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Managed Care Contracts Need Scrutiny

Greg Freeman, January 28, 2013

Try to make sure Medicare payment policies are not driving your business, Moorehead advises. A contract tied to current Medicare rates and policies will result in minimum payment and constant change, he says. A practice is likely to have some portion of its business tied to Medicare reimbursement anyway, so try to avoid having the potentially more profitable managed care contracts tied to the same Medicare rates.

"If Medicare has an 8% reduction in some modality or procedure you perform, you can bet the other managed care companies are going to try to take that 8% reduction too. They're letting Medicare set the policies and rates so they don't have to, and then they claim that is the industry standard," Moorehead says. "Contract negotiation is the time to say no, you want a better deal than that, a contract that is not directly tied to whatever Medicare is doing."

Once the contract is signed, you still have to make sure you are being paid according to the terms of the agreement, Moorehead says. That may sound simple, but it will require oversight, auditing, and measurement standards to determine when the agreement has been breached, he says.

"You have to fight for what is rightfully yours," Moorehead says. "They're in business to make money, too, so sometimes you have to make sure you're getting everything that you are due."

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1 comments on "Managed Care Contracts Need Scrutiny"


Maria Todd MHA PhD (1/29/2013 at 2:44 PM)
"What's needed is not anything new in terms of strategy, but now you have to get serious about it, says Taylor Moorehead, a partner in billing operations with healthcare billing consultants Zotec Partners and also its corporate compliance officer." amusing take on the matter. Maria Todd @askmariatodd