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For services to be considered as incident to a physician's professional service, 1) they must be rendered under the physician's immediate personal supervision by his/her employee, 2) they must be an integral, although incidental part of a covered physician's service, 3) they must be of kinds commonly furnished in
Managed Care Organizations (MCOs) are health care organizations that provide services to Medicaid participants in Maryland. These organizations contract with a network of doctors and other health care providers to provide covered services to their participants.
Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan's network.
A written order from your primary care physician giving you permission to see a specialist or get certain medical services. Many health plans require a referral before you can get medical care from anyone except your primary care physician.
Which administrative procedure should a medical practice follow when it contracts with a managed care organization (MCO)? Maintain separate bookkeeping systems for each capitated plan.
Appointed by Secretary of Health to 4-year terms: Valina R. Hartman, R.N.; Maura J. Rossman, M.D.
Lesson 9 - Chapter 3 Understanding Managed Care: Medical Contracts & Ethics. In working with patients and their insurance carriers, medical office specialists are entrusted with patients' personal information.
In July 2011, about three-quarters of Medicaid beneficiaries in the state were enrolled in managed care plans. Maryland began operating managed care in 1991 when it transferred most of its beneficiaries into a mandatory PCCM, Maryland's Access to Care (MAC).
Medical office specialists should be familiar with terms used in managed care contracts because they need to be able to review contracts and discuss issues with patients and carriers.
How do I enroll in an MCO? If you applied for Medicaid through Maryland Health Connection (MHC), once your application is complete and verified, you will choose an MCO and primary care provider (PCP) for your health care. Each eligible member of the household may enroll in a different MCO.