Risk Management And The Role Of Managed Care
Risk Management And The Role Of Managed Care
Addressing the knowledge you have gained, and building on that knowledge to add your evaluation of the role that the managed care organization (MCO) plays in today’s health care environment, develop a 500 word reflection to incorporate the following:
- What is a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with managed care organization (MCOs) standards?
- What is your assessment of the value provided to an organization that stems from the regulatory statutes of a typical MCO? Consider the establishment of conflict resolution and risk management strategies within the health care organization from the employer/employee perspective as well as in regards to patient conflict circumstances.
- What MCO responsibilities pertain to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws? Risk Management And The Role Of Managed Care
Prepare this assignment according to the guidelines found in the APA Style Guide
Risk management is essential, especially for cost reduction in the healthcare sector. Patients with low incomes always have a challenging time dealing with unprecedented medical expenses when they get injured in an accident, fall sick, or get injured due to a catastrophic event such as floods. At the same time, some well-off people find it challenging to take care of some expensive medical treatment such as cancer. Hence taking the appropriate measure to manage such unpredicted circumstances is vital to enhance affordable healthcare services. Management care organization has a crucial role that It plays in the healthcare organization by guaranteeing that patients access appropriate healthcare in case an emergency situation takes place that may require urgent medical attention. Hence the paper discusses the significance of managing risk and the purpose of medical care organizations. Risk Management And The Role Of Managed Care
Administrative Role in Executing Risk Management Policies
A health care institute has a huge role in the administrative role and implementation of risk management policies and guarantees subordination with the qualities developed by the health care organization. In a health care institution, the administrator gauges risk by identifying and evaluating risks as a strategy of reducing harm to visitors, workers, and patients (Alam, 2016). The administrator performs his role energetically and responsively to prevent the occurrence or reduce the consequences resulting from an event. Risk identification necessitates the healthcare workers to become responsive to the risks in the environment or services. Risk Management And The Role Of Managed Care
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Value of MCO in a Healthcare Institution
Regulatory statutes of a normal MCO ensure that medical care institutions offer cost-effective and quality healthcare to people. MCO regulations require health care institutes to keep the medical cost low by closely monitoring their functions and services (Ness, 2015). By regulating and preventing wastage of services, the cost is easily regulated. Additionally, MCO requires patients to get permits from their medical insurance institutions before receiving specialized treatment or being hospitalized to prevent conflicts between patients and the organization. Risk management strategies not only do they affect patients and employees but also healthcare professionals. The purpose of a risk management strategy is to avert any monetary repercussions, and patients must be their priority. Risk Management And The Role Of Managed Care
MCO Responsibilities
Affordable Care Act and Center for Medicare Services laws require the MCO to execute exhaustive programs to enhance the billing process to detect and avert healthcare services fraud, wastage, and abuse. Medicare can be compared to free-for-service dangers transferred to an intermediary insurer from the main payer, which avail numerous opportunities for fraud, abuse, and wastage, resulting in a denial of services and organizational barriers for patients (Thornton et al., 2015). Therefore, MCO has the obligation of identifying, investigate and evaluate possibilities of fraud in health care. CMS later analyses the information and detects any abuse and fraud cases. Risk Management And The Role Of Managed Care
Conclusion
Risk management strategies are not only beneficial to patients but also employees and healthcare professionals. They assist patients, and medical care providers cut health care making the services affordable to patients. Health care organizations ensure that healthcare professionals utilize these strategies to provide quality and affordable services to patients. MCOs ensure that they follow up the services provided by medical care institutions to ascertain their effectiveness and detect fraud, abuse, and wastage cases Risk Management And The Role Of Managed Care
