Question

1) In the Balanced Budget Act of 1997, the Centers for Medicare and Medicaid (CM) termed Manage Care Organizations (5ptu. (Spts) 2) MCOs focus on providing quality care by selecting providers carefully, emphasizing the health of their populations, using care management tools, and maintaining accreditation and participating in (5pts) 3) Evidence-based clinical practice guidelines are developed by national health research organizations such as the US Preventive Services Task Force (USPSTF), the Agency for Healthcare Research and Quality (AHRO), and the Centers for Disease Control and Prevention as well as by professional associations for specialists such as the American College of Cardiology and the 4) MCOS survey members to determine their satisfaction with services, perceptions of the plan's (5pts) strengths and weaknesses, suggestions for improvement, and 5) Name the three steps in medical necessity and utilization review. Spts) MacBook Air

Answer 1

1. In the balance budget act of 1997, the centers of medicare and medicaid termed management care organizations as it was allowed that states require most Medicaid beneficiaries to enroll in managed care organizations that do business only with Medicaid.

2. MCO focus on providing quality care by selecting providers carefully, emphazising the health of their populations, using care management tools, and maintaining accreditation and participating in quality improvement programs

3. Evidence based clinical practice guidelines are developed by national health research organization such as the US Preventive services task force, the agency for health research and quality and the centers of disease control and prevention, as well as the professional association for specialist such as the American College of Cardiology and the American Academy of Physical Medicine & Rehabilitation: Practice Guideline Resources, American College of Physicians (ACP) Clinical Recommendations, American Diabetes Association etc.

4. MCO survey members to determine their satisfaction with services, perceptions of the plan's strengths and weaknesses, suggestions for improvement and adequate access to all

5. Name the three steps in medical steps and utilization review. They are initial clinical review, peer clinical review, and appeals consideration.