The Preferred Provider's Handbook PDF Download
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Author: William L. Poynter
Publisher: Routledge
ISBN: 1135063850
Category : Psychology
Languages : en
Pages : 184
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Book Description
First published in 1994. Routledge is an imprint of Taylor & Francis, an informa company.
Author: William L. Poynter
Publisher: Routledge
ISBN: 1135063850
Category : Psychology
Languages : en
Pages : 184
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Book Description
First published in 1994. Routledge is an imprint of Taylor & Francis, an informa company.
Author: Rachelle A. Dorfman
Publisher: Psychology Press
ISBN: 9780876307083
Category : Medical
Languages : en
Pages : 188
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Book Description
First Published in 1994. Routledge is an imprint of Taylor & Francis, an informa company.
Author:
Publisher:
ISBN:
Category : Health insurance
Languages : en
Pages : 60
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Book Description
Author: Ellis Knight
Publisher:
ISBN: 9780997284768
Category : Medical
Languages : en
Pages : 50
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Book Description
This handbook enables your organization to systemize the tedious, ongoing, and mandatory process of credentialing your medical staff and to understand why you must! Healthcare organizations must have credentialed medical staffs to deliver their services. The reasons are two-fold: First, educated, licensed, experienced, and proven caregivers ensure that a hospital or medical practice is capable of delivering quality care. Secondly, payers require that the physicians and other licensed healthcare professionals are qualified and licensed to work with their patients. Before receiving payment for services, the provider must have specific credentials for providing that service. Verifying and documenting the credentials of a healthcare provider is tedious, ongoing, and mandatory. An organization with a large medical staff may struggle with keeping the credentialing function current, as many licenses have rolling expirations. Credentialing ensures that clinical practitioners are duly qualified, licensed, and board certified. It reports the history of malpractice claims, state-instituted sanctions, or other undesirable professional circumstances of providers. Credentialing and privileging of healthcare professionals protects patients and hospitals by minimizing the risk of medical errors that may result from the work of incompetent providers. It also undergirds the reputation and credibility of the institution in the eyes of providers and across the healthcare community. Further, credentialing with insurers forms the basis for reimbursement for professional services. Without the acceptance of the professional credentials of a provider, insurers and other third-party payers will not compensate his or her claims. The purpose of this book is to explain the necessity and to provide the process for the official documentation of each practitioner. The information presented in these chapters will serve as a practical resource for strengthening your organization's credentialing function. = Book Features! -Outlines the necessity for credentialing in the delivery of care and in attaining reimbursements for services provided -Explores options for in-house and outsourced credentialing function -Provides systematic process for ongoing credentialing operations
Author: Peter Reid Kongstvedt
Publisher: Jones & Bartlett Learning
ISBN: 9780834217263
Category : Medical
Languages : en
Pages : 1448
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Book Description
This thoroughly revised and updated book provides a strategic and operational resource for use in planning and decision-making. The Handbook enables readers to fine-tune operation strategies by providing updates on critical managed care issues, insights to the complex managed care environment, and methods to gain and maintain cost-efficient, high quality health services. With 30 new chapters, it includes advice from managers in the field on how to succeed in every aspect of managed care including: quality management, claims and benefits administration, and managing patient demand. The Handbook is considered to be the standard resource for the managed care industry.
Author: Jeffrey D. Mamorsky
Publisher:
ISBN:
Category : Health insurance
Languages : en
Pages : 764
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Book Description
Author: Barbara Jane Deaton
Publisher: Risk Adjustment
ISBN: 9780578575704
Category : Medical
Languages : en
Pages : 58
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Book Description
Providers have been counseled to code "to the highest specificity," yet are not taught how to accomplish it. Already overworked and often underpaid the Provider doesn't have time to plow through all the rules and regulations to produce the solution. Risk Adjustment Factor Made Easy hopes to cut through the jungle of red-tape, thick textbooks, and laborious internet searches to equip the Provider with quick access to the knowledge needed to be successful while providing references on topics for more exploration when desired. In this version of the Hierarchical Condition Coding (HCC) and Risk-Adjustment Factor (RAF) coding book, the busy provider will receive a simple short-cut to all the information necessary to be successful. This book is quick; easy-to-understand; focuses on common mistakes made by Providers and displays examples of proper coding with appropriate details to help the Provider describe the illnesses of their patients more effectively.HCC/RAF is designed to estimate a patient's "future" health care costs. With the changing of the payment system for Providers from "Paid for Services Rendered" to "Risk-Adjustment Value-Based Care" adherence to coding guidelines are vital to a Provider's bottom line. With the coding details listed, you will learn which codes carry high value and why the codes currently used are not increasing your risk score; thereby, lowering potential earnings. The business end of the practice often suffers because of simple coding errors. This RAF book will arm the provider with the tools necessary to ensure success in the "Value-Based Care" system. ABOUT THE AUTHOR: Barbara Jane Deaton, MSN, FNP-BC, ENP-BCBarbara holds a Master of Science in Nursing and is dually certified as a Family Nurse Practitioner and an Emergency Nurse Practitioner. She owns her own practice in North Carolina and is deeply involved in Risk Adjustment Factor Coding. She has been recognized by a major insurance agency for her understanding of the Risk Adjustment Factor and its role in the future of medicine. Her own risk score has significantly increased by implementing the rules contained in this book.Barbara has won numerous awards since entering the medical field. Among her awards are "Best Nurse Practitioner Award in Morganton, NC 2018" for Inclusion in the 2019-2020 Edition of Worldwide Leaders in Healthcare: nominated Best Nurse Practitioner Preceptor 2019 by Perdue University: Business of the Year Award in Burke County, NC Foundation Award; and the Emergency Physicians Award by the United States Commerce Association.NOTE FROM THE AUTHOR: Over the past year, as I became more interested in the Risk Adjustment Factor (RAF), I realized that much of my research portrayed RAF as complex and extremely difficult to learn. When I began putting RAF into play in my own practice, I realized that as a Family Provider, the main codes continued to reappear. The techniques developed became second nature. Gifted with the ability to translate complex medical problems into simple language for some of my uneducated patients; I became aware that this gift should be used to break down the barriers that exist with Risk Adjustment Factor Coding. This book is written in a simplified format with characterizations to help get the point across. By placing these techniques into practice, the patient's illnesses will be accurately portrayed, and the Provider's bottom line will improve
Author: Stein, Chiplin
Publisher: Wolters Kluwer
ISBN: 1454871172
Category : Medicare
Languages : en
Pages : 1008
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Book Description
To provide effective service in helping clients understand how they are going to be affected by health care reform and how to obtain coverage, pursue an appeal, or plan for long-term care or retirement, you need the most current information from a source you can trust - Medicare Handbook. This is the indispensable resource for clarifying Medicare's confusing rules and regulations. Prepared by an outstanding team of experts from the Center for Medicare Advocacy, Inc., it addresses issues you need to master to provide effective planning advice or advocacy services, including: Medicare eligibility rules and enrollment requirements; Medicare covered services, deductibles, and co-payments; coinsurance, premiums, penalties; coverage criteria for each of the programs; problem areas of concern for the advocate; grievance and appeals procedures. The 2017 Edition of Medicare Handbook offers expert guidance on: Health Care Reform Prescription Drug Coverage Enrollment and Eligibility Medigap Coverage Medicare Secondary Payer Issues Grievance and Appeals Home Health Care Managed Care Plans Hospice Care And more! In addition, Medicare Handbook will help resolve the kinds of questions that arise on a regular basis, such as: How do I appeal a denial of services? What steps do I need to take in order to receive Medicare covered home health care? What are the elements of Medicare's appeal process for the denial of coverage of an item, service, or procedure? Does my state have to help me enroll in Medicare so that I can get assistance through a Medicare Savings Program? When should I sign up for a Medigap plan? If I am on Medicare, do I have to buy health insurance in the insurance marketplace created by the Affordable Care Act? Is it true that I have to show medical improvement in order to get nursing and therapy services for my chronic condition? And more! The 2017 Medicare Handbook is the indispensable resource that provides: Extensive discussion and examples of how Medicare rules apply in the real world Case citations, checklists, worksheets, and other practice tools to help in obtaining coverage for clients, while minimizing research and drafting time Practice pointers and cautionary notes regarding coverage and eligibility questions where advocacy problems arise, and those areas in which coverage has been reduced or denied And more!
Author: Stein, Chiplin
Publisher: Wolters Kluwer
ISBN: 1543800459
Category :
Languages : en
Pages : 832
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Book Description
To provide effective service in helping people understand how they are going to be affected by health care reform and how to obtain coverage, pursue an appeal, or plan for long-term care or retirement, you need the most current information from a source you can trust - Medicare Handbook. This is the indispensable resource for clarifying Medicare's confusing rules and regulations. Prepared by an outstanding team of experts from the Center for Medicare Advocacy, it addresses issues you need to master to provide effective planning advice or advocacy services, including: Medicare eligibility rules and enrollment requirements; Medicare covered services, deductibles, and co-payments; coinsurance, premiums, penalties; coverage criteria for each of the programs; problem areas of concern for the advocate; grievance and appeals procedures. The 2019 Edition of Medicare Handbook offers expert guidance on: Medicare Enrollment and Eligibility Medicare Coverage in all Care-Settings Medicare Coverage for People with Chronic Conditions Medicare Home Health Coverage and Access to Care Prescription Drug Coverage Medicare Advantage Plans Medicare Appeals Health Care Reform And more! In addition, Medicare Handbook will help resolve the kinds of questions that arise on a regular basis, such as: How do I appeal a denial of services? What steps do I need to take in order to receive Medicare covered home health care? What are the elements of Medicare's appeal process for the denial of coverage of an item, service, or procedure? Does my state have to help me enroll in Medicare so that I can get assistance through a Medicare Savings Program? When should I sign up for a Medigap plan? If I am enrolled in Medicare, do I have to buy health insurance in the insurance marketplace created by the Affordable Care Act? Is it true that I have to show medical improvement in order to get Medicare for my nursing and therapy services? And more! The 2019 Medicare Handbook is the indispensable resource that provides: Extensive discussion and examples of how Medicare rules apply in the real world Case citations, checklists, worksheets, and other practice tools to help in obtaining coverage for clients, while minimizing research and drafting time Practice pointers and cautionary notes regarding coverage and eligibility questions when advocacy problems arise, and those areas in which coverage has often been reduced or denied And more! Note: Online subscriptions are for three-month periods. Previous Edition: Medicare Handbook, 2018 Edition ISBN 9781454884224
Author: J. L. Richardson
Publisher: J. L. Richardson M.D.
ISBN: 9780977178926
Category : Consumer education
Languages : en
Pages : 118
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Book Description
This concise, informative handbook provides patients with a doctors perspective on professional healthcare and allows patients to become their own best health advocates. The six chapters are arranged in an order that corresponds with the basic steps of healthcare, covering such things as the importance of keeping a medical diary and maintaining records to what to expect from a doctors visit to how to obtain quality health insurance. The book aims to teach readers to become proactive and to take their health, as much as possible, into their own hands.
