Відео

Absolutely- only in the USA. How to fix it: major question

Yes! Direct quote from the lawsuit!

Makes you want to ask "should this really be happening?"

Yes! Thank you. This was part of a live webinar-- hence the longer intro segment!

Well said! The whole premise is: How do we NOT pay.

Glad it was helpful!

So nice of you

Amen!

Means a lot !!

🙏🏼🙏🏼 it’s a movement and we are honored to have your support !

Thanks so much 😊☺️

I agree it’s hard to see - try this video: ua-cam.com/video/fpon-a8YwTY/v-deo.html I was able to find the following but I think it’s a more truncated version vs a more detailed one. Goal: Everyone should be able to walk out of this session feeling empowered by having learned basic flow of funds (starting at the payer) and reimbursement structures along the healthcare delivery value chain. Managed Care Bootcamp for Healthcare Entrepreneurs is a 'pilot' session designed to impart otherwise tribal, 'insider', knowledge so as to bend the learning curve of entrepreneurs in healthcare. Trends, current industry practices, and changes set to be effective in the future will be weaved into the session so as to contextualize the material. Agenda Items: I. Managed Care Mindset II. Lines of Business aka 'LOB' (funding source) Medicare (Traditional Medicare and Medicare Advantage, prts ABCD) Medicaid (managed Medicaid, state / federal, Medi-Cal) Duals (Medicare and Medicaid beneficiaries) Commercial (on exchange, off exchange) III. Products (benefit designs) HMO, PPO, POS, EPO, FFS IV. Difference between 'LOB' vs 'product'. V. Main Reimbursement structures (from payer to provider... eventually) Fee for service (FFS) Value based payment: upside, upside/downside Predominate California Market Structure, determine who is at risk Capitation Delegation Risk based (capitations and delegation of functions by the health plan to a third party): global-risk, shared risk, dual risk VI. Q/A

Try this video ua-cam.com/video/fpon-a8YwTY/v-deo.html

What a great question. Health Plan has a more narrow definition in terms of the organizational scope and regulatory implications to which it is subjected (varies by state as well). Managed Care Organization is a broader term that includes Health Plans but can also include IPAs and similar risk-bearing organizations. Managed Care is aka controlling costs by controlling utilization of care by managing care only to 'medically necessary' services. These can be and are often used interchangeably, yes. And 95% of the time when folks use "Managed Care org" they are really referring to a Health Plan. This is no different from setting to setting in terms of nomenclature usage, it's general industry way of referring to a paying entity in a payer-provider contractual relationship/discussion. Does that help? :)

Are you asking whether a healthcare provider can choose to implement a disease- or condition-specific care management model?

@@carenodes Yes. For example, I would like to manage the care for at home ventilator dependant patients only. Is it possible to get registered/certified as a managed care provider in let's say Texas?

@@carolinerono6569 as a health care provider you can choose to focus on a specific condition or disease and further focus on treating those conditions at home granted whatever certifications / training / credentialing you might require in the area in which the patient is based. You can do so as long as you follow all requirements and regulations. I don't see why not.

@@carenodes Thanks. This has been helpful. Why does the paper work to register as a point of service healthcare provider have to be so tedious and impossible to navigate by oneself 😅😅. Thank you once again.

@@carolinerono6569 Are you using NPPES to register the taxonomy as POS or is this a state level thing?

Great I'm glad you found this helpful