This topic contains a solution. Click here to go to the answer

Author Question: What are the various mechanisms by which an MCO can generate ... (Read 42 times)

CQXA

  • Hero Member
  • *****
  • Posts: 546
What are the various mechanisms by which an MCO can generate revenue?

Question 2

Compare and contrast the various organizations that can provide an MCO with accreditation.



Related Topics

Need homework help now?

Ask unlimited questions for free

Ask a Question
Marked as best answer by a Subject Expert

TDubDCFL

  • Sr. Member
  • ****
  • Posts: 357
Answer to Question 1

Premium payments represent the primary revenue for an MCO. Premiums can come from employers, individuals, individual states on behalf of their members, or CMS.

Answer to Question 2

NCQA: an independent nonprofit organization that develops new standards separate from those of trade associations. In 2010, NCQA offered accreditation programs for health plan accreditation, wellness and health promotion, and managed behavioral health care organizations, new health plans, and disease management.
The Joint Commission: each part of the entity may be accredited individually by The Joint Commission.
AAAHC: accredits the health care delivery portion of staff model, group model, and network model HMOs. AAAHC uses the Accreditation Handbook for Ambulatory Health Care to survey the physician office and clinic portions of these HMOs. The focus of this accreditation is on the delivery of health care rather than the insurance aspects of the HMO or MCO.
URAC: publishes both health plan and health network standards. The Health Plan accreditation program provides a comprehensive review of health plan operations in five areas and is appropriate for HMOs and other integrated plans. The Health Network accreditation does not include utilization management and is better suited for PPO accreditation.




CQXA

  • Member
  • Posts: 546
Reply 2 on: Jul 12, 2018
Wow, this really help


Viet Thy

  • Member
  • Posts: 329
Reply 3 on: Yesterday
Great answer, keep it coming :)

 

Did you know?

The longest a person has survived after a heart transplant is 24 years.

Did you know?

Medication errors are more common among seriously ill patients than with those with minor conditions.

Did you know?

After 5 years of being diagnosed with rheumatoid arthritis, one every three patients will no longer be able to work.

Did you know?

To combat osteoporosis, changes in lifestyle and diet are recommended. At-risk patients should include 1,200 to 1,500 mg of calcium daily either via dietary means or with supplements.

Did you know?

It is difficult to obtain enough calcium without consuming milk or other dairy foods.

For a complete list of videos, visit our video library