HSM420 Managed Care Accreditation

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HSM420 Managed Care Accreditation
Discuss the main elements of the managed care accreditation process. For each main element, explain why…

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HSM420 Managed Care Accreditation

HSM420 Managed Care Accreditation

Discussions Week 5 All Students Posts 36 Pages

Discuss the main elements of the managed care accreditation process. For each main element, explain why it is important.  Are these steps adequate?  Should more be done?  There are so many elements that must be monitored.  If healthcare facilities were not held accountable for delivering these elements in an efficient manner, quality care would not be delivered.  For reimbursement of Medicare claims must the facility be accredited?

What are some of the common standards mandated by NCQA? Although there are several standards, all facilities are not accredited.  What do non-accredited facilities do to compete with accredited facilities? Is your local hospital or healthcare facility NCQA accredited?  What information on your local facility can you find?  Were you able to find out why certain areas are accredited by NCQA and some are not?

What are some of the common standards mandated by several accreditation organizations? Although accreditation is not mandatory, what is the success rate of hospitals that are not accredited?  Are there insurance plans that require accreditation? If a facility is not accredited, what does this mean for the facility?  Are they eligible for reimbursement from government programs such as Medicare and Medicaid?…