Blue Cross 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
Premium Health insurance Managed care Health economics
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
Premium Health insurance Health care Managed care
experience in managed care is important and will be able to use technical and strategic skills to meet the negotiation process. Managed Care Payer Manager Participates in developing the strategic course for acute care hospitals and ancillary care providers in accordance with Company’s and Region’s overall guidance in such areas as delivery system redesign‚ health care reform and strategic pricing and recovery approaches; and for successful operations between Company and Managed Care Organizations‚ including
Premium Health care Medicine Health care provider
in order to be chosen. Mailing surveys out into the community could be a great way to recognize the target population that the department head is targeting. This would provide anonymity and wouldn’t require personal information. 2. A primary care medical group is trying to determine whether patients are being greeted and serviced appropriately by the billing and admitting departments. A convenience sample (nonprobability sample) is the methodology that the medical group should use in trying
Premium Health care Hospital Marketing
benefits cash flow certification coding coinsurance copayment covered services deductible diagnosis documentation electronic claim (e-claim) electronic health record (EHR) fee-for-service health care claim health information technology (HIT) health plan indemnity plan managed care managed care organization (MCO) medical assistant medical billing cycle medical documentation and billing cycle medical insurance medically necessary noncovered (excluded) services out-of-pocket PM/EHR policyholder practice
Premium Health care Insurance Health insurance
Health Maintenance Organizations are licensed health plans that place providers‚ as well as the health plans‚ with dealing with HMO’s there is a risk of medical expenses. The downfall with HMO is that patients must stay inside their network and if the go outside the network they will have to pay out of pocket expenses. HMO is very limited; many patients don’t like limitations when it comes to their decision about their health. PPO which stands for Preferred Provider Organizations provides patients
Premium Preferred provider organization Health insurance Health care
announced that it would purchase Prudential Health Care from Prudential Insurance Company for $1 billion in cash and debt. The merger created the biggest healthcare company in the United States with 22.4 million customers (Freudenheim). In July of the same year‚ Aetna had just purchased NYLCare from New York Life Insurance to become the fourth largest managed-care company‚ and it was still in the process of integrating (3-99 CV 398-H). The Prudential Health Care merger was the second big merger for Aetna
Premium Preferred provider organization Health care Health maintenance organization
payors to control costs. Many agree healthcare reform and controlling health care costs began as early as the 1960s‚ when federal funded Medicare‚ and federal and state funded Medicaid programs‚ reimbursed institutions for healthcare. Medicare eligible Americans 65 years of age and older‚ and Medicaid eligible Americans in the low income brackets receive health care coverage under these plans‚ requiring health care organizations and providers to comply with regulatory guidelines and set standards‚ necessary
Premium Generally Accepted Accounting Principles Balance sheet Income statement
Managed Care pros and cons The pros of managed care are since the patient is limited to a specific caregiver the premium is lower. The patient only pays a monthly payment and a co-payment. The cons of managed care are that the patients are not allowed to see the doctor of their choice unless the doctor is in their network. The consumers perspective the pros and cons of managed care. The pros from the consumers perspective
Premium Money Payment Insurance
Discuss how the relationship between the government and the managed health care industry changed over the years. Which changes do you believe had a positive impact on the managed health care industry? The relationship between government and the managed health care industry has a long history. Managed health care otherwise known as the pre years of managed care‚ started before the 1970’s. In the period from 1910 until 1970 the most significant example is the Western Clinic in Tacoma‚ Washington
Premium Health care Health insurance Health economics