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What is health maintenance organizations and other managed care organizations?
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∙ 16y ago
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∙ 16y ago
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What types of health insurance are available?
The insurance market is made up of the following:1. Federal Health Insurance (Medicare, Medicaid, Veterans Affairs, SCHIPS and Indian Health Service)and2. Commercial Health Insurance (Private or Public Companies such as United Healthcare, Nonprofit Organizations such as most Blue Cross Blue Shield Organizations, although some are for profit, and Patient Owned Co-ops such as Group Health in Washington state)Both the Federal and Commercial Insurance Companies have tried to lower expenses by allowing other companies (referred to as Managed Care Organization's) to act as the "agent" responsible in making sure that the patients (referred to as policy holders,beneficiaries and/or members) select a plan (also called a Policy) that covers the medical services (also called the benefits) most appropriate for each patient.In case you were wondering, HMOs (Health Maintenance Organizations) are considered Managed Care Companies.
What Careers in Master of Science in Health Care Administration?
management of hospitals and other health services organizations
What types of professional are employed in the managed care industry?
Managed care health professionals are equivalent to those in other health care environments: physicians, nurses, physical therapists, lab technicians, and occupational therapists
What is an HMO?
Health Maintenance Organization (also called an HMO) is one of three managed care health insurance systems in the United States. An HMO is designed to offer financial support and medical treatment to plan members. Some managed care systems don't offer medical treatment themselves. Rather, they offer different levels of financial coverage based on whether you visit in-network or out-of-network care providers. HMOs, on the other hand, have a system of physicians and hospitals that are involved in a specific coverage structure. If you're part of a Health Maintenance Organization, you are only covered if you go to a physician within the HMO network.
What is an HMO insurance?
HMO (Health Maintenance Organization) is one of three managed care health insurance systems in the United States. An HMO is designed to offer financial support and medical treatment to plan members. Some managed care systems don't offer medical treatment themselves. Rather, they offer different levels of financial coverage based on whether you visit in-network or out-of-network care providers. HMOs, on the other hand, have a system of physicians and hospitals that are involved in a specific coverage structure. If you're part of a Health Maintenance Organization, you are only covered if you go to a physician within the HMO network.
What are some ways in which accounting for health care organizations especially not-for-profit ones tends to differ from accounting in other industries?
accounting for healthcare organizations in not-for-profit ,tend to differ from accounting in other industries.
What is an HMO and what does it do?
Health Maintenance Organizations or HMOS are a type of health insurance plan. This type of plan requires patients to have a primary care physician or PCP. In order to visit other medical providers the PCP must provide a referral for the patient. This system allows the HMO to keep its costs low because the patients have to get authorization before they visit a specialist.
what other organizations regulate infection control?
The World Health Organization, Center for Disease Control and the National Institute of Health are the most prominent organizations that manage health issues like infectious disease. The NIH has a branch that specializes in infection called the National Institute of Allergy and Infectious Disease.
What is maintanance?
"Maintenance" is the continual repair and refurbishment required to keep something at its peak condition. It can refer to maintenance on cars, buildings, land or any other physical item that deteriorates over time. "Maintenance" can also be used to describe a regimen of drugs or vitamins to retain the physical health of the body. There are other definitions which include the maintenance of value of securities or other intangible assets, or the maintenance of an income stream. In general, "maintenance" it is keeping something functional, useful, pristine or working properly.
How are ambulatory surgery centers distinguished from other health care facilities?
by their use of a referral system for accepting patients and their maintenance of a dedicated operating room
What is a delegated entity in healthcare?
(1) "Delegated entity" means an entity, other than a health maintenance organization authorized to engage in business under Chapter 843, that by itself, or through subcontracts with one or more entities, undertakes to arrange for or provide medical care or health care to an enrollee in exchange for a predetermined payment on a prospective basis and that accepts responsibility for performing on behalf of the health maintenance organization a function regulated by this chapter, Chapter 222, 251, or 258, as applicable to a health maintenance organization, Chapter 843 or 1271, Section 1367.053, Subchapter A, Chapter 1452, or Subchapter B, Chapter 1507. The term does not include: (A) an individual physician; or (B) a group of employed physicians, practicing medicine under one federal tax identification number, whose total claims paid to providers not employed by the group constitute less than 20 percent of the group's total collected revenue computed on a calendar year basis. Taken from: INSURANCE CODE TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES SUBTITLE C. MANAGED CARE CHAPTER 1272. DELEGATION OF CERTAIN FUNCTIONS BY HEALTH MAINTENANCE ORGANIZATION SUBCHAPTER A. GENERAL PROVISIONS
What are NGO's merits and demerits?
NGOs (non-governmental organizations) provide essential services, promote social change, and fill gaps left by governments. They can be more flexible and responsive compared to governmental organizations. However, they may face challenges such as funding constraints, lack of accountability, and potential overlap or duplication of efforts with other organizations.
