Managed Care Law Manual

Hardcover (Print)
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Overview

Managed Care Law Manual is a unique legal guide specific to managed care filled with the facts health care attorneys, managed care organizations, and health care administrators need to make informed choices. This legal guide will help you know not only your legal obligations, but also those of your contracting partners, employers, third-party payers, physicians, and others so you can form the joint alliances that will be essential in the health care reform days ahead. This manual is always current with twice a year updates.

Managed Care Law Manual has been updated to include:

New information on CMS's proposed rule on the Medicare shared savings program for accountable care organizations

Up-to-date material on civil monetary penalty sanctions under the Health Insurance Portability and Accountability Act

Information on states that require coverage for autism treatment

Updated material on states that require health plans to cover patient care costs in clinical trials

Case law regarding unreasonable restraint of trade

New material on state external review laws

Recent ERISA case law addressing claims based on denial of coverage

Seff v. Broward County, a recent case dealing with voluntary wellness programs and the Americans with Disabilities Act (ADA)

New case law addressing false claims and credentialing

Recent OIG advisory opinions regarding the Anti-Kickback statute

Up-to-date material regarding state false claims acts

Information on the recently released IRS/Treasury Priority Guidance Plan

New CMS guidance regarding Medicare Advantage (MA) marketing and enrollment

Recent case law regarding mental health coverage

Provides practical information & sample contract language/ addresses major areas of HMOs/PPOs/direct contracting/etc.

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Product Details

  • ISBN-13: 9780834205413
  • Publisher: Wolters Kluwer Law & Business
  • Publication date: 4/21/1994
  • Format: Ringbound
  • Edition description: REV
  • Pages: 620

Table of Contents

• Managed Care Organizations, Affiliated Entities, and Integrated Delivery Systems
• Overview of Federal Regulation
• State Regulation of Managed Care
• Business Structures
• Antitrust
• External Review
• ERISA
• Trends in Managed Care Litigation
• Contracting
• Accreditation of Health Care Organizations
• Credentialing
• Fraud and Abuse Issues Affecting Managed Care Entities
• Special Issues for Tax-Exempt Organizations in Managed Care
• Contracting with the Government
• Pharmacy
• Behavioral Health Care
• Marketing
• Managed Care Compliance
• Electronic Information in Managed Care
• Resource

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