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Contracting 15 Questions.pdf

Contracting15questions.pdf
Preview of Contracting 15 Questions
🔗 Source: niatx.wisc.edu
📊 Size: 143 KB
👤 Author: AMA PMC
⬇️ Downloads: 189

Summary

15 questions to ask before signing a managed care contract:
1. Importance of the contract to your practice, revenue, and expenses.
2. Definition of "medically necessary" care and the standard used.
3. Verification of patient enrollment in a plan.
4. Determining coverage of medically necessary services.
5. Prior authorization requirements for services and procedures.
6. Claims payment under the contract, including fee schedules.
7. Sufficiency of claims payment to cover practice expenses.
8. Rights to appeal a claims payment decision.
9. Ability of the MCO to change claims payment terms unilaterally.
10. Obligation of the MCO to pay promptly, including payment time periods and interest.
11. Right of the MCO to "offset" alleged "overpayments".
12. Products required to participate in and ability to select or terminate participation.
13. Compliance with a prescription drug formulary and flexibility to go off-formulary.
14. Ability of the MCO to "rent" you to other entities, such as silent PPOs.
15. Provisions for terminating the contract, including breach and annual renewal.

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Description

15 questions to ask before signing a managed care contract:
1. Importance of the contract to your practice, revenue, and expenses.
2.

Technical Information

  • File Format: PDF
  • File Size: 143 KB
  • Pages: 3
  • Language: EN
  • Author: AMA PMC
  • Total Downloads: 189
  • Last Updated: 4 days ago

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This PDF document about Contracting 15 Questions provides comprehensive information and guidance. Whether you're a beginner or advanced user, this resource offers valuable insights into Contracting 15 Questions.

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