Managed Care Contracting

Karen M. Beard, CPC, CHCC
Senior Associate

With the volatility surrounding the Affordable Care Act and Medicare Expansion programs, it is vital that your practice has a complete and current set of your contracts with all your commercial plans as well as their Medicare and Medicaid replacement plans. Your practice should know not only that you participate in a plan, but in which specific benefit products your practice participates. A number of health plans may have a contract with you for the PPO or Point of Service (POS/Open Access) plans but have not included you in the approved Affordable Care Act Exchange plans or Medicaid or Medicare Alternatives.

The appointment schedulers and staff conducting benefit verification need an updated list of these programs by plan to ensure that patients are not booked when you are not available to them on their plan. A file with all your agreements should be accessible to your staff, including current fee schedules, to allow you to quote the contract in disputes and allow your accounts receivable staff to spot check payments against your contracts. If you cannot locate them, appoint a member of the staff to be responsible or requesting all the contracts and verifying your listing on the plan’s website. The list needs to updated and distributed to the front and back office staff as changes occur.

Need assistance in with you current contracts? Contact Karen Beard, Senior Associate, at 770-951-8427 or kmb@medicalmanagement.com.