization review programs that actually go into hospitals and try to teach doctors to review each other's work . I am very skeptical that you can take that kind of broad data and draw much in the way of a conclusion from it ...
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Common terms and phrases
activities administrative costs agree agreement allocation amount Article BCA's bill Blue Cross Association Blue Cross Plans Blue Shield budget Bureau of Health carrier changes charge claims processing committee contract Cost Accounting Standards cost reports data processing determined effective established evaluation executive executive compensation Federal Health Insurance Federal Procurement Regulations fiscal functions and duties funds Government Health Insurance Benefits HEW Audit hospital implementation increase instructions Insurance Benefits Account Intermediary issues letter of credit mediary Medicaid Medicare program ment million negotiation operations organization paragraph payment percent performance physicians Plan's prior approval private sector problems procedures proposed providers of services pursuant question records regional offices reimbursement responsibility role Secretary Social Security Act Social Security Administration specific staff STARK STEPNICK submit Suycott term termination TIERNEY tion TRESNOWSKI utilization review vice president Wisconsin
Popular passages
Page 220 - Contractor shall proceed diligently with the performance of the contract and in accordance with the Contracting Officer's decision. (b) This "Disputes" clause does not preclude consideration of law questions in connection with decisions provided for in paragraph (a) above : Provided, That nothing in this contract shall be construed as making final the decision of any administrative official, representative, or board on a question of law.
Page 174 - The decision of the Secretary or his duly authorized representative for the determination of such appeals shall be final and conclusive unless determined by a court of competent Jurisdiction to have been fraudulent, or capricious, or arbitrary, or so grossly erroneous as necessarily to imply bad faith, or not supported by substantial evidence.
Page 199 - Disputes" clause of this contract, (2) litigation or the settlement of claims arising out of the performance of this contract, or (3) costs and expenses of this contract as to which exception has been taken by the Comptroller General or any of his duly authorized representatives, shall continue until such appeals, litigation, claims, or exceptions have been disposed of.
Page 216 - Defense to procure supplies and services from responsible sources at fair and reasonable prices calculated to result in the lowest ultimate overall cost to the Government.
Page 199 - Contractor shall be afforded an opportunity to be heard and to offer evidence in support of its appeal. Pending final decision of a dispute hereunder, the Contractor shall proceed diligently with the performance of the contract and in accordance with the Contracting Officer's decision. b. This "Disputes" clause does not preclude consideration of law questions in connection with decisions provided for in paragraph a.
Page 223 - I know his signature, and his signature thereto is genuine; and that said bond was duly signed, sealed, and attested for and in behalf of said corporation by authority of its governing body. ["Corporate"!
Page 182 - Except as otherwise provided in this contract, any dispute concerning a question of fact arising under this contract which is not disposed of by agreement shall be decided by the Contracting Officer, who shall reduce his decision to writing and mail or otherwise furnish a copy thereof to the Contractor.
Page 134 - ... by providers of services and other persons to individuals entitled to benefits under this part, and provide procedures for and assist in arranging, where necessary, the establishment of groups outside hospitals (meeting the requirements of section...
Page 177 - States or any of his duly authorized representatives shall, until expiration of 3 years after final payment under this contract, or of the time periods for the particular records specified in Part 1-20 of the Federal Procurement Regulations (41 CFR Part 1-20), whichever expires earlier, have access to and the right to examine any directly pertinent books, documents, papers, and records of the Contractor involving transactions related to this contract.
Page 219 - ... or of the time periods for the particular records specified in Part 1-20 of the Federal procurement regulations (41 CFR Part 1-20), whichever expires earlier, have access to and the right to examine any directly pertinent books, documents, papers, and records of such subcontractor, involving transactions related to the subcontract. The term "subcontract...