Homework Clinic
Hands-on Clinic => Nursing and Clinical => Topic started by: EY67 on Jun 27, 2018
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Define and explain managed care and the various organizations that fall under that category.
What will be an ideal response?
Question 2
The following eight rules are important to consider when determining the correct surgical codes EXCEPT
a. Only one bone operation is allowable per toe.
b. Generally, two or more operations are allowable per incision.
c. Unna's boot (gauze soaked in zinc oxide) is considered part of the surgery itself and does not warrant an additional allowance.
d. Flexible casts are nothing more than a tape or bandage and do not warrant a casting benefit.
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Answer to Question 1
Answer:
Managed care is a system for organizing the delivery of health services so that the cost of care is reduced and the quality of care is maintained or improved. Managed care plans (MCPs) were created in an attempt to bring healthcare under control by having providers share some of the financial risks of healthcare with the patient and the insurance carrier. Managed care techniques are most often practiced by organizations and professionals who assume part or all of the risk associated with providing the medical care for a defined population of patients. It is best described as a multifaceted system for providing healthcare while maintaining costs.
There are many different types of managed care organizations, including Health Maintenance Organizations, Preferred Provider Organizations, Gatekeeper PPOs, Exclusive Provider Organizations, Physician Hospital Organizations, and Management Service Organizations. Several of these types of care were previously discussed in the introduction chapter under Types of Insurance.
Answer to Question 2
B