Managing Managed Care

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Author :
Publisher : National Academies Press
ISBN 13 : 0309175054
Total Pages : 394 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Managing Managed Care by : Institute of Medicine

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.

Managed Care Credentialing

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Publisher :
ISBN 13 : 9781683089650
Total Pages : 246 pages
Book Rating : 4.0/5 (896 download)

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Book Synopsis Managed Care Credentialing by : Amy N. Niehaus

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

Credentialing for Managed Care

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Publisher :
ISBN 13 : 9781683080800
Total Pages : 0 pages
Book Rating : 4.0/5 (88 download)

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Book Synopsis Credentialing for Managed Care by : Amy M. Niehaus

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.

Health Professions Education

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Publisher : National Academies Press
ISBN 13 : 030913319X
Total Pages : 191 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Health Professions Education by : Institute of Medicine

Download or read book Health Professions Education written by Institute of Medicine and published by National Academies Press. This book was released on 2003-07-01 with total page 191 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education. These core competencies include patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics. This book recommends a mix of approaches to health education improvement, including those related to oversight processes, the training environment, research, public reporting, and leadership. Educators, administrators, and health professionals can use this book to help achieve an approach to education that better prepares clinicians to meet both the needs of patients and the requirements of a changing health care system.

Handbook of Private Practice

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Publisher : Oxford University Press
ISBN 13 : 0190272163
Total Pages : 849 pages
Book Rating : 4.1/5 (92 download)

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Book Synopsis Handbook of Private Practice by : Steven Walfish

Download or read book Handbook of Private Practice written by Steven Walfish and published by Oxford University Press. This book was released on 2017 with total page 849 pages. Available in PDF, EPUB and Kindle. Book excerpt: Handbook of Private Practice is the premier resource for mental health clinicians, covering all aspects of developing and maintaining a successful private practice. Written for graduate students considering the career path of private practice, professionals wanting to transition into private practice, and current private practitioners who want to improve their practice, this book combines the overarching concepts needed to take a mental health practice (whether solo or in a group) from inception, through its lifespan. From envisioning your practice, to accounting and bookkeeping, hiring staff, managing the practice, and running the business of the practice, a diverse group of expert authors describe the practical considerations and steps to take to enhance your success. Chapters cover marketing, dealing with insurance and managed care, and how to choose your advisors. Ethics and risk management are integrated throughout the text with a special section also devoted to these issues and strategies. The last section features 26 niche practices in which expert practitioners describe their special area of practice and discuss important issues and aspects of their specialty practice. These areas include assessment and evaluation, specialized psychotherapy services, working with unique populations of clients, and more. Whether read cover-to-cover or used as a reference to repeatedly come back to when a question or challenge arises, this book is full of practical guidance directly geared to psychologists, counselors, social workers, and marriage and family therapists in independent practice.

Health Insurance and Managed Care

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Author :
Publisher : Jones & Bartlett Learning
ISBN 13 : 128415209X
Total Pages : 355 pages
Book Rating : 4.2/5 (841 download)

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Book Synopsis Health Insurance and Managed Care by : Peter R. Kongstvedt

Download or read book Health Insurance and Managed Care written by Peter R. Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2019-02-14 with total page 355 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.

The Credentialing Handbook

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Publisher : Jones & Bartlett Learning
ISBN 13 : 9780834209336
Total Pages : 604 pages
Book Rating : 4.2/5 (93 download)

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Book Synopsis The Credentialing Handbook by : Sheryl Deutsch

Download or read book The Credentialing Handbook written by Sheryl Deutsch and published by Jones & Bartlett Learning. This book was released on 1999 with total page 604 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Credentialing Handbook provides comprehensive, plain-English guida nce to understand and master the provider credentialing process in any health care setting. With sample forms, checklists, flowcharts, and c orrespondence, this practical guide walks you through every aspect of effective credentialing, appointment, and recredentialing. You'll lear n: key steps in the credentialing process; about express credentialin g models; how to credential allied health practitioners; typical time frames and tracking systems; pros and cons of delegating credentialin g, plus more.

The Managed Health Care Handbook

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Publisher : Jones & Bartlett Learning
ISBN 13 : 9780834217263
Total Pages : 1448 pages
Book Rating : 4.2/5 (172 download)

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Book Synopsis The Managed Health Care Handbook by : Peter Reid Kongstvedt

Download or read book The Managed Health Care Handbook written by Peter Reid Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2001 with total page 1448 pages. Available in PDF, EPUB and Kindle. Book excerpt: This thoroughly revised and updated book provides a strategic and operational resource for use in planning and decision-making. The Handbook enables readers to fine-tune operation strategies by providing updates on critical managed care issues, insights to the complex managed care environment, and methods to gain and maintain cost-efficient, high quality health services. With 30 new chapters, it includes advice from managers in the field on how to succeed in every aspect of managed care including: quality management, claims and benefits administration, and managing patient demand. The Handbook is considered to be the standard resource for the managed care industry.

Changing the Conversation

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Publisher :
ISBN 13 :
Total Pages : 256 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Changing the Conversation by :

Download or read book Changing the Conversation written by and published by . This book was released on 2000 with total page 256 pages. Available in PDF, EPUB and Kindle. Book excerpt:

A Guide to AHP Credentialing

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Author :
Publisher : HC Pro, Inc.
ISBN 13 : 9781578394784
Total Pages : 482 pages
Book Rating : 4.3/5 (947 download)

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Book Synopsis A Guide to AHP Credentialing by : Beverly E. Pybus

Download or read book A Guide to AHP Credentialing written by Beverly E. Pybus and published by HC Pro, Inc.. This book was released on 2004 with total page 482 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Changing the Conversation

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Publisher :
ISBN 13 :
Total Pages : 260 pages
Book Rating : 4.:/5 (327 download)

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Book Synopsis Changing the Conversation by : National Treatment Plan Initiative (U.S.)

Download or read book Changing the Conversation written by National Treatment Plan Initiative (U.S.) and published by . This book was released on 2000 with total page 260 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Leadership by Example

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Publisher : National Academies Press
ISBN 13 : 0309168880
Total Pages : 206 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Leadership by Example by : Institute of Medicine

Download or read book Leadership by Example written by Institute of Medicine and published by National Academies Press. This book was released on 2003-05-21 with total page 206 pages. Available in PDF, EPUB and Kindle. Book excerpt: The federal government operates six major health care programs that serve nearly 100 million Americans. Collectively, these programs significantly influence how health care is provided by the private sector. Leadership by Example explores how the federal government can leverage its unique position as regulator, purchaser, provider, and research sponsor to improve care - not only in these six programs but also throughout the nation's health care system. The book describes the federal programs and the populations they serve: Medicare (elderly), Medicaid (low income), SCHIP (children), VHA (veterans), TRICARE (individuals in the military and their dependents), and IHS (native Americans). It then examines the steps each program takes to assure and improve safety and quality of care. The Institute of Medicine proposes a national quality enhancement strategy focused on performance measurement of clinical quality and patient perceptions of care. The discussion on which this book focuses includes recommendations for developing and pilot-testing performance measures, creating an information infrastructure for comparing performance and disseminating results, and more. Leadership by Example also includes a proposed research agenda to support quality enhancement. The third in the series of books from the Quality of Health Care in America project, this well-targeted volume will be important to all readers of To Err Is Human and Crossing the Quality Chasm - as well as new readers interested in the federal government's role in health care.

Health Care Quality and Consumer Protection

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Author :
Publisher :
ISBN 13 :
Total Pages : 128 pages
Book Rating : 4.0/5 ( download)

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Book Synopsis Health Care Quality and Consumer Protection by : United States. Congress. Senate. Committee on Labor and Human Resources

Download or read book Health Care Quality and Consumer Protection written by United States. Congress. Senate. Committee on Labor and Human Resources and published by . This book was released on 1997 with total page 128 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Introduction to Health Services

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Publisher : Taylor & Francis US
ISBN 13 : 9780766836112
Total Pages : 448 pages
Book Rating : 4.8/5 (361 download)

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Book Synopsis Introduction to Health Services by : Stephen Joseph Williams

Download or read book Introduction to Health Services written by Stephen Joseph Williams and published by Taylor & Francis US. This book was released on 2002 with total page 448 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Introduction to Health Services, Sixth Edition builds upon its reputation as a classic book written by nationally recognized authors. This new edition addresses the significant changes and advances in biomedical research, government policy, information technology, and health care cost containment"--Back cover.

Health Insurance and Managed Care

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Author :
Publisher : Jones & Bartlett Learning
ISBN 13 : 1284194620
Total Pages : 380 pages
Book Rating : 4.2/5 (841 download)

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Book Synopsis Health Insurance and Managed Care by : Peter R. Kongstvedt

Download or read book Health Insurance and Managed Care written by Peter R. Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2019-02-15 with total page 380 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.

2008 Credentials Verification Desk Reference

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Publisher : HC Pro, Inc.
ISBN 13 : 1601461445
Total Pages : 718 pages
Book Rating : 4.6/5 (14 download)

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Book Synopsis 2008 Credentials Verification Desk Reference by : Kathy Matzka

Download or read book 2008 Credentials Verification Desk Reference written by Kathy Matzka and published by HC Pro, Inc.. This book was released on 2008 with total page 718 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Medicare HMO Regulation and Quality

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Publisher :
ISBN 13 :
Total Pages : 152 pages
Book Rating : 4.0/5 ( download)

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Book Synopsis Medicare HMO Regulation and Quality by : United States. Congress. House. Committee on Ways and Means. Subcommittee on Health

Download or read book Medicare HMO Regulation and Quality written by United States. Congress. House. Committee on Ways and Means. Subcommittee on Health and published by . This book was released on 1997 with total page 152 pages. Available in PDF, EPUB and Kindle. Book excerpt: