Hmam Case Study

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Part 1: What a medical biller can do to make sure a WC claim is paid as rapidly as possible.

The medical biller must be aware of the types of injuries that occur in workplace settings. By knowing the most common injuries, a medical biller can identify WC claims and bill the proper party. This information is found in the history and physical.

According to the e-book" If the medical biller determines that an illness or injury is potentially work related and therefore subject to WC insurance, the medical biller sends a letter with questions that will determine which party to bill for services. WC requires a Doctor’s First Report of Injury to be submitted before a case can be approved to be pursued through workers’ compensation insurance. Subsequent …show more content…


Part 2: Discuss the history of why HMOs were developed and if they met those goals as intended.

Health Maintenance Organization Plans - HMO Plans for short - are a type of managed care program. The idea behind managed care programs is that maintaining good health will be achieved by preventing disease and providing quality care. By maintaining good health, it is believed that escalating health care costs can be controlled.

“When HMO Plans were first introduced, members paid a fixed, prepaid monthly premium in exchange for health care from a contracted network of providers. The contracted network of providers includes hospitals, clinics and health care providers that have signed a contract with the HMO. In this sense, HMOs are the most restrictive form of managed care plans because they restrict the procedures, providers and benefits by requiring that the members use these providers and no others.

HMOs were intended to take health care in a new direction. They were designed by the government to do away with individual health insurance plans and to make affordable health insurance available to everyone. At that time employers were purchasing individual health insurance plans for their employees ~ a costly expense that many were starting to

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