Managing Managed Care in the Medical Practice / Edition 2

Managing Managed Care in the Medical Practice / Edition 2

by Kay B. Stanley, Coker Group, Coker
     
 

ISBN-10: 1579472931

ISBN-13: 9781579472931

Pub. Date: 02/01/2004

Publisher: AMA Press

Understand, assess and evaluate managed care arrangements offered in today's marketplace. Practical tips on the pros and cons of participation, analyzing a managed care contract, plus capitation ethical issues.  See more details below

Overview

Understand, assess and evaluate managed care arrangements offered in today's marketplace. Practical tips on the pros and cons of participation, analyzing a managed care contract, plus capitation ethical issues.

Product Details

ISBN-13:
9781579472931
Publisher:
AMA Press
Publication date:
02/01/2004
Series:
Practice Success Ser.
Pages:
158
Product dimensions:
8.50(w) x 11.00(h) x 0.40(d)

Table of Contents

1Managed Care Today1
Perspectives of Managed Care1
Management Styles for Each Perspective3
The Current Environment for Practices5
2Developing a Managed Care Strategy15
Specific Identification of the Contracting Parties15
Specifying the Rates and Products17
Maintaining an Exit Strategy17
Avoiding All-Products Provisions19
Avoiding "At the Payer's Discretion" Clauses20
Maintaining Complete Files22
Forming a Contract Negotiation Team22
Negotiation Planning25
ABCs of Language Review33
Timeliness of Payments36
Legal Rights and Boundaries37
3Providing Cost-effective Health Care39
Maximum Throughput39
Cost per RVU Calculation41
Using Cost per RVU to Budget43
4Billing for Medical Services in a Managed Care Environment51
Managing Managed Care Contracts52
The Claims Process52
Policies and Procedures and Their Documentation73
5Medicare and Medicaid and Managed Care77
Medicare Managed Care77
Medicaid Managed Care86
6Risk Contracting91
Risk Readiness92
Contracting95
Implementation100
7Ethical Considerations in Managed Care103
The Patient-Physician Relationship103
Conflicts Between Patient and Physician104
Patient Autonomy and Responsibility105
Guidelines From the Council on Ethical and Judicial Affairs105
8HIPAA and Compliance109
Legislative History109
Privacy Rule Overview111
Strategic Approach to HIPAA Compliance113
Who Must Comply114
Personnel Designations: Privacy Officer and Contact Person116
Policies and Procedures118
Permitted Uses and Disclosures119
Authorizations for Nonpermitted Uses and Disclosures121
Minimum Necessary Rule122
Acknowledgment of Privacy Practices124
Individual Rights126
Training128
Business Associates128
State Law Preemption131
App. APrompt-Pay Statutes and Regulations135
App. BAMA Model Managed Care Contract, Third Edition139
Glossary141
Index155

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