HSM 420 Entire Course

HSM 420 Entire Course Click Link Below To Buy: http://hwcampus.com/shop/hsm-420-entire-course/ Or Visit www.hwcampus.com HSM 420 Entire Course Managed Care and Health Insurance NEW DeVry HSM 420 Entire Course Project Week 2, 5, and 7 DeVry HSM 420 Course Project Topic Selection Week 2 (50 points) DeVry It is expected that you will provide a focused topic, including a statement of the key challenges or problems currently associated with the topic in America. Preview: … For the course project, the paper will focus on fraud and abuse in managed care and how to prevent such instances. The paper will include information on various fraudulent and abusive acts of healthcare providers, including steps the government has taken to… HSM 420 Course Project Outline Week 5 (100 points) DeVry It is expected that the outline be submitted in a formal outline format as demonstrated below. Your outline should show enough detail to demonstrate that you have begun thinking about the organization of your paper and the research required into the topic. After your outline, please submit a listing of the sources you have already identified for your paper. Preview: The Introduction part of the paper will provide an executive summary of the issues on fraud and abuse in managed care environments. It has been proven that fraud and abuse cases cause economic drain on the health care system, including the country’s health care system due to the health problems of its citizens. While it is true that… HSM 420 Final Course Project Week 7 (170 points) Preventing Fraud and Abuse in Managed Care DeVry It is expected that the final version of your Course Project will be 7–10 pages in length, with 6–8 sources identified. Preview: Fraud and abuse cases are among the leading reasons why a country’s health care system experiences economic drain. Despite the vigilance of various sectors in society in ascertaining that fraud and abuse cases in health care are brought to the forefront, only about 10% of these cases have been clearly identified. This is because many of those who are in the health care industry are involved in those cases. Additionally, even patients are involved in deception tactics in the… HSM 420 Webliography Week 7 DeVry Over the length of the course, upload three separate URL references to articles relating to current healthcare insurance and managed healthcare issues to the dropbox. Preview: Title: 8 Indicted in Identity Thefts of Patients at Montefiore Medical Center Web Link: http://www.nytimes.com/2015/06/20/nyregion/8-indicted-in-identity-thefts-of-patients-at-montefioremedical-center.html Author/Date: Liam Stack, June 19, 2015 Description: A Montefiore employee and seven others were indicted on charges of stealing the personal information of about 12,000 hospital patients and using the… HSM 420 Midterm Exam Managed Care and Health Insurance DeVry 100% Correct (TCO 1) Describe the preferred provider organization (PPO) model of managed care. Why do you feel that this is the dominant form of managed care today? In this plan, the patient uses a medical provider under contract with the insurer for an agreed-upon… (TCO 1) How has the relationship between government and managed care evolved over the years? What factors have driven this changing relationship? Over the past two decades, managed care organizations (MCOs) have emerged in the United States. The differences between types of managed care organizations are… (TCO 2) What is the role of the credentialing committee in a managed care organization? And why is this function so crucial? Credentialing refers to the review of a professional provider’s ability to meet the plan’s standards for participation, being board certified… (TCO 2) Why do managed care organizations have a board of directors? What is the function of the board of directors? Managed care has a board of directors to plan and to the shareholders in the event that the plan is for… (TCO 3) What are the three basic categories of utilization management? Provide a brief description of each category. The three primary categories of utilization management are: 1.) Prospective is for elective procedures or services prior to such services being… (TCO 3) What are meant by “outliers” in hospital reimbursement? How do outlier cases impact reimbursement to a hospital? Outlier’s cases refer to extra payment if a patient’s costs exceed certain thresholds. It is less… (TCO 4) Discuss some key general aspects of physician practice behavior? Include implicit messages from training, and also environmental factors, in your answer. As we all know, it takes a long process to be a physician. Thus, physicians are selected for medical school because of certain… (TCO 4) What is meant by large case management (LCM) under managed care? Provide some specific examples of this type of case management. Large case management (LCM) under managed care is a process of identifying plan members with special healthcare needs, developing a… (TCO 7) What is the purpose of the declarations in managed care contracts? The purpose of the declarations in managed care contracts the parties provide answers to a number of “what if” questions. This is simply… (TCO 7) What is the purpose of hold-harmless and balance-billing clauses in managed care contracts? The hold- harmless clause involves the provider agreeing to not pursue a patient for fees in excess of the allowed amount of the… HSM 420 Quiz Week 6 DeVry 100% Correct (TCO 5) What is the purpose of the Privacy Rule? How has this rule impacted healthcare organizations? (Points : 30) The Privacy Rule went into effect on April 14, 2001, and required that all “covered entities” must be in compliance with the privacy, security, and… (TCO 4) What happens if someone alleges that a physician has committed a criminal act such as fee splitting? What organizations would be involved in investigating such an allegation? (Points : 30) Fee splitting occurs when one physician offers pay another physician for the referral of patients. Fee splitting has been considered… (TCO 4) The medical record is legally owned by the (Points : 5) Patient Physician State Lawyer (TCO 8) All of the following vaccines and toxoids are required for children by law except (Points : 5) Measles Polio Pertussis Croup (TCO 5) The records of all adult patients should be kept a minimum of (Points : 5) 2 years 5 years 10 years None of the above (TCO 5) Medicare and Medicaid records should be retained for (Points : 5) 1 year 5 years 10 years None of the above HSM 420 Discussions Week 1-7 All Posts 457 Pages DeVry HSM 420 Indemnity Versus Managed Care and Managed Care Impacts Discussions Week 1 All Posts 60 Pages HSM 420 Indemnity Versus Managed Care Discussions 1 Week 1 All Posts 33 Pages Early models of health insurance in America were what we call “indemnity plans” or traditional health insurance plans. What is meant by an indemnity plan, and how is managed care different from traditional indemnity insurance?… HSM 420 Managed Care Impacts Discussions 2 Week 1 All Posts 27 Pages There can be no doubt that managed care has impacted everyone involved with healthcare delivery in America. What do you see as some of the most significant impacts of managed care for patients?… HSM 420 Provider Networks and Legal Issues in Provider Contracting Discussions Week 2 All Posts 63 Pages HSM 420 Provider Networks Discussions 1 Week 2 All Posts 31 Pages Why do managed care organizations seek to establish a provider network? What are the primary reasons for contracting with providers? Can an MCO survive without a provider network?… HSM 420 Legal Issues in Provider Contracting Discussions 2 Week 2 All Posts 32 Pages Describe and discuss the key issues associated with provider payment that should be addressed in any managed care contract. The way that providers are reimbursed has been simplified. Why are some providers having issues with receiving payment?… HSM 420 Utilization Management and Case Management Versus Disease Management Discussions Week 3 All Posts 67 Pages HSM 420 Utilization Management Discussions 1 Week 3 All Posts 33 Pages What are the primary categories of utilization management (UM)? How does UM determine medical necessity through the use of evidence-based guidelines? What do the categories used in utilization management mean in laymen’s terms?…. HSM 420 Case Management Versus Disease Management Discussions 2 Week 3 All Posts 34 Pages What are the key differences between conventional case management and disease management? Provide some examples of diseases that seem to benefit from a disease management model of care. What is case management? What is disease management? How would case management differ in an urban patient with kidney issues and a rural patient with kidney issues?…. HSM 420 Managed Care Pharmacy Benefits and Managed Behavioral Healthcare Discussions Week 4 All Posts 58 Pages HSM 420 Managed Care Pharmacy Benefits Discussions 1 Week 4 All Posts 31 Pages What are the most important elements of a managed care pharmacy benefit program? And how are patient prescription benefits typically different under managed care? Pharmacy benefits is a controversial topic within managed care. As a patient, what do you want? How often do pharmacists recommend certain drugs to providers? Is this recommendation for costs control or quality products?… HSM 420 Managed Behavioral Healthcare Discussions 2 Week 4 All Posts 27 Pages What factors surrounding behavioral health create special challenges and special considerations for managed care programs? How is managed behavioral healthcare different from managed acute medical or managed acute surgical care? The need for behavioral healthcare coverage is ever-growing in this country. What is the problem with providing adequate coverage? Do you think that if patients stopped using the ER as a doctor’s office and used it for emergencies only that there would be adequate staff?… HSM 420 Managed Care Accreditation and Managed Care Marketing Discussions Week 5 All Posts 64 Pages HSM 420 Managed Care Accreditation Discussions 1 Week 5 All 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?… HSM 420 Managed Care Marketing Discussions 2 Week 5 All Posts 28 Pages Discuss how managed care sales and marketing have evolved over recent decades, and how these may possibly evolve over the decades ahead. Does healthcare marketing vary based on location? With the Affordable Care Act, have the number of insured in rural areas increased?… HSM 420 Fraud and Abuse and Managed Care Marketing Discussions Week 6 All Posts 77 Pages HSM 420 Fraud and Abuse Discussions 1 Week 6 All Posts 44 Pages Discuss fraud and abuse in healthcare. Provide at least three specific examples of fraudulent practices that have taken place in U.S. healthcare, and describe ways to prevent these in our modern healthcare environment…. HSM 420 Managed Care Marketing Discussions 2 Week 6 All Posts 33 Pages Explain the difference between underwriting and rating. What are the key elements that typically go into rate development formulas? I agree that underwriters must remain knowledgeable of all new laws. This role involves continuous training. What do you think is the most stressful about this job? Do you think that it is difficult for the underwriter to keep emotion out of his/her decision?… HSM 420 State and Federal Regulation and Patient Protection and Affordable Care Act Discussions Week 7 All Posts 68 Pages HSM 420 State and Federal Regulation Discussions 1 Week 7 All Posts 34 Pages What are the most critical components of state regulation for managed care organizations? And which federal regulations also bring specific requirements for the operation of such entities? Discuss state and federal regulation of MCOs. Do you think that there are enough regulations for MCOs? … HSM 420 Patient Protection and Affordable Care Act Discussions 2 Week 7 All Posts 34 Pages Study the provisions of the Patient Protection and Affordable Care Act (PPACA) in your textbook. What will be the primary impacts of PPACA on managed care organizations. Consider both positive and negative impacts in your answer. Why was the PPACA developed?…