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Retrospective review: the good, the bad, and the ugly. 2006

Kirk A Abbott, and Jennifer Keller
DAXPY LLC, Houston, USA. kabbott@daxpy.com

A rigorous retrospective review of a hospital's managed care contracts should include: Contract modeling. Revenue calculation. Reporting. Follow-up.

UI MeSH Term Description Entries
D008329 Managed Care Programs Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS. Case Management, Insurance,Insurance Case Management,Managed Health Care Insurance Plans,Managed Care,Care, Managed,Managed Care Program,Management, Insurance Case,Program, Managed Care,Programs, Managed Care
D005375 Financial Audit An examination, review and verification of all financial accounts. Audit, Financial,Audits, Financial,Financial Audits
D005377 Financial Management, Hospital The obtaining and management of funds for hospital needs and responsibility for fiscal affairs. Hospital Financial Management,Hospital Financial Managements,Financial Managements, Hospital,Management, Hospital Financial,Managements, Hospital Financial
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D014481 United States A country in NORTH AMERICA between CANADA and MEXICO.
D032982 Contracts Agreements between two or more parties, especially those that are written and enforceable by law (American Heritage Dictionary of the English Language, 4th ed). It is sometimes used to characterize the nature of the professional-patient relationship. Contract

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