How is medical necessity checking handled with medicare

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Indicate your source or reference for each of the responses for the 9 questions.

Indicate if more than one source was utilized for each question with multi-part responses.

1) Explain the difference in philosophy on risk between Medicare and Managed Care. Indicate if they are risk adverse-why or why not.

2) Which of the payers have deductibles in their plans?

3) How is medical necessity checking handled with Medicare?

4) How the prior approval process is managed for Commercial and Managed Care plans?

5) Which of the payers require Premiums from their members for inpatient services?

6) What is the relationships of Medicare Advantage Plans with Commercial and Managed Care Plans?

7) Which plans allow for individual enrollment? Family enrollment? Or both?

8) How does Managed Care manage the selection of providers? Medicare? Commercial payers?

9) Identify based on your review which type of plan would BEST meet your needs as a patient and why.

Reference no: EM133033496

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