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Managed Care Insurance and Regs

As a health services manager with expert knowledge of managed care systems, insurance, and regulations, develop a payer mix goal with objective referenced rationale based on utilization management for a healthcare organization of your choice (real or hypothetical).

The payer mix should:

Be reported in terms of percentages for each patient group receiving services at your specified organization
Include pros and cons associated with your recommendation to address the recent loss in A/R (money coming in) based on the payer mix payment
Be based on a list of 10 common services and corresponding payment structures (e.g., make one recommendation if your payer mix payment dropped 20 percent in one quarter)

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