Is the administrative hassle worth what you’ll earn?
A managed care plan’s administrative and clinical management requirements are often more difficult for physician practices to swallow than the reduced reimbursement rates most plans offer, says Jay Williams, principal of Arista Associates, a health care consulting firm in Northbrook, IL.
Before you sign on with any health plan, be aware of the requirements and make sure you can live with them.
For instance, a health plan may have strict clinical protocols that it expects physicians to follow with each patient. If you contract with several health plans, you may be faced with having to following different protocols for the same illness, depending on which plans cover the patient.
"Some plans take a huge amount of control in patient management. Others delegate all of it. Some plans even charge the physicians extra for patient management even when it’s not necessarily in the best interest of the patients," Williams says.
Decide if the expected patient volume is worth the administrative burden of meeting the plan’s requirements. For instance, check out what kind of data are required for billing, and what you must do to verify patient coverage.
Make sure you can meet the requirements for reporting to the managed care contract. For instance, the plan may demand extensive severity-adjusted outcome data that may place a huge burden on your staff.
Physicians may get into an agreement where they don’t have the resources to provide the payer the information they want in the form they want and at the time they want, Williams says.
Health plans have to meet National Committee on Quality Assurance accreditation criteria. That can include factors such as how many times the phone rings at a physician office, how long it takes for the patient to get an appointment, how long they have to wait in the lobby, and attitude of the staff.
You may be faced with financial penalties or even cancellation of the contract if you can’t see patients in the manner specified by the health plan.
Be prepared to hire the staff and work the extra hours necessary in order to see a managed care plan’s patients in a timely manner.
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