Essentials Of Managed Health Care

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E-Book Overview

As the most widely-used textbook on managed care, Essentials of Managed Health Care provides an authoritative and comprehensive overview of the key strategic, tactical, and operational aspects of managed health care and health insurance. With a primary focus on the commercial sector, the book also addresses managed health care in Medicare, Medicaid, and military medical care. An historical overview and a discussion of taxonomy and functional differences between different forms of managed health care provide the framework for the operational aspects of the industry as well. New contributors New chapter on the Patient Protection and Affordable Care Act of March 2010 New chapter on enrollment and billing New chapter on fraud and abuse Completely re-written chapter on information systems and electronic data interchange Completely re-written chapter on Medicaid Managed Health Care Complete restructuring of section 2 with a new focus on structure and payment across all types of health care delivery systems New chapter on physician practice behavior and managed health care

E-Book Content

World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 [email protected] www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to [email protected] Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. This publication is designed to provide accurate and authoritative information in regard to the Subject Matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional service. If legal advice or other expert assistance is required, the service of a competent professional person should be sought. Essentials of Managed Health Care is an independent publication and has not been authorized, sponsored, or otherwise approved by the owners of the trademarks or service marks referenced in this product. Some images in this book feature models. These models do not necessarily endorse, represent, or participate in the activities represented in the images. Production Credits Publisher: Michael Brown Managing Editor: Maro Gartside Editorial Assistant: Kayla Dos Santos Editorial Assistant: Chloe Falivene Production Assistant: Rebekah Linga Senior Marketing Manager: Sophie Fleck Teague Manufacturing and Inventory Control Supervisor: Amy Bacus Composition: Laserwords Private Limited, Chennai, India Cover Design: Kristin E. Parker Cover Image: © Barauskaite/ShutterStock, Inc. Printing and Binding: Courier Kendallville Cover Printing: Courier Kendallville To order this product, use ISBN: 978-1-4496-5331-6 Library of Congress Cataloging-in-Publication Data Essentials of managed health care / [edited by] Peter R. Kongstvedt.—6th ed. p. ; c