The truth about managed care: the silent provider discount.

Abstract

At a time when many managed care organizations (MCOs) have announced improvements in administrative systems and a desire to ease provider relations and pay providers correctly and timely, many physician organizations continue to experience great difficulty in obtaining prompt and accurate claims payment. To understand this phenomenon better, physician organizations at two leading academic medical centers in the Northeast and South, respectively, compiled an analysis of their recent managed care claims payment experience. This analysis revealed substantial underpayments from MCOs, and documented the added administrative expense required to recover such underpayments.