Managing Managed Care in the Medical Practice / Edition 2

Paperback (Print)
Used and New from Other Sellers
Used and New from Other Sellers
from $7.45
Usually ships in 1-2 business days
(Save 86%)
Other sellers (Paperback)
  • All (5) from $7.45   
  • New (2) from $8.49   
  • Used (3) from $7.45   
Sort by
Page 1 of 1
Showing All
Note: Marketplace items are not eligible for any coupons and promotions
Seller since 2008

Feedback rating:



New — never opened or used in original packaging.

Like New — packaging may have been opened. A "Like New" item is suitable to give as a gift.

Very Good — may have minor signs of wear on packaging but item works perfectly and has no damage.

Good — item is in good condition but packaging may have signs of shelf wear/aging or torn packaging. All specific defects should be noted in the Comments section associated with each item.

Acceptable — item is in working order but may show signs of wear such as scratches or torn packaging. All specific defects should be noted in the Comments section associated with each item.

Used — An item that has been opened and may show signs of wear. All specific defects should be noted in the Comments section associated with each item.

Refurbished — A used item that has been renewed or updated and verified to be in proper working condition. Not necessarily completed by the original manufacturer.

1579472931 New Condition. Ships immediately!

Ships from: Lindenhurst, NY

Usually ships in 1-2 business days

  • Standard, 48 States
  • Standard (AK, HI)
  • Express, 48 States
  • Express (AK, HI)
Seller since 2005

Feedback rating:


Condition: New
2004-02-01 Paperback 2 New 1579472931 New Condition. Ships immediately!

Ships from: plainview, NY

Usually ships in 1-2 business days

  • Canadian
  • International
  • Standard, 48 States
  • Standard (AK, HI)
  • Express, 48 States
  • Express (AK, HI)
Page 1 of 1
Showing All
Sort by


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.

Read More Show Less

Editorial Reviews

Doody's Review Service
Reviewer: Fang Sun, PhD (California State University Dominguez Hills)
Description: This is the second edition of an overview of today's concept of managed care as it relates to the business aspects of medical practice. The first edition was published in 1996.
Purpose: Due to the dynamics of managed care since 1996, such an objective is certainly worthy to pursue. The authors have done a wonderful job to meet the objective.
Audience: The book is intended for the people who manage or simply are interested in managed care in medical practices. With years of experience in the field, the authors are truly credible authorities in the subject matter of the book.
Features: The book reviews the fundamentals and concepts, and terminology and definitions of managed care. It provides practical strategies to manage managed care in medical practices and useful tools on assessing plans and reviewing contracts.
Assessment: This is a good resource for understanding various aspects of, and managing, managed care in medical practices. It is worthy reading by all who care about how to maintain the fiscal health of their medical practices in the environment of managed care.

3 Stars from Doody
Read More Show Less

Product Details

  • ISBN-13: 9781579472931
  • Publisher: AMA Press
  • Publication date: 2/1/2004
  • Series: Practice Success Ser.
  • Edition number: 2
  • Pages: 158
  • Product dimensions: 8.50 (w) x 11.00 (h) x 0.40 (d)

Table of Contents

1 Managed Care Today 1
Perspectives of Managed Care 1
Management Styles for Each Perspective 3
The Current Environment for Practices 5
2 Developing a Managed Care Strategy 15
Specific Identification of the Contracting Parties 15
Specifying the Rates and Products 17
Maintaining an Exit Strategy 17
Avoiding All-Products Provisions 19
Avoiding "At the Payer's Discretion" Clauses 20
Maintaining Complete Files 22
Forming a Contract Negotiation Team 22
Negotiation Planning 25
ABCs of Language Review 33
Timeliness of Payments 36
Legal Rights and Boundaries 37
3 Providing Cost-effective Health Care 39
Maximum Throughput 39
Cost per RVU Calculation 41
Using Cost per RVU to Budget 43
4 Billing for Medical Services in a Managed Care Environment 51
Managing Managed Care Contracts 52
The Claims Process 52
Policies and Procedures and Their Documentation 73
5 Medicare and Medicaid and Managed Care 77
Medicare Managed Care 77
Medicaid Managed Care 86
6 Risk Contracting 91
Risk Readiness 92
Contracting 95
Implementation 100
7 Ethical Considerations in Managed Care 103
The Patient-Physician Relationship 103
Conflicts Between Patient and Physician 104
Patient Autonomy and Responsibility 105
Guidelines From the Council on Ethical and Judicial Affairs 105
8 HIPAA and Compliance 109
Legislative History 109
Privacy Rule Overview 111
Strategic Approach to HIPAA Compliance 113
Who Must Comply 114
Personnel Designations: Privacy Officer and Contact Person 116
Policies and Procedures 118
Permitted Uses and Disclosures 119
Authorizations for Nonpermitted Uses and Disclosures 121
Minimum Necessary Rule 122
Acknowledgment of Privacy Practices 124
Individual Rights 126
Training 128
Business Associates 128
State Law Preemption 131
App. A Prompt-Pay Statutes and Regulations 135
App. B AMA Model Managed Care Contract, Third Edition 139
Glossary 141
Index 155
Read More Show Less

Customer Reviews

Be the first to write a review
( 0 )
Rating Distribution

5 Star


4 Star


3 Star


2 Star


1 Star


Your Rating:

Your Name: Create a Pen Name or

Barnes & Review Rules

Our reader reviews allow you to share your comments on titles you liked, or didn't, with others. By submitting an online review, you are representing to Barnes & that all information contained in your review is original and accurate in all respects, and that the submission of such content by you and the posting of such content by Barnes & does not and will not violate the rights of any third party. Please follow the rules below to help ensure that your review can be posted.

Reviews by Our Customers Under the Age of 13

We highly value and respect everyone's opinion concerning the titles we offer. However, we cannot allow persons under the age of 13 to have accounts at or to post customer reviews. Please see our Terms of Use for more details.

What to exclude from your review:

Please do not write about reviews, commentary, or information posted on the product page. If you see any errors in the information on the product page, please send us an email.

Reviews should not contain any of the following:

  • - HTML tags, profanity, obscenities, vulgarities, or comments that defame anyone
  • - Time-sensitive information such as tour dates, signings, lectures, etc.
  • - Single-word reviews. Other people will read your review to discover why you liked or didn't like the title. Be descriptive.
  • - Comments focusing on the author or that may ruin the ending for others
  • - Phone numbers, addresses, URLs
  • - Pricing and availability information or alternative ordering information
  • - Advertisements or commercial solicitation


  • - By submitting a review, you grant to Barnes & and its sublicensees the royalty-free, perpetual, irrevocable right and license to use the review in accordance with the Barnes & Terms of Use.
  • - Barnes & reserves the right not to post any review -- particularly those that do not follow the terms and conditions of these Rules. Barnes & also reserves the right to remove any review at any time without notice.
  • - See Terms of Use for other conditions and disclaimers.
Search for Products You'd Like to Recommend

Recommend other products that relate to your review. Just search for them below and share!

Create a Pen Name

Your Pen Name is your unique identity on It will appear on the reviews you write and other website activities. Your Pen Name cannot be edited, changed or deleted once submitted.

Your Pen Name can be any combination of alphanumeric characters (plus - and _), and must be at least two characters long.

Continue Anonymously

    If you find inappropriate content, please report it to Barnes & Noble
    Why is this product inappropriate?
    Comments (optional)