Download or read book Managed Care Credentialing written by Amy N. Niehaus and published by . This book was released on 2019 with total page 246 pages. Available in PDF, EPUB and Kindle. Book excerpt: The role of the MSP is expanding to include payer enrollment and delegated credentialing responsibilities for managed care organizations. Traditionally siloed, MSPs are now beginning to take on both responsibilities, which means they must learn the nuances of managed care credentialing as well as the regulatory and accreditation requirements of NCQA, CMS, and URAC. Managed Care Credentialing: Compliance Strategies for Health Plans, CVOs, and Delegated Entities provides the answers to MSPs' inevitable questions as they begin to manage the tasks of payer enrollment and delegated credentialing. Author Amy M. Niehaus guides readers through each payer's requirements, the differences between hospital and managed care credentialing, and how to help their organization establish delegated credentialing agreements and prepare for audits. As new and existing MSP responsibilities begin to collide, this resource also outlines ways MSPs can modify their current processes to reduce duplication of efforts and develop a comprehensive and compliant managed care credentialing program. Whether you are new to managed care credentialing or are taking on delegated credentialing responsibilities, this book will help you: Learn the regulatory and accreditation requirements related to managed care credentialing Streamline the provider enrollment process through delegation Meet your organizational goals of compliance, operational efficiency, cost savings, and practitioner satisfaction Identify the differences between hospital and managed care credentialing
Download or read book Credentialing in the Managed Care Environment written by Hugh P. Greeley and published by . This book was released on 1996 with total page 248 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Credentialing for Managed Care written by Amy M. Niehaus and published by . This book was released on 2016-08-17 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Credentialing for Managed Care: Compliant Processes for Health Plan and Delegated Entities Amy M. Niehaus, CPMSM, CPCS, MBA New to managed care credentialing? Whether you work for a health plan or a hospital medical staff services department, this how-to guide answers all of your health plan credentialing and enrollment questions. Learn the regulatory and accreditation requirements related to managed care credentialing, including those from CMS, NCQA, and URAC. Author Amy M. Niehaus, CPMSM, CPCS, MBA, provides readers with the guidance to create a comprehensive and compliant credentialing program to support your health plan or to streamline your hospital's provider enrollment process through delegation. MSPs in all healthcare environments can benefit from understanding credentialing in the managed care world to support their organizational goals of compliance, operational efficiency, cost savings, and practitioner satisfaction. This book will help you: - Understand NCQA, URAC, and CMS requirements for health plans - Develop a comprehensive and compliant managed care credentialing program - Establish delegated credentialing agreements - Audit credentials files - Recognize how payer credentialing requirements impact other healthcare organizations - Streamline provider enrollment through delegation - Identify the differences between hospital and managed care credentialing - Evaluate whether a credentials verification organization is right for your organization About the author: Amy M. Niehaus, CPMSM, CPCS, MBA, is a consultant with The Greeley Company, an industry-leading healthcare consulting firm. She has over 25 years' experience in the medical services and credentialing profession. In her current role, she advises clients in the areas of accreditation, regulatory compliance, credentialing, process simplification and redesign, credentialing technology, and credentials verification organizations (CVO) development and delegation. Niehaus has worked in multiple environments throughout her career, including acute care hospitals, CVOs, and managed care organizations (MCO). She has been a member of the National Association Medical Staff Services (NAMSS) since 1991 and achieved her CPMSM certification in 1992 and her CPCS certification in 2002. Niehaus is a NAMSS instructor and previously served as chair of its MCO Task Force, as well as chair and member of the NAMSS Education Committee. She is a former president of the Missouri Association Medical Staff Services and its greater St. Louis area chapter. Niehaus holds a bachelor's degree from the University of Missouri and a master's degree in business administration from Maryville University in St. Louis. Niehaus has developed and presented various programs to local and national audiences on topics such as credentialing and privileging processes; Joint Commission, National Committee for Quality Assurance (NCQA), and URAC accreditation standards; and delegation.
Download or read book State and CMS Oversight of the Medicaid Managed Care Credentialing Process written by CreateSpace Independent Publishing Platform and published by Createspace Independent Publishing Platform. This book was released on 2018-07-05 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt: State and CMS oversight of the Medicaid managed care credentialing process.
Download or read book State and CMS Oversight of the Medicaid Managed Care Credentialing written by United States. Department of Health and Human Services. Office of Inspector General and published by . This book was released on 2013 with total page 23 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book The Greeley Guide to Managed Care Credentialing written by Hugh Greeley and published by . This book was released on 1998-11-01 with total page 179 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Managed Care Strategies written by George B. Moseley and published by Jones & Bartlett Learning. This book was released on 1999 with total page 644 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book is a guide to strategic training for physicians in an era of managed care. The first half of the book provides a step-by-step process to help physicians take their practices into the new world of integrated delivery systems. The second half of the book covers a variety of key topics such as credentialing, reimbursement systems, and utilization management.
Download or read book The Medical Staff Services Handbook written by Cindy Gassiot and published by Jones & Bartlett Learning. This book was released on 2011-08-24 with total page 523 pages. Available in PDF, EPUB and Kindle. Book excerpt: Rev. ed. of: The medical staff services handbook / [edited by] Cindy A. Gassiot, Vicki L. Searcy, Christina W. Giles. c2007.
Download or read book State and CMS Oversight of the Medicaid Managed Care Credentialing written by United States. Department of Health and Human Services. Office of Inspector General and published by . This book was released on 2013 with total page 23 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Verify and Comply written by Carol S. Cairns and published by HC Pro, Inc.. This book was released on 2004 with total page 174 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book The Credentialing Handbook written by Sheryl Deutsch and published by Jones & Bartlett Learning. This book was released on 1999 with total page 604 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Credentialing Handbook provides comprehensive, plain-English guida nce to understand and master the provider credentialing process in any health care setting. With sample forms, checklists, flowcharts, and c orrespondence, this practical guide walks you through every aspect of effective credentialing, appointment, and recredentialing. You'll lear n: key steps in the credentialing process; about express credentialin g models; how to credential allied health practitioners; typical time frames and tracking systems; pros and cons of delegating credentialin g, plus more.
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 2007 with total page 874 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed Care
Download or read book Managed Care written by Peter Reid Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2004 with total page 348 pages. Available in PDF, EPUB and Kindle. Book excerpt: A managed care expert overviews the history, structure, regulation, and issues of the complex US health care system. This second edition work was originally published by Aspen in 2002. Much of the information is distilled from another of the doctor's books, The Managed Care Handbook, 4th ed. An extensive glossary is included, but there are no refer
Download or read book Managing the Risks of Managed Care written by Barbara J. Youngberg and published by Jones & Bartlett Learning. This book was released on 1995 with total page 306 pages. Available in PDF, EPUB and Kindle. Book excerpt: The dominance of managed care is spreading quickly and risk managers are suddenly faced with major new challenges. With Managing the Risks of Managed Care, the risk manager will learn about risk management challenges in an integrated delivery system. The book also presents expert analysis on issues like contracting, peer review, ethical dilemmas, antitrust and more.
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 Managed Care Answer Book written by Sheryl Tatar Dacso and published by . This book was released on 1999 with total page 1142 pages. Available in PDF, EPUB and Kindle. Book excerpt: This is an indispensable reference for all professionals involved in the design, implementation, financing, or operation of a managed care program, written in the classic answer book format. You'll find extensive sections providing basic understanding of managed care, cost containment strategies, and advice on organization and implementation of programs. The topic is covered from the ground up, with crucial questions and authoritative, up-to-date answers on every facet of managed care, including such valuable features as: Contract negotiation strategies and dispute resolution techniques Maximizing utilazation review and outcomes assessment Techniques for managed care implementation and administration Plus payer and provider contracting; advice on legal and regulatory considerations; important issues covered from both purchaser's and provider's perspectives; and discussion on information technology and telemedicine.
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.