FlexiCourse 8A - Delivering Treatment Under Managed Care - 'YES, NO, or How About If I Do THIS?'
Delivering Treatment Under Managed Care. It's The Good, The Bad, and The Ugly. It's A Paradigm Shift.
FlexiCourse 8A (8 contact hours) contains 2 of the 4 modules from FlexiCourse 10A (Modules 201 and 401). 'Bite-sized' portions of this course appear in MiniCourses 1C, 3A, and 5B.
WANT A FAST NO-FRILLS DESCRIPTION of what's covered in this 8 CREDIT HOUR COURSE? Just hop on over to our course catalog now and take a look. If you want a detailed look at this course, just click the link in the catalog and we'll bring you right back to this page. Or just read on!
With this CEU FlexiCourse, you get 2 fully automated CE courses and 2 (yes, two) certificates in the package. Take the courses online, with no waiting, and claim your 2 certificates immediately - or take up to year to earn both certificates.
If you are already involved in a public sector managed care conversion, be prepared to shout YES! - or maybe NO! - as you scroll through our no-holds-barred slides and humorous artwork. Who says that Continuing Education has to be boring?
IN SUMMARY: This FlexiCourse covers the essentials that provide insight into how managed care companies operate and what drives them to make the decisions that they make about approval or denial of patient care. We provide an introductory look at the adjustments that behavioral health professionals must make clinically and programmatically under managed care, in order to survive this paradigm shift. And finally we suggest practical and workable approaches to various problems and issues which arise when a provider negotiates and implements a contract with an HMO -- including how to respond to denied claims.
FlexiCourse 8A is a set of courses which contain content awarding two (2) separate CE certificates. You may earn both of the CE Certificates now, or you may wish to delay earning one or both certificates for up to one year after purchase of the course -- whenever you need them most! It's your choice!
Are there different kinds of Managed Care plans? Yes indeed. There's The Good, The Bad, and The Ugly - for the Managed Care companies AND for the providers and their clients! But we don't just throw you out there - we identify those plans that are 'mostly safe' (like Fee for Service and Case Rates) vs. those that are 'nerve wracking' vs. those with 'don't even think about it!' written all over them.
1. Understanding the impact of this new health care approach upon providers - it's called 'Care Management'!.
2. Review of 'What's a Capitation Contract' - the primary type of State-HMO managed care contract used in Medicaid and Medicare managed care conversions. Can it possibly work? Yes. And what about FEE FOR SERVICE?
3. Understanding a couple of other Managed Care designs - one is The Good, and one The Truly Ugly (Watch Out! Run Fast!).
4. And should providers take on ANY of these high-risk arrangements, working as a provider for an HMO? Or as the 'substitute' for an HMO? What kind of risk are they taking? And can they succeed in any of these arrangements? (Answer: Yes.)
5. How does Managed Care (and the 'Care Management' process) affect the way that we deliver treatment to Mental Health and Chemical Dependency clients? Here's some creative service options for treatment providers which allow more autonomy.
In this Module we look at many sticky issues that treatment providers encounter when they are working within a Managed Care system. Things to beware of, things to pursue. When to say YES, when to say NO, and when to say 'How about if I do THIS?' How to avoid those 'duh!' provider errors which can cause you to lose the AUTHORIZATION to deliver treatment or be paid for it. How to collect when the MCO has erroneously denied your claim or withdrawn prior authorization for treatment. And other real-life issues like that!
1. Review of "How The Managed Care Company Thinks - What Is 'Medical Necessity of Treatment' At A Practical Level" . . . i.e., how and why they make those sometimes frustrating treatment decisions that may conflict with our clinical beliefs about what is needed.
2. Why DOCUMENTATION in your clients' records must reflect all of these 'LOC decision' factors. Why documentation must be 'clinical' in its content.
3. How to work within a MCO Care Management system and contract - how to deal with multiple issues which affect the treatment we are allowed to provide to clients and the funding we receive to do it.
4.. What to do about erroneous CLAIMS DENIALS, and how to AVOID making ERRORS that cause providers to lose AUTHORIZATION to provide treatment.
5. Specific EXAMPLES of creative ways that we can serve our CD and MH clients under a Managed System of Care.
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