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Home > Medicine & Health Science textbooks > Medical specialties, branches of medicine > Psychiatry > Negotiating Managed Care: A Manual for Clinicians
Negotiating Managed Care: A Manual for Clinicians

Negotiating Managed Care: A Manual for Clinicians


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About the Book

For many psychiatrists and other mental health professionals, the clinical review is the most burdensome and disagreeable part of managed care. In that review clinicians 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 will convince the reviewer to approve the patient's care. The goal of this text is to teach psychiatrists, mental health professionals and administrators how reviewers think and how to present a case in a manner that greatly increases the likelihood that a reviewer will approve the request for care. Beginning with four questions that must be answered in every managed care review, the author demonstrates how to: present effective requests for inpatient, partial hospital, and substance abuse care; negotiate with a reviewer to get approval for your patient's care; respond when you and the reviewer disagree; write clinical notes that substantiate your request for care; deal with unethical reviewers and managed care companies; and appeal denials of care. These and many other important issues are highlighted in brief vignettes illustrating a clinician's presentation of a patient's case and a typical reviewer's comments.

About the Author :
Michael A. Fauman, Ph.D., M.D., is Clinical Associate Professor of Psychiatry at the University of Michigan School of Medicine in Ann Arbor, Michigan. He is also Medical Director and Vice President for Medical Services at Magellan Behavioral of Michigan, Inc. in Farmington Hills, Michigan.

Review :
Although it is addressed to clinicians, this book will also be a good primer for managed care reviewers. Proper and improper reviewer responses to clinicians are illustrated and discussed. Interspersed with the cases are handy tables that outline the generally accepted medical necessity criteria that apply at different levels of care. Overall, this short book is worth the two hours or so that it takes to read. Jay M. Pmerantz, M.D., Psychiatric Services


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Product Details
  • ISBN-13: 9781585620425
  • Publisher: American Psychiatric Association Publishing
  • Publisher Imprint: American Psychiatric Association Publishing
  • Height: 229 mm
  • No of Pages: 128
  • Returnable: 01
  • Sub Title: A Manual for Clinicians
  • Width: 152 mm
  • ISBN-10: 1585620424
  • Publisher Date: 02 Apr 2001
  • Binding: Paperback
  • Language: English
  • Returnable: 01
  • Spine Width: 6 mm
  • Weight: 254 gr


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