Research benefits for Preferred Provider (PPO) Health Management (HMO)
Explanation of Benefits
Research benefits for Preferred Provider (PPO) Health Management (HMO) and Managed Care
(MCO) organizations. What is the difference between the plans? What are five key pieces of
information most important for patients to know? How can you explain the benefits to a patient for an
office visit and a procedure? Write a one page brochure or informational document for explanation of
benefits to patients. A comparison chart is also acceptable. Cite your sources for information
Use Internet resources and identify the top five codes for a family practice, emergency room, and a
specialist (any one is fine).
Create a chart comparing ICD?9 books and chapters to ICD?10 books and chapters. Use Internet
resources to create.
Identify the certification body providing the exam you will be taking. Identify the requirements to take
the certification. Download the content outline or blueprint and review for content covered in
Fraudulent Practices Research
Using the Internet as a research source, go to your state?s website for the Department of Health.
Research the laws that apply to billing for medical services in your state. Create a list of laws that
are relevant to the issue of fraudulent practices in billing and coding
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