DICTIONARY: Health Insurance and Managed Care

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DICTIONARY: Health Insurance and Managed Care

GLOSSARY OF TERMS

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Health Dictionary Series of Administrative Terms

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To keep up with the ever-changing healthcare industrial complex, we must learn new definitions and re-learn old terminology in order to correctly apply it to practice. By aggregating the most up-to-date abbreviations, acronyms, definitions and terms, the Health Dictionary Series offers a wealth of information to help understand the ever-changing terms-of-art in healthcare today.

Each 10,000 item handbook is essential for doctors, nurses, benefits managers, financial advisors/planners, and insurance agents, CPAs, and administrators; as well as graduate and under graduate students and professors. Our goal to for each dictionary to be designated as a Doody’s Core Title.

Dictionary of Health Insurance and Managed Care

With more than 10,000 definitions, 4,000 abbreviations and acronyms, and a 3,000 item oeuvre of resources, readings, and nomenclature derivatives, this dictionary covers the Medicare, managed care and Medicaid, private insurance, Veteran’s Administration and PP-ACA language of the entire health and long-term care insurance sector.

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Dictionary of Health Economics and Finance

Health economics and finance is an integral component of the health care industrial complex. Its language is a diverse and broad-based concept covering many other industries: accounting, mathematics, the actuarial sciences, stochastics and statistics, salary reimbursements, physician payments, compensation and forecasting are all commingled arenas.

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Dictionary of Health Information Technology Security

There is a myth that all healthcare stakeholders understand the meaning of information technology jargon. In truth, the vernacular of contemporary systems is unique, and often misused or misunderstood. Moreover, emerging Heath Information Technology (HIT) thru the HITECG initiatives; in the guise of terms, definitions, acronyms, abbreviations and standards; often puts the non-expert in a position of maximum uncertainty and minimum productivity.

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FOREWORDS

[Mike Stahl PhD MBA] *** [Foreword Dr.Mata MD CIS] *** [Dr. Getzen PhD] 

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FINANCIAL ADVISORS: Prospecting Physician Clients?

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LINK: https://medicalexecutivepost.com/2014/12/21/why-youre-probably-using-the-wrong-medical-dictionary/

On “Meaningful” Tchotchkes and Health Dictionaries for Doctors

The doctor is out: 5 tips when leaving an inside sales ...

ASSESSMENT: Your thoughts are appreciated.

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Today is [Health] “Dictionary Day” 2014

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Promoting the … Health Dictionary Series™

By Dr. David Edward Marcinko FACFAS MBA CMP™

[Editor-in-Chief]

DEM blue

A day for lexicographers everywhere, Dictionary Day was founded to celebrate the achievements and contributions of Noah Webster – the father of the modern dictionary.

The objective of this day is to emphasize the importance of dictionary skills, and seeks to improve vocabulary.

History

Webster began to write his dictionary at the age of 43. It took him 27 years to finish it! In addition to traditional English vocabulary, it contained uniquely American words.

Our Health Dictionary Series™

The HDS Consists of three handbooks:

  1. Dictionary of Health Insurance and Managed Care
  2. Dictionary of Health Information Technology and Security
  3. Dictionary of Health Economics and Finance

Each has 10,000 terms, definitions and initialisms!

Dictionary Foreword Links:

Assessment

Why not take the opportunity to learn some new health administration terms, words and definitons? Designated as Doody’s Core Titles.

“Health care economist Dr. David Edward Marcinko, MBA, and his colleagues at the Institute of Medical Business Advisors, Inc., should be complimented for conceiving and completing this laudable project. The Dictionary of Health Insurance and Managed Care lifts the fog of confusion surrounding the most contentious topic in the health care industrial complex today. My suggestion, therefore, is to “read it, refer to it, recommend it, and reap.”

-Dictionary of Health Insurance and Managed Care

Michael J. Stahl, PhD
[Director, Physician Executive MBA Program]
William B. Stokely Distinguished Professor of Business
College of Business Administration
The University of Tennessee

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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What is Leadership and Can it Be Defined?

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Of Characteristics and Commonalities

[By Dr. David Edward Marcinko MBA CMP™]

[By Eugene Schmuckler PhD MBA EMd CTS]

manageIt does not matter if you are in the healthcare or financial services sector; or both.

Many psychologists and behavioral experts believe there are commonalities and characteristics applicable to all industries and sectors; including education which is a big part of what we do here at the Medical Executive Post.

Key Leadership Competencies – Definitions

And so, here is a list of key leadership competencies and definitions for your review.

  • Living by personal conviction – Means you know and are in touch with your values and beliefs, are not afraid to take a lonely or unpopular stance if necessary, are comfortable in tough situations, can be relied on in intense circumstances, are clear about where you stand, and will face difficult challenges with poise and self-assurance.
  • Possessing emotional intelligence – Means you recognize personal strengths and weaknesses; see the linkages between feelings and behaviors; manage impulsive feelings and distressing emotions; are attentive to emotional cues; show sensitivity and respect for others; challenge bias and intolerance; collaborate and share; are an open communicator; and can handle conflict, difficult people, and tense situations effectively.  Emotional intelligence may often be labeled EQ, or emotional intelligence quotient.
  • Being visionary – Means that you see the future clearly, anticipate large-scale and local changes that will affect the organization and its environment, are able to project the organization into the future and envision multiple potential scenarios/outcomes, have a broad way of looking at trends, and are able to design competitive strategies and plans based on future possibilities.
  • Communicating vision – Means that you distill complex strategies into a compelling call to march, inspire and help others see a core reason for the organization to make change, talk beyond the day-to-day tactical matters that face the organization, show confidence and optimism about the future state of the organization, and engage others to join in.
  • Earning loyalty and trust – Means you are a direct and truthful person; are willing to admit mistakes; are sincerely interested in the concerns and dreams of others; show empathy and a generally helpful orientation toward others; follow promises with actions; maintain confidences and disclose information ethically and appropriately; and conduct work in open, transparent ways.

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  • Listening like you mean it – Means you maintain a calm, easy-to-approach demeanor, are patient, open minded, and willing to hear people out; understand others and pick up the meaning of their messages; are warm, gracious and inviting; build strong rapport; see through the words that others express to the real meaning (i.e., cut to the heart of the issue); and maintain formal and informal channels of communication.
  • Giving feedback – Means you set clear expectations, bring important issues to the table in a way that helps others “hear” them, show an openness to facing difficult topics and sources of conflict, deal with problems and difficult people directly and frankly, provide timely criticism when needed, and provide feedback messages that are clear and unambiguous.
  • Mentoring others – Means you invest the time to understand the career aspirations of your direct reports, work with direct reports to create engaging mentoring plans, support staff in developing their skills, support career development in a non-possessive way (will support staff moving up and out as necessary for their advancement), find stretch assignments and other delegation opportunities that support skill development, and role model professional development by advancing your own skills.
  • Developing teams – Means you select executives who will be strong team players, actively support the concept of teaming, develop open discourse and encourage healthy debate on important issues, create compelling reasons and incentives for team members to work together, effectively set limits on the political activity that takes place outside the team framework, celebrate successes together as a unit, and commiserate as a group over disappointments.

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  • Energizing staff – Means you set a personal example of good work ethic and motivation; talk and act enthusiastically and optimistically about the future; enjoy rising to new challenges; take on your work with energy, passion and drive to finish successfully; help others recognize the importance of their work; are enjoyable to work for; and have a goal oriented, ambitious and determined working style.
  • Generating informal power – Means you understand the roles of power and influence in organizations; develop compelling arguments or points of view based on knowledge of others’ priorities; develop and sustain useful networks up, down and sideways in the organization; develop a reputation as a go-to person; and effectively affect the thoughts and opinions of others, both directly and indirectly, through others.
  • Building consensus – Means you frame issues in ways that facilitate clarity from multiple perspectives, keep issues separated from personalities, skillfully use group decision techniques (e.g., Nominal Group Technique), ensure that quieter group members are drawn into discussions, find shared values and common adversaries, and facilitate discussions rather than guide them.

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  • Making decisions effectively – Means you make decisions based on an optimal mix of ethics, values, goals, facts, alternatives and judgments; use decision tools (such as force-field analysis, cost-benefit analysis, decision trees, paired comparisons analysis) effectively and at appropriate times; and show a good sense of timing related to decision making.
  • Driving results – Means you mobilize people toward greater commitment to a vision, challenge people to set higher standards and goals, keep people focused on achieving goals, give direct and complete feedback that keeps teams and individuals on track, quickly take corrective action as necessary to keep everyone moving forward, show a bias toward action, and proactively work through performance barriers.
  • Stimulating creativity – Means you see broadly outside of the typical, are constantly open to new ideas, are effective with creative group processes (e.g., brainstorming, Nominal Group Technique, scenario building), see future trends and craft responses to them, are knowledgeable in business and societal trends, are aware of how strategies play out in the field, are well read, and make connections between industries and unrelated trends.
  • Cultivating adaptability – Means you quickly see the essence of issues and problems, effectively bring clarity to situations of ambiguity, approach work using a variety of leadership styles and techniques, track changing priorities and readily interpret their implications, balance consistency of focus against the ability to adjust course as needed, balance multiple tasks and priorities such that each gets appropriate attention, and work effectively with a broad range of people.

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More:

Assessment

Is if often said that leaders rise to the occasion. What do you think?

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Order Our “Best-Selling” Healthcare Administration Dictionaries

Get ’em … While They are Hot!

By Ann Miller RN MHA

[ME-P Executive Director]

Just click on the book icon to order; get any one or all three! You’ll be glad you did.

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

 

Taking Medical Jargon Out of Doctors’ Visits

Explaining Healthcare Administration Terms, Too!

By Ann MiIler RN, MHA

[Executive-Director]

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According to the Wall Street Journal, when it comes to understanding medical information, even the most sophisticated patient may not fully understand. Nearly nine out of 10 adults have difficulty following routine medical advice, largely because it’s often incomprehensible to average people, the CDC says. And that’s bad for health care.

Enter the Medical Jargon

Confused by scientific jargon, doctors’ instructions and complex medical phrases, patients are more likely to skip necessary medical tests or fail to properly take their medications, the agency says. Studies show that poor health literacy drives up costs to the health-care system and worsens patient outcomes. 

http://online.wsj.com/article/SB10001424052748703620604575349110536435630.html

Assessment

And so, we too have attempted to explain some of the healthcare administration and practice management jargon in use today

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Understanding Modern Health Plan Delivery Models

By Defining Terms and Concepts

Staff Writers

www.HealthcareFinancials.comho-journal10

Here are four important health care delivery models that should be understood by all financial advisors, their clients, patients and the public:

1. PHYSICIAN ORGANIZATION (PO)

A PO is a group of physicians banding together, usually for the purpose of contracting with managed care entities, or to represent the physician component in a Physician Hospital Organization. The PO is a managed care contracting entity owned by and composed exclusively of physicians. The PO tends to be more tightly controlled in terms of members and adherence to treatment protocols than an Independent Physician Association. POs typically share information systems, claims-processing procedures, financial data, medical records, and other technical support functions.

2. PHYSICIAN PRACTICE MANAGEMENT CORPORATION (PPMC)

A firm that purchases physicians’ practices in exchange for a percentage of the gross receivables. The PPMC leases the office back to the doctor or employs the doctor on a salaried basis. The PPMC then contracts with the areas MCOs.

3. POINT OF SERVICE PLAN (POSP)

A type of managed care plan that allows members to choose whether to seek medical care within the plan’s network or seek medical care out of network at the point of service (i.e., at the time services are rendered). It allows members to pay little or nothing, if they stay within the established HMO delivery system. But, it also permits members to choose and receive services from an outside doctor, any time, if they are willing to pay higher co-payments, deductibles and possibly monthly premiums. It is also called an “open-ended” plan.

4. PREFERRED PROVIDER ORGANIZATION (PPO)

A PPO is a select, approved panel of physicians, hospitals, and other providers who agree to accept a discounted fee schedule for patients and to follow utilization review and pre-authorization protocols for certain treatments. It is a system in which a payer negotiates lower prices with certain doctors and hospitals. Patients who go to a preferred provider get a higher benefit — for example, 90% or 100% coverage of their costs — than patients who go outside the network.

Assessmentdhimc-book20

Link: www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated?

Link: https://healthcarefinancials.wordpress.com/2009/03/13/rip-retail-financial-services-industry/

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