HSM 546 Provider Payment Threaded Discussions 1 Week 4 Keller

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HSM 546 Provider Payment Threaded Discussions 1 Week 4 Keller
Discuss the challenges and benefits of pay for performance under managed care plans.  Ever heard of the logic game – The Prisoner’s Dilemma? …

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HSM 546 Provider Payment Threaded Discussions 1 Week 4 Keller

HSM 546 Provider Payment Threaded Discussions 1 Week 4 Keller

HSM 546 Provider Payment Discussions 1 Week 4 All Posts 41 Pages Keller

Discuss the challenges and benefits of pay for performance under managed care plans.  Ever heard of the logic game – The Prisoner’s Dilemma?  Many of the private practices here have sold to Vanderbilt or St. Thomas. The hospital then provides management services to the practice.  But here’s a question…. if MCOs employ doctors and nurses, why are these types of claims denied?  Doctors know that some patients will not follow their advice and of course should not be penalized. Which is why documentation by the doctor is so vital.  Thoughts?

You have just become the manager for WECARE a managed health care plan. The manager who had the position before you did not do a good job. In fact, the company has been losing members as well as contracted physicians. Your first course of action is to address member services.

How will you address WECARE’s problems in this area?…