References: BlueCross BlueShield Association. (N.A.) Blue Beginnings. Retrieved July 31‚ 2011 from: http://www.bcbs.com/about/history/blue-beginnings.html Getzen‚ T. E. (2013). Health Care Economics and Financing (5th Ed). Hoboken‚ NJ: John Wiley & Sons. Reisinger‚
Premium Health care Economics Health insurance
improve care. The requirements forced organizations to transition from a “nursing home” standard to a more facilitated quality of care. The quality of care within nursing homes were poor because of lack of funding; therefore‚ Medicare‚ Medicaid‚ BlueCross‚ and other funding providers improved the policies for long-term care funding to support care standards. With the influence of OBRA‚ AHCA‚ and National Association of Long-Term Care Administrator
Premium Nursing Centers for Medicare and Medicaid Services Nursing home
Role and Functions of Law Sara Winstead LAW/421 December 22‚ 2014 Safiya Byars Role and Functions of Law The role of law functions in everyday business transactions and the surrounding societies. Melvin (2011) stated‚ “Law is a body of rules of action or conduct prescribed by controlling authority and having legal binding force” (p. 4). Role of law in a business and society are the same however can impact businesses differently. Kelly and Associates Insurance Group are compliant with many state
Premium United States United States Congress United States Constitution
A review of the records reveals the member to be an adult female with a birth date of 03/01/1960. The member has a diagnosis of morbid obesity. The member’s treating provider‚ Noel Williams‚ MD recommended the member undergo a laparoscopic longitudinal sleeve gastrectomy. The carrier has denied coverage of laparoscopic longitudinal sleeve gastrectomy as not medically necessary. There is a letter from the carrier to the member dated 11/03/2015‚ which states in part: “This request has been denied
Premium Obesity Bariatric surgery
Cultural Competence: Is it necessary? What is Cultural Competence? Many different definitions of cultural competence are out there‚ but probably the most widely accepted is the following: “Cultural and linguistic competence is a set of congruent behaviors‚ knowledge‚ attitudes‚ and policies that come together in a system‚ organization‚ or among professionals that enables effective work in cross-cultural situations. “Culture” refers to integrated patterns of human behavior that include the
Premium Health care Health care provider Medicine
Management Methodology o Just as projects are unique‚ so are approaches to project management. o Many organizations develop their own project management methodologies‚ especially for IT projects; a methodology describes how things should be done. o BlueCross BlueShield of Michigan used the PMBOK as a guide in developing their IT
Premium Project management
Some of the health plans and hospitals that are online with OHP are Premera Blue Cross‚ Premera Blue Cross Blue Shield of Alaska‚ Providence Health System‚ Regence BlueShield‚ Regence BlueCross BlueShield of Oregon‚ Uniform Medical Plan‚ LifeWise Health Plan of Arizona‚ Oregon and Washington‚ First Choice Health‚ Group Health Cooperative‚ Community Health Plan‚ and Asuris Northwest Health. Each health plan has access to patient information
Premium Health care Health informatics Medicine
According to the National Institute on Drug Abuse‚ drug abuse can be a cause of other diseases such as cancer‚ heart disease‚ and HIV/AIDS. Addiction to a substance can lead to those diseases or worse‚ death. Globally‚ the misuse of legal and illegal drugs kills around 200‚000 people annually (Drug Abuse Kills). Addiction should not be taken lightly or treated like the addict’s own fault. As such‚ substance abuse should be considered a disease and treated as such in order to effectively rehabilitate
Premium Drug addiction Addiction Heroin
MARKETING AND THE HEALTH CARE SYSTEM BY Tanya Brown Strayer University 305 Health Services Marketing Professor Charmaine RhamesMay 5‚ 2013 Marketing and the Health Care System Today‚ most people get their health insurance through their work. But every year‚ more and more people are choosing to shop in the private market for a health care provider. Many people depend on Blue Cross Blue Shield in the state of Alabama for their health care provider. Blue Cross Blue Shield of Alabama is affordable
Premium Health insurance Health care Health economics
Introduction On December 8‚ 2003‚ President Bush signed into existence the Medicare Prescription Drug‚ Improvement‚ and Modernization Act (CMS‚ 2003). This Act over the years is intended to provide prescription drug benefits to seniors. It will also provide subsidies to insurance companies‚ health maintenance organizations‚ and would allow private plans to compete with Medicare (CMS‚ 2003). Why were changes to Medicare deemed necessary? The changes to Medicare where deemed necessary‚ because
Premium Pharmacology Health insurance Medicare