Contracts and Contract Negotiations / Compensation - 7 Point to Examine

Why This Topic Matters

Managed care contract language can affect cash flow, administrative burden, and how payment disputes are handled. Reviewing these terms carefully helps practices anticipate billing requirements and avoid avoidable payment delays or denials.

Article Sections

1. How the plan reimburses you

   Discusses general reimbursement timing and submission workflow considerations for managed care claims. It also addresses contract timing provisions that can affect accounts receivable management.

2. Required automatic adjustments

   Covers broad contract terms related to automatic billing adjustments and retroactive payment changes. The section focuses on administrative and financial impacts on practice compensation.

3. Copayments and deductibles

   Reviews patient cost-sharing collection issues in the context of anesthesia practice and managed care. It highlights operational considerations for handling these amounts under different plan designs.

4. Payment of claims and return of withhold/risk pool funds

   Summarizes payment cycle considerations and the return of held funds under managed care arrangements. It also notes the importance of understanding statutory and plan-level deadlines.

5. CRNA compensation

   Addresses contracting issues involving CRNA services and medical direction compensation. It focuses on how payer arrangements may affect physician payment structure.

6. Utilization review disapproval of a service for payment

   Covers preauthorization, medical necessity review, and denial considerations in anesthesia-related care. The section also mentions special attention areas such as pain management and obstetric cases.

7. Settlement of disputes

   Describes dispute and appeals provisions that may be included in a managed care contract. It emphasizes the importance of having a clear review process when payment is denied.