Private Sector Advocacy
Unnecessary administrative costs can be reduced, if not eliminated, through increased automation, but increased automation can only occur if the current electronic standard claims transactions for patient eligibility verification and benefits, physician payment, and claims acknowledgement are enhanced and fully enforced. The AMA has made specific recommendations on these standard transactions and rules, and supports multi-stakeholder efforts to standardize and streamline health care data exchange.
All health plans need to disclose to their beneficiaries and the physicians, other healthcare professionals and health facilities providing services to those beneficiaries, all information necessary to determine the relative financial rights and responsibilities of all parties prior to the provision of a healthcare service. This includes full, complete transparency of the contract-specific payer fee schedule, payer medical payment policies, reimbursement rules, and other payment reductions.
The AMA Practice Management Center helps physicians take charge of the business side of their practices with educational resources and tools that help physicians and their practice staff address private payer and practice management issues with ease. Working side by side with national medical specialty societies and state and county medical associations, the AMA Practice Management Center helps physicians and their practice staff navigate a challenging marketplace.
Visit the Practice Management Center home page for more resources.
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