Last edited by Febar
Tuesday, April 28, 2020 | History

4 edition of Guide to key legal issues in managed care quality found in the catalog.

Guide to key legal issues in managed care quality

Alice G. Gosfield

Guide to key legal issues in managed care quality

  • 130 Want to read
  • 29 Currently reading

Published by Faulkner & Gray in New York .
Written in English

    Places:
  • United States.,
  • United States
    • Subjects:
    • Managed care plans (Medical care) -- Law and legislation -- United States.,
    • Medical care -- United States -- Quality control.

    • Edition Notes

      Includes references, glossary, and table of cases.

      Statementby Alice G. Gosfield.
      SeriesFaulkner & Gray"s quality in managed care series ;, v. 2
      Classifications
      LC ClassificationsKF1183 .G7 1996
      The Physical Object
      Paginationx, 253 p. ;
      Number of Pages253
      ID Numbers
      Open LibraryOL736200M
      ISBN 101881393712
      LC Control Number97126895
      OCLC/WorldCa36083179

        Contracting with Managed Care Organizations: Key Issues for Health Centers Posted June 2, Contracting with Managed Care Organizations (MCOs) and other payors can significantly expand access to Federally Qualified Health Center (FQHC) . In , we undertook the Quality Improvement System for Managed Care (QISMC) initiative to accomplish several goals: (1) To update the QARI guidelines; (2) to develop coordinated Medicare and Medicaid quality standards that would reduce duplicative or conflicting efforts; (3) to make the most efficient and effective use of recent.


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Guide to key legal issues in managed care quality by Alice G. Gosfield Download PDF EPUB FB2

Alice Gosfield’s enlightening book, "A Guide to Key Legal Issues in Managed Care Quality" is now available directly from Alice G. Gosfield and Associates, P.C. Originally sold for $, we can make this page book, originally published by Faulkner and Gray available to you for $95 plus $5 shipping and handling ($ total prepaid).

Get this from a library. Guide to key legal issues in managed care quality. [Alice G Gosfield]. Managed Care Litigation is the only treatise on the market that offers in-depth analysis of all the important issues in managed care litigation.

Providing both a basic overview of managed care litigation and a comprehensive examination of the legal issues facing managed care practitioners, Managed Care Litigation gives you practical guidance on.

Certain issues arise in the Medicaid managed care context that do not arise in the commercial environment. (FN2) The MCOs need to understand the legal and financial implications associated with participation in Medicaid managed care programs, as well as the special needs of the Medicaid population in this managed care context.

The Legal Framework for Correctional Health Care; As a first chapter, this information sets a foundation for the remaining ones.

Fred Cohen addresses all key legal issues including isolation, restraints, and even healthcare copayment. The Present and the Future of Correctional Health and Mental Health Care. It guides readers through the maze of managed care with solid coverage of a wide variety of topics related to health care organizations, reimbursement, quality care, legal and ethical issues, changes in roles and responsibilities, tools and strategies used to monitor care, and changes in clinical by: 9.

Managed Care Law Manual is a unique legal guide specific to managed care filled with the facts health care attorneys, managed care organizations, and health care administrators need to make informed choices. This legal guide will help you know not only your legal obligations, but also those of your contracting partners, employers, third-party payers, physicians, and others so you can form the.

• A denial due to issues relating to copayments, deductibles, or other cost-sharing requirements. Any rescission of coverage (essentially, a cancellation with retroactive effect), whether or not there is an adverse effect on any particular benefit at that time. Introducing a report that addresses such a complex and dynamic issue as managed behavioral health care is a daunting task.

The charge to the Committee on Quality Assurance and Accreditation Guidelines for Managed Behavioral Health Care was to develop a framework to guide the development, use, and evaluation of performance indicators, accreditation standards, and quality improvement mechanisms. This is information about health care services provided to Minnesota Health Care Program enrollees through managed care plans.

It includes information about quality of care, efforts to improve services, incentives for providers to improve care and enrollee surveys.

Here are 13 legal issues affecting hospitals and health systems in 1) Lawsuits against the mandate to buy health insurance. Since Congress is unlikely to repeal healthcare reform in the face of. Understand key legal and regulatory issues in the government entitlement programs that affect private managed care plans.

Understand the unique key aspects of how Medicare pays Medicare Advantage Plans. Explain at a high level the basics of the Medicare Quality Bonus Payment Program, also called Medical Stars or simply Stars. enter into Medicaid managed care contracts with MCOs.

This guide includes examples of sample managed care contract language on specific issues. Managed care contracts define several relationships: the NF’s/ALF’s relationship with the MCO, the MCO’s relationship with the State, and the State’s relationship with the federal Size: KB. The Fourth Edition of Changing the U.S.

Health Care System addresses the key topics in health care policy and management, presenting evidence-based views of current issues. Each chapter is written by an expert in the field who integrates evidence to. Managed Care is a health care delivery system organized to manage cost, utilization, and quality.

Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services.

A wide range of legal questions are considered as Aligning Forces for Quality Alliances pursue innovative ways to improve the quality of care provided in their communities.

From state fair process laws to federal antitrust regulations, AF4Q Alliances must work within the parameters of the law as well as understand how it can enhance their work. Epstein Becker Green was one of the innovators of, and is a prominent law firm in, managed care delivery systems.

The firm has worked with managed care organizations for more than three decades, and firm attorneys have provided key technical advice to Congress, federal agencies, and states throughout the development, passage, and implementation of managed care legislation.

Ethical Issues in Managed Care: Guidelines for Clinicians and Recommendations to Accrediting Organizations by Joan D. Biblo, Myra J. Christopher, Linda Johnson, and Robert Lyman Potter A basic managed care concept is that managed care providers help keep treatment costs down, for the ben-efitof each patient and of the membership as a whole.

The Second Edition of this comprehensive "how to" text has been comple tely revised and updated. This text outlines the basics of case manage ment and illustrates some of the pitfalls encountered in the field of case management.

A useful tool, Case Management: A Practical Guide to Success in Managed Care, provides information on the new Case Manageme nt Standards, supplies standard definitions 4/5(2).

Managed care’s effect on outcomes Managed Care While much research has been conducted on whether managed care delivery systems result in better outcomes than traditional fee for service (FFS), there is no definitive conclusion as to whether managed care improves or worsens access to or quality of care for beneficiaries.

Managed Care Contracting Pediatricians entering into managed care contracts need to take certain steps before signing a contract: assessing their readiness and the readiness of the practice for managed care; assessing the strengths and weaknesses of the managed care plans they are considering, and selecting a professional advisor to assist in.

View a sample of this title using the ReadNow feature. If you are not an AHLA member and would like to purchase this book, click here. The Health Plans Contracting Handbook, Seventh Edition from AHLA traces the managed care contracting process from preparing to negotiate the contract, to formation and implementation, to termination issues.

It identifies key questions typically encountered in. CMS Issues Managed Care Rate Setting Consultation Guide. Oct 3 ; Health Law Sidebar; On Wednesday, October 2, the Centers for Medicare and Medicaid Services (“CMS”) issued its consultation guide for states to use when setting reimbursement rates with respect to any Medicaid managed care program subject to actuarial soundness requirements in 42 CFR during.

Answer: The key issues associated with the managed healthcare are: 1. Difficulty in approvals: Insurance companies just to make more profits dont give approvals so easily and thus i view the full answer.

The Managed Health Care Handbook is a key strategic and operational resource for use in planning and decision-making. It includes first-hand advice from experienced managers on how to succeed in every aspect of managed care: quality management, claims and benefits administration, managing patient demand, as well as risk management, subacute Price: $ Managed Care High quality: A Practical Guide is a set of purposes and experiences gathered from working towards well being professionals within the subject of managed care.

and practices concerned in high quality well being care packages and presents options to issues sometimes encountered in managed care.

If you're looking for a free. Telemedicine is an important tool to help you care for patients while staying safe as the COVID pandemic evolves. Learn how to implement it in your practice and get reimbursed for telehealth.

This chapter considers laws relating to prescription of opioids, informed consent and advance directives, and assisted suicide. Among those with clinical, administrative, or similar involvement in end-of-life care, much of the debate about issues such as prescription regulation or informed consent is practical.

Four major themes of the book -- The Health Care Environment: What It Is and How It Is Affected by Managed Care; Managed Care: What It Is and How It Works; Issues Affecting the Results of Managed Care; Managed Care: Implementations for the Nurse -- are divided into separate units to help readers better understand managed care.

Application of Legal Concepts and Issues in Case Management Practice Case Management Systems, The Case Manager and the Legal Process -- Sources of Anxiety for Today's Case Managers -- "Legal and Ethical Issues for Health Professionals is a guide to aid in the resolution of ethical dilemmas with legal implications.

This comprehensive reference provides both the student and practicing health care professional with an overview of the ethical and legal issues that face health care providers today.

The reader will better understand ethical dilemmas and learn how to evaluate and 5/5(2). Access and Quality in Managed Care However, poorly designed or implemented Medicaid managed care programs can also create issues for states that may lead to poor enrollee health outcomes.

In developed in order to guide our future work on access to care and services for Medicaid and CHIPFile Size: 1MB. The related Key Issues will appear below. Agriculture and Food (4) Auditing and Financial Management (9) Budget and Spending (3) Business Regulation and Consumer Protection (5) Economic Development (6) Education (5) Employment (3) Energy (20) Equal Opportunity (2) Financial Markets and Institutions (4) Government Operations (29) Health Care ( Judgments about quality of life involve both factual issues (e.g., what do data and experience suggest about a child's prognosis with or without the treatment in question) and subjective elements (e.g., when has a child's suffering become so great that it outweighs any benefits of the treatment).

the procedures and policies of managed care Author: End-of-Life Care for Children, Their Families, Marilyn J. Field, Richard E. Behrman. Health Care Counsel Ruder Ware, L.L.S.C. First Street, Suite P.O. Box Wausau, WI Tel Fax As the most widely-used textbook on managed care, Essentials of Managed Health Care provides an authoritative and comprehensive overview of the key strategic, tactical, and operational aspects of managed health care and health insurance.

With a primary focus on the commercial sector, the book also addresses managed health care in Medicare, Medicaid, and military medical care. This article will examine some of the ethical and legal issues correctional nurses must address in their practice.

Ethical Concerns For the nurse in a traditional medical setting, ethical decisions occur occasionally and at times the nurse may face ethical dilemmas.

In contrast, the correctional nurse may face ethical situations daily. Health Care Quality Movement. Quality has been a topic of attention in American health care since the early years of this century (Donabedian, ).Although quality has not been neglected in the intervening years, the focus on quality is a fairly recent phenomenon, beginning in the late s (O'Leary and Walker, ).Since then, quality has become a front-and-center issue for providers Cited by: Managed care organizations are paving the way to the future of health care delivery in the United States and countries around the world.

As managed care systems evolve, a major concern is quality. Managed Care Quality: A Practical Guide is a collection of applications and experiences gathered from p. Keep a low child-to-adult ratio. Child Care Aware suggests that the caregiver-to-child ratio should be at least for infants and young toddlers, for older toddlers and for preschool-aged kids.

Staff is under-trained. The single best way to improve safety and prevent injury is to have sound health and safety policies that all. For health-related personal matters, the key planning tool is a health care advance directive, which includes a living will, a health care power of attorney, or both.

For financial and other property matters, the key legal planning tools are a financial power of attorney, a will. The balance of the book is a fairly comprehensive look at nursing homes and legal issues. The most enjoyable and informative aspect of the text is the legal cases specifically related to nursing homes and other long-term care facilities.

George D. Pozgar uses cases as recent asincreasing the book's relevancy.The well managed health care organization is the book for the class The well managed health care organization is the book for the class.

Religious Health Care operates in a community ofcalled Middleville. Summary statistics on Religious and its competitors, from the AHA Guide, are shown in .