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Questions About Managed Care Negotiations

Questions About Managed Care Negotiations

Managed care contracts are a special type of health insurance. The contracts provide care for certain members from a variety of medical facilities and health care providers. There are three common types of managed care plans: Health Maintenance Organizations (HMOs,) Preferred Provider Organizations (PPOs,) and Point of Service (POS) plans. Each plan has a variety of advantages and drawbacks, but personnel with specific training can help parties negotiate mutually beneficial contracts.

#What Do Managed Care Contracts Do?

These plans provide the framework for the relationship between managed care organizations, health care professionals, and, ultimately, the patients. In the past, a simple agreement between doctor and patient was enough to ensure the doctor was paid fairly and the patient received certain standards of care. This contract isn’t as straightforward today.

#What’s the Purpose of the Plans?

One of the main goals of working with managed care consultants is to determine fair compensation for health-related services. Naturally, hospital administrators and office managers want to be sure that bills are paid, employees are reimbursed for their services, and the budget has room for emergencies. However, there are other important goals to consider, namely the impact on the payer and, in turn, on the organization.

#How Are Managed Care Plans Created?

As part of the work completed by the consultants, generating payer profiles have a vital impact on the rest of the negotiations. Some of the techniques used to generate these profiles include communicating directly with the payer or with the contracting professional representing the payer, reviewing internal claims data, reading through denials for recurring problems, and asking revenue cycle staff for their insights.

#Who Benefits From the Care Plans?

Hospital management professionals, medical office personnel, and other entities requiring managed care contracts rely on the results of negotiations for improved revenue, operations, and relationships with clients. These contracts are crucial to the financial stability of the organizations. However, it takes careful planning and a sense of collaboration to put together a plan that promotes patient satisfaction as well as benefits the medical organization.

All parties to a managed care contract may benefit when negotiations are successful. Consultants with experience, skill, and a healthy network can put together effective, satisfactory contracts.
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