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Related Experiment Videos

The top ten pitfalls in managed care contracts.

F Fedor1, A Orlowski

  • 1Murphy Austin Adams Schoenfeld LLP, Sacramento, California, USA. ffedor@murphyaustin.com

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|April 13, 2001
PubMed
Summary

Managed care contracts often include confusing clauses that can harm providers. Understanding and modifying these terms, along with clear dispute resolution strategies, is crucial for healthcare providers.

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Area of Science:

  • Healthcare Administration
  • Contract Law
  • Health Policy

Background:

  • Managed care contracts are complex legal agreements between healthcare providers and payers.
  • Ambiguous or poorly understood contract clauses can lead to disputes and financial detriment for providers.
  • Lack of clarity in contract terms poses significant risks to healthcare providers.

Purpose of the Study:

  • To highlight the risks associated with unclear clauses in managed care contracts.
  • To advise healthcare providers on strategies for mitigating risks related to contract disputes.
  • To emphasize the importance of proactive contract review and dispute resolution planning.

Main Methods:

  • Analysis of common issues in managed care contract language.
  • Review of legal and administrative strategies for contract negotiation and dispute resolution.

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  • Identification of key elements for effective provider-payer agreements.

    • Main Results:

    • Many managed care contracts contain clauses with unclear or unrecognized purposes.
    • These clauses can be invoked by payers during disputes, negatively impacting providers.
    • Proactive measures such as clause modification and clear dispute resolution planning are essential.

    Conclusions:

    • Healthcare providers must actively scrutinize managed care contracts for ambiguous clauses.
    • Defining terms, documenting agreements, and establishing dispute resolution mechanisms are vital.
    • Strategic contract management protects providers from adverse outcomes during payer disputes.