Question

Please provide a checklist for the analysis of a Managed Care Organization:Contract Review

Answer 1

Ans) A CHECKLIST FOR REVIEWING MANAGED
CARE CONTRACTS:
- Contracting for the delivery of health care services is not a new concept. Hospitals, physicians, advanced practice nurses, and other licensed health professionals have been
contracting directly with hospitals, clinics, and industry for many years.

- Today, in response to the demands of managed care, these same hospitals, physicians, advanced practice nurses, and licensed health care providers have become
increasingly dependent upon managed care contracts with health plans, health maintenance organizations, and various other forms of managed care organizations (hereinafter
collectively referred to as “MCOs”) to market their services.
- These contracts, while contributing to the provider’s patient base, introduce new legal, contractual, and financial risks that must be taken into consideration during the negotiation
process.

- Whether contacting directly, or through a MCO,
providers should understand the conditions associated with the assumption of these risks and the relationships created as a result of these contracts.
THE CHECKLIST:
- There are certain provisions in any managed care contract that the provider and his legal
counsel must carefully consider. Although this article is not exhaustive, it provides a general
framework for health care providers and their legal counsel to use in reviewing contracts in order to identify those provisions that should be clarified, revised, or otherwise deleted from the agreement before the parties agree to “sign on the bottom line.”