Managed Health Care, Keeping it Running Smoothly


Managed health care is a controversial thing in todays world. A network choosing which healthcare professionals you can see, How long your hospital visits can be and what your insurance covers is something that can frustrate anyone these days. Managed healthcare was sparked when the Health Maintenance Organization Act in 1973. The people who support and also disagree with managed care have vastly different opinions and stand on completely different sides of the table in terms of how it effects U.S. healthcare. It can be hard with managed healthcare creating such a large complex system to create contract compliance between all parts of the system.

One of the most commonly known parts of managed healthcare is the panel or network system in which each enrollee is assigned a panel of healthcare professionals including a primary care physician to take care of basic problems and write referrals. HMO\’s are licensed on a state level under a license that is called a Certificate of Authority instead of an insurance license. It can be hard for a HMO to create over all compliance including contract compliance to ensure revenue is kept at accurate levels, When there are so many ins and outs. Contract Compliance ensures agreements between insurances companies and doctors offices as well as specialty practices run smoothly.

Things Managed Healthcare take care of include disease management, Case Management, Educating Patients, Incentives for being healthy, Payment reviews, and revenue recovery, The allow things to be monitored on a larger scheme for more contract compliance and also payment Compliance. With managed healthcare creating a large system full of enrollees and different doctors and billing systems organization is required for contract compliance between all parties. Things such as managed care review and Making sure all aspects of the specific organization are running smoothly. Understanding what managed healthcare does is the first step to understanding how to get the most out of your healthcare, and ensure a healthy life.

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