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Pages:
2 pages/β‰ˆ550 words
Sources:
4 Sources
Style:
APA
Subject:
Health, Medicine, Nursing
Type:
Essay
Language:
English (U.S.)
Document:
MS Word
Date:
Total cost:
$ 8.64
Topic:

Risk Management Policies: Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS)

Essay Instructions:

Base on the previous works, you have identified, examined, and provided individual as well as collaborative analysis on multiple facets of risk management in the health care setting.
Addressing that knowledge, and build on that knowledge to add the evaluation of the role that the managed care organization (MCO) plays in today's health care environment, develop a 250-500 word reflection to incorporate the following:
What is a health care organization's administrative role regarding oversight of risk management policies and ensuring compliance with managed care organization (MCOs) standards?
What is your assessment of the value provided to an organization that stems from the regulatory statutes of a typical MCO? Consider the establishment of conflict resolution and risk management strategies within the health care organization from the employer/employee perspective as well as in regards to patient conflict circumstances.
What MCO responsibilities pertain to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?
Prepare this assignment according to the guidelines found in the APA Style Guide
please follow these rubics:
An explanation of a health care organization's administrative role regarding oversight of risk management policies and ensuring compliance with MCO standards is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.
A discussion regarding assessment of the value provided to an organization that stems from a typical MCO (regulatory statutes, inclusive of conflict resolution and risk management strategies from the employer/employee perspective and patient conflict circumstances) is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate
A description of MCO responsibilities pertaining to PPACA and CMS focus on fraud, waste, and abuse laws is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.
A discussion addressing course content and learning is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.
Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
Writer is clearly in command of standard, written, academic English.
All format elements are correct.
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Essay Sample Content Preview:

My Reflection on Risk Management in the Health Care Setting
Name
Institution
Date
My Reflection on Risk Management in the Health Care Setting
Administrative roles of the healthcare organizations in relation to oversight of risk management policies that ensure compliance with MCO standards include, developing policies and programs to engage stakeholder and the public in decision-oriented activities. Health care organizations develop an elaborate provider contract that includes criteria to be used in appointing practitioners. The contracts also stipulate termination process when practitioners do not meet quality standards (McGinnis, Houston & Brown, 2013).
The organization coordinates formal and informal grievance appeal mechanism as part of its customer service function. This includes collecting through investigations, analyzing and presenting problems identified in delivering services. (McGinnis, Houston & Brown, 2013). Quality management function includes ensuring that standards of staff, the program, and management performance comply with the MCO standards by assessing and introducing ongoing improvements. Standard setting activities include periodic reviews, analysis, and recommendations on areas of focus for continuous quality improvement. Health care organizations develop an overall quality assessment and performance improvement programs.
The regulatory statutes of a typical MCO provide for the establishment of conflict resolution and risk management strategies within health care organizations from the employer/employee perspective and in regards to patient conflict circumstances including specific protocols. These protocols are designed by the MCO regulations to help them identify and diagnose problems areas in its dispute system and also address the underlying causes of particular problems (Barbee, 2016). According to the MCO regulations, the dispute resolution system addresses efficiency and effectiveness, fairness and integrity, employee satisfaction and retention and organization learning feedback. These four components help the organization to plan its resources and design process to develop a cost effective well-informed and timely dispute resolutions (Barbee, 2016)...
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