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Hmam Case Study

451 Words2 Pages

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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The Patient Protection and Affordable Care Act (ACA) approved the use of Accountable Care Organizations (ACOs) to provide protection, value of care and reduce health care costs in Medicare. The ACO program is a charitable program which began on January 1, 2012. An ACO represents a group of providers and suppliers of services such as hospitals, physicians, and those involved in patient care. These individuals have agreed to work together to coordinate care for the patients they serve under the original Medicare. The objective of an ACO is to provide continuous, high quality care for Medicare beneficiaries, simultaneously improve quality and lower costs.

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Accountable Care Organizations: Similarities Between ACO And Managed Care

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Both Medicare ACO programs need the ACOs to inform the payee that they are participating the ACOs, and the ACOs will be responsible for reducing the cost for these beneficiaries. A significant difference from traditional HMO, however, Medicare patients can still see any physician they want to see without a referral. Whereas many private managed care plans force patients to choose a primary care provider (PCP), (Shafrin,2011). The shared savings features of ACOs and integration of care, discussed above, provide incentives to keep unnecessary utilization down, and could, therefore, lower costs (Barnes et

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Compare and Contrast CIGNA HMO and Heritage California ACO from the lens of the consumer Introduction In the US, there are many health insurance plans designed to meet different individual needs with various advantages and disadvantages of their own. This research paper, focuses on the two different health plan models those are Cigna HMO and Heritage California ACO. Health Maintenance organization (HMO) is basically a type of health plan that limits the freedom of choice of the provider, as the coverage is given to patients who take care from the physicians who contact with the HMO and its main focus is on the prevention and wellness (Wedig, 2013). ACO health plans basically focuses on the care coordination, promote prevention and wellness,

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232 Words | 1 Pages

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1059 Words | 5 Pages

Managed care plans are seperated into three different catergories: HMO (Health Maintenance Organization), PPO (Preferred provider organization), and last but not least, POS (Point of Service). HMOs are plans that only pay for care within a certain network of doctors. In the case of PPOs, the person covered normally pays more if they get care within the network. They also pay part of the cost if they go outside the network. Furthermore, POSs are plans that lets it’s member choose between an HMO or a PPO every time they need care.

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Unit 2 Assignment 2 Health And Social Care

192 Words | 1 Pages

• According to (2017 Medical Mutual) stated;” HMO stands for health maintenance organization, “and “PPO stands for preferred provider organization.” The information that I have gather from the several articles that I have read is that it is really up to the individual depending upon, what the individual wants. More about the HMO, HMO you will have to choose a primary doctor.

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411 Words | 2 Pages

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553 Words | 3 Pages

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1163 Words | 5 Pages

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862 Words | 4 Pages

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664 Words | 3 Pages

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417 Words | 2 Pages

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470 Words | 2 Pages

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448 Words | 2 Pages

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