HSM 420 Indemnity Versus Managed Care Discussions 1 Week
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HSM 420 Indemnity Versus Managed Care Discussions 1 Week 1 Early models of health insurance in America were what we call “indemnity plans” or traditional health insurance plans. What is meant by an indemnity plan, and how is managed care different from traditional indemnity insurance?…
Why was managed care created? Was indemnity not suitable? With the Affordable Care Act, are we still concerned with managed care backlash? Managed care has allowed many individuals to receive care that they were unable to receive prior to its existence. Having said that, it is also noted that managed care has changed throughout the years. Services have been streamlined, coverage has been minimized.
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HSM 420 Indemnity Versus Managed Care Discussions 1 Week 1 Early models of health insurance in America were what we call “indemnity plans” or traditional health insurance plans. What is meant by an indemnity plan, and how is managed care different from traditional indemnity insurance?…
Why was managed care created? Was indemnity not suitable? With the Affordable Care Act, are we still concerned with managed care backlash? Managed care has allowed many individuals to receive care that they were unable to receive prior to its existence. Having said that, it is also noted that managed care has changed throughout the years. Services have been streamlined, coverage has been minimized.
Tags: HSM 420 DISCUSSIONS, HSM 420 DISCUSSIONS WEEK 1 DEVRY
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Source: https://www.devrycourses.com/product/hsm-420-discussions-week-1-devry/
Why do managed care organizations seek to establish a provider
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HSM 420 Provider Networks Discussions 1 Week 2
Why do managed care organizations seek to establish a provider network? What are the primary reasons for contracting with providers? Can an MCO survive without a provider network?…
In a small town, how large can the provider network be? It is often stated that the small town insured individuals complain about having to drive many miles to receive care. What is the average mileage an individual has to drive to receive care? In many areas, patients have to travel 30 miles or more to receive basic care. What can MCOs do to entice providers to practice in such areas? You stated that purpose of managed care is to provide health care services. To whom are these services to be provided?
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HSM 420 Provider Networks Discussions 1 Week 2
Why do managed care organizations seek to establish a provider network? What are the primary reasons for contracting with providers? Can an MCO survive without a provider network?…
In a small town, how large can the provider network be? It is often stated that the small town insured individuals complain about having to drive many miles to receive care. What is the average mileage an individual has to drive to receive care? In many areas, patients have to travel 30 miles or more to receive basic care. What can MCOs do to entice providers to practice in such areas? You stated that purpose of managed care is to provide health care services. To whom are these services to be provided?
Tags: HSM 420 DISCUSSIONS, HSM 420 DISCUSSIONS WEEK 2 DEVRY
Source: https://www.devrycourses.com/product/hsm-420-discussions-week-2-devry/
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What do the categories used in utilization management mean
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HSM 420 Utilization Management Discussions 1 Week 3
What are the primary categories of utilization management (UM)? How does UM determine medical necessity through the use of evidence-based guidelines? What do the categories used in utilization management mean in laymen’s terms?….
If physicians are in charge of the care of the patient, why should they not be in charge of which services and how often the services should be rendered? How does this apply to what is taking place in healthcare today? How has the Affordable Care Act impacted utilization management? What is your analysis of the information that you provided? Who is responsible for ensuring that all providers are following the medical guidelines as they deliver care?
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HSM 420 Utilization Management Discussions 1 Week 3
What are the primary categories of utilization management (UM)? How does UM determine medical necessity through the use of evidence-based guidelines? What do the categories used in utilization management mean in laymen’s terms?….
If physicians are in charge of the care of the patient, why should they not be in charge of which services and how often the services should be rendered? How does this apply to what is taking place in healthcare today? How has the Affordable Care Act impacted utilization management? What is your analysis of the information that you provided? Who is responsible for ensuring that all providers are following the medical guidelines as they deliver care?
Tags: HSM 420 DISCUSSIONS, HSM 420 DISCUSSIONS WEEK 3 DEVRY
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What is the protocol is the brand name is not covered
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HSM 420 Managed Care Pharmacy Benefits Discussions 1 Week 4
What are the most important elements of a managed care pharmacy benefit program? And how are patient prescription benefits typically different under managed care? Pharmacy benefits is a controversial topic within managed care. As a patient, what do you want? How often do pharmacists recommend certain drugs to providers? Is this recommendation for costs control or quality products?…
With healthcare reform are we seeing more coverage for prescriptions? How has reform changed pharmacy benefits? What is the protocol is the brand name is not covered, but it has been determined that your body responds better to the brand?
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HSM 420 Managed Care Pharmacy Benefits Discussions 1 Week 4
What are the most important elements of a managed care pharmacy benefit program? And how are patient prescription benefits typically different under managed care? Pharmacy benefits is a controversial topic within managed care. As a patient, what do you want? How often do pharmacists recommend certain drugs to providers? Is this recommendation for costs control or quality products?…
With healthcare reform are we seeing more coverage for prescriptions? How has reform changed pharmacy benefits? What is the protocol is the brand name is not covered, but it has been determined that your body responds better to the brand?
Tags: HSM 420 DISCUSSIONS, HSM 420 DISCUSSIONS WEEK 4 DEVRY
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What are some of the common standards mandated by NCQA
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HSM 420 Managed Care Accreditation Discussions 1 Week 5
Discuss the main elements of the managed care accreditation process. For each main element, explain why it is important. Are these steps adequate? Should more be done? There are so many elements that must be monitored. If healthcare facilities were not held accountable for delivering these elements in an efficient manner, quality care would not be delivered. For reimbursement of Medicare claims must the facility be accredited?…
What are some of the common standards mandated by NCQA? Although there are several standards, all facilities are not accredited. What do non-accredited facilities do to compete with accredited facilities?
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HSM 420 Managed Care Accreditation Discussions 1 Week 5
Discuss the main elements of the managed care accreditation process. For each main element, explain why it is important. Are these steps adequate? Should more be done? There are so many elements that must be monitored. If healthcare facilities were not held accountable for delivering these elements in an efficient manner, quality care would not be delivered. For reimbursement of Medicare claims must the facility be accredited?…
What are some of the common standards mandated by NCQA? Although there are several standards, all facilities are not accredited. What do non-accredited facilities do to compete with accredited facilities?
Tags: HSM 420 DISCUSSIONS, HSM 420 DISCUSSIONS WEEK 5 DEVRY
Source: https://www.devrycourses.com/product/hsm-420-discussions-week-5-devry/
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Provide at least three specific examples of fraudulent
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HSM 420 Fraud and Abuse Discussions 1 Week 6
Discuss fraud and abuse in healthcare. Provide at least three specific examples of fraudulent practices that have taken place in U.S. healthcare, and describe ways to prevent these in our modern healthcare environment….
Imagine how many other deceased patients there are that have been billed for services that they did not receive. Many families will just ignore the bill and the provider will receive payment. Monitoring fraud and abuse needs to be a priority. Decreasing such acts will save the country millions. What are some of the consequences that are given to providers who abuse the system or commit fraud? What are Medicaid and Medicare agencies doing to prevent this type of fraud?
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HSM 420 Fraud and Abuse Discussions 1 Week 6
Discuss fraud and abuse in healthcare. Provide at least three specific examples of fraudulent practices that have taken place in U.S. healthcare, and describe ways to prevent these in our modern healthcare environment….
Imagine how many other deceased patients there are that have been billed for services that they did not receive. Many families will just ignore the bill and the provider will receive payment. Monitoring fraud and abuse needs to be a priority. Decreasing such acts will save the country millions. What are some of the consequences that are given to providers who abuse the system or commit fraud? What are Medicaid and Medicare agencies doing to prevent this type of fraud?
Tags: HSM 420 DISCUSSIONS, HSM 420 DISCUSSIONS WEEK 6 DEVRY
Source: https://www.devrycourses.com/product/hsm-420-discussions-week-6-devry/
Source: https://www.devrycourses.com/product/hsm-420-discussions-week-6-devry/
What are the most critical components of state regulation
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HSM 420 State and Federal Regulation Discussions 1 Week 7
What are the most critical components of state regulation for managed care organizations? And which federal regulations also bring specific requirements for the operation of such entities? Discuss state and federal regulation of MCOs. Do you think that there are enough regulations for MCOs? …
What are the most critical components of state regulation? What are a few of the mandates? What are some of the unique state regulations mandated in your state? Why was this law developed? What are the healthcare regulations mandated in your state? What are some of the federal regulations that take precedence over state regulations?
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HSM 420 State and Federal Regulation Discussions 1 Week 7
What are the most critical components of state regulation for managed care organizations? And which federal regulations also bring specific requirements for the operation of such entities? Discuss state and federal regulation of MCOs. Do you think that there are enough regulations for MCOs? …
What are the most critical components of state regulation? What are a few of the mandates? What are some of the unique state regulations mandated in your state? Why was this law developed? What are the healthcare regulations mandated in your state? What are some of the federal regulations that take precedence over state regulations?
Tags: HSM 420 DISCUSSIONS, HSM 420 DISCUSSIONS WEEK 7 DEVRY
Source: https://www.devrycourses.com/product/hsm-420-discussions-week-7-devry/
Source: https://www.devrycourses.com/product/hsm-420-discussions-week-7-devry/
Flashcard set info:
Author: CoboCards-User
Main topic: Education
Topic: Education
School / Univ.: devry university
City: UK
Published: 12.02.2020
Tags: INTERNATIONAL STUDY, COMPUTER SCiENCE, ENGINEERING & TECHNOLOGY, Accounting, Business, PSCYCHOLOGY, SOCIAL SCIENCE, POLITICAL Science, Social Science, Project Risk Management, ARTS & HUMANITIES, RELIGIOUS STUDIES SOCIOLOGY
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