healthcare services to its members in return for a monthly premium for their

Healthcare services to its members in return for a

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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
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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
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  • Fall '19
  • Health care provider, Mechanics of Insurance and Reimbursement

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