decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Answer_Book / Managed_Care / How_Medicare_evaluates_HMOs
Subscribe or sign in to view the full article.
Article Overview
This article explains how CMS evaluates and oversees Medicare HMOs, with emphasis on the agency’s general approach to plan oversight, patient protections, complaint handling, and the relationship between Medicare requirements and managed care plan operations. It is relevant to physicians, billing staff, managed care administrators, and compliance professionals who need a high-level understanding of Medicare HMO oversight and where plan-level decisions take precedence.
Why This Topic Matters
Understanding CMS oversight of Medicare HMOs helps providers and administrative staff know which issues are handled by the plan versus Medicare, how patient complaints and appeals are routed, and what general expectations apply to managed care participation.
What You Will Learn
- How CMS oversees Medicare HMOs at a high level
- How plan operations and physician payment decisions are handled within managed care arrangements
- What patient protections and complaint pathways exist for Medicare HMO members
- What kinds of managed care issues have drawn CMS attention and external review
Who Should Read This
- Physicians
- Medical billing staff
- Managed care administrators
- Compliance professionals
- Practice managers
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com