decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Medicare Managed Care / More Medicare Choices
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Article Overview
This article explains major Medicare+Choice policy changes tied to managed care plans, including private fee-for-service arrangements, enrollment and disenrollment timing, physician participation requirements, plan consultation processes, and restrictions related to provider incentives and patient communications. It is intended for physicians, billing and coding professionals, practice managers, and others who need a broad understanding of how Medicare managed care rules were changing under the Balanced Budget Act of 1997.
Why This Topic Matters
The article helps readers understand how evolving Medicare managed care rules may affect plan participation, patient access, provider obligations, and payment relationships. It is useful for practices that need to recognize which parts of Medicare managed care apply to different plan types and how those differences can affect operational and compliance considerations.
What You Will Learn
- How Medicare+Choice expanded managed care options
- How enrollment and disenrollment timing was changing
- What new participation and notice requirements applied to plans
- How physician input into plan operations was described
- How provider incentive limitations and private fee-for-service exceptions were addressed
Who Should Read This
- Physicians
- Practice managers
- Medical billing professionals
- Compliance staff
- Healthcare administrators
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