In: Nursing
Medical Billing question: This week students will Describe the six Managed Care Models ( Found in Chapter 3, 3-4) and provide details about each. Please remember to describe in your own words.
Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities to provide care for members at reduced costs.
The six Managed Care Models includes the following:-
1. IDS (Integrated Delivery System)
Affiliated provider sites that offer joint healthcare. PHO, MSO,
Medical foundation, group practices without walls.
2. EPO (Exclusive Provider Organization)
Cannot contract with other managed care plans and Provides benefits
to subscribers who are required to receive services from NETWORK
PROVIDERS> Managed care plans that provide benefits to
subscribers who are required to receive from network providers
3. PPO ( Preferred Provider Organization)
A network of physicians and hospitals the have JOINED TOGETHER to
contract with insurance co, employers, or other organizations.
3. HMO (Health Maintenance Organization)
An ALTERNATIVE traditional to group health insurance coverage and
provides healthcare services voluntary enrolled members on a
PREPAID basis.
3. POS (Point of Sale)
Patients have the freedom to used managed panel of providers (out
of network) higher out of pocket.
3. TOP (Triple Option Plan)
It gives patients multiple choices such as HMO, PPO, or traditional
plan, Also called cafeteria plan.