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Managed Care Contracts - Key Provisions for Providers ( September 2004 )
The contract between a physician or other health care professional and a managed care organization (MCO) such as a provider-sponsored network, integrated delivery system, health maintenance organization, or other health care plan, is the fundamental document which frames, defines and governs their relationship. Contractual provisions can affect payment, office organization, practices and procedures, and confidential records as well as clinical decision-making. -
Managed Care: Managed Costs or Managed Medicine? ( September 2004 )
Many people believe that the rising costs of medical care in the United States, and the increasing numbers of ordinary citizens who cannot afford it, have combined to threaten this country's social and economic health. By the year 2000, unless fundamental changes occur in the health care delivery and financing system, these costs will rise to $1.6 trillion, or 16.4 percent of the GNP. -
Rhode Island's New Consumer Orientated Health Care Law: A Model ( September 2004 )
Health care professionals and providers, insurance companies and health maintenance organizations ("HMOs"), and individual consumers and groups are all praising the passage of the "Health Care Accessibility and Quality Assurance Act" (the "Act") by the Rhode Island legislature this July. Patterned after the American Medical Association's "Patient Protection Act," the new law empowers the state Department of Health to regulate and monitor managed care plans to ensure a proper balance between the rights of the plan, the people who pay the premiums, and the patients who receive the care. -
Managed Care Contract Issues ( October 2000 )
This article reviews managed care contract issues and suggests providers should negotiate clean claim language and penalties for the payors failure to pay such clean claims within a timely manner. -
New Outpatient PPS Regulations and Provider-Based Status ( April 2000 )
On April 7, 2000, the Health Care Financing Administration (HCFA) issued final regulations regarding the P. -
Larsen Reins In HMOs; No New Regulations Needed ( February 2000 )
As Insurance Commissioner Steven B. Larsen ends his first year as head of the Maryland Insurance Administration ("M. -
Health Industry Alert--October 6, 1999 ( October 1999 )
On September 27, 1999, California Governor Gray Davis signed into law an impressive "package" of new health care bills affecting the managed care industry in California. Although many of the 21 new laws take effect as late as January 1, 2001, there is little question that the new legislation will have immediate and far-reaching effects on the managed care industry throughout the country. -
Managed Health Care and You ( October 1999 )
Many individuals receive their major medical insurance through an employee benefit plan. Often, these employee plans are subscribers to a Health Maintenance Organization (HMO). -
New External Appeal Law in New York ( August 1999 )
The New York State Legislature recently passed a law permitting independent external appeals for denials of covera.
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