A physician practice should base its fee schedule on the true cost of providing a service, not on what a payer says is a fair price. Developing an accurate fee schedule before contracting with health insurers will help you understand the cost of running your practice and providing services. This toolkit walks you through the fee schedule development process.
Because most patients are covered by some type of managed care plan, most physicians participate in managed care contracts. Indeed, virtually all health insurance provided by employers is available to individuals in the private insurance market. Increasingly the health coverage provided by public programs, including Medicare and Medicaid, is some type of managed care program.
The AMA has created numerous resources to help physicians involved in negotiating or enforcing these contracts. Learn how managed care contracts are related to your fees.
Developed by the AMA and experts in physician payment issues, this series of resources discusses each of the various payment options physicians are now being asked to consider. These guides also set forth the key issues physicians must consider when determining whether to agree to a particular payment system, how to determine a fair price and how to reconcile any payments received to ensure that they are accurate. Make sure you have all the relevant information, whether you are considering a fee-for-service, bundled payment, pay-for-performance, capitation or other payment proposal. And before you agree to any payment system which depends on coming in under budget, make sure you know whether the budget is actuarially sound, and whether your performance will be adequately risk-adjusted.
Receiving fair payment for services is necessary for your practice’s success. Learn more about payment option topics.