State Compensation Insurance Fund (SCIF) is one of California’s largest workers’ compensation insurance carriers. It was established in 1914 through the Boynton Act, which made workers’ compensation insurance mandatory in most organizations and businesses. SCIF operates within the bureaucratic model similar to other public agencies. Houchin Community Blood Bank (HCBB) is considered to be the largest provider of blood supply for the hospitals in the Kern County service area. It is a local nonprofit that works with the community to achieve their mission of ensuring there is a safe consistent blood supply available to the area hospitals.…
My organization, Hennepin Health is a Medicaid HMO plan that has 10,000 recipients, and we only service Hennepin County residents. Medica health plan announced last year, they are exiting the Medicaid market, due to increased deficits. There will be 300,000 people in the public healthcare market that need to select a health plan. The following health plans will receive an influx in enrollment: BCBS, Hennepin Health, Health Partners, and UCare.…
I, Berta Monterroso de Gonzalez with provider number 41398 and case number KT130730097 have a question. I received a payment summary with a paycheck of the amount of $273.22, but I noticed that you didn’t pay the full hours for Christopher Rojas Gonzalez. Attached to this note I have added the hours of the week of the 03/27/2017 to 04/09/2017, and the payment summary so you can double check and send the payment or explain why I didn’t get paid. Barbara A. Gonzalez the parent of the child has agreed to send this note.…
What stands out most to me about the Predictive Modeling Analysis of Medicare Claims is that the predictive analytics system uses algorithms and models to examine Medicare claims in real time to flag suspicious billing. Real time claims streaming to build profiles and create risk scores and CMS is streaming all Medicare claims through its predictive modeling technology. As each claim streams through the predictive modeling system, the system builds a profile of the providers, networks, billing patterns, and beneficiary utilization. The profiles let CMS create risk scores that will estimate the likelihood of fraud as well as flag potentially fraudulent claims and billing patterns.…
As you may recall this law firm represented your husband, Reginald, in his 09/17/1986 Workers’ Compensation case. His case has been established for injuries to the back, head, both shoulders and both knees with an average weekly wage of $488.74. A finding has been made that your husband has a permanent total disability and he should be receiving benefits at the permanent total disability rate of $300.00 per week. I recently received a letter from Safe, LLC, the current third-party administrator on this claim, extending an offer to settle the case for $54,600.00 in indemnity plus a Medicare set-aside. The settlement represents approximately 3.5 years at the current disability rate plus an amount of money which Medicare would agree would cover…
Wage and condition complaints were a major factor in Arizona’s history. This caused laborers to organize, and created tension between laborers and management. Strikes, and general production disruptions were a result. Laborers, such as the miners, would form unions to protect themselves. The miners formed the “Western Federation of Miners (Text Pg. 178).”…
Everywhere the screams for equality echo throughout the United States. The accomplishments of the early 1900’s originally seemed enough to turn America around. Especially when combined with the ratification of the nineteenth amendment. It was hoped women that women would be able to work their way up into an equal position with men. Many people argue the goals of feminism have been met.…
Due to Medica exiting the Medicaid Program marketplace. My organization Hennepin Health membership is expected to increase by at least 20,000 recipients. The adaptive challenges, my organization continuously faces is a delay in claims payment from our vendor TMG. An increased membership will result in an overflow of unresolved claims issues. The most difficult, challenge is we assigned new processes, due to an individual’s lack of claims knowledge or someone enhanced skilled sets.…
CANADA PROMPT PAYMENT ACT UPDATE: SENATE HEARINGS LEAD TO PROPOSED AMENDMENTS In an effort to lead reform in the construction industry, the Canadian Senate introduced prompt payment legislation under Bill S-224, the Canada Prompt Payment Act (the “Bill”) which, if passed, would apply to construction contracts and related subcontracts made with the Federal Government. After passing its second reading last November, the Bill was referred to the Standing Committee on Banking, Trade and Commerce (the “Committee”).…
Jordann Davis Ms. Northerns English 1113 28 September 2017 Draft 3 Paycheck fairness is an often-debated subject among the working class. Many people believe that women are paid lower because of society's bias; however, in "Facts and Fallacies About Paycheck Fairness," Phyllis Schlafly argues that there is no real pay gap between male and female workers. In her article, Schlafly states that women's lower pay is caused by personal preferences and choices. The author's attempt to convince the audience that there is no real problem of a pay gap is ineffective because of her unwarranted logical appeals, lack of credibility, and excessive use of pathos.…
Losers Pay The U.S pays millions of dollars in courts everyday, but what if there was a way to reduce all of those litigations and cases in court? It has been a debate whether the U.S should have a losers pay rule in court. Some say that a losers pay rule would scare average Americans away from the court system, others say that it will reduce the litigations in the U.S and improve the overall justice system. America should have a loser pays rule because it would decrease litigations in the U.S, reduce the number of cases in courts, and because it has worked well in other countries.…
Benchmarking in a healthcare facility is extremely important because it will show where improvements need to be made. In other words, there are certain performance measures that should be monitored for the purpose of maximizing reimbursement. The performance measures include days in accounts receivable (A/R) and claims at first pay rate. First, there is days in A/R, which is important to strive to have it over 90 days. In other words, this relates to having patient claims being paid within 90 days.…
Compensation can be a strategic tool for organizations to attract, retain, and motivate their employees. More than a wages and salary earned by employee, compensation also includes benefits provided. An official statement specifying a company’s standpoint on compensation is known as compensation philosophy. According to the article, “It essentially explains the “why” behind employee pay and creates a framework for consistency.…
• Why is it important to use current codes and coding books? According to the coding guidelines “Every year codes are revised and deleted, and new codes are released. Correct coding is imperative to avoiding costly coding errors. Incorrect code assignment may cause under- and over-coding, fraudulent claims and even legal issues.…
Answer to Question No. 1 (a) Fringe benefit refers to the benefit that is provided toan employee or an associate of the employee by the employer or associate of an employer in any given year in respect of the employment of the employee. It refers to any benefit that is provided over and above the salary of an employee. Benefit refers to anything that is provided to the employee by the employer which he would actually have to incur himself if the benefit was not provided by the employer. It aims at levying tax on the benefits that cannot be availed by the employee or an associate of employee but cannot be converted into cash. All the benefits that are provided are in respect of the employment of the employee.…