RESUMO
An effective managed care contract negotiation strategy should be founded on: Internal analysis that compares performance of your current managed care contracts in terms of volume versus discount rates and volume versus profit. External analysis that compares your current contracts with those of competitors and assesses prevailing market rates, contract language and provisions, and premium trends Payment performance analysis that identifies payment promptness and accuracy and associated penalty dollars for each payer.
Assuntos
Contratos , Programas de Assistência Gerenciada/organização & administração , Administração da Prática Médica/economia , Honorários e Preços/tendências , Guias como Assunto , Renda , Estados UnidosRESUMO
To ensure that insurance carriers pay providers in a timely manner, Texas has adopted strict payment regulations. Enforcement of the regulations has led to restitution payments for many providers. However, issues such as clean claims, underpayment, discrepancies in payment dates, and self-funded claims continue to present challenges.