10 Jun Health Maintenance Organization (HMO)
HMOs, unlike PPOs, require a great deal of labor to be performed by the provider’s staff. Pre-approvals are a major component of this labor for events such as specialist-based consultations from those that are in-network and out-of-network, letter generation, appointments, and even facility approvals for tests such as those within the radiology domain.
Some of this labor is handled electronically, such as the ANSI X12 270 standard that involves eligibility, coverage, or benefit inquiry. Others such as letter writing and scheduling involve elements from within a Document Management platform or Practice Management Systems (PMS).
To support this Discussion, search the Internet for information on HMOs and PPOs, such as can be found at the Health Insurance Web site
http://www.agencyinfo.net/iv/medical/types/hmo-ppo-pos.htm
In this Discussion, answer the following questions:
- What are the technical challenges of a medical practice that engages in electronic transactions, document management, and scheduling but also uses analog forms?
- How are the IT needs for an HMO and a PPO different?
- How can the IT needs for an HMO and PPO be integrated, especially if there is not one overarching HIS Application handling it all?
- NOTE: it should be in APA format topic, subtopic to all question, In text citation and reference as well.
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