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."
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