BUSINESSHow to avoid singing the managed care contract bluesContract Language. By Steven M. Harris, amednews contributor. April 1, 2002. Last month this column discussed common traps that doctors fall into during the negotiation, execution and renewal of managed care contracts -- namely, traps involving undefined responsibilities, prompt payment and balance billing, renewal provisions, reimbursement for services and "gag" provisions. Of course, these aren't the only traps physicians can fall into. Here are five more that physicians should avoid as they review managed care agreements. As a physician, you will, as of April 2003, be subject to the use and disclosure of health care information pursuant to the Health Insurance Portability and Accountability Act of 1996. HIPAA requirements will also need to be reconciled with other considerations in your managed care contracts. Payers will often try to incorporate broad compliance language in managed care agreements to hold physicians accountable for these standards and requirements. You must watch out for broad-based compliance terms. You need to be prepared on the substantive HIPAA issues and requirements to ensure a mutuality of accountability for these provisions in your contract. HIPAA requires health plans, clearinghouses and physicians to use common standards, common implementation guides, and common codes for submission of health care transactions electronically. Carve-out arrangements are primarily designed to allow you to provide a specialized type of care such as rehabilitation or behavioral health. You should consider the use of carve-out arrangements to tailor reimbursement to high cost or unpredictable frequency of services.
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