- Identify how the managed care environment, players, and dynamics can impact your organization.
- Review insurance, PPO and ERISA plan contracts in order to successfully maximize reimbursements and minimize denials.
- Recognize problematic contract terms affecting both reimbursement and operations.
- Discuss capitation per diem and percentage of charges rate, and understand the risks assumed, plus develop strategies for managing and sharing those risks.
- Review the driving forces in managed care (including healthcare reform), specifics on payer initiatives, public policy, and patient service imperatives that are shaping change.
In a 1 page Word document, explain how each one impacts contract management in your own organization (or an organization that you may have encountered in your own research). Then, give an example for each key component of how contract management would be negatively impacted should that component be ignored.
PLEASE MEET Criteria!!
How managed care impacts an individual organization environment?
How can review and understanding of an insurance contract help maximize reimbursement and minimize denials? Give examples and negative impact if this component is ignored.
Identify problematic contract terms and explain how they can challenge HIM operations. Give examples and negative impact if this component is ignored.
Discuss capitation and percentage of charges. Identify the risks for healthcare provider and identify strategies for the healthcare provider to succeed in spite of them.
Review the driving forces in managed care and initiatives that are driving healthcare change.
Professional written, formatted with good grammar, spelling, punctuation, etc.