Ramifications of Partipiacting Contracts


Ramifications of Participating Contracts
Dawn Ott
March 20, 2014
Bosede Olaogun- Muftau

Ramifications of Participating Contracts
Participation contracts were put into place to allow the providers an overview of a plan to determine if they will participate in that particular plan or not. Providers will use the plan to decide if the participation in that plan will benefit them financially. The plan is broken down into different parts that include the following: Introductory section, contract purpose and covered medical services, physician’s responsibilities, managed care plan obligations, and compensation and billing guidelines. Physician fees usually are higher than what the plan will pay. The plan may bring in more patients, but the provider could experience less revenue because of the plan paying less in the provider’s fees. Providers will also make sure that the plans protocol does not hinder the professional medical judgment in treating their patient. Some plans also want to use the provider’s names in advertisement such as: newspaper, radio, or television. This could help increase revenue for the provider.
With any arrangement, there are positive and negative ramifications that go along with it and discounted fee- for –service arrangements are no different. Positive ramification is that a provider will be paid on the services performed and not just a monthly income, therefore providers would be more likely to provide more services. A negative ramification would be that not all fee- or- service plans will cover the cost for preventive care (Valerius et al., 2014).

Billing tip page 295
I think that most participation contracts require physicians to notify patients if they withdraw from the patient’s managed care organization because they would have to give them an effective date that this would take place and also to notify them they would need to start to look for a new provider under their plan.