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Author : Sandra Gutierrez
Publisher :
ISBN 13 :
Total Pages : 108 pages
Book Rating : 4.:/5 (822 download)
Download or read book Managed Care and Its Impact on Credentialing Standards for Providers written by Sandra Gutierrez and published by . This book was released on 1997 with total page 108 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : Peter R. Kongstvedt
Publisher : Jones & Bartlett Publishers
ISBN 13 : 1449649823
Total Pages : 295 pages
Book Rating : 4.4/5 (496 download)
Download or read book Managed Care: What It Is and How It Works written by Peter R. Kongstvedt and published by Jones & Bartlett Publishers. This book was released on 2008-09-19 with total page 295 pages. Available in PDF, EPUB and Kindle. Book excerpt: The new Third Edition of Managed Health Care: What It Is and How It Works is a concise introduction to the foundations of the American managed health care system. Written in clear and accessible language, this handy guide offers an historical overview of managed care and then walks the reader through the organizational structures, concepts, and practices of the managed care industry. This thorough revision has been completely updated with all the newest data on this dynamic industry and features all new sections on: pay for performance, consumer directed health plans, new approaches to care management, as well as advances in information technology.
Author : Peter Kongstvedt
Publisher : Jones & Bartlett Learning
ISBN 13 : 0763759112
Total Pages : 295 pages
Book Rating : 4.7/5 (637 download)
Download or read book Managed Care written by Peter Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2009-10-07 with total page 295 pages. Available in PDF, EPUB and Kindle. Book excerpt: The origins of managed health care -- Types of managed care organizations and integrated health care delivery systems -- Network management and reimbursement -- Management of medical utilization and quality -- Internal operations -- Medicare and Medicaid -- Regulation and accreditation in managed care.
Author : George B. Moseley
Publisher : Jones & Bartlett Learning
ISBN 13 : 9780834207356
Total Pages : 644 pages
Book Rating : 4.2/5 (73 download)
Download or read book Managed Care Strategies written by George B. Moseley and published by Jones & Bartlett Learning. This book was released on 1999 with total page 644 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book is a guide to strategic training for physicians in an era of managed care. The first half of the book provides a step-by-step process to help physicians take their practices into the new world of integrated delivery systems. The second half of the book covers a variety of key topics such as credentialing, reimbursement systems, and utilization management.
Author : Amy M. Niehaus
Publisher :
ISBN 13 : 9781683080800
Total Pages : 0 pages
Book Rating : 4.0/5 (88 download)
Download or read book Credentialing for Managed Care written by Amy M. Niehaus and published by . This book was released on 2016-08-17 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Credentialing for Managed Care: Compliant Processes for Health Plan and Delegated Entities Amy M. Niehaus, CPMSM, CPCS, MBA New to managed care credentialing? Whether you work for a health plan or a hospital medical staff services department, this how-to guide answers all of your health plan credentialing and enrollment questions. Learn the regulatory and accreditation requirements related to managed care credentialing, including those from CMS, NCQA, and URAC. Author Amy M. Niehaus, CPMSM, CPCS, MBA, provides readers with the guidance to create a comprehensive and compliant credentialing program to support your health plan or to streamline your hospital's provider enrollment process through delegation. MSPs in all healthcare environments can benefit from understanding credentialing in the managed care world to support their organizational goals of compliance, operational efficiency, cost savings, and practitioner satisfaction. This book will help you: - Understand NCQA, URAC, and CMS requirements for health plans - Develop a comprehensive and compliant managed care credentialing program - Establish delegated credentialing agreements - Audit credentials files - Recognize how payer credentialing requirements impact other healthcare organizations - Streamline provider enrollment through delegation - Identify the differences between hospital and managed care credentialing - Evaluate whether a credentials verification organization is right for your organization About the author: Amy M. Niehaus, CPMSM, CPCS, MBA, is a consultant with The Greeley Company, an industry-leading healthcare consulting firm. She has over 25 years' experience in the medical services and credentialing profession. In her current role, she advises clients in the areas of accreditation, regulatory compliance, credentialing, process simplification and redesign, credentialing technology, and credentials verification organizations (CVO) development and delegation. Niehaus has worked in multiple environments throughout her career, including acute care hospitals, CVOs, and managed care organizations (MCO). She has been a member of the National Association Medical Staff Services (NAMSS) since 1991 and achieved her CPMSM certification in 1992 and her CPCS certification in 2002. Niehaus is a NAMSS instructor and previously served as chair of its MCO Task Force, as well as chair and member of the NAMSS Education Committee. She is a former president of the Missouri Association Medical Staff Services and its greater St. Louis area chapter. Niehaus holds a bachelor's degree from the University of Missouri and a master's degree in business administration from Maryville University in St. Louis. Niehaus has developed and presented various programs to local and national audiences on topics such as credentialing and privileging processes; Joint Commission, National Committee for Quality Assurance (NCQA), and URAC accreditation standards; and delegation.
Author : Peter Reid Kongstvedt
Publisher : Jones & Bartlett Publishers
ISBN 13 : 1284087115
Total Pages : 418 pages
Book Rating : 4.2/5 (84 download)
Download or read book Health Insurance and Managed Care written by Peter Reid Kongstvedt and published by Jones & Bartlett Publishers. This book was released on 2016 with total page 418 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : Vicki DeBaca
Publisher :
ISBN 13 : 9781578010790
Total Pages : 196 pages
Book Rating : 4.0/5 (17 download)
Download or read book Understanding Managed Care written by Vicki DeBaca and published by . This book was released on 2003 with total page 196 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : John Eugene Billi
Publisher : University of Michigan Press
ISBN 13 : 0472023721
Total Pages : 307 pages
Book Rating : 4.4/5 (72 download)
Download or read book The Challenge of Regulating Managed Care written by John Eugene Billi and published by University of Michigan Press. This book was released on 2010-02-01 with total page 307 pages. Available in PDF, EPUB and Kindle. Book excerpt: Representatives of industry, government, caregivers, and consumers join scholars and policy analysts in comparing market forces to regulation as potential means for righting what is wrong with managed care. The contributors that John E. Billi and Gail B. Agrawal have gathered here quickly move the healthcare debate beyond the classroom, think tank, and statehouse to the boardroom and examining room. Some argue strongly that the solution is to be found in the democratic process and government intervention, while others maintain that only market forces in a competitive environment can respond quickly to the needs of consumers and purchasers alike. The contributors' diverse opinions about the oversight of managed care reflect an enduring divide, one that will affect how society ultimately resolves questions about the inevitable tradeoffs among health-care quality, cost, and access in an environment of limited resources. The Challenge of Regulating Managed Care will appeal to policymakers, those in the medical field, and all readers interested in the American experience with managed care. John E. Billi is Associate Professor of Internal Medicine and Medical Education; Associate Dean for Clinical Affairs, University of Michigan Medical School; and Associate Vice President for Medical Affairs, University of Michigan. Gail B. Agrawal is Associate Professor of Law, University of North Carolina, Chapel Hill.
Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309175054
Total Pages : 394 pages
Book Rating : 4.3/5 (91 download)
Download or read book Managing Managed Care written by Institute of Medicine and published by National Academies Press. This book was released on 1997-04-21 with total page 394 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.
Author : United States. Congress. House. Committee on Commerce. Subcommittee on Health and the Environment
Publisher :
ISBN 13 :
Total Pages : 336 pages
Book Rating : 4.0/5 (18 download)
Download or read book Contract Issues and Quality Standards for Managed Care written by United States. Congress. House. Committee on Commerce. Subcommittee on Health and the Environment and published by . This book was released on 1996 with total page 336 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : Steven F. Isenberg
Publisher : Thieme
ISBN 13 : 9780865776876
Total Pages : 374 pages
Book Rating : 4.7/5 (768 download)
Download or read book Managed Care, Outcomes, and Quality written by Steven F. Isenberg and published by Thieme. This book was released on 1998 with total page 374 pages. Available in PDF, EPUB and Kindle. Book excerpt: The first section leads us through the complicated and risky business of capitation and examines reimbursement in a managed care environment. The idiosyncrasies of managed care contracts are detailed and you will learn how to negotiate with managed care companies. There is a focus on practice profiling and the presentation of an expertise on referral guidelines. The final chapter explores the ethical issues of managed care. In section II you will find a description of outcome research and youseful information for the implementation of outcomes research in community-based office practices. The third section begins with two chapters on improving office efficiency and managing staff in a managed care environment. The next chapter leads us through the important and complicated software selection process for the individual practitioner's needs. A private practitioner offers his insight into managing a medical practice and the section completes with some helpful pointers to avoid malpractice claims. Section IV provides the physicians' response to managed care. The legal issues of mergers and networks are discussed. Several practicing physicians outline their personal experiences in the rapidly changing world of physician network development. The book's final chapter leaves us with an expertise on how physicians can take back healthcare
Author : Peter Reid Kongstvedt
Publisher : Jones & Bartlett Learning
ISBN 13 : 9780763724986
Total Pages : 348 pages
Book Rating : 4.7/5 (249 download)
Download or read book Managed Care written by Peter Reid Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2004 with total page 348 pages. Available in PDF, EPUB and Kindle. Book excerpt: A managed care expert overviews the history, structure, regulation, and issues of the complex US health care system. This second edition work was originally published by Aspen in 2002. Much of the information is distilled from another of the doctor's books, The Managed Care Handbook, 4th ed. An extensive glossary is included, but there are no refer
Author : Hugh P. Greeley
Publisher :
ISBN 13 :
Total Pages : 248 pages
Book Rating : 4.:/5 ( download)
Download or read book Credentialing in the Managed Care Environment written by Hugh P. Greeley and published by . This book was released on 1996 with total page 248 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : Sheryl Tatar Dacso
Publisher :
ISBN 13 :
Total Pages : 1142 pages
Book Rating : 4.4/5 (91 download)
Download or read book Managed Care Answer Book written by Sheryl Tatar Dacso and published by . This book was released on 1999 with total page 1142 pages. Available in PDF, EPUB and Kindle. Book excerpt: This is an indispensable reference for all professionals involved in the design, implementation, financing, or operation of a managed care program, written in the classic answer book format. You'll find extensive sections providing basic understanding of managed care, cost containment strategies, and advice on organization and implementation of programs. The topic is covered from the ground up, with crucial questions and authoritative, up-to-date answers on every facet of managed care, including such valuable features as: Contract negotiation strategies and dispute resolution techniques Maximizing utilazation review and outcomes assessment Techniques for managed care implementation and administration Plus payer and provider contracting; advice on legal and regulatory considerations; important issues covered from both purchaser's and provider's perspectives; and discussion on information technology and telemedicine.
Author : Amy N. Niehaus
Publisher :
ISBN 13 : 9781683089650
Total Pages : 246 pages
Book Rating : 4.0/5 (896 download)
Download or read book Managed Care Credentialing written by Amy N. Niehaus and published by . This book was released on 2019 with total page 246 pages. Available in PDF, EPUB and Kindle. Book excerpt: The role of the MSP is expanding to include payer enrollment and delegated credentialing responsibilities for managed care organizations. Traditionally siloed, MSPs are now beginning to take on both responsibilities, which means they must learn the nuances of managed care credentialing as well as the regulatory and accreditation requirements of NCQA, CMS, and URAC. Managed Care Credentialing: Compliance Strategies for Health Plans, CVOs, and Delegated Entities provides the answers to MSPs' inevitable questions as they begin to manage the tasks of payer enrollment and delegated credentialing. Author Amy M. Niehaus guides readers through each payer's requirements, the differences between hospital and managed care credentialing, and how to help their organization establish delegated credentialing agreements and prepare for audits. As new and existing MSP responsibilities begin to collide, this resource also outlines ways MSPs can modify their current processes to reduce duplication of efforts and develop a comprehensive and compliant managed care credentialing program. Whether you are new to managed care credentialing or are taking on delegated credentialing responsibilities, this book will help you: Learn the regulatory and accreditation requirements related to managed care credentialing Streamline the provider enrollment process through delegation Meet your organizational goals of compliance, operational efficiency, cost savings, and practitioner satisfaction Identify the differences between hospital and managed care credentialing
Author : James R. Lyle
Publisher :
ISBN 13 :
Total Pages : 248 pages
Book Rating : 4.3/5 (91 download)
Download or read book The Managed Care Handbook written by James R. Lyle and published by . This book was released on 1994 with total page 248 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : William N. Tindall
Publisher : Jones & Bartlett Learning
ISBN 13 : 9780834217652
Total Pages : 322 pages
Book Rating : 4.2/5 (176 download)
Download or read book A Guide to Managed Care Medicine written by William N. Tindall and published by Jones & Bartlett Learning. This book was released on 2000 with total page 322 pages. Available in PDF, EPUB and Kindle. Book excerpt: Provides physicians, administrators, and other health professionals with information on managed care, from its history, forms and practices to detailed information on managed care contracting, physician compensation, monitoring, reporting, management, risk, productivity, and accountability. Annotati
