course project outline -topic attached

Week 2 Course Project Outline

Managed Care Contract Issues

1. Silent PPOs

A silent PPO emerges when a contracting element arranges rebates with a Provider and afterward pitches access to rebates to other, non-related gatherings after the Provider renders administrations to people secured by the non-related gatherings. protection strategies.

2. Medical Record Issues

Under South Carolina law, a patient has the privilege to privacy for the data contained in his or her medical records.

3. Alteration Language

One of the key issue zones in oversaw care contracting includes revision to the understandings. Providers ought to be tireless in limiting the oversaw care associations capacity to singularly revise the agreement.

4. Debate Resolution Process

Many oversaw care contracts contain debate determination conditions. Debate determination provisos manage how question identified with the assertion will be taken care of by the gatherings.

a. Intercession - This is a casual procedure where a free outsider will attempt to unite the gatherings in understanding before the start of discretion or prosecution;

b. Discretion - This is a more formal and frequently restricting procedure in which both sides show their separate position to a free authority who will choose the result of the debate; and

c. Suit in court - This is a customary seat trial before a judge or a jury trial before a jury.

5. Use Management and Quality Assurance Programs and Compliance

One of the key issues in the regions of usage administration and quality affirmation is that the oversaw care associations will subject providers to use administration approaches and systems which are conflictingly and unjustifiably directed.

6. Commitments After the Termination of a Managed Care Agreement

A provider ought to contemplate its commitments under the assention once the agreement has been ended.

7. Co-pay and Deductible Collections

Providers may charge enrollees and HMO just for beforehand determined installments, for example, co-installments, deductibles, or for non-secured administrations. Under these conditions, the provider may not charge the patient if the HMO neglects to pay its share of the bill.

8. Billing and Claims Issues

Keeping in mind the end goal to secure providers. ideal to repayment, providers ought to endeavor to arrange "clean claim or uncontested claim" dialect into the agreement. Under this idea, once the provider has issued a spotless or uncontested claim, then the payor would have a specific timeframe in which to pay that claim

Reference:

http://corporate.findlaw.com/litigation-disputes/managed-care-contract-issues.html