Understanding Health Insurance: A Guide to Billing and Reimbursement
14th Edition
ISBN: 9781337679480
Author: GREEN
Publisher: Cengage
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Managed care organizations
compete with each other on quality and low cost provision of services.
exclude health maintenance organizations.
exclude preferred provider organizations.
exclude closed-panel HMOs.
are often run by the federal government.
Managed care has had an impact on the healthcare industry since its inception. It introduced different managed care models as well as different payment systems. More directly, managed care has changed patient and provider behavior in terms of what they can and can’t do. Healthcare providers have been directly impacted in the way they are reimbursed and the factors that lead to maximum reimbursement. Conduct research on how the role of the physician has changed with the advent of managed care. Write a 4-5-page paper that addresses the following: Explain how managed care has changed the healthcare landscape. Discuss how managed care impacts provider reimbursement. Describe how the relationship between physician and patient has changed through managed care. Explain whether, in your opinion, the new focus on healthcare outcomes is better or worse. Discuss who benefits from the new reimbursement approach. Describe the relationship between first, second, and third-party in a managed care…
When asked the difference between a health maintenance organization (HMO) and a preferred
provider organization (PPO) plan, what would be the correct response?
A patient with a PPO plan will have no additional costs for services.
An HMO provides better access to outpatient services and drug benefits.
The two plans are essentially the same.
A patient may choose any physician with an HMO plan.
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- A diverse patient population like blue collar workers are hard workers. Describe any facts or tips that you think are important for your classmates to know about this select population.Discuss how the clinical assessment and diagnosis may be impacted by any special characteristics or historical background of this diverse patient population. Be sure to consider how you might avoid bias during the assessment and diagnosis process.arrow_forwardDiscuss the importance of advocacy as it pertains to patient care. What is the nurse's role in patient advocacy? Describe a situation in which you were involved with patient advocacy. Explain what the advocacy accomplished for the patient, and what the repercussions would have been if the patient would not have had an advocate.arrow_forwardCoordination of benefits (COB) includes: Reimbursement when a patient is covered by more than 1 health plan Reimbursement for non-covered services Reimbursement for not medically necessary services Reimbursement for diagnosis mismatcharrow_forward
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