Managed Care Agreements

The managed care contracting manual should be read to all hospital managers, regardless of the department that manages them. The problems and solutions Ms. Todd addresses can make the difference between health care providers who don`t survive and do well.: Jackie Hodges, President, HRC Solutions Negotiating Managed Care Contracts can cause headaches for providers. For this reason, it is important that you understand that simply more contracts do not guarantee more value. Despite the fact that more than three-quarters of the U.S. population has a health insurance plan that could be called an “administered care plan,” many would not know about it. They also do not know that the coverage they receive, the health costs they pay and the health care professional they can see “in their network” are largely determined by them. In the simplest, a managed care contract is an agreement between a health professional and a manague care organization (MCO) that defines the relationship (both financially and in terms of care). Most importantly, the supplier must feel free to ask questions of MCO representatives and negotiate the terms of the contract. Few contracts, even printed standard contracts, are non-negotiable.

Start-ups with little market share will negotiate more easily, but larger organizations will also discuss certain provisions with multi-specialist groups, tertiary care specialists, key providers or specialists willing to accept corporate financing agreements. Suppliers should carefully consider every detail of each contract before agreeing to their terms. According to FindLaw, “A good managed care contract, like any other form of business agreement, is clear, consistent, comprehensive and concise. It will be consistent with the intent of the parties, but will set out its respective rights and obligations, as well as the requirements of national and federal law. The New Health Age: The Future of Healthcare Delivery in America – the Changing Role of Providers At Healthcents, our experts determine contracts that are perfectly aligned with your strategy, service space and unique offerings. With our extensive network of relationships and proven process, we can not only help you sign better-managed care contracts, but also negotiate higher rates for new and existing contracts. According to Christine Tobin, the purpose of managed care is clear: “Managed care is a system that integrates the financing and provision of appropriate health care with a complete offer. Managed Care is any method of organizing health care providers to achieve the dual objectives of controlling health costs and quality of care. The contract between a physician or other physician and a managed health care organization (MCO), such as a provider-sponsored network, an integrated care system, a health care organization or other health plan, is the basic document that frames, defines and regulates their relationship.

Contractual arrangements can affect payment, office organization, practices and procedures, as well as confidential records and clinical decision-making. Why is that so? And what exactly is a management care contract? What are the best contract management strategies? The key element of the managed care contract for the supplier is probably the payment mechanism. The contract should indicate how, when and what the supplier is paid for. Supplier staff should understand claims processing forms and procedures. Does the MCO have the right to change the pricing plan or premium rate from time to time? Currently, there are three primary forms of care plans administered.