The document discusses the top challenges facing insurance claims departments, including rising claim volumes, lack of adjuster expertise, mandatory reporting requirements, high subpoena and litigation fees, and privacy issues. It outlines strategies to address each challenge, like implementing tracking systems and validating requests. A case study shows how outsourcing to OneSource helped an insurance company by centralizing processing and using specialized staff. Qualities to look for in a partner include implementation plans, tracking systems, industry expertise, and customer satisfaction.
This document summarizes a paper on motor premium rating in India. It discusses the current tariff regime for motor insurance that is leading to losses for many companies. With the likely deregulation of motor insurance tariffs, companies will need to use actuarial fundamentals to scientifically price policies. It emphasizes the importance of collecting comprehensive driver, vehicle, and policy data to analyze risk groups and determine appropriate premiums. The document provides an overview of how to calculate an adequate overall premium and determine differential ratings based on risk factors.
This publication includes the deal activity in the insurance sector such as overall highlights, key announced transactions, and the outlook ahead. Read our full report to learn more.
The group insurance market shows real promise but, as of yet, most carriers are still trying to determine the best path forward. Moving from being in a quiet sector to the front lines of new ways of doing business has shaken the industry and confronted it with challenges –and opportunities – many could not have foreseen even a decade ago.
In spring 2016, PwC investigated the current state and
future direction of stress testing. We surveyed 55 insurers
operating in the US about their stress testing framework and
the specific stresses that they test. We also engaged in more
detailed dialogue with a number of insurers in the US and
globally, as well as with some North American insurance
regulators.
A survey found that businesses with less than 250 employees spend on average $1,602 per employee per year on HR activities. The study also showed that smaller companies have higher per-employee HR costs. Another study found that administrative costs accounted for 8-12% of payroll for companies with 1-9 employees, 4-8% for those with 10-24 employees, and 3-6% for companies with 25-49 employees. The document provides a calculator to help companies determine their own administrative costs by considering factors like payroll preparation, benefits administration, and retirement plan expenses.
A change to the FHA claim filing rule is coming. Learn how you can prepare for it with this joint point of view from PwC's Consumer Finance Group and Financial Services Regulatory Practice.
1) Tracking incoming certificates of insurance from vendors is not explicitly required by GAAP or SOX, but can help companies reduce risks and costs.
2) While the simplest approach is just capturing certificates, more rigorous tracking allows companies to confirm coverage meets contractual requirements and transfer liability to vendors.
3) Outsourcing certificate tracking to an experienced provider is more efficient and effective than doing it in-house, as resources are freed up and experts handle the process.
This document summarizes a paper on motor premium rating in India. It discusses the current tariff regime for motor insurance that is leading to losses for many companies. With the likely deregulation of motor insurance tariffs, companies will need to use actuarial fundamentals to scientifically price policies. It emphasizes the importance of collecting comprehensive driver, vehicle, and policy data to analyze risk groups and determine appropriate premiums. The document provides an overview of how to calculate an adequate overall premium and determine differential ratings based on risk factors.
This publication includes the deal activity in the insurance sector such as overall highlights, key announced transactions, and the outlook ahead. Read our full report to learn more.
The group insurance market shows real promise but, as of yet, most carriers are still trying to determine the best path forward. Moving from being in a quiet sector to the front lines of new ways of doing business has shaken the industry and confronted it with challenges –and opportunities – many could not have foreseen even a decade ago.
In spring 2016, PwC investigated the current state and
future direction of stress testing. We surveyed 55 insurers
operating in the US about their stress testing framework and
the specific stresses that they test. We also engaged in more
detailed dialogue with a number of insurers in the US and
globally, as well as with some North American insurance
regulators.
A survey found that businesses with less than 250 employees spend on average $1,602 per employee per year on HR activities. The study also showed that smaller companies have higher per-employee HR costs. Another study found that administrative costs accounted for 8-12% of payroll for companies with 1-9 employees, 4-8% for those with 10-24 employees, and 3-6% for companies with 25-49 employees. The document provides a calculator to help companies determine their own administrative costs by considering factors like payroll preparation, benefits administration, and retirement plan expenses.
A change to the FHA claim filing rule is coming. Learn how you can prepare for it with this joint point of view from PwC's Consumer Finance Group and Financial Services Regulatory Practice.
1) Tracking incoming certificates of insurance from vendors is not explicitly required by GAAP or SOX, but can help companies reduce risks and costs.
2) While the simplest approach is just capturing certificates, more rigorous tracking allows companies to confirm coverage meets contractual requirements and transfer liability to vendors.
3) Outsourcing certificate tracking to an experienced provider is more efficient and effective than doing it in-house, as resources are freed up and experts handle the process.
The document provides an overview of potential issues with employee leasing arrangements. It summarizes that while employee leasing promises to pass employer responsibilities and liabilities to a PEO, in practice clients may still be liable for certain issues and subject to additional regulations. It also notes several ways client companies may end up paying more than anticipated for services like workers' compensation, payroll taxes, and administrative fees under such arrangements. The document advises carefully reviewing contracts and financial proposals to understand full costs and responsibilities before entering an employee leasing relationship.
How to Make Your Specialty Services Lending Rock: Credit Considerations for 4...Colleen Beck-Domanico
Make better specialty services lending decisions. This slide deck discusses credit risk considerations for the four most-researched specialty services industries—dental practices, physician practices, HVAC, and new car dealers—on eStatement Studies.
2017 Top Issues - DOL Fiduciary Rule - January 2017PwC
The document discusses the impact of the Department of Labor's Fiduciary Rule on the insurance industry. The rule requires financial advisors to act as fiduciaries, putting clients' interests ahead of their own. This will significantly impact compensation structures and require changes to training, products offered, and data collection. Insurers will need to streamline compensation, rationalize products, enhance agent training on fiduciary responsibilities, and improve data and technology to demonstrate compliance. The rule is spurring widespread changes beyond just compliance, including potential consolidation in the insurance and distribution sectors.
The Pitfalls of Linking Pay With Performance and How To Overcome ThemCBIZ, Inc.
Linking pay with performance can be beneficial for your company, but it could also have dire implications if done improperly. Read on as Ed Rataj explains what could go wrong, and how to overcome the pitfalls of linking pay with performance.
One of the fastest growing concerns on insurers’ enterprise risk agenda is model risk
management. From being a phrase that primarily actuaries and other modelers used, “model risk” has become a major focus of regulators and the subject of intense activity and debate at insurers. How model risk management has evolved from ad hoc efforts to its currentproactive stage is an interesting story. But more interesting still is
what we believe could be its next stage – generating measurable business value.
This document provides an overview of key client due diligence (CDD) challenges facing wealth managers and how new technologies are helping address these issues. It finds that wealth managers are increasing CDD spending, with the majority focusing on hiring more staff or investing in technology. CDD tasks like politically exposed person screening and verifying source of wealth are cited as major pain points. There is significant variation in how frequently firms rescreen clients. New tools are delivering automation, collaboration and auditability to help slash onboarding times and improve processes. The report is based on a survey of over 100 wealth professionals and in-depth interviews with 20 compliance experts. It examines CDD resource needs, pain points, rescreening practices and how technologies are
This document provides an overview of key client due diligence (CDD) challenges facing wealth managers and how new technologies are helping address these issues. It finds that wealth managers estimate it takes an average of 5.4 hours to screen high-risk clients, 2.5 hours for medium-risk, and 1.6 hours for low-risk. The biggest pain points for CDD are politically exposed person/watchlist screening and proving source of wealth/funds. While most firms initially screen clients through relationship managers, almost a third outsource some CDD currently. The document examines variability in rescreening frequencies and risk ratings across different countries/regions. It concludes that new technologies are enabling greater automation, collaboration and auditability to
Claims Management - Edge through Efficiencyneetamundra
The document discusses improving the claims management process for insurance companies in India. It outlines issues with the current process such as high costs and poor customer satisfaction. An efficient claims system would use technology to streamline the process, reduce costs, speed up claims resolution, and improve customer satisfaction through features like automatic adjudication and fraud detection. Selecting a claims management system that meets requirements, is configurable, scalable, and supports standards would help insurance companies process claims more efficiently.
This presentation contains forward-looking statements reflecting the company's expectations involving risks and uncertainties. The document discusses the company's plans, objectives, growth opportunities in their market, and prospects. It notes that actual results could differ from forward-looking statements due to risks and uncertainties. The presentation promotes the company's position as a market leader and discusses opportunities to grow revenue through new customers, products, and geographic expansion.
Insurers are upgrading their technology to support more complex
products, lower operating costs, and get closer to their customers.
But they can do more harm than good when they make changes
that alienate their independent agents. We’ve identified five steps
that can help insurers engage agents early and create a
transition plan that meets agents’ needs—converting these
important stakeholders into enthusiastic advocates.
2015 Patent Litigation Study: A change in patentee fortunesPwC
Intellectual property matters have an indisputable link to competitive advantage. Our 2015 Patent Litigation Study provides a comprehensive analysis from a database of US patent infringement actions, which includes data from 1995 through 2014. The observations and trends identified in our analysis can help executives, legislators, and litigators assess their patent enforcement or defense strategies.
This issue of BIZGrowth Strategies includes articles on Enterprise Risk, Tax Issues of Using Fulfillment by Amazon, Traits to Look for in a Health Insurance Advisor, Summer HR Strategies and Protecting Your Wealth.
Acct 444 ( all weeks 1 5 quizzes and homework assignments ) full coursebestwriter
This document provides the full course materials for DeVry University's ACCT 444 course, including quizzes and homework assignments for weeks 1 through 5. It includes 10 multiple choice questions for the week 1 quiz covering topics like GAAS, auditor responsibilities, auditor independence, and ethics. It also provides quizzes for weeks 2 and 3 covering auditor liability, fraud, audit objectives, audit evidence, audit planning, risk, and materiality. Each quiz contains 10 additional multiple choice questions.
This document discusses how an enterprise data warehouse (EDW) can help healthcare organizations improve their bottom line by better analyzing revenue cycle and value-based purchasing data. An EDW aggregates data from across departments and systems into a centralized location that provides easy access through dashboards. This allows financial teams to more efficiently analyze key metrics in real time and make informed decisions. The document provides examples of metrics available through an EDW and how it can help organizations increase reimbursements, manage denials, improve collections, and meet value-based purchasing criteria.
This document provides an overview of Wateridge Insurance Services' risk management and insurance brokerage program. It details Wateridge's company information, office locations, service team, coverage capabilities across various lines of insurance including property & casualty, workers' compensation, employee benefits, and risk services. It also outlines Wateridge's brokerage services, carriers represented, and workers' compensation programs and services.
Overpayments, audits and reimbursement conundrums 7.7.15Polsinelli PC
This webinar will help health care entities strategize, manage and respond to both internal and external audits through which potential overpayments are found. Presenters will provide examples on how to navigate the resolution of potential overpayments and audits in unique reimbursement contexts. Polsinelli PC
1) Organizations can and should use data to measure the effectiveness of their ethics and compliance programs, just as they use data to measure operational efficiencies. Data-driven assessments provide an objective, fact-based analysis of program effectiveness over time.
2) Compliance officers should work with data experts to identify, collect, and analyze relevant structured and unstructured data from internal and external sources. This includes establishing appropriate metrics and benchmarks to assess compliance programs.
3) Presenting data analyses in a dashboard format allows easy access to meaningful information and demonstrates the organization's commitment to compliance. Dashboards can track metrics related to guidelines like the Federal Sentencing Guidelines.
This presentation will present insights into web user psychology, how to think about and write for the web, how to identify common content mistakes and how writing for the web will improve your search engine rankings.
The document discusses plans for an upcoming book about innovation platforms in maize and cassava production in Africa. It details that workshops were held in Burkina Faso and Gambia where platform actors from 12 countries shared experiences. Six core themes and six countries were selected for focus in the book. The themes are startup of platforms, stakeholder interaction, sustainability, policy pathways, gender inclusion, and knowledge sharing. The countries contributing case studies are Congo, Cameroon, Sierra Leone, Mali, Burkina Faso, and Gambia. The book aims to document lessons learned from the platforms and be published by December 2013.
Between SEO, social media and content marketing, the digital marketing landscape is becoming increasingly complex. Learn how to develop a comprehensive, robust digital strategy and how to develop content topics you users will be interested in.
Imparare la statistica consolidando le competenze in matematica (Caterina Primi)Francesco Cabiddu
Slides quarto intervento giornata 24 Maggio 2013 :
“Una Statistica più consapevole per decisioni migliori.
Giornata di Metodologia e Statistica per le Scienze Umane.”
Mattina (ore 10 – 12:30): Apprendimento del Ragionamento Statistico.
Università degli studi di Cagliari. Dipartimento di Pedagogia, Psicologia e Filosofia.
Università di Cagliari.
TITOLO: “Imparare la statistica consolidando le competenze in matematica (Caterina Primi, Marianna Donati, Francesca Chiesi)”. Università di Firenze
Diretto e montato da Marco Camba
ABSTRACT:
Ricerche recenti (tra gli altri, Budé et al., 2007; Chiesi & Primi, 2010; Dempster & McCorry, 2009) hanno messo a punto alcuni modelli secondo i quali l’apprendimento della statistica è il risultato dell’interazione tra diversi fattori, tra i quali le conoscenze matematiche. Tuttavia scarsa attenzione viene data alle competenze matematiche nei corsi introduttivi data l’opinione condivisa che i concetti matematici utilizzati sono prevalentemente di base, e quindi ritenuti in possesso degli studenti al termine della scuola superiore. Spesso però gli studenti dimostrano di avere un debole background in matematica e di utilizzare certe procedure matematiche in modo meccanico senza capirne il significato (Johnson & Kuennen, 2006; Lunsford & Poplin, 2011). Ad esempio la maggior parte degli studenti sono in grado di calcolare un rapporto ma non sempre sono capaci di interpretarne il significato. Lo scopo di questo lavoro è stato quello di mettere a punto delle attività da svolgere durante il corso di Psicometria volte a rafforzare le competenze matematiche di base. Attraverso un disegno prima- dopo è stato confermato un incremento delle nozioni di tipo matematico durante il corso. Inoltre risulta una relazione positiva tra competenze in matematica e ragionamento statistico. In particolare, competenze di base come sapere fare delle operazioni con frazioni e con numeri decimali risultano essere dei buoni predittori del ragionamento statistico. L’insieme dei risultati porta a concludere che alcune competenze matematiche di base favoriscono l’acquisizione dei concetti della statistica.
Using Northwoods' step-by-step framework, learn how to develop a robust blog that can boost website traffic and increase leads.
Northwoods President and CEO Pat Bieser presented this workshop at the company's (TUG) Titan User Group event on Thursday, June 4.
The document provides an overview of potential issues with employee leasing arrangements. It summarizes that while employee leasing promises to pass employer responsibilities and liabilities to a PEO, in practice clients may still be liable for certain issues and subject to additional regulations. It also notes several ways client companies may end up paying more than anticipated for services like workers' compensation, payroll taxes, and administrative fees under such arrangements. The document advises carefully reviewing contracts and financial proposals to understand full costs and responsibilities before entering an employee leasing relationship.
How to Make Your Specialty Services Lending Rock: Credit Considerations for 4...Colleen Beck-Domanico
Make better specialty services lending decisions. This slide deck discusses credit risk considerations for the four most-researched specialty services industries—dental practices, physician practices, HVAC, and new car dealers—on eStatement Studies.
2017 Top Issues - DOL Fiduciary Rule - January 2017PwC
The document discusses the impact of the Department of Labor's Fiduciary Rule on the insurance industry. The rule requires financial advisors to act as fiduciaries, putting clients' interests ahead of their own. This will significantly impact compensation structures and require changes to training, products offered, and data collection. Insurers will need to streamline compensation, rationalize products, enhance agent training on fiduciary responsibilities, and improve data and technology to demonstrate compliance. The rule is spurring widespread changes beyond just compliance, including potential consolidation in the insurance and distribution sectors.
The Pitfalls of Linking Pay With Performance and How To Overcome ThemCBIZ, Inc.
Linking pay with performance can be beneficial for your company, but it could also have dire implications if done improperly. Read on as Ed Rataj explains what could go wrong, and how to overcome the pitfalls of linking pay with performance.
One of the fastest growing concerns on insurers’ enterprise risk agenda is model risk
management. From being a phrase that primarily actuaries and other modelers used, “model risk” has become a major focus of regulators and the subject of intense activity and debate at insurers. How model risk management has evolved from ad hoc efforts to its currentproactive stage is an interesting story. But more interesting still is
what we believe could be its next stage – generating measurable business value.
This document provides an overview of key client due diligence (CDD) challenges facing wealth managers and how new technologies are helping address these issues. It finds that wealth managers are increasing CDD spending, with the majority focusing on hiring more staff or investing in technology. CDD tasks like politically exposed person screening and verifying source of wealth are cited as major pain points. There is significant variation in how frequently firms rescreen clients. New tools are delivering automation, collaboration and auditability to help slash onboarding times and improve processes. The report is based on a survey of over 100 wealth professionals and in-depth interviews with 20 compliance experts. It examines CDD resource needs, pain points, rescreening practices and how technologies are
This document provides an overview of key client due diligence (CDD) challenges facing wealth managers and how new technologies are helping address these issues. It finds that wealth managers estimate it takes an average of 5.4 hours to screen high-risk clients, 2.5 hours for medium-risk, and 1.6 hours for low-risk. The biggest pain points for CDD are politically exposed person/watchlist screening and proving source of wealth/funds. While most firms initially screen clients through relationship managers, almost a third outsource some CDD currently. The document examines variability in rescreening frequencies and risk ratings across different countries/regions. It concludes that new technologies are enabling greater automation, collaboration and auditability to
Claims Management - Edge through Efficiencyneetamundra
The document discusses improving the claims management process for insurance companies in India. It outlines issues with the current process such as high costs and poor customer satisfaction. An efficient claims system would use technology to streamline the process, reduce costs, speed up claims resolution, and improve customer satisfaction through features like automatic adjudication and fraud detection. Selecting a claims management system that meets requirements, is configurable, scalable, and supports standards would help insurance companies process claims more efficiently.
This presentation contains forward-looking statements reflecting the company's expectations involving risks and uncertainties. The document discusses the company's plans, objectives, growth opportunities in their market, and prospects. It notes that actual results could differ from forward-looking statements due to risks and uncertainties. The presentation promotes the company's position as a market leader and discusses opportunities to grow revenue through new customers, products, and geographic expansion.
Insurers are upgrading their technology to support more complex
products, lower operating costs, and get closer to their customers.
But they can do more harm than good when they make changes
that alienate their independent agents. We’ve identified five steps
that can help insurers engage agents early and create a
transition plan that meets agents’ needs—converting these
important stakeholders into enthusiastic advocates.
2015 Patent Litigation Study: A change in patentee fortunesPwC
Intellectual property matters have an indisputable link to competitive advantage. Our 2015 Patent Litigation Study provides a comprehensive analysis from a database of US patent infringement actions, which includes data from 1995 through 2014. The observations and trends identified in our analysis can help executives, legislators, and litigators assess their patent enforcement or defense strategies.
This issue of BIZGrowth Strategies includes articles on Enterprise Risk, Tax Issues of Using Fulfillment by Amazon, Traits to Look for in a Health Insurance Advisor, Summer HR Strategies and Protecting Your Wealth.
Acct 444 ( all weeks 1 5 quizzes and homework assignments ) full coursebestwriter
This document provides the full course materials for DeVry University's ACCT 444 course, including quizzes and homework assignments for weeks 1 through 5. It includes 10 multiple choice questions for the week 1 quiz covering topics like GAAS, auditor responsibilities, auditor independence, and ethics. It also provides quizzes for weeks 2 and 3 covering auditor liability, fraud, audit objectives, audit evidence, audit planning, risk, and materiality. Each quiz contains 10 additional multiple choice questions.
This document discusses how an enterprise data warehouse (EDW) can help healthcare organizations improve their bottom line by better analyzing revenue cycle and value-based purchasing data. An EDW aggregates data from across departments and systems into a centralized location that provides easy access through dashboards. This allows financial teams to more efficiently analyze key metrics in real time and make informed decisions. The document provides examples of metrics available through an EDW and how it can help organizations increase reimbursements, manage denials, improve collections, and meet value-based purchasing criteria.
This document provides an overview of Wateridge Insurance Services' risk management and insurance brokerage program. It details Wateridge's company information, office locations, service team, coverage capabilities across various lines of insurance including property & casualty, workers' compensation, employee benefits, and risk services. It also outlines Wateridge's brokerage services, carriers represented, and workers' compensation programs and services.
Overpayments, audits and reimbursement conundrums 7.7.15Polsinelli PC
This webinar will help health care entities strategize, manage and respond to both internal and external audits through which potential overpayments are found. Presenters will provide examples on how to navigate the resolution of potential overpayments and audits in unique reimbursement contexts. Polsinelli PC
1) Organizations can and should use data to measure the effectiveness of their ethics and compliance programs, just as they use data to measure operational efficiencies. Data-driven assessments provide an objective, fact-based analysis of program effectiveness over time.
2) Compliance officers should work with data experts to identify, collect, and analyze relevant structured and unstructured data from internal and external sources. This includes establishing appropriate metrics and benchmarks to assess compliance programs.
3) Presenting data analyses in a dashboard format allows easy access to meaningful information and demonstrates the organization's commitment to compliance. Dashboards can track metrics related to guidelines like the Federal Sentencing Guidelines.
This presentation will present insights into web user psychology, how to think about and write for the web, how to identify common content mistakes and how writing for the web will improve your search engine rankings.
The document discusses plans for an upcoming book about innovation platforms in maize and cassava production in Africa. It details that workshops were held in Burkina Faso and Gambia where platform actors from 12 countries shared experiences. Six core themes and six countries were selected for focus in the book. The themes are startup of platforms, stakeholder interaction, sustainability, policy pathways, gender inclusion, and knowledge sharing. The countries contributing case studies are Congo, Cameroon, Sierra Leone, Mali, Burkina Faso, and Gambia. The book aims to document lessons learned from the platforms and be published by December 2013.
Between SEO, social media and content marketing, the digital marketing landscape is becoming increasingly complex. Learn how to develop a comprehensive, robust digital strategy and how to develop content topics you users will be interested in.
Imparare la statistica consolidando le competenze in matematica (Caterina Primi)Francesco Cabiddu
Slides quarto intervento giornata 24 Maggio 2013 :
“Una Statistica più consapevole per decisioni migliori.
Giornata di Metodologia e Statistica per le Scienze Umane.”
Mattina (ore 10 – 12:30): Apprendimento del Ragionamento Statistico.
Università degli studi di Cagliari. Dipartimento di Pedagogia, Psicologia e Filosofia.
Università di Cagliari.
TITOLO: “Imparare la statistica consolidando le competenze in matematica (Caterina Primi, Marianna Donati, Francesca Chiesi)”. Università di Firenze
Diretto e montato da Marco Camba
ABSTRACT:
Ricerche recenti (tra gli altri, Budé et al., 2007; Chiesi & Primi, 2010; Dempster & McCorry, 2009) hanno messo a punto alcuni modelli secondo i quali l’apprendimento della statistica è il risultato dell’interazione tra diversi fattori, tra i quali le conoscenze matematiche. Tuttavia scarsa attenzione viene data alle competenze matematiche nei corsi introduttivi data l’opinione condivisa che i concetti matematici utilizzati sono prevalentemente di base, e quindi ritenuti in possesso degli studenti al termine della scuola superiore. Spesso però gli studenti dimostrano di avere un debole background in matematica e di utilizzare certe procedure matematiche in modo meccanico senza capirne il significato (Johnson & Kuennen, 2006; Lunsford & Poplin, 2011). Ad esempio la maggior parte degli studenti sono in grado di calcolare un rapporto ma non sempre sono capaci di interpretarne il significato. Lo scopo di questo lavoro è stato quello di mettere a punto delle attività da svolgere durante il corso di Psicometria volte a rafforzare le competenze matematiche di base. Attraverso un disegno prima- dopo è stato confermato un incremento delle nozioni di tipo matematico durante il corso. Inoltre risulta una relazione positiva tra competenze in matematica e ragionamento statistico. In particolare, competenze di base come sapere fare delle operazioni con frazioni e con numeri decimali risultano essere dei buoni predittori del ragionamento statistico. L’insieme dei risultati porta a concludere che alcune competenze matematiche di base favoriscono l’acquisizione dei concetti della statistica.
Using Northwoods' step-by-step framework, learn how to develop a robust blog that can boost website traffic and increase leads.
Northwoods President and CEO Pat Bieser presented this workshop at the company's (TUG) Titan User Group event on Thursday, June 4.
Alessandra Medda 24 maggio 2013 I prerequisiti matematici per la PsicometriaFrancesco Cabiddu
Slides secondo intervento giornata 24 Maggio 2013 :
"Una Statistica più consapevole per decisioni migliori.
Giornata di Metodologia e Statistica per le Scienze Umane."
TITOLO "I prerequisiti matematici per la psicometria: Primi risultati di uno studio sugli studenti di Cagliari (Alessandra Medda, Eraldo Nicotra e Gianmarco Altoè)"
Università degli studi di Cagliari. Dipartimento di Pedagogia, Psicologia e Filosofia.
InsulaR: un gruppo cagliaritano di utenti di R (Davide Massidda)Francesco Cabiddu
SLIDES Primo intervento giornata 24 Maggio 2013 :
"Una Statistica più consapevole per decisioni migliori.
Giornata di Metodologia e Statistica per le Scienze Umane."
TITOLO "InsulaR: un gruppo cagliaritano di utenti di R (Davide Massidda, Francesco Cabiddu, Gianmarco Altoè)"
Università degli studi di Cagliari. Dipartimento di Pedagogia, Psicologia e Filosofia.
- See more at: http://www.insular.it
Property & Casualty: Deterring Claims Leakage in the Digital AgeCognizant
For property and casualty insurers, the persistent and vexing problem of claims leakage can be effectively curtailed by applying digital technology with cutting-edge clarity.
The document provides 7 strategies for minimizing coding claim denials:
1. Code claims correctly the first time by ensuring coders have proper training in coding and specialty areas.
2. Understand submission requirements of top payers and Medicare as a standard. Improve communication between coding and billing departments.
3. Use triage methodology to identify and prioritize common denial reasons like registration errors or incorrect codes/modifiers for targeted training.
4. Expect some unavoidable denials and work to appeal denials of medical necessity by verifying documentation supports the claim.
5. Maintain strong audit protocols and educate providers to minimize EMR claim errors.
6. Ongoing training, certification, and specialty
The property and casualty insurance industry has seen declining profits in recent years due to lower investment returns and high claims costs. Fraud represents a significant portion of claims costs, estimated at $30 billion annually in the US alone. Predictive analytics can help insurers more efficiently identify fraudulent claims, recover costs through subrogation, optimize staff scheduling, and improve loss reserving. Early adopters of predictive analytics in claims processing are seeing returns of over 100% and improved customer retention compared to companies that have not adopted these techniques.
Navigating Dermatology Billing Common Mistakes and Best PracticesRM Healthcare
Explore the intricacies of dermatology billing in the United States with our comprehensive article, "Navigating Dermatology Billing: Common Mistakes and Best Practices." Dive into the world of dermatology billing services and discover the most prevalent mistakes that can impact your practice's financial health. Learn about the best practices and strategies to avoid these pitfalls, ensuring efficient and compliant dermatology billing processes. Whether you're a dermatologist seeking to enhance your billing practices or interested in the nuances of US medical billing, this article provides valuable insights to help you navigate this complex terrain effectively.
Effective Complaint Management: The Key to a Competitive Edge for Medical Dev...Cognizant
By establishing strong complaint management processes, medical device firms can make continuous improvements in patient safety, regulatory compliance and customer satisfaction.
Compliance in Manufacturing: A Very Personal Affair (2013)Melih ÖZCANLI
This document summarizes key findings from a study on compliance management in the manufacturing industry. It finds that most companies expect to expand their compliance systems and will likely seek external help. It also finds that lower management has a less favorable view of compliance than top management. The document recommends integrating compliance into business processes, allocating appropriate resources, and establishing an independent compliance department that reports directly to the executive board. It identifies anti-corruption, product safety, and data protection as areas of expected growth in compliance incidents and investment. Finally, it outlines A.T. Kearney's compliance framework to help companies build effective compliance systems.
Adam Gobin presented on Emory Healthcare's denial management process. They applied management engineering techniques like DMAIC to streamline denial workflows through hyper-specialization and centralization. Key steps included defining denial categories, measuring trends through reports, analyzing patterns, improving through standardized workflows, and controlling quality. This led to significant improvements such as reduced write-offs, registration denials, and medical record requests as well as increased payments for aged claims. Lessons included planning resources, stakeholder buy-in, and using standardized reporting for accountability.
The Importance of Outsourcing Medical Billing: Streamline Your Practice with ...OmniMD Healthcare
Outsourcing medical billing is a crucial decision that most healthcare providers need to take. It is a personal decision that usually depends upon the staff's experience and expertise. Outsourcing medical billing services allows you to streamline your practice with professional services.
Dependent Verification: What You Don't Know Can Hurt YouHodges-Mace
Regardless of whether an employee’s intent is to defraud their employer, or whether the employee simply does not understand the plan rules, the time to correct an eligibility error is before a major health issue arises.
This document discusses challenges in managing workers' compensation claims and strategies for improvement. It notes that claims often get passed between different units as they progress, with each handoff risking issues. It also notes the dual responsibilities of claims adjusters to accurately reserve financial liability and provide good customer service. While companies once invested heavily in training new claims adjusters, most now take a "processing" approach with little experience. The document argues leadership, creativity, technology, pipeline management, and focusing on outcomes can help address these issues.
This document provides instructions for an assignment for an HMGT 300 course. Students are asked to select one of four scenarios facing an ambulatory surgery center and develop a 10-12 slide PowerPoint presentation addressing the current status, an overview, and recommendations. The scenarios include: maintaining and increasing patient volume; physician recruitment; out of network reimbursement challenges; and doing more with less in a changing reimbursement environment. Students are to discuss how the Affordable Care Act may impact the services and use APA formatting for references. Additional resources on ambulatory surgery centers are provided.
This document discusses how predictive modeling can be integrated into workers' compensation claims handling processes to achieve better outcomes. It explains that early identification of high-risk claims using predictive models is only the first step, and that successful intervention strategies are also required once claims are identified. The document provides an example of how one company has integrated predictive analytics into its claims handling by using models to identify high-risk claims early and developing intervention strategies like drug utilization reviews. It stresses the importance of a feedback loop between claims experts and predictive modeling teams to continuously improve processes.
Denial Management in Medical Billing.pdfalicecarlos1
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Points to keep in mind when looking for an ATE on a multi claimant commercial...Demi Edmunds
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Onesource 5crucialsteps copy
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2. 2
Table of Contents
1. Background......................................................................................................3
2. Top Five Challenges .........................................................................................5
3. Strategies to Alleviate the Pain.........................................................................8
4. Case Studies ....................................................................................................11
5. What to Look for in a Partner............................................................................13
6. About the Sponsor: OneSource.........................................................................14
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<< 1 >> Background
On a daily basis, the experts at OneSource Document Management, Inc., an industry leading
insurance document management and claims request fulfillment company, interact with
No-Fault Claims Directors, Managers, and Supervisors. Our proven ability to investigate
and solve their challenges and provide solutions that meet their highly specialized needs
is what drives our business. Our business is impacted by their need to succeed.
As a service to the industry, OneSource commissioned a study to explore the major challenges
that every Claims Department experiences in claims management. This eBook not only reveals
some startling statistics and trends in the insurance industry, but also uncovers the five
major challenges that every Claims Department faces relative to the successful processing
of subpoenas. For each challenge identified, a strategy is also outlined to help Claims
Departments everywhere thrive within the current environment.
Statistics and Trends
Before revealing these challenges, let’s examine some
fairly troubling statistics and trends in the insurance
claims industry.
1. The industry is growing in volume … and so are
the costs:
• There are 262,540 claims adjusters around the world.
• There were 200,000 no-fault filings in New York during 2009.
• Nearly half of all no-fault claims now result in litigation.
• New York’s Personal Injury Protection (PIP) average claim costs $8,690 per claim.
• The average payout per no-fault auto insurance injury claim has increased more than
55% since 2004.
2. Adjuster time is becoming a diminishing resource. The rising claims and associated costs
can be traced back to a lack of claims efficiency. Only 60% of their time is now spent on
activities that actively assist in bringing a claim to a prompt and reasonable end. These
inefficiencies associated with inefficient processes, inappropriate use of claims resources,
and excessive legal bills, drive costs up in the form of loss adjustment expense.
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3. Losing talent is costing additional money that should not have to be lost. There is a real
fight for talent. Carriers are losing their top adjusters each year and must find ways to keep
this talent on board. Another reason for talent loss is that there is an overall aging among
experienced adjusters. For example, 70% are over the age of 45 and 33 percent are over
the age of 55, which means that many are nearing retirement. Only four percent are under
the age of 35. There is clearly very little new talent joining the ranks. Research from Deloitte
Consulting indicates that there will be a talent shortfall of 84,000 claims adjustors by 2014.
All of these trends taken together are costing the industry. For each worker replaced in the
United States, a company must spend $17,000 on average.
This shortfall is critical because adjusters are considered to be the first line of defense.
They are the means for driving the necessary maximum efficiency into the claim
handling process. But, in order to contend with the shortfall and attract more talent to
the industry, organizations must develop and implement a more effective approach for
processing claims.
With so many startling statistics impacting the industry, the
most of important question is: Why is this happening? Let’s
look at the pain points that are behind the current trends in
the insurance claims industry.
The total losses in leakage are thought to be estimated
at 1% to 4% of Net Written Premium (NWP), which
is the written premium less deductions for
commissions and ceded reinsurance, while
claims indemnity leakage is estimated at
6% to 10% NWP. The inefficiencies are also
adversely impacting customer satisfaction.
What is shocking is that only 43% of customers
who reported that they were not very satisfied said
that they would definitely renew their policies.
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<< 2 >> Top Five Challenges
There are five major pain points that undermine Claims Departments:
1. Rising Number of Claims: Adjustors are under a lot of pressure. They are now assigned
anywhere from 50 to 100 claims a month, and they must close at least 50 or more of
these per month. They must also perform well because the costs of No-Fault cases are
significantly rising and costing companies considerably more than ever before.
2. Lack of Expertise: While there are those adjustors
within every Claims Department that are the definition
of the best adjustor – they’re highly efficient; do not
make inappropriate claim expense payments, and
deliver the highest levels of customer satisfaction
– they cannot handle every claim. Despite having
increasing responsibility, which includes minimizing
settlement amounts, settling quickly, and delivering top-notch service, there are actually
no formal education requirements to be a claims adjuster. A high school degree is the only
passport into this type of job, which means the lack of expertise far outweighs the number
of best adjusters.
3. Mandatory Reporting: New regulations are adding to the pain felt in Claims Departments.
Forexample,theCentersforMedicareandMedicaidServices(CMS)arerequiringsignificantly
more data to be reported. Now, claims that involved no-fault insurance must be reported to
the CMS. There is greater scrutiny on what insurers are doing in terms of claims that involve
Medicare beneficiaries.
This has put pressure on Claims Departments to devise the most effective strategies
related to adding process and technology capabilities to handle this additional mandatory
reporting. Now,the question has become whether to build or buy the technology and process
capabilities. There are clearly time constraints on developing and implementing changes.
There are also cost and efficiency challenges to consider, including long-term process
improvement, assessment and reporting fees, set-up costs and systems maintenance.
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4. Subpoenas and Litigation Fees: There are a number of quantitative ways to illustrate
this pain point. First, 20% to 25% of an insurer’s claims are in litigation, which requires
the use of defense attorneys. The no-fault regulations provide for attorney’s fees of
20% of the claim, which caps out at $850. For preparatory services related to the
arbitration forum or court, the attorney can receive up to $70 per hour or a maximum
of $1,400. These fees cannot be avoided and here’s why.
Subpoenas are legal documents issued by the
court, so they cannot be avoided or refused
without being subject to fines or incarceration.
Insurers are required to defend their
policyholders against lawsuits. Unfortunately,
this has led to some staggering facts and figures about the American tort system. It now
stands as the most expensive civil justice system in the world, costing $260 billion in 2004.
This totals $886 in litigation tax per person, an increase of $41 per person from 2003. And,
the costs keep growing. This results in higher insurance premiums to off-set these costs.
5. Privacy Issues: Subpoenas are often part of the claims process. Processing subpoenas
may include copying or reproducing hundreds, sometimes thousands, of pages of medical
records as well as additional parts of the claims file. All of that information is considered
confidential and protected.
As court cases have tested the parameters of HIPAA, certain outcomes have bout privacy has
created additional challenges for Claims Departments. For example, the release of protected
health information (PHI) must be limited to the minimum necessary to accomplish the intended
purpose of the use. In order for the health care provider to get access to the insurance
company’s file, a special authorization must be signed by the patient, which complies with
HIPAA regulations. A medical provider is only entitled to see that portion of the insurance
company’s file that relates to litigating the issues that are involved in the dispute.
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In summary, the five major challenges result in the following:
• A backlog in claims and lack of quality decisions due to the pressure of contending with
such high volumes;
• Inefficient claims processes related to a lack of expertise among adjusters who are not
required to have any formal education beyond a high school diploma;
• A burden of mandatory reporting requirements, which lead to complicated and costly
decisions about investing in process and technology capabilities;
• Challenges related to strict subpoena requirements; and
• New education requirements for adjusters about how to contend with privacy rules in
relation to releasing PHI in a claimant’s file.
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<< 3 >> Strategies
Based on the aforementioned challenges facing claims departments, there are five crucial
steps that have been identified to successfully process subpoenas for claims files.
Step 1: Logging, Tracking, and Validating the Request
• Create a workflow for receiving requests.
• Define all the elements that determine if the request is valid.This means asking questions
like: Is the claimant identifiable? Is the DOA accurate? Does the authorization meet
compliance guidelines?
• Implement a system for tracking the status of each request.
• Establish standards for validating the request and authorization.
Step 2: Retrieving Claimant Information
• Verify claim number and conduct search in order to determine if the claimant is insured
through the insurance company.
• Locate a claim file by accessing the main system that houses claims information and
identify any secondary record systems.
• Consider the use a platform that can combine paper records with an electronic record.
• Investigate a method to retrieve electronic and/or paper files that are stored on-site or
off-site.
• Develop expertise for identifying the parts of the claims file that is authorized for release,
which requires a complete understanding about what exactly is being requested.
Step 3: Releasing Only Authorized
Information
• Determine if the request can or cannot be
processed.
• Implement a validation process that
verifies all 26 requirements listed on the
Request and Authorization Checklist. This
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includes asking the following questions: Does the date of birth listed on the request
match the one on the file? Did the claimant sign and date the authorization? If the
claimant is deceased, is there the correct paperwork on file, such as a distribute form or
proof of relationship, in order to release the records?
• If the request cannot be processed, immediately notify the requestor and update the
status of the request in your tracking tool.
Step 4: Safeguarding Confidential Information
• Examine and review every page that fulfills the
request for any and all legally protected or misfiled
information.
• Comply with the 15 document types listed on the
Document Release Form, including Arbitration
documents, attorney letterhead, and medical bills.
• Understand the regulations and guidelines laid out
by HIPAA, which are intended to protect the medical
records found within a claims file.
• Communicate updates with the requestor on the
status of the request and update that information in
the tracking tool.
Step 5: Completing the Request
• Select the appropriate documents to be copied or
reproduced.
• Verify the claimants’ identification on all the
documents.
• Compare the copied files with the original request
letter.
• Confirm that the status of the request is updated in
the tracking tool.
• Choose the delivery option, such as mail, UPS or FedEx, CD or electronic transmission.
• Provide customer service throughout the process.
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Results of Incorrectly Processed Subpoena
There are many steps and strategies to be maintained in order to ensure this quality service.
However, what would happen if a subpoena was not processed correctly? Here are some of the
potential outcomes:
• Turnaround time increases dramatically.
• Customer service complaints rise.
• Privacy laws are violated.
• Legalauthoritiesofthecourtsystemcanimposefinesagainstthepartywhoisresponsible
for not complying with the subpoena.
• Policy holders are adversely affected by legal implications.
• Adjusters could jeopardize their jobs.
• Insurance rates increase.
With these in mind, let’s look at a case study of how OneSource was able to help one insurance
company achieve successful results.
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<< 4 >>Case Studies
Consider this case study of an insurance company burdened by these challenges, ultimately
benefitting from a OneSource partnership.
Pain Points
This insurance company has been in business
for several years and currently serves close to
eight million insurers. The company faced a
number of challenges in processing subpoenas
for claims files. That included a decentralized
process at five claims offices. They had a high
volume of subpoena requests, but the current
number of adjusters and support staff could not
handle this volume at a large claims office. The
largest of the claims offices was experiencing
staffing constraints that were due in part to
the increases in volume and stress level that accompanied this volume. For example, more
than 50 percent of the requests consisted of more than five hundred pages that needed to be
photocopied by adjustors and support staff.
Although the insurance company had previously hired a service to try and help with copying the
medical records, this did not address the bigger issues they were facing. Since their records
were in an hybrid system, parts of the claim files were located on an electronic system, which
required printing. All of this resulted in a lot of time and resource utilization that was costing the
insurance company a significant amount of money. More importantly, processing subpoenas
for claims files was not part of the carrier’s core business and did not add value to their
customer base like other services they provided.
The OneSource Solution
This insurance company was desperate to find a solution. They needed one fast and decided
to partner with OneSource. There were some attractive features to this partnership. First,
OneSource could centralize the process from one location. Second, OneSource hired well-
educated and experienced specialists to handle all functions and responsibilities related to
processing subpoenas and medical authorizations.
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Third, OneSource installed high-speed scanning technology as well as supplied innovative
tracking and bridging software. Finally, OneSource proved that they could process more than
200 requests of more than 65,000 pages per month for this insurance company.
The Results
This carrier concluded that they had found the right partnership in OneSource that fit their
needs. They no longer had to worry about having enough trained staff to process requests.
They were able to eliminate unnecessary printing of electronic documents as well as relying
on dated photocopying technology to reproduce thousands of pages. Now, this insurance
company is able to refocus their resources on their core business.
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<< 5 >> What to Look for in a Partner
This case study helps illustrate what to look for when searching for a partner to handle
subpoenas for claims files.
What to Ask?
Start your search by asking some critical questions:
• How many clients are you currently servicing?
• How many of these clients renew their contracts each year?
• What are the qualifications of the specialists you have
on staff?
• Is there open communication with upper management?
• How can you determine how many employees you will need to handle a sudden change
in volume?
• How do you handle customer service calls?
• Has your company ever committed a privacy breach?
• Do you feel like you spend any time at all on your core business or you are trying to
handle the pain points listed in this eBook?
Qualities to Look for in a Partner
When you are searching for a partner who can help you answer these
questions and provide a solution for your subpoena processing of your
claims files, consider checking for these admirable partnership qualities:
• Detailed implementation plan.
• Proven training program and tools.
• Robust tracking system.
• Continuous and open ommunication with management.
• Streamlined and documented processes and workflows.
• Detailed plans for equipment downtime and backup system.
• Strategies for changes in volume and unexpected absences.
• Disaster recovery and business continuity plan.
• Established set of best practices.
• Demonstrated industry expertise
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<< 6 >> About the Sponsor: OneSource
OneSource is a proven industry leader with more than 17 years of experience. Our team provides
exceptional service to more than 60 clients. We are dedicated to claims request processing and
leverage the best business practices to deliver a measurable impact on clients and exceed
their goals and expectations.
The OneSource Advantage
There are a number of advantages to working with OneSource:
• Our clients trust us. The result: Over 98% of them renew their contracts annually.
• We want our clients to succeed. The result: We reduce more than 95% of the customer
service calls they receive about
requests by handling them from our
main office.
• We care about our clients. The result:
100% of them get customized,
documented operational business
practices for their department.
• Our clients rely on us. The result:
100% of our staff is HIPAA trained.
What Our Clients Say
“Our department sees a high volume of requests and, knowing OneSource has reliable and
experienced staff, I am assured these requests are processed timely. Having the Customer
Service department at OneSource resolve any concerns relieves our staff from being burdened
by this task.”
“As an automobile TPA in the assigned risk business, we are a high volume company with strict
New York State Regulatory guidelines to follow and we depend heavily on OneSource’s services.
Their staff is professional, courteous, and easy to work with. They are always looking to make
things more efficient and are compliant with all of our policies.”