Catalogue


Managing managed care : secrets from a former case manager /
Susan Frager.
imprint
New York : John Wiley, c2000.
description
xi, 276 p.
ISBN
0471351776 (pbk. : alk. paper)
format(s)
Book
Holdings
More Details
imprint
New York : John Wiley, c2000.
isbn
0471351776 (pbk. : alk. paper)
catalogue key
3649299
 
Includes bibliographical references and index.
A Look Inside
About the Author
Author Affiliation
Susan Frager, Lcsw, is a clinical social worker and psychotherapist
Reviews
Review Quotes
"The Author provides material that will help both new and experienced clinicians gain insight in working creatively with the managed care community. This volume is a "must read" for all that hope to unravel the complex area called "Managed Care"". -Roger Q. Harmon (American Journal of Pastoral Counseling, Dec 01)
"The Author provides material that will help both new and experienced clinicians gain insight in working creatively with the managed care community. This volume is a "must read" for all that hope to unravel the complex area called "Managed Care"". --Roger Q. Harmon (American Journal of Pastoral Counseling, Dec 01)
To find out how to look for other reviews, please see our guides to finding book reviews in the Sciences or Social Sciences and Humanities.
Summaries
Main Description
* File claims that get paid * Get more sessions for your clients * Take the stress out of communicating with managed-care companies * Promote your clients' Confidentiality Learn to take charge of managed care A "how-to" guide for dealing with the everyday practice issues related to working with managed care. Written by an industry insider, Managing Managed Care offers a candid and unprecedented behind-the-scenes view, with focus on issues of vital importance to today's practitioner: * Understanding the "participating-provider" contract * Challenging fee reductions * Writing treatment reports in "managed-care- friendly" language to enhance the likelihood of obtaining continued authorization * The nuts and bolts of "medical necessity" * Effectively fighting denials of care * Getting claims paid Managing Managed Care features insights from case managers, other managed-care employees in critical areas such as network, quality, consumer service, and managed- behavioral care company executives. Learn why they close the panels. Who gets the referrals, and why? How are managed-care and insurance companies shifting financial risk to practitioners? How is managed care itself changing as a result of market pressures? What effect does NCQA have on managed-care companies? How does all this affect you and your clients, and what can you do about it?
Back Cover Copy
File claims that get paid Get more sessions for your clients Take the stress out of communicating with managed-care companies Promote your clients' Confidentiality Learn to take charge of managed care A "how-to" guide for dealing with the everyday practice issues related to working with managed care. Written by an industry insider, Managing Managed Care offers a candid and unprecedented behind-the-scenes view, with focus on issues of vital importance to today's practitioner: Understanding the "participating-provider" contract Challenging fee reductions Writing treatment reports in "managed-care- friendly" language to enhance the likelihood of obtaining continued authorization The nuts and bolts of "medical necessity" Effectively fighting denials of care Getting claims paid Managing Managed Care features insights from case managers, other managed-care employees in critical areas such as network, quality, consumer service, and managed- behavioral care company executives. Learn why they close the panels. Who gets the referrals, and why? How are managed-care and insurance companies shifting financial risk to practitioners? How is managed care itself changing as a result of market pressures? What effect does NCQA have on managed-care companies? How does all this affect you and your clients, and what can you do about it?
Bowker Data Service Summary
This work addresses the practice issues faced by therapists to get treatment authorization and reimbursement from a managed care organization. It offers tips on such areas as handling fees, getting claims paid, and getting sessions authorized.
Main Description
This book addresses the day-to-day practice issues faced by every therapist struggling to get treatment authorization and reimbursement from managed care organization. Authored by an insurance industry insider, it supplies tips and techniques on handling fees, getting claims paid, getting sessions authorized, and writing treatment plans and reports that guarantee results.
Unpaid Annotation
File claims that get paidGet more sessions for your clientsTake the stress out of communicating with managed-care companiesPromote your clients' Confidentiality Learn to take charge of managed care A " how-to" guide for dealing with the everyday practice issues related to working with managed care. Written by an industry insider, Managing Managed Care offers a candid and unprecedented behind-the-scenes view, with focus on issues of vital importance to today' s practitioner: Understanding the " participating-provider" contractChallenging fee reductionsWriting treatment reports in " managed-care- friendly" language to enhance the likelihood of obtaining continued authorizationThe nuts and bolts of " medical necessity" Effectively fighting denials of careGetting claims paid Managing Managed Care features insights from case managers, other managed-care employees in critical areas such as network, quality, consumer service, and managed- behavioral care company executives. Learn why they close the panels. Who gets the referrals, and why? How are managed-care and insurance companies shifting financial risk to practitioners? How is managed care itself changing as a result of market pressures? What effect does NCQA have on managed-care companies? How does all this affect you and your clients, and what can you do about it?
Table of Contents
Life Inside Managed Carep. 1
Getting on Participating-Provider Panelsp. 24
Credentialing and Network Managementp. 43
The Managed Care Contractp. 61
Getting Referrals and Getting Them Scheduledp. 76
Adding Value, Subtracting Privacyp. 84
Medical Necessityp. 101
Requesting Additional Sessionsp. 120
Completing the Outpatient Treatment Reportsp. 143
Completing the OTR: Writing Treatment Plansp. 168
Managed Care's Clinical Predispositionsp. 191
Denials and Appealsp. 205
Getting Paidp. 222
The Finances of Managed Carep. 237
Putting the Money at Riskp. 252
Appendixp. 263
Bibliographyp. 268
Indexp. 271
Table of Contents provided by Syndetics. All Rights Reserved.

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