decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Answer_Book / Managed_Care / Private_or_federal,_managed_care_is_here
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Article Overview
This article explains how managed care affects physician and therapy practices, including Medicare managed care. It discusses broad operational topics such as contract planning, referral requirements, utilization review, coding communication, and recordkeeping expectations tied to plan accreditation. It is aimed at coders, practice managers, and clinicians who work with HMOs and other managed care plans.
Why This Topic Matters
Managed care can change how services are authorized, documented, and communicated between practices and plans. This article helps readers understand the operational areas that affect coverage, workflow, and compliance without replacing the full premium guidance.
What You Will Learn
- How managed care changes the relationship between practices, patients, and health plans
- Why contract details matter in managed care arrangements
- How referral and authorization processes affect coverage in HMO settings
- Why coding communication and utilization review are important in managed care
- How accreditation and medical record review relate to plan participation
Who Should Read This
- Medical coders
- Practice managers
- Physicians
- Therapy practices
- Billing staff
- Healthcare administrators
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