This book links quality and reimbursement issues, using a systems approach that clinicians may incorporate into their practice. Updated to provide practical advice for primary care providers (PCPs) about major trends that have emerged over the past five years, such as growing patient enrollment in managed care health plans, performance evaluation of PCPs by outside agencies, and the dramatic increase in billing being audited.Includes a free CD-ROM with customizable forms and checklists.

This book has been updated to provide practical advice for primary care providers (PCPs) about major trends that have emerged over the past several years, such as growing patient enrollment in managed care health plans, performance evaluation of PCPs by outside agencies, and the dramatic increase in billing being audited. This book links quality and reimbursement issues, using a systems approach that clinicians may incorporate into their practice. The included CD-ROM contains customizable forms, with checklist progress note forms for the 20 most common primary care diagnoses and checklists of 20 primary care tasks for HEDIS measurements.

This text is offered as a medical legal resource of the physician assistant profession. It is intended for use through all phases of the professional development of the physician assistant, from the high school student sorting through options in career choices, to physician assistant students, practicing physician assistants and supervisory physicians, or those who are considering practicing with a physician assistant. The history and development of the profession is reviewed, allowing an understanding of the role the physician assistant plays in the healthcare team approach to patient care. The scope of practice is defined, along with the key collaboration between the physician assistant and the supervising physician. Regulatory requirements are delineated by state, including basic requirements and maintenance of licensure and certification.

This book provides readers with an invaluable set of tools to convert the endless challenges for quality and myriad opportunities for improvement into meaningful and useful change. It considers how to manage primary care organisations in order to improve quality of care; how general practices are regulated and held accountable; various techniques used for assessing and measuring; and commonly used quality improvement frameworks.

Nurse Practitioner’s Business Practice and Legal Guide, Third Edition lays a solid foundation of knowledge upon which students can build their practice confidently and effectively, whether it be in developing an employment relationship, undertaking a business venture, giving testimony before the state legislature, composing a letter to an insurance company about an unpaid bill, teaching at a school of nursing, or serving as president of a state or national organization. The Third Edition of this best-seller is newly revised and updated to include topics such as: • How to write an effective business plan using the most up-to-date informationand planning strategies • How to avoid malpractice and other lawsuits • How to effectively negotiate managed care contracts • What must take place for NPs to become primary care providers • What decisions need to be made before starting a practice • State-by-state laws completely updated! • New section on the NP Portfolio - What is it? - What goes in it? - Why is it necessary?

Designed to save time and assist busy practitioners, this book guides standardized assessment and documentation of a patient's condition by providing ready-to-use forms that represent the 'gold standard' of current practice.

For both patients and providers, the words managed care are loaded with negative connotations, synonymous with inefficiency and bureaucracy. Forced to perform a delicate balancing act of offering the best possible care for their clients while carefully adhering to various managed care policies and procedures, providers in particular often wince at the prospect of having to deal with managed care companies, or MCOs. Fearing burdensome paperwork, low reimbursement rates, and denials of care, it's not surprising that a number of mental health professionals choose to limit their involvement with managed care companies-or eliminate it altogether. "My clients are all on different health plans; how can I keep the policies straight?" "Getting services approved is so time-consuming that I'm better off accepting only self-paying clients, aren't I?" "Do the benefits of working with MCOs really outweigh the drawbacks?" The answer, according to two industry insiders, is yes. If you know how to work with the system, the system can work for you. Mental Health Provider's Guide to Managed Care is the first handbook of its kind to offer clinicians a window into the inner-workings of MCOs. Authors Reich and Kolbasovsky candidly draw on their combined 37 years experience in the field to walk readers through all the major elements of how to successfully work within the system: marketing yourself and your practice to an MCO, getting onto a MCO's network, maintaining a good relationship and communicating with MCOs for quick service approval, reducing your liability, understanding your rights and responsibilities, getting paid, and more. Every issue—big and small—is covered, from capitation versus fee-for-service payment arrangements to evaluating which MCOs are a good fit to join, and everything in between. After explaining how to work with the system, the authors reveal how to put the system to work for you. Tips for building your practice through referrals, generating business through doctor collaboration, and understanding future practice opportunities are all covered.By demystifying the complexities of managed care and offering a unique, inside view of the process, this book mitigates the negative connotations associated with MCOs and exposes the hidden benefits of a seemingly burdensome process. Exceedingly reader-friendly and packed with insightful tips and vignettes, Mental Health Provider's Guide to Managed Care is one clinician's guide you won't want to be without.