Healthcare services to its members in return for a

healthcare services to its members in return for a monthly premium for their membership in the
HMO. According to Latour and Eichenwald Maki, “HMO Premiums are based on a projection of
the costs that are likely to be involved in treating the plan’s average enrollee over a specified
period” ( Latour & Eichenwald Maki, 2013 , p. 427).
The EPO requires that the member choose a PCP and the care must be coordinated by the PCP.
The EPOs are regulated by the state insurance department ( LaTour & Eichenwald Maki, 2013 ,
p. 428).
IDSs are comprised of multiple facilities that can provide care along the continuum of care for
the patient and their family. They consist of physician’s offices, ambulatory surgical centers,
outpatient clinics, and acute care facilities ( LaTour & Eichenwald Maki, 2013 , p. 428).
When negotiating these contracts, it is important that the healthcare provider or facility makes
their expectations clear to the payer while also taking the needs of the payer into
consideration[ CITATION Veg18 \l 1033 ]
Health Maintenance organizations usually only pay for care within the network.
Reimbursement are rendered. Claims are submitted to insurance companies for reimbursement
for services. “By successfully understanding the components of the multifaceted revenue cycle, it
can assist providers with studying potential flaws in the financial system, boost efficiency, and

guarantee that establishments are getting the full amount of revenue for the services they
rendered” (Mcaskill, 2014).
Patient Intake: understand the
patients chief complaint and
take down everything the
patient is advising is wrong .
Demographics: Get the
correct spelling of patients
first and last name, DOB,
Address, Phone number,
Insurance Information
Pre-Regestration & Regestration:
Make sure patient has refferals if
needed, check insurance to make
sure it is active
Confirm with the patient again all
of their demographics, scan ID and
insurances cards into chart , advise