Managed Care History

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Knowledge of health care systems helps with acknowledging questions and comprehension of the jobs within medical billing and coding work environments. A professional specialist in billing must understand comprehend the history of the process involved in the billing like insurance information, what key terms means in the managed care system of health care and etc.

Managed care is a type of healthcare system that helps costs and how the medical field services those who belong to a plan or plans. There are three types of managed care plans; health maintenance organization (HMO), preferred provider organization (PPO), and point-of-service (POS). Each one of these has rules and regulations that are monitored and must be billed correctly in order
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This type of practice generally uses a central billing office if it chooses not to handle its claims in house. If the practices decides to have an office management specialist such as a medical biller this person would handle direct claims to be sent out and approved. A hospital has an in house setting where the billing occurs within the same building. Medicaid and Medicare is a form of public health insurance. Medicaid is for low income individual’s where as Medicare is for retiree’s. Both are federally funded.

The need to accurately document medical records when applying billing codes and is essential to the billing process for insurers. Most bills are processed without ever being reviewed which in turn causes billing issues and getting payments on time. Auditing is an important process to have in place to check for missing or inaccurate information being sent out so that claims do not get denied. January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction, disciplinary action and exclusion from participation in government

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