Managed Care

The healthcare delivery system is constantly evolving. Traditional fee-for-service provider arrangements are giving way to negotiated contractual fees. Benefit plans are routinely changing to reflect these new contracted provider relationships. Fixed dollar-per-service rates are slowly replacing indemnity deductible and coinsurance payments. Utilization controls are now less dependent on out-of-pocket incentives than on actual need evaluations performed on the behalf of the insurance companies, Health Maintenance Organizations (HMOs), and Utilization Review Organizations (UROs). In short, there is a need for greater administrative control.

The Complete Managed Care Billing & Tracking System

Features:

• Track authorizations.
• Track referrals.
• Track deductibles.
• Track co-payments.
• Effectively handle Medicare/fee co-pay arrangements.
• Unlimited number of contracts.
• Manage authorizations and referrals by date range.
• Manage authorizations and referrals by count.
• Manage authorizations and referrals by service provider.
• Manage authorizations and referrals by service type.
• Sliding scale co-payments by financial class and service type.
• Prevent claims from being submitted for non-authorized services.
• Print reports that include authorizations for additional services.
• Automatically link authorization and referral numbers with claims.

Using the Accumedic Complete Managed Care Billing & Tracking System in conjunction with the AccuScheduler Appointment Scheduling / Medical Scheduling Software Programs Program will also:

• Schedule appointments only for authorized services.
• Remind receptionists to collect co-payments and balances due at the time of the visit.
• Create Charge Entry transaction directly from the Scheduler