Form Of Claims Research Articles

Work-related stress in Australia: The effects of legislative interventions and the cost of treatment

The Australian Institute of Health and Welfare data published in 2002 shows a continued rise in health care costs to the Australian community due to the growing number of people diagnosed with mental health disorders. Those mental health disorders may originate from a number of sources, including work and non-work-related factors. The so called work-related stress claims in all Australian jurisdictions are the most expensive form of workers compensation claim. In the most part this is due to the lengthy period of absence (duration) and complicated medical care which are characteristic of these claims. In Australia, in the last decade, attempts have been made to reduce the costs of compensable stress-related claims by imposing special legislative thresholds on such claims. This ‘back end’ approach to cost reduction has resulted in an array of legislative formula designed to exclude work-related stress claims. This article surveys the various legislative provisions dealing with work-related stress claims in Australia and provides an analysis of their effectiveness. A range of options are presented as alternatives to the exclusion of particular forms of work-related stress claims. The use of a corporate citizenship approach to the prevention and management of stress claims is also discussed as a proactive alternative to occupational safety and health legislative provisions and the workers compensation legislative exclusions.

Competitive Irish Dance: Art, Sport, Duty (review)

Reviewed by: Competitive Irish Dance: Art, Sport, Duty Jill Franks Competitive Irish Dance: Art, Sport, Duty, by Frank Hall, pp. 150. Madison: Macater Press, 2008. Distributed by University of Wisconsin Press. $29.95. Frank Hall's book will appeal to a wide audience, including those interested in dance, anthropology, Cultural Studies, and Irish politics. Its style and content are not too technical for the reader unfamiliar with dance, though parts of chapters four and five contain meticulously detailed descriptions of dance steps that nonspecialists may wish to skip. The theoretical analyses of Irish dance as national symbol are also accessible to all readers, and free of the jargon saturation that characterizes many books in Cultural Studies. Over the course of a year of study and attendance at Irish dance classes, performances, and competitions, the anthropologist Hall (who is also a dancer and musician) researched two questions: what happens to an expressive form when it is put into competition, and what happens to an expressive form when it is linked to national identity? His answers, and his means of finding them, are clear, well-researched, and well-theorized. Hall's style is readable and personable, although readers would probably appreciate more discussion of his personal interactions with teachers and students of Irish dance; his quotations of teachers, adjudicators, and parents are so amusing and forthright that they spark the desire for more. Irish dance's link to national identity formation begins with the founding of the Gaelic League in 1893. Douglas Hyde's diagnosis of Ireland's dire need to form its own cultural identity gave rise to various promotions of Irish language, sports, and arts forms. Early feisanna were not just dances, but parliamentary meetings accompanied by sports and entertainment. Under the auspices of the Gaelic League, however, the dance portion of the feis became competitive. Partly out of embarrassment for the violence that occasionally erupted over adjudication standards for dance competition, a governing body, An Coimisiún, was established in 1929 with the mission to control all aspects of Irish step dancing. This move institutionalized the genre and raised questions [End Page 144] of authenticity and national identity. One of the most interesting parts of the book is Hall's analysis of three foreign importations to Irish step dancing: the heel click, the butterfly, and the toe stand. Paradoxically, these least Irish steps seem to receive highest marks from adjudicators in dance competition; a dancer's conformity to the original dance—if one can even speak of such a thing—is thus not the key requirement for excellence in this "Irish sport." Closely related to the issue of authenticity in dance steps is the question of posture. The chief characteristic of Irish step dancing, as opposed to other forms of folk dance, is stiffness of the upper body, combined with extreme flexibility and speed of movement of the legs and feet. This posture provokes much discussion of its origins and meanings. Hall's investigation of historical accounts reveals amusing hypotheses. One implausible explanation is that during the time of the Penal Laws, dancers held their upper bodies rigid so that passing British authorities looking into windows would not know they were dancing. Another fanciful interpretation is that the dancers were interested in demonstrating the kind of control of their bodies that the Catholic church imposed on their minds. Hall's discussion of the whimsical figure of the dance master is also entertaining. Often speaking and behaving as if he were above his own social class, the dance master inspired in his peasant students the desire to look and seem as if they belonged to the middle or upper classes. Here, controlled dance movements were one form of politesse or claim to social status. Dancers' concern for how Irishness is perceived, both inside and outside of the country, persists in today's competitions. Although adjudicators are aware that ornate costumes are costly—and thus accessible only to students of higher social classes—they admit to awarding points for fancy dress. Typical costumes feature several Irish symbols embroidered onto the shiny fabric of bodice and skirt, while the girl's tightly curled coiffure is topped by a glittering tiara. To be...

Calculating Interests: Climate Change and the Politics of Life

Calculating Interests: Climate Change and the Politics of Life

New Medicare Guidance to University Clinics

New Medicare Guidance to University Clinics

The CMS-1500 Claim Form

The CMS-1500 Claim Form

From Underdog to Overmatch: Computer Games and Military Transformation

The rise of the military-entertainment complex has encouraged an increase in critical attention to military computer games. For the most part, these criticisms have taken the form of emotive claims concerning media effects, or politicized dismissals of games as simplistic and distortive propaganda. Through an analysis of the games Conflict: Desert Storm, Conflict: Desert Storm II, Full Spectrum Warrior, Full Spectrum Warrior: Ten Hammers, Call of Duty 4, F2C2, and Tom Clancy's Ghost Recon Advanced Warfighter, this article challenges such perceptions in showing the extent to which computer games are pushing an image of warfare that perfectly matches that presented by the U.S. policy of military transformation. In doing so, it questions what the consequences of such computer game representations are for understandings of warfare and the utility of force.

'The Byzantine logic of patent law jurisprudence': patent protection for dosage regimes revisited

The question of whether patent protection extends to treatment or dosage regimes is an important one since patentees are continually seeking to find new and efficient methods of administering known pharmaceutical drugs. The Court of Appeal in Bristol-Myers Squibb seemingly rejected the view that such patents are allowable under the Patents Act 1977. Actavis v Merck rejected the received learning of Bristol-Myers Squibb by first claiming that it contained no ratio to the effect that: (a) a novel, non-obvious dosage regime specified in a Swiss form of claim cannot make it novel and (b) such a claim is to a method of medical treatment. Secondly, if it was wrong on that point, the Court of Appeal accepted that since the EPO had a ‘settled view’ to the contrary, it was entitled (but not bound) to follow that view, even if it was inconsistent with Bristol-Myers Squibb. Patents for treatment and dosage regimes are now available under the 1977 Patents Act. However, it is still an open question whether such patents are available under the Patents Act, as amended, to reflect the changes made under the EPC 2000.

Making a Move Away From Insurance Contracts

Making a Move Away From Insurance Contracts

Affordability of essential medicines used for treating chronic diseases in Malaysia: An academic perspective

The aim of this study is to measure the affordability of drugs used in treating common chronic diseases. The study was conducted in the Universiti Sains Malaysia (USM) and in 5 private retail pharmacies. The study measured prescriptions contents of Universiti Sains Malaysia panel of clinics claim forms of patients for the year 2006. Affordability of medicines used was

Answers to Questions About Medicare Changes

You have accessThe ASHA LeaderIn Private Practice1 Nov 2008Answers to Questions About Medicare Changes Mark Kander and Ingrida Lusis Mark Kander Google Scholar More articles by this author and Ingrida Lusis Google Scholar More articles by this author https://doi.org/10.1044/leader.IPP.13152008.21 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Since the July passage of the federal Medicare Improvements for Patients and Providers Act (MIPPA), ASHA staff has sought to equip members interested in serving Medicare patients. As first described in the Sept. 2 issue of The ASHA Leader, MIPPA takes effect July 1, 2009. On that date, private-practice speech-language pathologists who have enrolled as Medicare providers will be able to bill Medicare directly for services delivered to beneficiaries under Medicare Part B. Selected questions from a Sept. 23 ASHA teleseminar on MIPPA implementation are excerpted here. The full text of the Q&A is available at The Leader Online, along with other articles on the countdown to Medicare. Q: Is the National Provider Identifier (NPI) portable? Yes. Once you have received an NPI, it is your number to be used for all health plan payers. Q: I have an NPI for my private practice. Will I be able to use that for Medicare? Yes. Your NPI can be used for both private insurance and Medicare. Remember that applying for an NPI does not automatically enroll you in the Medicare program; that is a separate process. Information on Medicare enrollment can be found on ASHA’s Web site. Q: I am a Medicare provider under my audiology number—do I need to enroll again? Yes. You need to enroll separately in the program as an SLP. Your NPI application/record should include the audiology and speech-language pathology taxonomy codes. Q: Can I bill independently and also as part of a corporation where my benefits are reassigned? Yes. The reassignment of payment only applies when the claim form identifies that corporation as the “billing provider.” Q: How do I verify Medicare eligibility on patients? To verify Medicare eligibility, contact your Medicare administrative contractor. For Medicare contractor contact information, visit the HHS Web site [PDF]. Q: Will a physician still be able to bill “incident to” for speech-language pathology services? Yes. Whether or not an SLP enrolls in Medicare, his/her services can be billed as an employee or contractor of a physician practice. Q: Do we know yet if SLPs will be able to see patients in home settings or must patients come to an office? SLPs will have the option of seeing patients in an office or the patient’s home. ASHA has requested that CMS include in its draft regulations a third patient care setting—“patient’s natural environment”—when there is a need to treat patients in the locations where they participate in daily activities. Q: How soon after I submit my claims can I expect payment from Medicare? The Medicare contractor is expected to process “clean” claims within 30 days. A claim that is incomplete or contains an error does not satisfy the “clean” definition. Please note that the payment process is shortened if claims are submitted electronically. Q: Does the change in speech-language pathology private-practice status change the therapy caps? No, the legislation does not change the therapy caps, and SLPs continue to share a cap with physical therapy. The legislation did, however, call for the continuation of the therapy cap exceptions process that allows beneficiaries to receive additional therapy services above the cap if they are medically necessary. Q: What is the Physician Quality Reporting Initiative (PQRI)? PQRI allows physicians or other professionals to receive a bonus payment when they report recognized quality measures to Medicare. SLPs are one category of providers eligible for this bonus payment. ASHA is working with the Centers for Medicare and Medicaid Services to recognize functional communication measures from ASHA’s National Outcomes Measurement System for reporting purposes. Author Notes Mark Kander, director of health care regulatory analysis, can be reached at [email protected]. Ingrida Lusis, director of political and federal advocacy, can be reached at [email protected]. Additional Resources FiguresSourcesRelatedDetails Volume 13Issue 15November 2008 Get Permissions Add to your Mendeley library History Published in print: Nov 1, 2008 Metrics Downloaded 54 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2008 American Speech-Language-Hearing AssociationLoading ...

"I Am Isabel, You Know?": The Antipodean Framing of Jane Campion’s Portrait of a Lady

"I Am Isabel, You Know?": The Antipodean Framing of Jane Campion’s <i>Portrait of a Lady</i>

The Gay Agenda

The Gay Agenda argues that the current gay rights agenda has been overly determined by the culture war and calls for a deliberate step outside of culture war discourse in order to see law reform possibilities that have largely been obscured. When anti-gay forces speak in terms of traditional family values, the paper observes, pro-gay rejoinders tend to come in the form of rights claims accompanied by rhetorical efforts to depict the gay family as morally indistinct from an idealized version of the heterosexual family (i.e., monogamous, bourgeois, and more about love than sex). These dual strategies of rights - especially equality - and normalization have serious costs that have gone under-recognized by the architects of the contemporary gay rights movement. Much of the paper is dedicated to illuminating those costs. The remainder of the paper proposes concrete possibilities for reconstructing a law reform agenda. This part draws on the insights of American Legal Realism, Critical Legal Theory and Queer Theory, which have something real and valuable to offer the gay rights movement - if what participants in that movement want is to combat sexual moralism and to ameliorate the full range of hardships faced by persons associated with marginal sexual or gender identities or practices. The proposed agenda described in this part is less consumed with achieving formal equality between gay and straight people and more interested in using law to create the best possible conditions against which a broad array of people can make choices about how to organize their erotic and domestic lives.

How to Win Private Plan Appeals

How to Win Private Plan Appeals

Making Representations: Modes and Strategies of Political Parties

This article critically addresses the varied ways in which political parties can be said to represent. Three important ideal-typical modes of party representation are outlined: the popular, the statal, and the reflexive. Arguments are offered for countering the common view that, for example, popular modes are the most democratic, and statal modes the least democratic. Statal modes in particular are often taken to be an indicator of a decline in parties’ representative functions; however, shifting modes of party representation often have more to do with strategic choices and contextual pressures than democratic ideals. No one ideal-typical mode is intrinsically more democratic than others. Further, there is evidence that a new mode of party representation, the reflexive, may be emerging; parties may be transforming into something they never were in order to continue to do the things they have always sought to do. Whether democracy is unthinkable save for political parties is no longer the question we need to ask. Rather, we need to ask: what kinds of representative democracy are thinkable? And what forms of party claims, if any, are appropriate to them?

Evidence for Health Claims on Foods: How Much is Enough? Introduction and General Remarks

Through advances in clinical trial design, analytical methodologies for assessing the nature and level of the bioactive constituents, and establishment of processes for systematic assessment of available literature, health claims on foods are becoming increasingly recognized as important and consequently are being legally regulated in more and more countries around the world. Legislation pioneered largely in Japan began to emerge in the 1980s to bring some systematization to the issue of how much data are required to substantiate a claim for a given dietary agent in order to improve a function and/or modify physiological processes in a manner consistent with the attenuation of disease risk. Various jurisdictions around the globe have now developed series of systematic approaches for reviewing scientific data and ascribing linkages between dietary ingredients and disease risk reduction, as well as performance and well-being, with the common objectives of identifying the threshold of scientific evidence needed to substantiate an authoritative statement to the general public in the form of a label claim for a given marketed food product. This process of systematic assessment of scientific evidence linking functional ingredients to health through the use of health claims on foods possesses potential benefits for several stakeholders. First, the individual consumer profits from guidance on which foods and food ingredients possess the potential to reduce risk of degenerative disease, improve longevity, and reduce dependence on pharmaceuticals. Second, health care service providers enjoy reduced operating costs resulting from a healthier population with reduced requirements for drugs. Third, corporations profit from improved market share, subsequent to increased appeal and penetration of products bearing health claims within the food marketplace. Fourth, food producers profit from higher commodity prices obtained from food constituents with added health value. Last, research activity in the agriculture-food-health continuum ensures continued livelihood and activity of scientists and technologists, thus improving food-related bioproducts. As a result, this supplement, which captures the proceedings of a symposium held at the Canadian Nutrition Congress meeting in Winnipeg, Canada, June 21, 2007, endeavors to achieve 2 objectives. In the first part, Global Assessment of Health Claims Frameworks, a cross-jurisdictional review is undertaken, profiling the history and current state of the art regarding legislative and scientific processes for establishment of health claims on foods. The second part, Evidence-Based Review of Health Claims on Bioactives in Foods, gives examples of how specific functional ingredients have dealt with complex science issues that need to be addressed for the establishment of health claims.

Evidence for Health Claims: A Perspective from the Australia–New Zealand Region

Establishing the evidence for health claims involves reviewing the available body of scientific knowledge and linking this to statements meaningful to consumers. This requires an understanding of scientific merit as well as consumer perceptions of health messages. Food Standards Australia New Zealand sets standards for current nutrient content claims and is close to approving a proposed new framework for all forms of nutrition and health claims on foods. This article discusses this proposed health claims standard in light of the challenges health claims pose to nutrition science. It critically describes the framework for the standard, reviews issues related to substantiation of claims, and provides commentary on the proposed assessment of evidence. This spectrum of permission reflects the use of food in health promotion, disease prevention, and early disease management when therapeutic agents may not be required. The position is consistent with an understanding that food delivers nutrients and bioactive substances at levels that support the improved health of the human organism in the early stages of the health-disease spectrum. Increasing knowledge of the role of food components and its intelligent application in dietary modification can result in this strategy playing a major role in disease prevention and early disease management. The amount of evidence required to enable health claim labeling should be based on a reasonable judgment and clear understanding of the role of nutrition in health and disease.

Ten-year outcome of crowns placed within the General Dental Services in England and Wales

Aim It is the aim of this paper to consider the factors associated with the need for re-intervention on a crown, and the times to re-intervention. Methods A data set was established consisting of patients, 18 years or older, whose birthdays were included within a set of a randomly selected dates, one of which was chosen in each possible year of birth and whose restoration records contained the placement of one or more indirect restorations on courses of treatment with last date on the claim form after 31st December 1990, and with date of acceptance after September 1990 and before January 2002. For each tooth treated with a crown, the subsequent history of intervention on that tooth was consulted, and the next date of intervention, if any could be found in the extended data set, was obtained. Thus, a data set was created of crowns which have been placed, with their dates of placement and their dates, if any, of re-intervention. Results Data for over 80,000 different adult patients were analysed, of whom 46% were male and 54% female. A total of 47,474 crown restoration occasions were obtained from the data over a period of 11 years. Metal crowns were found to have the longest survival—68% at 10 years, and all-porcelain crowns the shortest—48% at 10 years. Factors which were found to influence outcome of crowns included type of crown, age of patient, patient payment exemption status, patient attendance pattern and placement of a root filling in the same course of treatment as a crown. Conclusions Full-coverage all-metal crowns have longer survival times before re-intervention than metal-ceramic crowns and all-ceramic crowns. Root fillings are associated with reduced survival time of the crowns examined in this study.

The legacy of the ‘care challenge’: re‐envisioning the outcome of the justice‐care debate

The ‘care challenge’ to moral psychology, articulated in the justice‐care debate, has been borne out in a number of ways. Empirically, claims regarding gender difference in use of justice and care reasoning, gender bias claims regarding early forms of Kohlberg's scoring manual and claims regarding the centrality of cultural conceptions of masculinity and femininity to moral psychology have all been established. Conceptually, six hallmarks of the care challenge have now become commonplace assumptions in moral psychology. It is argued that theorists in Character Education, Social‐Emotional Learning and Positive Psychology now generally accept the moral legitimacy of the ethic of care and the scientific legitimacy of the relational psychology underlying it. In retrospect, the ‘care challenge’ had an evolutionary effect on the field, helping theorists and social scientists of all kinds to create more philosophically inclusive and psychologically realistic conceptions of moral engagement in the moment and moral development over time.

The Limits of Functional Family: Lesbian Mother Litigation in the Era of the Eternal Biological Family

This article contends that the ‘functional family’ model falters in the context of lesbian and gay intra-family disputes. Functional family arguments have frequently been misused in disputes between separated lesbian mothers who are contesting issues around children and in disputes between lesbian mothers and known sperm donors/biological fathers. I argue that the rise of fathers’ rights movements and increasing emphasis on biological family gives both discursive and legal authority to essentialised, gendered and symbolic status claims made by biological parents, valorising distant biological fathers over mother-led family units, and separated biological mothers over non-biological mothers. Finding that the functional family approach cannot usefully resist the current ideological climate, the article concludes with an exploration of an alternative: framing a form of status claim for lesbian co-parents based on intentionality.

The Limits of Functional Family: Lesbian Mother Litigation in the Era of the Eternal Biological Family

This article contends that the 'functional family' model falters in the context of lesbian and gay intra-family disputes. Functional family arguments have frequently been misused in disputes between separated lesbian mothers who are contesting issues around children and in disputes between lesbian mothers and known sperm donors/biological fathers. I argue that the rise of fathers' rights movements and increasing emphasis on biological family gives both discursive and legal authority to essentialised, gendered and symbolic status claims made by biological parents, valorising distant biological fathers over mother-led family units, and separated biological mothers over non-biological mothers. Finding that the functional family approach cannot usefully resist the current ideological climate, the article concludes with an exploration of an alternative: framing a form of status claim for lesbian co-parents based on intentionality.