LP2.8 Assignment: Managed Care Overview Homework Help

LP2.8 Assignment

COMPLETE the LP2.8 Assignment: Managed Care Overview.

Download the attached worksheet for LP2.8 Assignment template to complete the paper for Managed Care Overview. In this assignment you are to use the readings from Chapter 7 in the Guide to Medical Billing and the Internet to prepare a typed, one (minimum) page paper discussing the following points as if you are providing an overview for a potential employer:

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Include the following:

• Describe the types of managed care organizations, functions and how they set their reimbursement schedules, their reasoning’s for doing so and specific services covered or not covered under the plans.
• Describe what information is to be listed on the insurance card; how the insurance company receives the insured’s group enrollment information and updates.
• What happens if the insured is under the care of a Primary Care Physician (PCP) who is their gatekeeper orchestrating all of the patients care-but the patient no longer wants to receive care by that provider-how does the member change providers? What documenting will be required to complete that process?
• What if the patient has a complaint about their Physician, care, denials, etc.?  What is the process that patient will need to follow?  What if the patient wants a second opinion?
• By the same token-a provider decides he wants to discontinue caring for individuals under a certain Managed Care Organization (MCO)-and no longer be a participating provider-what is the process for achieving that goal?
  • Until the paperwork is processed, how will the physician get paid (stop loss reimbursement) for still providing care for those patients?
  • Discuss how you would communicate with the insurance plan the desire of your provider in not wanting to accept their guidelines, fee schedules, etc.
  • Discuss how you would facilitate and provide communication between the patient and the provider for continuing care and referrals to other providers in the interim.

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The paper will include the following guidelines:
1. Double spaced
2. 12 point font
3. 1 inch margins
4. Separate title page

Submit this assignment to your instructor via the dropbox LP2.8 Assignment: Managed Care Overview.   This assignment is worth 20 points.

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