Download or read book Health Insurance and Managed Care written by Peter R. Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2019-02-14 with total page 355 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.
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 Managing Managed Care written by Institute of Medicine and published by National Academies Press. This book was released on 1997-04-21 with total page 394 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.
Download or read book Improving the Medicare Market written by Institute of Medicine and published by National Academies Press. This book was released on 1996-11-01 with total page 384 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare beneficiaries are rapidly moving into managed care, as attempts to restrain the growth of this costly entitlement program progress. However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sectorâ€"yet protect them as consumers and patients. This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed careâ€"how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters. The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.
Download or read book Managed Care and You written by Michael E. Cafferky and published by McGraw-Hill Companies. This book was released on 1995-01-01 with total page 210 pages. Available in PDF, EPUB and Kindle. Book excerpt: Explains how an HMO works, details the types of managed care organizations and their differences, and offers advice on choosing a primary care physican and hospital
Download or read book Managed Care written by Peter Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2009-10-07 with total page 295 pages. Available in PDF, EPUB and Kindle. Book excerpt: The origins of managed health care -- Types of managed care organizations and integrated health care delivery systems -- Network management and reimbursement -- Management of medical utilization and quality -- Internal operations -- Medicare and Medicaid -- Regulation and accreditation in managed care.
Download or read book Managed Care written by Joe Barrett and published by . This book was released on 2023-05-18 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Is it too much to ask that a managed care facility refund a year's advance payment when your grandfather dies before he can move in?
Download or read book Managed Care and You written by Michael E. Cafferky and published by Health Information Press. This book was released on 1997 with total page 234 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Managed Care written by Kongstvedt and published by Jones & Bartlett Publishers. This book was released on 2008-09-19 with total page 294 pages. Available in PDF, EPUB and Kindle. Book excerpt: The new Third Edition of Managed Health Care: What It Is and How It Works is a concise introduction to the foundations of the American managed health care system. Written in clear and accessible language, this handy guide offers an historical overview of managed care and then walks the reader through the organizational structures, concepts, and practices of the managed care industry. This thorough revision has been completely updated with all the newest data on this dynamic industry and features all new sections on: pay for performance, consumer directed health plans, new approaches to care management, as well as advances in information technology.
Download or read book Mental Health Providers Guide To Managed Care written by Leonard Reich and published by W. W. Norton & Company. This book was released on 2006 with total page 252 pages. Available in PDF, EPUB and Kindle. Book excerpt: For both patients and providers, the words managed care are loaded with negative connotations, synonymous with inefficiency and bureaucracy. Forced to perform a delicate balancing act of offering the best possible care for their clients while carefully adhering to various managed care policies and procedures, providers in particular often wince at the prospect of having to deal with managed care companies, or MCOs. Fearing burdensome paperwork, low reimbursement rates, and denials of care, it's not surprising that a number of mental health professionals choose to limit their involvement with managed care companies-or eliminate it altogether. "My clients are all on different health plans; how can I keep the policies straight?" "Getting services approved is so time-consuming that I'm better off accepting only self-paying clients, aren't I?" "Do the benefits of working with MCOs really outweigh the drawbacks?" The answer, according to two industry insiders, is yes. If you know how to work with the system, the system can work for you. Mental Health Provider's Guide to Managed Care is the first handbook of its kind to offer clinicians a window into the inner-workings of MCOs. Authors Reich and Kolbasovsky candidly draw on their combined 37 years experience in the field to walk readers through all the major elements of how to successfully work within the system: marketing yourself and your practice to an MCO, getting onto a MCO's network, maintaining a good relationship and communicating with MCOs for quick service approval, reducing your liability, understanding your rights and responsibilities, getting paid, and more. Every issue—big and small—is covered, from capitation versus fee-for-service payment arrangements to evaluating which MCOs are a good fit to join, and everything in between. After explaining how to work with the system, the authors reveal how to put the system to work for you. Tips for building your practice through referrals, generating business through doctor collaboration, and understanding future practice opportunities are all covered.By demystifying the complexities of managed care and offering a unique, inside view of the process, this book mitigates the negative connotations associated with MCOs and exposes the hidden benefits of a seemingly burdensome process. Exceedingly reader-friendly and packed with insightful tips and vignettes, Mental Health Provider's Guide to Managed Care is one clinician's guide you won't want to be without.
Download or read book Basics of the U S Health Care System written by Niles and published by Jones & Bartlett Learning. This book was released on 2016-12-14 with total page 449 pages. Available in PDF, EPUB and Kindle. Book excerpt: Basics of the U.S. Health Care System, Third Edition provides students with a broad, fundamental introduction to the workings of the healthcare industry. Engaging and activities-oriented, the text offers an especially accessible overview of the major concepts of healthcare operations, the role of government, public and private financing, as well as ethical and legal issues. Each chapter features review exercises and Web resources that make studying this complex industry both enjoyable and easy. Students of various disciplines—including healthcare administration, business, nursing, public health, and others—will discover a practical guide that prepares them for professional opportunities in this rapidly growing sector.
Download or read book Managed Care Outcomes and Quality written by Steven F. Isenberg and published by Thieme. This book was released on 1998 with total page 374 pages. Available in PDF, EPUB and Kindle. Book excerpt: The first section leads us through the complicated and risky business of capitation and examines reimbursement in a managed care environment. The idiosyncrasies of managed care contracts are detailed and you will learn how to negotiate with managed care companies. There is a focus on practice profiling and the presentation of an expertise on referral guidelines. The final chapter explores the ethical issues of managed care. In section II you will find a description of outcome research and youseful information for the implementation of outcomes research in community-based office practices. The third section begins with two chapters on improving office efficiency and managing staff in a managed care environment. The next chapter leads us through the important and complicated software selection process for the individual practitioner's needs. A private practitioner offers his insight into managing a medical practice and the section completes with some helpful pointers to avoid malpractice claims. Section IV provides the physicians' response to managed care. The legal issues of mergers and networks are discussed. Several practicing physicians outline their personal experiences in the rapidly changing world of physician network development. The book's final chapter leaves us with an expertise on how physicians can take back healthcare
Download or read book Managed Care written by Montague Brown and published by Jones & Bartlett Learning. This book was released on 1994 with total page 286 pages. Available in PDF, EPUB and Kindle. Book excerpt: Here in 25 authoritative articles drawn from the highly respected journal Health Care Management Review, you'll discover what you'll need to lead your organization into the generation of managed care. From short range issues like making existing product lines efficient to the policy logic of building comprehensive, integrated systems, this reference will help managers in a provider, insurer, buyer, or government organization create a successfully integrated organization.
Download or read book The Physician s Guide to Managed Care written by David B. Nash and published by Jones & Bartlett Learning. This book was released on 1994 with total page 280 pages. Available in PDF, EPUB and Kindle. Book excerpt: You'll find the practical guidance you need to transition smoothly int o the managed care environment. You'll learn the pros and cons of prac ticing in a managed care setting, the daily life of managed care physi cians, the role of managed care in medical education and health care r eform. Discover how to take advantage of new opportunities and avoid p itfalls, balance cost consideration with clinical decision-making, and understand the case mix systems most frequently used in managed care. Written almost entirely by physicians, The Physician's Guide to Manag ed Care is a must for any physician interested in meeting future chall enges.
Download or read book Making Them Pay written by Rhonda D. Orin and published by Macmillan + ORM. This book was released on 2011-04-01 with total page 274 pages. Available in PDF, EPUB and Kindle. Book excerpt: Most people don't understand health insurance, and insurance companies know it. Unfair denials, late payments, and hopeless confusion are the norm. At last there is a solution. In eight easy steps, Making Them Pay gives practical advice about the things that drive people crazy. Like: -Figuring out what health plans really say -Understanding what benefits they provide -Finding, and understanding, the exclusions -Determining what health plans really cost -How to talk to customer service, and other painful details -Easy ways to keep good records -Laws that can change your life-like the mandatory benefits laws in all fifty states -How to prepare successful appeals Along with this useful advice, Making Them Pay offers a much-needed sense of humor. It's filled with cartoons, sidebars, and vignettes that will make you laugh as you learn. Based on Rhonda D. Orin's extensive experience as a litigator, a journalist, and a mother fighting her own family's insurance battles, Making Them Pay is the book your health insurer doesn't want you to read. "A compact reference [that] simplifies a convoluted subject. -
Download or read book Breaking Free of Managed Care written by Dana C. Ackley and published by Guilford Press. This book was released on 1999-08-01 with total page 340 pages. Available in PDF, EPUB and Kindle. Book excerpt: Providing therapists practical solutions to managed care's erosion of their freedom to practice, this book presents a working blueprint for a private-pay psychotherapy practice. Dana C. Ackley casts out the distortions that have crept into many clinicians' thinking as a result of reliance on third-party reimbursement. Based on his own experience, he shows how you can serve clients--and yourself--better by developing real alternatives to the pressures and bureaucracy of managed care. In clear step-by-step detail, including practical exercises and checklists, sample marketing materials, and payment plans, the volume shows you how to: *Rediscover the economic and clinical value of your work *Discard assumptions that might block your progress *Educate yourself about the needs of potential clients *Market and sell your services effectively *Learn ethical, reasonable business-of-practice skills *Diversify into the rewarding area of psychological consultation to businesses. No matter what your clinical style, theoretical orientation, or practice history, you will benefit from the hard-won lessons Dr. Ackley shares in this book.
Download or read book Managed Care written by Wendy Knight and published by . This book was released on 1998 with total page 292 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed Care: What It Is and How It Works, the title says it all! This introduction to managed care is a must have for managed care professionals new to the industry, health care professionals who traditionally have had limited exposure to managed care, and professionals in other industries eager to capitalize on the business opportunities generated by managed care. It also serves as a textbook or supplemental reading for health-related courses in public health, medical, nursing, allied health, business, and public policy schools and programs. This book provides the reader with the basic structures, concepts, and practices of managed care in a concise, easy-to-read format. Winner of the 1998 AJN Book of the Year Award in the Managed Care category.
