The West Virginia Health Improvement Institute has launched its website that provides an overview of the efforts to improve the health care system in West Virginia.

The mission of the Institute is to assist with the execution of the strategies outlined in the Transformation Grants awarded by the Centers for Medicare and Medicaid. One main focus is on migrating primary care in West Virginia to the medical home model. The “About WVHII” has more about the Institute - what it is? why it’s needed? its structure? etc.

As a part of the project I am chairing one of the four workgroups, the work group on the Adoption of Health Information Technology. The other work groups are:

• Measurement/Reporting/Reimbursement
• Provider Outreach and Education
• Self Management

The Adoption of Health Information Technology work group’s efforts will be focused on understanding what health information technology is currently being used successfully by providers in West Virginia. We will be looking at opportunities to innovate and participate in projects that help to accelerate the adoption of technology, including that which supports the medical home model.

For more information on our work group and the other three work groups - check out the Workgroups section.

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 For example an unheard of medical loss ratio of 91 percent, means that 91 cents out of every dollar goes to practitioners and providers. This never happens, of course.   Most medical loss ratios are in the neighborhood of 80 - 81 percent. The mission of the U.S.  insurance industry is to keep this ratio as low as possible.  The way they do this is with companies like  TC3 Total Claims Capture and Control which I'm going to introduce you to today.  When the medical loss ratio creeps up, the for-profit insurer turns to TC3 to bring it down.

Let's take a look at this denial machine called TC3.

I've selected this company for some well-deserved scrutiny, but you should understand, there are tons of companies just like this one.These companies sell insurers computer programs and claims management protocols designed to reject as many legitimate claims as possible.  Also keep in mind, that for many, once a claim is rejected, the process of an appeal is so daunting and overwhelming, that many of these claims go unpaid.  This is part of the scandalous business model of the insurance industry.

The regulators have disappeared so I defy you, as an individual, to take on the TC3 Funnel once they have "targeted" you and your doctor for a denial. And make no mistake, TC3 brags to its customer base that "targeting" is how they achieve savings.

Utilizing our proprietary claims management system, the TC³ Funnel, we target $250 billion in healthcare claims overpayments to validate payment integrity and maximize cost savings for our clients. TC³ enables our payer clients to take advantage of multiple state-of-the-art loss control technologies through a single connectivity source to prevent paid claims errors on a pre-payment basis, reducing paid claims by 3-10% annually.

Your doctor is the first person TC3 targets. Your doctor is viewed by this company as essentially a criminal lacking integrity who submits an endless stream of fraudulent claims. This is how  TC3 sells its Provider Integrity Program.

Fraudulent healthcare claims generate a large portion of more than $250 billion in healthcare overpayments. TC³ provides healthcare payers with a highly effective system for healthcare fraud detection .

. . .TC³’s Provider Integrity Program (“PIP”) is a comprehensive provider data analysis and modeling application designed to review healthcare claims that may represent questionable or abusive billing practices. Historically, PIP has provided savings in healthcare fraud detection in the range of 1% - 3% of total claims dollars which are in addition to any identified by internal systems or procedures.

To help detect healthcare fraud PIP examines and flags potential claims daily prior to payment. The review process identifies claims and providers processed by a payer’s system and compares each claim against proprietary databases that are updated daily from ongoing investigations.

If you want to know why your doctor will no longer accept your insurance it's because of companies like TC3. If TC3  "flags" your doctor, then her claims will be subject to endless audits and denials.

The software identifies patterns of unusual behavior and provides a risk score based on the claim's degree or probability of fraud. The scores allow TC³’s seasoned team of fraud investigators to determine which claims need to be taken out of the payment stream for further investigation, and allow the rest of the claims to be fast-tracked for payment.  

And a customer testimonial: TC3 is their "secret weapon".  Are you interested in how the TC3 repricing software works? 

The ODS Companies is committed to providing the highest value products supported by the best possible service.  On October 20, 2003 the ODS Companies entered into a partnership with TC³ Health to assist us in implementing a total claims solution focusing on healthcare costs and customer service.  Strategically, we focused on the areas we felt we could save our customers (both groups and members) money. 

With the assistance of TC³ Health and their suite of products, we have differentiated ourselves from the competition.   We are saving our customers money through TC³'s out of network repricing services, enhanced clinical editing services and the provider integrity program.

The individuals we have worked with from TC³ have been extremely knowledgeable and service oriented.   They are a pleasure to work with.  We value our partnership with TC³ and look forward to a long lasting relationship. 

TC³ is our top-secret weapon against fighting the on-going rising cost of healthcare.  

Vice President, Medical Claims and Customer Service
The ODS Companies  

TC3 offers another chilling service, this one revolving around the USA PATRIOT ACT. Does this mean if your doctor treats an undocumented alien who happens to be insured, and then he submits a claim, he'll be reported to Homeland Security?  Again, I ask, why would any doctor want to be in the database of such a company?  This is why more and more doctors are refusing to accept insurance, making healthcare even less accessible.

 Specially Designated Nationals and Blocked Persons (SDNs) that prohibits US underwriters, brokers, agents, primary insurers, reinsurers and US citizen employees of foreign firms in the insurance industry of making or receiving or any contribution of funds, goods or services for the benefit of persons designated as SDNs. Payers are required to screen provider and member data against the SDN master list and to notify OFAC of a match or block the assets. OFACsecure(SM) is an automated screening tool that utilizes TC3's proprietary technology and alerts the compliance office of potential regulatory requirements. OFAC regulations are promulgated under federal law and Presidential Declarations and thereby preempt state insurance regulations.

I urge you to familiarize yourself with this company so you'll understand the full dimension of what you and I are up against.

We are in this fight alone, battling massive denial machines. There are no regulators, and the political class, save for a few like Rocky Delgadillo, the Los Angeles City Attorney,  have turned a blind eye.

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Author:
David Collins

Article:
Everybody has a favourite automobile. Whether it’s something
you’ve seen in the movies, a vehicle you remember from your
past or a newer, sportier model you see in showrooms across the
country.

For those who have the time and money to invest in their
passion, restoring an old classic car to its former glory can be
a very rewarding experience.

Indeed, there is no shortage of enthusiasts clubs across the
country, with a wide range of vehicles - from cars from the
forties to the souped-up sports cars of today - who organise
meetings and show off their vehicles at events dedicated to
celebrating them.

When it comes to finding the vehicle itself, the internet has
seemingly replaced the local advertisement pages, allowing
enthusiasts and owners alike to buy and sell vehicles and spare
parts between themselves - both at home and abroad - and
discover those little gems and much sought after parts for
completing their projects.

Owning such a specialised vehicle can sometimes lead to problems
with finding cheap car insurance. However there are a range of companies that
specialised in catering to the tastes of those with performance
vehicles and older cars.

For those who like to take their vehicles to show at meets and
enter into competitions, insurance
is an essential part of owning a classic vehicle.

Having some cover to protect your prized vehicle against damage
on the way to, and during shows and organise drives is
essential, for you don’t want all that hard work and money
wasted in one incident.

Whilst there are a number of individual companies that
specialised in cover for older and performance cars it can be
worth checking the reputation of the company you want to go
with, for there can be nothing worse than having to make a claim
- only to find out you cannot recover any costs back from them.

Shopping around for the best deal on classic car insurance
is recommended for those who are looking to partake in
restoration projects.

About the author:
David is an experienced writer based in the UK, currently
working in the dotcom industry

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43 years ago today, Medicare became the law of the land.  And since that day, millions and millions of seniors and disabled Americans have received high-quality healthcare without the for-profit overhead and waste.

Today, 91 Congressional representatives are co-sponsors of HR676, a single payer healthcare bill, which would create Medicare-like coverage for all Americans. It would provide public funding of privately delivered healthcare and free every American to choose his or her own doctors and caregivers rather be bound by insurance company choices.

It's an affordable and ethical way to bring healthcare to all.  Call your Congressional rep today.  And do not worry if the call is placed tomorrow or the next day.  It still matters. Take action. 

And let's bring real healthcare to all.

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I know I have written about this before, but it comes up fairly frequently in my practice. What is comprehensive? What is collision? Can my rates go up for filing one of these claims? So, lets start with the basics….
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Author:

Andrena Markley

Article:
The car insurance scheme have various options for car owners.
There are several car insurance policies that enable people to
remain on the safe side. In case vehicles run through an
accident the owners are safeguarded by these policies.

The car is undoubtedly a valuable possession. It is necessary to
protect one’s car from any mishap. The car insurance schemes
make it possible for people to protect their much treasured car
that people sometimes bring after a lifetime’s investment. The
insurance related to cars is of several types. They vary in
forms such as bodily injury liability, personal injury
protection, property damage liability, collision and
comprehensive coverage.

The insurance schemes give a sense of reliability to car owners
who can approach insurance
companies in case they meet with an accident. The car
companies offer insurance schemes while selling a car. These
schemes are cheap and so customer get the confidence to buy
costly cars. It leaves no option for bearing any losses if in
case the car runs to meet with an accident. The whole system is
very innovative and it takes into consideration the long term
benefits of car insurance.

The car insurance schemes have bodily injury reliability and
are applicable to the policyholder. They cover the damages that
are caused to other cars. The second category of insurance is
the Personal Injury Protection. This scheme makes it possible
for policy holders to claim for the medical expenses of a driver
or the passenger who face an accident. It covers expenditures
such as hospital bills, X-rays and cost of surgery. The third
type is the Property damage liability. It helps to protect the
policy holder if one damages some one else’s car. However, the
mode of accident also determines the policy that it attracts. If
one undergoes collision then the user can claim for collision
coverage. Then there is also the comprehensive coverage policy.
Such coverage allows the policy holder to ask for comprehensive
coverage from insurance companies in the form of natural
calamity, hail, fire, tornado, floods and so on.

With many options in hand, it becomes safe to drive cars on
road. The user can make use of insurance
policies and be confident about driving without the fear of
an accident. These unavoidable policies make one feel more
secured about cars.

About the author:
Andrena Markley is the webmaster of
rupizcompare.co.uk/insurance. Get latest information on
>Car insurance and home insurance. Apply for free insurance
quotes.

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Are you creative, looking for a place to be creative or have a need to find others who create?

Come experience all that West Virginia has to offer. For a taste of the creative community plan to attend the Create West Virginia Conference 2008. More on Create WV.

Watch the instructional/art video of creating Create WV Conference by KD Lett.

Create West Virginia Conference 2008
October 20-22, 2008
Snowshoe Mountain Resort
Snowshoe, WV
Register Here

What is the focus of the conference?

West Virginia is in a state of creation! Communities in every pocket of West Virginia are embracing new opportunities brought about by the New Economy.

Hear how communities just like yours are attracting young entrepreneurs, artists, scientists, technologists and others who are adding quality and growth to our state. Learn how improving your community’s quality of place, access to and adoption of technology, embracing tolerance and diversity for new people and ideas, and innovative education and talent development are opening new opportunities for everyone in West Virginia!

Check out the full agenda, speakers, etc. here. More on Create WV via Create WV Facebook Group.

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Ryan Brown, a health care attorney at Flaherty, Sensabaugh & Bonasso, PLLC who I regularly work with recently put together information on the use of arbitration agreements in the health care setting. More and more these types of agreements are being used as a way to avoid unnecessary litigation and provide an alternative venue to resolve health care conflicts between provider and patient.

Following are some excerpts about the topic from Ryan:

As many health care providers know all too well, disputes can often arise between a patient and a health care provider. Many times, the dispute can result in litigation in which a jury will be given the ultimate responsibility of resolving the conflict. However, courts are not the only venue for resolving these conflicts. An ever increasing number of health care providers, especially long-term care facilities, are looking at arbitration as an alternative to the traditional litigation system.

Health care providers in favor of arbitrating disputes point to benefits such as the ability to select an arbitrator who is an expert in the appropriate field, the ability to keep the dispute private, reduced time frame for resolving disputes, and the finality of the decision. Arbitration advocates also point out that arbitration is less expensive than the traditional litigation system.

Over the last decade, many state courts have upheld arbitration agreements that were signed prior to the patient receiving treatment by a physician, hospital, or nursing home. Additionally, courts have held that these arbitration agreements are enforceable not only to the patient, but also any potential beneficiaries of the patient’s estate.

In order to maintain the enforceability of arbitration agreements, a health care provider should strictly comply with the Federal Arbitration Act, state arbitration statutes, and state contract law. Additionally, health care providers should be mindful to carefully draft arbitration agreements and establish proper procedures for presenting arbitration agreements to patients so that courts do not determine the arbitration agreements to be unenforceable.

Ryan A. Brown concentrates his practice on providing legal counsel to a variety of health care providers in medical professional liability actions. Mr. Brown’s experience in medical malpractice cases includes defending nursing homes, hospitals, physicians, and nurses in all phases of litigation. Apart from his health care litigation practice, Mr. Brown provides legal counsel to health care providers and corporations involved in acquisitions and joint ventures.

Contact Ryan if you are interesting in learning more about the use of arbitration in the health care setting and how to include arbitration provisions and protections in your health care agreements.

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Images, photos and news articles of car accidents, crashes…..

Warning!
Some Images may be gruesome or offensive

>> More Car Crash Images

car crash images, car crash photos, car crashes, car insurance
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Here's another McSame healthcare curveball, all in a one minute. This is scary stuff.

 "Allow cooperation among states in the purchase of insurance".  This is code speak for the infamous and despicable Enzi Bill, which the Republicans deceptively named the Health Insurance Marketplace Modernization and Affordability Act of 2005 and had it become law (God forbid),  would have thrown even the most modest state health insurance consumer protection laws out the window.

In 2006, Mr. Bush and the U.S. House tried to pass legislation to allow associations to offer health coverage to their small-business members.

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