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Spiro Nikolouzos case: United States Texas: 2005 A family wishes to keep life support for a man in a persistent vegetative state. David Vetter: United States Texas: 1984 A boy dies at age 12 after living a lifetime with highly unusual medical care in a sterile environment. Jahi McMath case: United States California: 2013
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Artificial intelligence in healthcare is the application of artificial intelligence (AI) to analyze and understand complex medical and healthcare data. In some cases, it can exceed or augment human capabilities by providing better or faster ways to diagnose, treat, or prevent disease.
Case managers working for health care providers typically do the following: Verify coverage & benefits with the health insurers to ensure the provider is appropriately paid; Coordinate the services associated with discharge or return home; Provide patient education; Provide post-care follow-up; and; Coordinate services with other health care ...
Health information technology (HIT) is "the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making." [43] Health information technology components:
It provides a means for one healthcare practitioner, system, or setting to aggregate all of the pertinent data about a patient and forward it to another practitioner, system, or setting to support the continuity of care. Its primary use case is to provide a snapshot in time containing the pertinent clinical, demographic, and administrative data ...
The Andersen healthcare utilization model is a conceptual model aimed at demonstrating the factors that lead to the use of health services. According to the model, the usage of health services (including inpatient care, physician visits, dental care etc.) is determined by three dynamics: predisposing factors, enabling factors, and need.
The FBI estimates that Health Care Fraud costs American tax payers $80 billion a year. [2] Of this amount $2.5 billion was recovered through False Claims Act cases in FY 2010. Most of these cases were filed under qui tam provisions. Over the course of FY 2010, whistleblowers were paid a total of $307,620,401.00 for their part in bringing the ...