risk management handbook for health care organizations

Principles of Risk Management and Patient Safety identifies changes in the industry and describes how these changes have influenced the functions of risk management in all aspects of healthcare. The book is divided into four sections. The first section describes the current state of the healthcare industry and looks at the importance of risk management and the emergence of patient safety. It also explores the importance of working with other sectors of the health care industry such as the pharmaceutical and device manufacturers. The last three sections focus on the three main components of the risk manager s responsibility: claims management, risk financing and proactive loss control. The final section touches on solutions for seamless integration between risk management and patient safety functions. Using an integrative approach Principles of Risk Management and Patient Safety offers a comprehensive review of the current issues which formulate the basis of a risk management program and provide the knowledge that a risk manager would be expected to have.
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Best review for Principles of Risk Management and Patient Safety

This book offers governing boards, chief executive officers, administrators, and health profession students the opportunity to organize and devise a successful risk management program.
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Best review for Risk Management in Health Care Institutions, Second Edition: A Strategic Approach

For many psychiatrists and other mental health professionals, the clinical review is the most burdensome and disagreeable part of managed care. In that review they are asked, by a representative of the managed care company, to justify their patient’s need for care and to defend the treatment they are providing. Clinicians usually feel at a disadvantage in these discussions because they are never quite sure what information the reviewer needs to approve the patient’s care. This does not have to be the case. The goal of this book is to teach psychiatrists, mental health professionals, and administrators how reviewers think and how to conceptualize, present, and document clinical care in a manner that greatly increases the likelihood that reviewers will approve their request for care. Beginning with five questions that must be answered in every managed care review, the author discusses the following key topics and many others. -Presenting your case to a reviewerAHow to effectively present requests for inpatient, partial hospital, and substance abuse care and avoid common mistakes that decrease the likelihood that your request will be approved. How to answer the four clinical questions that must be addressed in every review even if they are not asked by the reviewer. -Negotiating with the reviewerAHow to negotiate with a reviewer who is reluctant to approve the care you request. -Writing effective notesAHow to write effective clinical notes in the patient’s record that substantiate your request for care and increase the likelihood that it will be approved. -Dealing with unethical reviewersAHow to identify and take action against unethical reviewers and managed care companies that are insensitive to your patient’s clinical needs. -Appealing denials of careAHow to appeal denials of care when you do not agree with the reviewer’s decision. These and many other important issues are highlighted in brief vignettes illustrating a clinicianAs presentation of a patientAs case and a typical reviewerAs comments. This tremendously useful volume will be welcomed by every mental health care practitioner who must negotiate the current managed care landscape.
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Best review for Negotiating Managed Care: A Manual for Clinicians

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. This revision includes updates to all chapters, as well as: New chapters on disease management, case management, pharmacy benefits management, behavioral health management, prevention, and the use of data and analysis in care management. New chapters on claims administration, sales and marketing, healthcare consumerism, and the employer s view of managed health care. Completely revised chapter on the new Medicare/Medicaid laws and programs. New chapters on the military health system and managed care in a global context. New chapter on HIPAA.
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Best review for Essentials of Managed Health Care (MANAGED HEALTH CARE HANDBOOK ( KONGSTVEDT))