Blue Shield of South Carolina Shauna McKinnon Health Care Systems 235 University of Phoenix 2011 The name of the agency of my selected provider is Blue Cross Blue Shield of South Carolina. I researched different websites to obtain my information about Blue Cross Blue Shield. I researched Blue Cross Blue Shield of South Carolina‚ which was updated in 2011‚ Manta Media which was updated
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Medicare and Medicaid Medicare and Medicaid have similar names and are both are government programs. The name sounds so similar that most people get them confused. Medicare is for people who are older or disabled. While‚ Medicaid is for people with limited income and resources. Some people do qualify for both Medicare and Medicaid. There are several differences between the two. Medicare is for adults over the age of sixty-five and some younger with certain disabilities such as end stage renal disease
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Benefit and Planning Chapter 12 What is the term PPO stands for? Preferred Provider Organization What is the Characteristics of PPO? Tends to be used in two ways. One way to apply to health care providers that contract with employers‚ insurance companies‚ union trust fund‚ third-party administrators‚ or others to provide medical care services at a reduced fee. PPO may be organized by the Providers themselves or by other organizations‚ such as insurance companies the Blues. Like HMO they may take
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government provided extremely favorable tax incentives to employers that offered them. The earliest formal health insurance offerings were Blue Cross plans‚ which were created by provider organizations in the 1930s and offered prepaid hospital benefits. Managed care organizations‚ specifically health maintenance organizations‚ began to develop about 40 years later‚ in response to a dramatic increase in spending on healthcare costs. Today‚ healthcare spending continues to rise and is an every increasing
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US Health Care System An explanation of what a managed care organization (MCO) is and how MCOs evolved The identification of the accrediting bodies for MCOs and an explanation of the types of care they oversee. A description of managed care plans‚ such as HMOs and PPOs explanation of the impact of MCOs on cost‚ access‚ and quality. An explanation of what accountable s 3/19/15 What is managed care organization (MCO)? Managed Care is a system that s structured to regulate cost‚ operation‚
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A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations‚ Preferred Provider Organizations‚ Private Fee-for-Service Plans‚ Special Needs Plans‚ and Medicare Medical Savings Account Plans. The Medicare Advantage program also allows beneficiaries to switch health plans during an annual open enrollment period each November
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the other coverage denies responsibility for payment‚ pays less than the Medicaid fee schedule‚ or if Medicaid covers procedures not covered by the other policy. * Medicaid covered services are payable only when the service is determined by the provider to be medically necessary. * inpatient (no mental) * outpatient hospital * lab/ xray * pediatric / nurse practitioner * NSF 21/ OLDER * kids under 21 physicals * family planning/supplies * dentist med/surg * home
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are the three common forms of managed care plans? Individual practice organizations‚ point-of-service plans‚ health maintenance organizations Health maintenance organizations‚ preferred provider organizations‚ point-of-service plans Preferred provider organizations‚ point-of-service plans‚ individual practice organizations Preferred provider organizations‚ health maintenance organizations‚ individual practice organizations 0.2 points Question 4 1. Single employees pay a larger percentage
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1. What competencies are needed for entry level employment in healthcare/HIS? Healthcare skills: (anatomy and physiology‚ medical terminology‚ pathophysiology‚ clerical and administrative procedures‚ laws and ethics‚ communications)‚ Computer skills :(MS office‚ EHR‚ Internet‚ billing-related/PM‚ data mining‚ records management‚ coding/cac‚ And knowledge of healthcare reform: (privacy and security‚ HIPPA‚ HITECH‚ PPACA‚ ICD-10) for the greatest career opportunities for advancement. 2.
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increased independent specialty practices and the growth of managed care plans (DeNavas-Walt‚ Proctor‚ & Smith‚ 2007). Such plans include Health Maintenance Organizations (HMOs)‚ Preferred Provider Organizations (PPOs)‚ and Point of Service (POS). Managed care plans are defined as health insurance plans that contract with health care providers and facilities to provide necessary and efficient health care for members at appropriate costs (MedlinePlus‚ 2010). Recently‚ state and federal governments
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