Sunday, August 25, 2019

38.1725: Information Modeli

38 USC 1725 as an Information Model

38 USC 1725 is the Law about the business relationships with veterans, DVA, community providers, private insurance and others.. This information model describes the business relationships.

Technical Background

Dictionary: An information model in software engineering is a representation of concepts and the relationships, constraints, rules, and operations to specify data semantics for a chosen domain of discourse. Typically, it specifies relations between kinds of things, but may also include relations with individual things. It can provide a sharable, stable, and organized structure of information requirements or knowledge for the domain context.

Ontology Models – Formal structures (classification systems, assemblies, and parts, language)

Affinity Models – Abstract structures (diagnostic, association, disassociation, discrimination, acceptance)  

Social Models – Tribe structures (law, group dynamics, bias influences, behavior expectation, linguistics)

Modeler Skills – Psychology, Information Science, Data Systems, Computer Science, Business Science (contract law, accounting, finance, economics, marketing), Domain Knowledge (medical, manufacturing, service, sales), Systems Analysis & Design, Communications, Business Arts (writing, speaking, management, social networks), Negotiation Reduction.   

Information Bridges 

Every domain has collective and subjective models particular to the domain. Engineering, science, teaching, government, family, medicine, transportation, recreation, commerce has different information modals inclusive to the domain. In the theater domain is serval well-understood information elements.  During the analysis of other domains, often the theater elements functions can be useful for affinity identification. Sometimes in domain analysis, information modelers use the theater element names provide a concept bridge into the domain under analysis. As the information model matures, the domain name replaces the theater name.

Theater
Function
Business
Actors
Participants
Principals
Role
Activity
Party
Play
Interaction
Contract
Property
Things of Interest
Deliverables, Services
Stage
Environment
Law
Director
Goal Insight
Operations
Audience
Client
Customer
Tickets
Demand for property
Invoice
Performance
Production
Payout
Writers
Title
Owners

Watchwords:

During the analysis process, word terminology can be overloaded based on many factors.  If the analysis is specific to a domain, the terms can still be overloaded. Even two people can misunderstand each other. Nature grants people the ability to build the mind’s information model. As a result, every person’s information model is specific to the person.  Watchwords are terms the modeler use to as alerts that may affect the model. In language, word order defines syntax elements. Each word has a definition, order relationships together with definitions create communication meaning. Watchwords signal information semantics.

Common Terminology:

  • Wherever the term money appears, the term means value, use, and title.
  • The insured hires the insurance company, insurer, to limit the payout liability of the insured. When the insured pays premiums for the insurance policy, the premium provides an obligation on the insurer with a guarantee the insurer will transfer title of the insurer’s money to the insured. Sometimes the insured will delegate authority to the insurer to pay money to the entity the insured has an obligation.
  • Agency is the most common type of contract for consumers.
  • Invoices and payments are contract instruments identifying money transfer.
  • A medical episode-of-care can have one or more medical expenses which is a fee for a medical service.
  • Grantor and grantee are actors in a title transfer.
  • Business accounting is a recording of money use.
  • Assets = Liability + Owner Equity (Revenue – Expenses) (a.k,a Net Assets)
  • Trade Þ Purpose Þ Needs & Wants Þ Contract
  • Data Þ Value Þ Meta-data Þ Roles
  • Program Þ Process Þ Schedule Þ Property Þ Value
  • Value Þ Quantity & Quality
  • Production Þ Cost D Quality D Schedule balance
  • Title Þ Ownership & Asset ~ copyright, trademark, procession
  • Follow-the-Money Þ Process Þ Trade Þ Money
  • Payment Þ Money
  • If exist Þ then Þ else
  • Syntax (structure) Þ Semantics (meaning)
  • Joint and Disjoint  Þ In contracts, the two principals (A & B ) have a joint agreement. When a activity involves more than two principals (A,B, C) . A & B and B & C are two separate joint agreements.. A & C are disjoint with no common agreement.  B may supply parts to A. C may supply parts to B, that B uses to make parts for A. 

Medical Business Terms

  • Medical Expense = fee & medical service
  • An Episode of Care Þ Medical Expense & Qualification {Edibility, Time, Purpose}
  • Authorize Þ Permission to transfer title
  • Reimbursement = A principal’s payback to a principal for money paid the principal paid on behalf of a contract.
  • Copayment = the policy amount insurer pays and and insured each agree to pay for  medical fee. 
  • Deductible = The insurer’s time-based threshold amount of medical fees the insured pays before the insurer’s payout.
  • Premiums = the direct cost of an insurance policy. Usually an employer pays some and the employee pays some.
  • Insurance = a contract, policy, between the insured and the insurer whereby the insurer guarantees liability protection for the insured. 
  • Insurance payout = the insurer's liability protection amount given to the insured for purposes of paying the liability. 
  • Patient = the person receiving medical treatment at a provider.
  • Provider = the person or organization supplying medical treatment.
  • In-network provider =  an agreement between the provider and the insurance copy on cost for medical expenses.
  • Explanation of Benefits =  the insurer's calculation report based the in-network agreement detailing the copayment amounts.
  • Provider Invoice =  a detail list of the treatment fees and services requesting patient payment
  • Invoice Payment =  the money paid against the invoice

Veteran:

  • Paragraph 38 U.S. Code § 1725. Reimbursement for emergency treatment Statue (a)(2) instructs (assigns) the VA either pay the veteran or pay the provider.
  • Title USC 38 Veterans’ Benefits is a benefit grant from Congress to every veteran and an authorization for Veteran’s Administration to be Congress's Agent to use the Federal Budget for veteran's benefits payment. 
  • 38 USC 1725 Contracts
  1. VA & Veteran  ~ role: Benefit Payout
    1. VA & Provider ~ role: Veteran assigns VA to pay medical expense treatmentPatient & Provider ~ role: treatment & payment responsibility
    2.  Provider & Insurance Company ~ role in-network agreement
    3. Patient (insured) & Insurance Company (insurer)
Note: the VA does not have a contract with an insurance company at non-VA faculty therefore not rights to policy terms. The VA is disjoint from the insurance company.
  • Maximum Allowable Amount = Medicare fee

  • Information Generation Distortion =  The VA's multiplication of business instructions causes errors in compliance with the Law:   Law > Regulations > Policy > Procedures
  • The effect is the whisper game:




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