AMA unveils model managed care contract
AMA unveils model managed care contract
The American Medical Association (AMA), based in Chicago, recently announced a model managed care contract to help physicians negotiate with HMOs over such issues as contracting, payment, and medical liability.An article in a recent issue of American Medical News outlined some of the provisions contained in the model health care contract. These include:
• Terminations of physician contracts without cause.
Current termination-without-cause clauses lack due process protections and independent appeals and simply allow physicians to be dismissed with only so much as a letter stating they have been terminated, the AMA says. The AMA’s termination-without-cause model clause will require the terminating party to state the reason for its decision, provide written notice 120 days before termination, and allow the contract to remain in effect for existing enrollees for one year or until the anniversary date of the contract, whichever comes first.
• Payment delays from health plans.
Late payments to physicians are blamed by plans on lost claims or "unclean" claims (those with missing or incorrect information). The AMA says its model contract will begin to solve this by requiring payment of a clean claim within 45 days and will require interest payments on claims that are not reimbursed promptly.
• Medical liability.
The AMA House of Delegates passed a measure that will hold HMOs accountable for their actions. They are asking the AMA to support changes in federal law to prohibit employer-sponsored managed health care plans’ exemption from state medical liability laws.
The model health plan contract was developed by Chicago attorney Mark E. Rust, the article stated. t
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