Feca Procedure Manual Part 6

HCM 2 Flashcards Quizlet managed care is a healthcare delivery system that provides health care and controls costs THROUGH A NETWORK of physicians, hospitals, and other healthcare providers these plans include the coordinated home health and hospice care program, exclusive provider organizations, health maintenance organizations HMO, outpatient pretreatment authorization plans, point of service plans, preferred provider organizations, and second surgical opinionsExclusive provider organization EPO similar to a health maintenance organization that provides healthcare services through a network of doctors, hospitals, and other healthcare providers, except that members are NOT REQUIRED TO SELECT a primary care provider, and they do not need a referral to see a specialist. HOWEVER, they must obtain services from EPO providers only or the patient is responsible for chargesMO fixed fee for servicesutpatient pretreatment authorization plan OPAP requires preauthorization of outpatient physical, occupational, and speech therapy services in addition OPAP requires periodic txprogress plans to be filed also known as prospective authorization or precertificationOS point of service plan allows subscribers to choose, at the time medical services are needed, whether they will go to a provider win the plans network or outside the network subscribers choose a primary care provider PCP from the payers PCP list PCP is gatekeeper when the subscriber goes outside the network to seek care, out of pocket expenses and copayments generally increase provide a full range of inpatient and outpatient servicesPO preferred provider organizations offers discounted healthcare services to subscribers who use designated healthcare providers who contract with PPO but also provides coverage for services rendered by healthcare providers who are not part of the PPO network Sometimes described as as a subscriber driven program, and BCBS substitutes the terms subscriber or member for POLICYHOLDER the subscriber member is responsible for remaining within the network of PPO providers and must request referrals to PPO specialists whenever possible subscriber must also adhere to the managed care requirements of the PPO policy, such as obtaining required second surgical opinions andor hospital admission review failure to adhere to these requirements will result in denial of the surgical claim or reduced payment to the provider. Patient is responsible for the difference or balance bw the reduced payment and the normal PPO allowed rateSecond Surgical opinion SSO a requirement necessary when a patient is considering elective, nonemergency surgical care if a second opinion is not obtained prior to surgery, the patients out of pocket expenses may be greatly increased. Scarface The Fix Zip more. TMS_Philpott_Limos_Thumbnail00000000_848x480_746533955878.jpg?w=670&quality=70&strip=all' alt='Feca Procedure Manual Part 6' title='Feca Procedure Manual Part 6' />Materials Reference System May 2006 Introduction The Materials Reference System or MRS is a collection of contract administration materials assembled by the. Clover Park Cna Program'>Clover Park Cna Program. The DHS Acronyms, Abbreviations, and Terms DAAT list contains homeland security related acronyms, abbreviations, and terms that can be found in DHS documents. Adobe After Effects Cc Mr Mercury'>Adobe After Effects Cc Mr Mercury.