managed care contract

http://www.ama-assn.org/ama1/pub/upload/mm/368/mmcc_4th_ed.pdf
AMA National Managed Care Contract Navigation ISSUE BRIEF
AMA “A guide to working with health insurer representatives
Here are a few contract terms that are commonly found in a managed care contract. Your assignment is to find where these terms (or similar terms) are discussed in the sample contract provided above. This portion of the exercise will build your familiarity with the format of managed care contracts.

Once you find where these terms (or similar terms) are discussed in the sample contract you must then compare the common terms provided below to the actual terms that appear in the sample contract. In your comments you must indicate whether each of the terms that appear in the sample contract are favorable or unfavorable for the provider (physician) when compared to the common terms. This portion of the exercise will sharpen your critical thinking skills related to managed care contracting.

Common Terms
the provider must provide treatment, and present patient with treatment options, regardless of whether the plan covers the service.
physicians must discuss any financial incentives that they have that could impact their ability to provide care
the practitioner must submit claims within 90 days of services provided
the practitioner may not charge the patient if services are covered by the plan
the plan will pay the lesser of the charges that the practitioner charges and the agreed upon fee schedule amount
the plan can update the fee schedule when they feel it is appropriate
malpractice requirements

 
ORDER THIS ESSAY HERE NOW AND GET A DISCOUNT !!!

You can place an order similar to this with us. You are assured of an authentic custom paper delivered within the given deadline besides our 24/7 customer support all through.