The Basics of Managed Care: What You Need to Know-The Basics of Managed Care: What You Need to Know (Slides)

The Basics of Managed Care: What You Need to Know (Slides)

Pdf Summary

In this document, the presenter discusses the basics of managed care, focusing on what healthcare providers need to know. The presentation covers various topics such as the definition of managed care, the different parts of Medicare, different reimbursement models, and the process of participating in insurance plans as a form of payment. The presenter also emphasizes the importance of proper documentation and the submission of claims, as well as the need for compliance with insurance regulations and laws.<br /><br />The document also mentions the availability of free resources for IHS members, including a comprehensive guide for hearing healthcare providers on managed care, which covers billing and credentialing, appealing denials, state and federal programs, and more. Additionally, a compliance plan template will be available for IHS members in the future.<br /><br />The importance of obtaining a National Provider Identifier (NPI) number and a Taxonomy Code is highlighted, as these are necessary for participation in insurance plans. The document also explains the process of credentialing with insurance companies and the importance of negotiating fee schedules. It mentions the need for proper eligibility verification, accurate documentation, and adherence to HIPAA rules.<br /><br />The presentation also provides insights into the reimbursement process, including submitting claims, negotiating with insurance carriers, and managing write-offs. The role of the Office of Inspector General (OIG) in overseeing government programs and investigating cases of fraud, waste, and abuse is highlighted.<br /><br />Overall, the document provides valuable information for healthcare providers regarding the basics of managed care and the necessary steps for participation and compliance. It also emphasizes the importance of proper documentation, understanding insurance policies, and adhering to regulations and laws to avoid potential legal issues.

Keywords

managed care

healthcare providers

Medicare

reimbursement models

insurance plans

documentation

compliance

IHS members

credentialing

HIPAA rules