The top ten pitfalls in managed care contracts.
Managed care contracts may contain clauses that either have no purpose or have a purpose that the provider does not fully understand. Such clauses may go unrecognized by providers until they are invoked by payers during a contract dispute, often to the detriment of providers. Providers should attempt to exclude or modify such clauses. Providers also should define basic concepts, such as identifying the terms of the contract, determining how disputes might arise over these terms, documenting the agreement struck with the payer, selecting an appropriate dispute-resolution mechanism, and developing a strategy for speedy dispute resolution.
Fedor
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Murphy Austin Adams Schoenfeld LLP, Sacramento, California, USA. ffedor@murphyaustin.com
Orlowski
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D003284:Contract Services / Q000145:classification*; D005375:Financial Audit; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration*; D017008:Negotiating; D020400:Provider-Sponsored Organizations / Q000191:economics / Q000458:organization & administration*; D012051:Reimbursement Mechanisms; D014481:United States