For both patients and providers, the words managed care are loaded with negative connotations, synonymous with inefficiency and bureaucracy. Forced to perform a delicate balancing act of offering the best possible care for their clients while carefully adhering to various managed care policies and procedures, providers in particular often wince at the prospect of having to deal with managed care companies, or MCOs. Fearing burdensome paperwork, low reimbursement rates, and denials of care, it's not surprising that a number of mental health professionals choose to limit their involvement with managed care companies-or eliminate it altogether. "My clients are all on different health plans; how can I keep the policies straight?" "Getting services approved is so time-consuming that I'm better off accepting only self-paying clients, aren't I?" "Do the benefits of working with MCOs really outweigh the drawbacks? The answer, according to two industry insiders, is yes. If you know how to work with the system, the system can work for you. Mental Health Provider's Guide to Managed Care is the first handbook of its kind to offer clinicians a window into the inner-workings of MCOs. Authors Reich and Kolbasovsky candidly draw on their combined 37 years experience in the field to walk readers through all the major elements of how to successfully work within the system: marketing yourself and your practice to an MCO, getting onto a MCO's network, maintaining a good relationship and communicating with MCOs for quick service approval, reducing your liability, understanding your rights and responsibilities, getting paid, and more. Every issue—big and small—is covered, from capitation versus fee-for-service payment arrangements to evaluating which MCOs are a good fit to join, and everything in between. After explaining how to work with the system, the authors reveal how to put the system to work for you. Tips for building your practice through referrals, generating business through doctor collaboration, and understanding future practice opportunities are all covered. By demystifying the complexities of managed care and offering a unique, inside view of the process, this book mitigates the negative connotations associated with MCOs and exposes the hidden benefits of a seemingly burdensome process. Exceedingly reader-friendly and packed with insightful tips and vignettes, Mental Health Provider's Guide to Managed Care is one clinician's guide you won't want to be without. --- from the publisher Critical Acclaim: "If a busy clinician is inclined to read one book this year on the topic of managed care, this is definitely the book to read. It is deeply informative . . . and should be read cover to cover by new clinicians beginning to work with managed care organizations, and seasoned clinicians should consult specific chapters on issues that have created past frustrations for them. All readers will find a practical guide that offers immensely useful tips. " —Edward R. Jones, Ph.D., former Chief Clinical Officer for PacifiCare Behavioral Health "Reich and Kolbasovsky have written a sensible, practical, and immediately useful guide that ought to be handed out with every mental health clinician's degree. Were this guide available ten years ago, the acrimonious battles between managed behavioral health care and mental health professionals might have been moderated. Of if not, at least we would all have been speaking the same language." —Eric N. Goplerud, Ph.D., Research Professor, Department of Health Policy, George Washington University Medical Center, and President of the American College of Mental Health Administration "Reich and Kolbasovsky's realistic, positive approach is a refreshing change from the usual polarizations about managed care. Legal and ethical issues are both fully addressed, and the summary tips and professional vignettes are immensely useful. All in all, this book is practical and essential reading for mental health providers of all types, at every level, in every setting." —Cecilia Mikalac, M.D., author of Money and Outpatient Psychiatry "In my years as a practicing psychologist, one of the most important lessons I have learned is that in today's managed care environment is it not enough to know how to provide clinically effective treatment to your clients. If you want to develop a satisfying and financially rewarding practice . . . you need to know how to make the managed care system work for you. Whether you are just starting a career in mental health, are in the middle of your career, or are nearing retirement, this book has practical information that you need . . . My only regret about this book is that it was not available sooner." —Karen Somary, Ph.D., psychologist in private practice About the Authors: Leonard Reich, Ph.D., is the Vice President of Mental Health Services of the Health Insurance Plan of New York. He was in private practitioner for 10 years. Andrew Kolbasovsky, Psy.D., is a licensed psychologist and Director of Clinical Development and Behavioral Medicine for the Mental Health Service of the Health Insurance Plan of New York.
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