October 2017

Our e-newsletter for Enterprise Risk Management, Claim Settlement and Healthcare Solutions.

Enterprise Risk Management (ERM): 

The Ostrich in the Room – Data Avoidance

Have you ever been confronted with information that you would rather not believe because it changes your view of career-long held “truths”?  Risk and claim managers naturally cling to their tools and methods for reserving and settling claims.  But what if data driven technology changes the calculus and potential outcomes?  Read more >>

Claim Settlement, Medicare, and Medicare Set Asides:

CIGA Win Assists Medicare Reimbursement Negotiations

In January of this year, the U.S. District Court for the Central District of California provided relief to the California Insurance Guarantee Association (CIGA) from Medicare demands that CIGA pay full invoices of provider charges, regardless of applicability to the referenced case.  Read more >>

Healthcare:

Medicare Beneficiaries With Diabetes Face Challenges

A new study from the Centers for Medicare & Medicaid Services (CMS) using data from the 2013 Medicare Current Beneficiary Survey (MCBS) reports significant insights and challenges for diabetes patients.  This report presents prevalence and access to care patterns of persons with type 1 and type 2 diabetes among Medicare beneficiaries aged 65 years and over.   Read more >>

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