Top Managed Care Contracting Clauses: A Tool-kit for Providers
HC Pro, Inc., 2007 - Medical - 134 pages
As a provider, your survival hinges on your ability to maximize reimbursements from managed care contracts and control access to agreed-upon discounts. But money lost at the time of service or through the collection process is often determined well before the patient ever comes through the door. In many cases, that money was lost back when the contract was negotiated. Top Managed Care Contracting Clauses: A Toolkit for Providers contains practical strategies and tools for any organization facing the prospect of negotiating a new managed care contract.
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Copayments coinsurance and deductibles
Billing and claims
Ensuring prompt payment
Denials and claim adjustments
Dealing with outofnetwork and silent PPO issues
Limiting the frequency and scope of audits
Mediation arbitration and appeals
Controlling the products accessing your agreements
Transparency of pricing and quality information
How to use the ﬁles on your CDROM
ABC Plan accept adjustment agree agreement Alternative Dispute Resolution American Health Lawyers amount appeal apply arbitration Ashland attorney audit requests audit session Beneﬁt Plans bill the patient coinsurance collect company’s conﬁdential rate information consider cont contract language contract performance report Copayments costs coverage Covered Services customary rates deductible denial determine discount Dispute Resolution Service dispute-resolution processes downgrade due-diligence requirements effective date ensure fees Fisk Law Ofﬁce following sample health maintenance organization health plans health savings account healthcare high-deductible Hospital insert insurer insurer’s issues limit managed care company managed care contracts Mediation medical necessity Medicare negotiate noncompliance notice obligation offset online consults organization overpayments paid parties payment rate physician plan’s policies preauthorized preferred provider organization procedures protect provider’s reasonable reimbursement remedies Robin Fisk sample clause sample contract Sample language Sample letter self-insured group self-insured plans silent PPO Source speciﬁc termination usual and customary