HSM546 Course Discussions Week 6

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HSM546 Course Discussions Week 6
Precertification is common for many medical services but what happens when services are…

SKU: HSM 546 Utilization Review Medicare Advantage Plans Medicaid Plans Week 6 Categories: , Tags: , , ,

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HSM546 Course Discussions Week 6

HSM546 Course Discussions Week 6

All Students Posts – 92 Pages 

Utilization Review – 47 Pages 

Describe the three categories of utilization review and explain why utilization review is the framework for utilization management.  And what happens when services are denied? Could the numbers get in the way?   Precertification is common for many medical services but what happens when services are rendered and then the insurance company UR denies the service?  You have taken charge of your health. So DM for you is at the personal level.  Now, how might your case fit into your insurance company’s DM program?  Referring back to the NY law of mandatory reporting for A1c., when does DM  interfere with a patient’s privacy?…

Medicare Advantage Plans and Medicaid Plans – 45 Pages 

Compare and contrast Medicare Advantage plans and Medicaid plans.  What are these plans?  What are some differences between Original Medicare and Medicare Advantage Plans?  Typically Medicaid pays even less than Medicare – so why would a physician choose to participate in that program?  Do you know what your state’s requirements are for Medicaid eligibility?…