Publications
and Articles
Self-Funding Actuarial Services, Inc.
Out of Print
Self-Funding of Health Care
Benefits $100
This essential book is comprehensive
reference for all persons involved with
self-funding. Information is of value of
attorneys, accounts, actuaries, consultants,
and insurers. Every possible dimension of
self-funding is explored in depth.
This guide shows every current ICD-9 diagnosis code by name and description,
indicating for each diagnosis the appropriate underwriting action -- accept,
reject, postpone, or rate for cause.
This guide focuses on the fraud problem as it
relates to health care plans with particular
emphasis on self-funded plans. After a
general view, the test discusses the role of
administrators in combating fraud. Physician
code gaming is discussed in some detail.
Many examples of fraud are provided and the
legal aspects are briefly reviewed.
This guide covers all areas of the self-funded plan with which the accountant may
be involved -- plan-related, employer-related, tax-related, and audit-related. Important
recent issues, such AICPA SAS 70 and SOP 92-6, are discussed in depth.
This guide discusses networking in general and HMOs, PPOs, and EPOs in depth.
Also discussed are the newer arrangements involving PHOs and direct-contracting as
well as the movement to corporate medicine. The following areas are presented --
ancillary challenges of utilization review; outcome management; data management;
integrated health care systems; and legal/taxJcomputerapplications.
This guide is a basic how-to text for the broker, consultant, and risk manager in
the marketing, installation, and renewal of the self-funded plan. Issues unique to
the self-funded plan are discussed, such as risk management, cost containment,
funding, stop-loss, and legal implications. Cafeteria plans are included
Guide is divided into three parts
1. Claims -- processing, administration, medical, records, providers, ERISA
requirements, COBs, audits, stop-loss, drugs, dental, death.
2. Questionable or Not Covered Items -- some 600 items are discussed and
action recommended consistent with the model plan document.
3. Administration -- funding, COBRA, government-sponsored, compliance,
computer, medical deductions for cafeteria, Federal mandates.
Guide is divided into three parts.
1. Legal Commentary -- specific topics discussed.
2. Non-ERISA Court Decisions -- most of these pre-date ERISA and are
categorized by subject, such as subrogations, etc.
3. ERISA Court Cases -- these are categorized by subject, such as standards
of review, experimental, etc.
Booklet/Document Guide $300
Guide is divided into four parts.
1. General Discussion -- basics, laws, regulations, court decisions, etc.
2. Certificate
Booklet
3. Plan
Document
4. Plan Document Commentary -- Exhaustive chapter and verse commentary on the plan
document.
TPA Guide (whole or in part) is not sold in North Carolina, South Carolina, or Virginia
All mailings carry a $7 shipping/handling charge
All
products sold with a 30-day free-look privilege.