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Full-Text Articles in Law
Hurricanes, Fraud, And Insurance: The Supreme Court Weighs In On, But Does Not Wade Into, The Concurrent Causation Conundrum In State Farm Fire And Casualty Company V. Rigsby, Chris French
Christopher C. French
In the December 6, 2016 Supreme Court decision, State Farm v. Rigsby, a homeowner’s house was damaged by Hurricane Katrina. The homeowner had homeowners insurance with State Farm and a flood insurance policy that was administered by State Farm on behalf of the federal government. The claims adjusters assigned by State Farm to handle the homeowner’s claim allegedly were instructed by State Farm to misclassify wind damage as flood damage in order to shift State Farm’s own liability for the loss to the federal government. The claims handlers filed a lawsuit against State Farm under the False Claims Act (FCA), …
Revenue-Cycle Management And Reimbursement: The Impact Of Health Law And Health Reform On Providers, Timothy D. Martin
Revenue-Cycle Management And Reimbursement: The Impact Of Health Law And Health Reform On Providers, Timothy D. Martin
Timothy D Martin
Healthcare payment systems are complex and difficult to administer. Over the years, providers have developed a complex process, called revenue-cycle management, for administering their interactions with payers operating under various payment systems. The Patient Protection and Affordable Care Act of 2010 will have a significant impact on payment systems—as will other recent reform measures. This paper contains primers on revenue-cycle management, health insurance systems, medical claims, claim coding, electronic-data interchange (EDI), claims processing, and public and private reimbursement methods for hospitals and physicians. But its focus is on the impact recent healthcare reform initiatives have had and are likely to …