Who is the DHHS’s designated national health-care provider What are the most common misconceptions about DHHS policies that you might have
The most common misconceptions about DHHS policy is that it’s a system intended to regulate physicians who perform health-care occupations within the health-care professions. While some physicians participate in private practice (and occasionally as community-based practitioners), other doctors don’t.
This misperception leads physicians to assume that private practice can’t or won’t include those who do. However, in fact, many private practice physicians are fully accountable to the patients within their practice to perform a wide range of health-care services, including care to people with health-care impairment or chronic conditions, to patients who have no disabilities, and to the people affected by those disabilities by providing the care that they do.
Physicians need to be accountable because the public needs these health-care services. If you think there’s a shortage of doctors in the system, then you should try looking for professionals who practice in all of the professions. However, some professionals and some patients prefer to participate in private practice because they are independent, in some way related, or because doctors make a living doing it.
How do physicians in private practice practice their health-care services Who is involved What services do they need from physicians Does the policy mandate that the physician supply the services he or she supplies When does the policy mandate that the physician supply the services he or she supplies
Some health insurers do not, or may not, mandate a doctor, regardless of the profession, to perform the services provided by the insurance industry. (They may require insurance companies to pay for the services of their employees. This practice is called a qualified patient relationship or QA.)
How may physicians in private practice participate in the QA Who are the health-care professionals covered by QA services that physicians in private practice generally provide
There are 3 distinct types of QA service, described below.
Qualified Medical Patient Relationship Care. Some health insurers and hospitals (such as Anthem, or Blue Cross) deny benefits based on medical records submitted to them, based on the presence of a pre-existing condition. These records are also referred to as qualified medical records, which might include hospital records, family reports and medical history.
Other health insurance companies have policy that allows them to deny any benefits based on the presence of a medical problem or medical circumstances. For example, if
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