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Medical Review Criteria Guidelines for Managed Care - 820 pages + CD contain more than 750 detailed clinical review criteria guidelines listing specific indications Medical for ambulatory care/inpatient tests and procedures. Extensive references. "The Bible" for HMO benefit interpretations. Very useful for provider education and claims management, as well as traditional UM. Updated every 4 months - additional guidelines added. ISBN 1-893826-00-7 $575. Please add $14.00 for the first manual plus $9.50 for each additional manual. The manual price includes the print version plus the entire contents on a CD or disc.
Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.
More than 1,600 evidence-based clinical review criteria guidelines listing specific reasonable and medically necessary indications & criteria for ambulatory or inpatient care, tests, referrals and procedures. Comprehensive coverage information. Length of stay benchmarks. Payment criteria. Extensive authoritative references. ¿The Bible¿ for health plan and Medicare benefit interpretations. Critical resource for provider education and claims management, as well as traditional UM. The most comprehensive review criteria guideline resource available.
Medicare beneficiaries are rapidly moving into managed care, as attempts to restrain the growth of this costly entitlement program progress. However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sectorâ€"yet protect them as consumers and patients. This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed careâ€"how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters. The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.
More than 1,500 evidence-based clinical review criteria guidelines listing specific reasonable and necessary indications & criteria for ambulatory care and/or inpatient tests, referrals and procedures. Comprehensive coverage information. Length of stay benchmarks. Payment criteria. Extensive authoritative references. The Bible for health plan and Medicare benefit interpretations. Critical resource for provider education and claims management, as well as traditional UM. Visit apollomanagedcare.com for full list of contents.
The Second Edition of this comprehensive "how to" text has been completely revised and updated. This text outlines the basics of case management and illustrates some of the pitfalls encountered in the field of case management. The book provides information on the new Case Management Standards, supplies standard definitions and guidelines of case management for the practicing case manager, and presents information on caring for clients in a wide variety of health care settings. New to this edition--chapters focusing on Quality Reviews and Risk Management with a strong emphasis on Continuous Quality Improvement (CQI), ethical and legal issues, and various case studies.
Medical Review Criteria for Managing Care, 2008: More than 1600 guidelines for medical necessity coverage of all aspects of medical-surgical care - a chapter for each specialty. Each guideline has current literature references and links to other authoritative resources.
This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.