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Q1: After asking these questions he provider should Scrutinize the terms of the contract so that they are aware of their obligations and be aware of what covered services they are asked to provide. A healthcare provider should not undertake any obligations to deliver services not unusually offer by them. ”
There is a detailed process called “credentialing” that each physician must be completed before a physician is part of the plan. Kongstvedt (2013) states that “without performing proper credentialing, the plan has no knowledge of the quality or acceptability of physicians. Furthermore, in the event of legal action against a physician, the plan may expose itself to some liability by having failed to call out proper credentialing.” There are various tools that help plans make this decision.
Define the National Practitioner Data Bank and why it would be used by HMOs.