Managed care contracts – locate and describe ten contract issues – 3
1. Inadequate reimbursement: Managed Care Organizations (MCOs) tend to pay lower rates than fee-for-service providers, and may require prior authorization for specific services. This can create difficulties in obtaining adequate reimbursement for services rendered.
2. Poor communication between MCOs and providers: MCOs often have complex administrative processes that can be difficult to navigate, resulting in miscommunication or delays with payments which can disrupt the continuity of care for patients.
3. Accessibility issues: Many MCOs limit their networks of healthcare providers, meaning patients may not have access to the provider they prefer or need due to geographic constraints or other factors. This can result in poorer quality of care than what could be provided if there was more flexibility in choice of provider.
4. Regulatory risks: Contracts with MCOs are closely monitored by state and federal regulators, which means that any violation could lead to fines or other penalties being imposed on the provider organization. Additionally, changes in regulations due to political developments or health reform legislation may also affect contractual obligations with a given MCO.