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How to respond when a payer is in breach of contract

Editor's note: In part two of this two-part look at contracts, we examine how to respond if a payer fails to follow through with its end of a contract. In part one, we reviewed clauses to watch for when negotiating your payer contracts. When a managed-care contract deviates from the terms outlined, you need to know how to proceed and prevent more problems, says Sherri C. Staat, CMPE, administrator for Orthopaedic Associates Medical Clinic in Visalia, CA, and a presenter for a contracts seminar during the 2006 MGMA Financial Management Society-Managed Care Assembly in San Diego. Staat; Physician Practice Consultant Michael Fleischman, FAAHC, of the Georgia-based Gates, Moore & Company; and Maria K. Todd, MHA, PhD, vice president of HealthPro Consulting, Inc., in Brooklyn, NY, offer the following tips to use when payers deviate from the contract terms