Download or read book Healthcare Risk Adjustment and Predictive Modeling written by Ian G. Duncan and published by ACTEX Publications. This book was released on 2011 with total page 350 pages. Available in PDF, EPUB and Kindle. Book excerpt: This text is listed on the Course of Reading for SOA Fellowship study in the Group & Health specialty track. Healthcare Risk Adjustment and Predictive Modeling provides a comprehensive guide to healthcare actuaries and other professionals interested in healthcare data analytics, risk adjustment and predictive modeling. The book first introduces the topic with discussions of health risk, available data, clinical identification algorithms for diagnostic grouping and the use of grouper models. The second part of the book presents the concept of data mining and some of the common approaches used by modelers. The third and final section covers a number of predictive modeling and risk adjustment case-studies, with examples from Medicaid, Medicare, disability, depression diagnosis and provider reimbursement, as well as the use of predictive modeling and risk adjustment outside the U.S. For readers who wish to experiment with their own models, the book also provides access to a test dataset.

Download or read book Risk Adjustment Risk Sharing and Premium Regulation in Health Insurance Markets written by Thomas G McGuire and published by Academic Press. This book was released on 2018-08-10 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice describes the goals, design and evaluation of health plan payment systems. Part I contains 5 chapters discussing the role of health plan payment in regulated health insurance markets, key aspects of payment design (i.e. risk adjustment, risk sharing and premium regulation), and evaluation methods using administrative data on medical spending. Part II contains 14 chapters describing the health plan payment system in 14 countries and sectors around the world, including Australia, Belgium, Chile, China, Columbia, Germany, Ireland, Israel, the Netherlands, Russia, Switzerland and the United States. Authors discuss the evolution of these payment schemes, along with ongoing reforms and key lessons on the design of health plan payment.

Download or read book Event and Data Centric Enterprise Risk Adjusted Return Management written by Kannan Subramanian R and published by Apress. This book was released on 2022-01-06 with total page 1090 pages. Available in PDF, EPUB and Kindle. Book excerpt: Take a holistic view of enterprise risk-adjusted return management in banking. This book recommends that a bank transform its siloed operating model into an agile enterprise model. It offers an event-driven, process-based, data-centric approach to help banks plan and implement an enterprise risk-adjusted return model (ERRM), keeping the focus on business events, processes, and a loosely coupled enterprise service architecture. Most banks suffer from a lack of good quality data for risk-adjusted return management. This book provides an enterprise data management methodology that improves data quality by defining and using data ontology and taxonomy. It extends the data narrative with an explanation of the characteristics of risk data, the usage of machine learning, and provides an enterprise knowledge management methodology for risk-return optimization. The book provides numerous examples for process automation, data analytics, event management, knowledge management, and improvements to risk quantification. The book provides guidance on the underlying knowledge areas of banking, enterprise risk management, enterprise architecture, technology, event management, processes, and data science. The first part of the book explains the current state of banking architecture and its limitations. After defining a target model, it explains an approach to determine the "gap" and the second part of the book guides banks on how to implement the enterprise risk-adjusted return model. What You Will Learn Know what causes siloed architecture, and its impact Implement an enterprise risk-adjusted return model (ERRM) Choose enterprise architecture and technology Define a reference enterprise architecture Understand enterprise data management methodology Define and use an enterprise data ontology and taxonomy Create a multi-dimensional enterprise risk data model Understand the relevance of event-driven architecture from business generation and risk management perspectives Implement advanced analytics and knowledge management capabilities Who This Book Is For The global banking community, including: senior management of a bank, such as the Chief Risk Officer, Head of Treasury/Corporate Banking/Retail Banking, Chief Data Officer, and Chief Technology Officer. It is also relevant for banking software vendors, banking consultants, auditors, risk management consultants, banking supervisors, and government finance professionals.

Download or read book Risk Adjustment Documentation and Coding written by Sheri Poe Bernard and published by American Medical Association Press. This book was released on 2020-03-02 with total page 500 pages. Available in PDF, EPUB and Kindle. Book excerpt: Risk-adjustment practices consider chronic diseases as predictors of future health care needs and expenses. Correct and detailed documentation and compliant diagnosis coding are critical for proper risk adjustment. Risk Adjustment Documentation & Coding, 2nd Edition provides: Risk-adjustment parameters to improve documentation related to severity of illness and chronic diseases. Code abstraction guidelines and recommendations to improve diagnostic coding accuracy without causing financial harm to the practice or health facility. Chronic disease ICD-10-CM coding summaries for quick reference and study. The impact of risk-adjustment coding (hierarchical condition category (HCC) coding) on a practice should not be underestimated: More than 75 million Americans are enrolled in risk-adjusted insurance plans. This population represents more than 20% of those insured in the United States. Insurance risk pools under the Affordable Care Act include risk adjustment. CMS has proposed expanding audits on risk-adjustment coding. FEATURES AND BENEFITS Five chapters delivering an overview of risk adjustment, common administrative errors, best practices, and guidance for development of internal risk-adjustment coding policies. Ten chronic disease ICD-10-CM coding summaries for quick reference and study. Two appendices offering mappings and tabular information of ICD-10-CM codes that risk-adjust to HCCs and RxHCCs. Learning and design features: Vocabulary terms highlighted within the text and defined at the bottom of the page. "Advice/Alert Notes" that highlight important coding and documentation advice from federal regulatory sources. "Sidebars" that provide derivative story and additional information, such as "Coding Tips" that guide coders with practical advice from sources like AHA's Coding Clinic and cautionary notes about conflicts and exceptions "Clinical Examples" that underscore key documentation issues for risk adjustment "Clinical Coding Examples" that provide snippets or full encounter notes and codes to illustrate risk-adjustment coding and documentation concepts "Documentation tips" that highlight recommendations to physicians regarding what should be included in the medical record or how ICD-10-CM may classify specific terms "Examples" that explain difficult concepts and promote understanding of those concepts as they relate to a section "FYI" call outs that provide quick facts "Abstract & Code It!" exercises that test diagnosis abstraction and coding skills (exclusive to Chapter 4) Extensive end-of-chapter "Evaluate Your Understanding" sections that include multiple-choice questions, true-or false questions, audit and Internet-based exercises. Two downloadable course tests and slide presentations for each chapter. Exclusive content for academic educators: A test bank containing 100 questions and a mock risk-adjustment certification exam with 150 questions.

Download or read book Handbook of Industrial and Systems Engineering Second Edition written by Adedeji B. Badiru and published by CRC Press. This book was released on 2013-10-11 with total page 1480 pages. Available in PDF, EPUB and Kindle. Book excerpt: A new edition of a bestselling industrial and systems engineering reference, Handbook of Industrial and Systems Engineering, Second Edition provides students, researchers, and practitioners with easy access to a wide range of industrial engineering tools and techniques in a concise format. This edition expands the breadth and depth of coverage, emphasizing new systems engineering tools, techniques, and models. See What’s New in the Second Edition: Section covering safety, reliability, and quality Section on operations research, queuing, logistics, and scheduling Expanded appendix to include conversion factors and engineering, systems, and statistical formulae Topics such as control charts, engineering economy, health operational efficiency, healthcare systems, human systems integration, Lean systems, logistics transportation, manufacturing systems, material handling systems, process view of work, and Six Sigma techniques The premise of the handbook remains: to expand the breadth and depth of coverage beyond the traditional handbooks on industrial engineering. The book begins with a general introduction with specific reference to the origin of industrial engineering and the ties to the Industrial Revolution. It covers the fundamentals of industrial engineering and the fundamentals of systems engineering. Building on this foundation, it presents chapters on manufacturing, production systems, and ergonomics, then goes on to discuss economic and financial analysis, management, information engineering, and decision making. Two new sections examine safety, reliability, quality, operations research, queuing, logistics, and scheduling. The book provides an updated collation of the body of knowledge of industrial and systems engineering. The handbook has been substantively expanded from the 36 seminal chapters in the first edition to 56 landmark chapters in the second edition. In addition to the 20 new chapters, 11 of the chapters in the first edition have been updated with new materials. Filling the gap that exists between the traditional and modern practice of industrial and systems engineering, the handbook provides a one-stop resource for teaching, research, and practice.

Download or read book Active Projects Report written by and published by . This book was released on 2000 with total page 232 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Risk Adjustment Coding and Hcc Guide 2019 written by and published by Optum 360. This book was released on 2018-08-22 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The Risk Adjustment Coding and HCC Guide brings together hard-to-find information about risk adjustment (RA) coding and hierarchical condition categories (HCCs) in a new comprehensive resource that explains this complex reimbursement methodology. Now your organization will have a guide that provides both the big picture and the fine detail needed to document, code, and report essential information so that accurate risk levels are assigned and appropriate reimbursement received.

Download or read book Statistical Procedures for the Medical Device Industry written by Wayne A. Taylor and published by . This book was released on 2017 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Essentials of Managed Health Care written by Peter Reid Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2003 with total page 918 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Risk Management written by Satyajit Das and published by John Wiley & Sons. This book was released on 2005-10-14 with total page 1348 pages. Available in PDF, EPUB and Kindle. Book excerpt: Risk Management consists of 8 Parts and 18 Chapters covering risk management, market risk methodologies (including VAR and stress testing), credit risk in derivative transactions, other derivatives trading risks (liquidity risk, model risk and operational risk), organizational aspects of risk management and operational aspects of derivative trading. The volume also covers documentation/legal aspects of derivative transactions (including ISDA documentary framework), accounting treatment (including FASB 133 and IAS 39 issues), taxation aspects and regulatory aspects of derivative trading affecting banks and securities dealers (including the Basel framework for capital to be held against credit and market risk).

Download or read book Trading Systems 2nd Edition written by Urban Jaekle and published by Harriman House Limited. This book was released on 2019-12-17 with total page 410 pages. Available in PDF, EPUB and Kindle. Book excerpt: Completely revised and updated second edition, with new AmiBroker codes and new complete portfolio tests Every day, there are traders who make a fortune. It may seem that it seldom happens, but it does – as William Eckhardt, Ed Seykota, Jim Simons, and many others remind us. You can join them by using systems to manage your trading. This book explains how you can build a winning trading system. It is an insight into what a trader should know and do in order to achieve success in the markets, and it will show you why you don't need to be a rocket scientist to become successful. It shows how to adapt existing codes to the current market conditions, how to build a portfolio, and how to know when the moment has come to stop one system and use another one. There are three main parts to Trading Systems. Part One is a short, practical guide to trading systems development and evaluation. It condenses the authors' years of experience into a number of practical tips. It also forms the theoretical basis for Part Two, in which readers will find a step-by-step development process for building a trading system, covering everything from writing initial code to walk-forward analysis and money management. Two examples are provided, including a new beginning of the month trading system that works on over 20 different stock indices worldwide – from the US, to Europe, to Asian indices. Part Three shows you how to build portfolios in two different ways. The first method is to combine a number of different trading systems, for a number of different markets, into an effective portfolio of systems. The second method is a new approach to system development: it provides step-by-step instructions to trade a portfolio of hundreds of stocks using a Bollinger Band trading strategy. A trader can never really say they were successful, but only that they survived to trade another day; the black swan is always just around the corner. Trading Systems will help you find your way through the uncharted waters of systematic trading and show you what it takes to be among those that survive.

Download or read book FINANCIAL MARKETS FINANCIAL INSTITUTIONS AND FINANCIAL SERVICES SECOND EDITION written by GOEL, SANDEEP and published by PHI Learning Pvt. Ltd.. This book was released on 2023-06-12 with total page 602 pages. Available in PDF, EPUB and Kindle. Book excerpt: Financial system is the backbone of any economy. During the last few years, India, with its strong financial system, has emerged as one of the fastest growing economies in the world. Today, with the financial sector experiencing an unprecedented boom due to increasing globalisation, the subject of this book has become more important than ever before. In view of the inevitable importance of financial system globally and in India, the present book provides an up-to-date overview of the Indian financial system and an elaborative discussion on its three inter-woven wings of financial markets, institutions and services. Supported by various teaching aids including cases, projects, objectives and review questions, this is a complete book on the subject which covers conventional as well as contemporary topics, besides cultivating a clear understanding of the basic concepts and practices of the constituents of financial system. Primarily designed for postgraduate and undergraduate students of management and allied disciplines of commerce, finance and economics, it is equally useful to the business managers and corporate leaders who would like to be well versed with the basic concepts and mechanism of financial system for achieving professional and personal growth. KEY FEATURES • Covers, in-depth, three constituents and entire gamut of the Financial System in India—financial markets, financial institutions and financial services. • Comprehends the financial instruments and financial innovations that are taking place in the financial markets, such as barter exchange, plastic money, venture capital, credit rating, and more. • Thoroughly updated with current concepts, corporate practices, recent trends, and current data on the subject. • Provides illustrations, case studies, tables, figures for a vivid visual impact and related concepts to real life situations, and presenting complex topics into pleasurable reading and learning experience. • Comprises graded pedagogy—MCQs with solutions, True/false, Fill in the blanks, Short answer questions, Critical thinking questions and discussion problems at the end of each chapter. • Instructor’s manual and Learning Material for Faculty and Students are available at https://www.phindia.com/financial_markets_institutions_and_services_sandeep_goel. TARGET AUDIENCE • MBA (Finance) • M.Com. / MA (Economics) • M.Sc. (Financial Economics)

Download or read book Senate Report No 105 36 105 1 written by and published by . This book was released on 1998 with total page 1202 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book The Healthcare Answer Book written by Healthcare Intelligence Network and published by Healthcare Intelligence Net. This book was released on 2006-09 with total page 130 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Healthcare Answer Book provides detailed solutions to 323 of the top challenges faced by healthcare executives today.You''ll get recommended software and tools, staff ratios, program structures, ROI measurement and results for various programs, protecting patient privacy and security in a number of scenarios -- answered by some of the nation''s leading healthcare experts to help you plan, evaluate, manage and improve your organization?s healthcare initiatives.Compiled from a series of live audio conferences in which these industry experts answered questions from the field, this report delves into a variety of topics, including cost containment, disease management, e-Health initiatives, HIPAA security and privacy, healthcare industry trends and workplace wellness.Indexed by topic and by keyword, this guide will become your indispensable research assistant for questions that challenge you and your staff each day. You''ll get the answers you need to such questions as:Cost Containment * What type of software tools are you using for predictive modeling? * Which predictive modeling tools are best for the ROI calculation? * What level of payment or financial risk is needed to change provider behavior? * What is the range of pay-for-performance paybacks and how often are they calculated? * What is the best ROI methodology on P4P programs that you have evaluated and how does it work? * Are tiered networks feasible in smaller markets?Industry Trends * Do you have a recommended reading level for translated written materials for preventative services in either low socio-economic status populations or for children? Also, is there a web site or written reference indicating how to do that? * In this era of consumer-driven healthcare, what quality-related information helps consumers make informed choices about health plans or providers?eHealth Initiatives * What screening requirements do you use for telemedicine patients? Do you evaluate factors outside disease severity? * Can you describe the kind of investment needed to implement e-health tools, how quickly you can achieve an ROI, and what kind of ROIs you can expect? * What criteria are payors and physicians using to determine whether or not an e-visit is billable? Are there clear-cut guidelines? * What lessons have you learned through your personal health record rollout process? What advice can you share with other organizations as they implement their own PHRs?HIPAA Security and Privacy * What are the biggest challenges to offering single sign-on? * How do you secure e-health physician-patient communication?Disease Management * How do strategies for asthma disease management differ for community-based health programs that target the under-served? * What is your staff-to-patient ratio in your depression management program? * How effective are physician-specific report cards in getting physicians in practice with the guidelines? * Is there any other type of literature that would support the effectiveness as well? * What is an accurate assessment of a member?s readiness to change, and how do you create interventions that are applicable to each member?s stage of readiness? * How are the health coaches trained, and what kind of training gets them geared up to work with patients? * What is the average amount of time a health coach spends per call per participant?The Healthcare Answer Book is also available on CD-ROM with keyword searching capability.Table of Contents * About This Document * Cost Containment o Predictive Modeling o Pay for Performance o Predictive Modeling in Pay for Performance o Predictive Modeling for Asthma & Pre-Natal o Reducing Trend & Spend o Tiered Networks * Industry Trends o Cultural Competency o Physician Engagement o Health Plan Quality Improvement o URAC Standards for Consumer Education and Support o The Patient?s Home: The New Healthcare Hub * e-Health Initiatives o Web Technology in CDHC o e-Visits o Moving from High-Tech to High-Touch o The Role of e-Health Initiatives o Personal Health Records & Electronic Medical Records * Disease Management o Asthma o Obesity o Depression o Behavior Modification o Resistant Patients o Health Coaches o Health Coach Training o Pre- and Post-Natal Care o The Role of Primary Care Physicians o Healthcare Toolkits * Workplace Wellness o HRAs o Incentives for Healthy Lifestyles o A Team Approach to Wellness * HIPAA Security and Privacy o HIPAA Security Compliance o HIPAA Security Auditing, Audit Trails & Audit Logs o HIPAA Security Risk Assessment * About the Experts * Glossary * For More Information * Index

Download or read book Risk Uncertainty and Profit written by Frank H. Knight and published by Cosimo, Inc.. This book was released on 2006-11-01 with total page 401 pages. Available in PDF, EPUB and Kindle. Book excerpt: A timeless classic of economic theory that remains fascinating and pertinent today, this is Frank Knight's famous explanation of why perfect competition cannot eliminate profits, the important differences between "risk" and "uncertainty," and the vital role of the entrepreneur in profitmaking. Based on Knight's PhD dissertation, this 1921 work, balancing theory with fact to come to stunning insights, is a distinct pleasure to read. FRANK H. KNIGHT (1885-1972) is considered by some the greatest American scholar of economics of the 20th century. An economics professor at the University of Chicago from 1927 until 1955, he was one of the founders of the Chicago school of economics, which influenced Milton Friedman and George Stigler.

Download or read book Practical Risk Adjusted Performance Measurement written by Carl R. Bacon and published by John Wiley & Sons. This book was released on 2021-10-18 with total page 327 pages. Available in PDF, EPUB and Kindle. Book excerpt: Explore different measures of ex-post risk-adjusted performance measurement and learn to choose the correct one In the newly revised Second Edition of Practical Risk-Adjusted Performance Measurement, accomplished risk and investment expert Carl R. Bacon delivers an insightful, accessible, and real-world guide to ex-post risk measurement. The author bridges the gap between theory and practice, showing you how to apply the former to the latter without introducing unnecessary mathematical complexity. The book describes the fundamentals of risk in the asset management context and the descriptive statistics used to describe it. It builds on that foundation with detailed examinations of concepts like regression, drawdown, and partial moments, before moving on to topics like fixed income risk and Prospect Theory. With helpful additions that include recently developed measures of risk, supplementary explanatory sections, and six brand-new chapters, this book also offers: A practical classification of all ex-post risk measures and how they connect to one another An explanation of how risk-adjusted performance measures impact performance fees A discussion of risk measure dashboard designs Instructions on how appraisal measures should be used for manager selection Perfect for portfolio managers, asset owners, risk controllers, and investment performance analysts, Practical Risk-Adjusted Performance Measurement is an indispensable resource for anyone looking for a hands-on exploration of the buy-side, asset management perspective.

Download or read book Analytical Corporate Finance written by Angelo Corelli and published by Springer. This book was released on 2018-09-10 with total page 511 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book draws readers’ attention to the financial aspects of daily life at a corporation by combining a robust mathematical setting and the explanation and derivation of the most popular models of the firm. Intended for third-year undergraduate students of business finance, quantitative finance, and financial mathematics, as well as first-year postgraduate students, it is based on the twin pillars of theory and analytics, which merge in a way that makes it easy for students to understand the exact meaning of the concepts and their representation and applicability in real-world contexts. Examples are given throughout the chapters in order to clarify the most intricate aspects; where needed, there are appendices at the end of chapters, offering additional mathematical insights into specific topics. Due to the recent growth in knowledge demand in the private sector, practitioners can also profit from the book as a bridge-builder between university and industry. Lastly, the book provides useful information for managers who want to deepen their understanding of risk management and come to recognize what may have been lacking in their own systems.