管理式医疗的真相:沉默的提供者折扣。

Managed care quarterly Pub Date : 2004-01-01
Richard J Zall
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引用次数: 0

摘要

当许多管理式医疗组织(MCOs)宣布改善管理系统,并希望缓解提供者关系,正确及时地支付提供者时,许多医生组织在获得及时准确的索赔支付方面仍然遇到很大困难。为了更好地理解这一现象,美国东北部和南部两家领先的学术医疗中心的医生组织对他们最近的管理医疗索赔支付经验进行了分析。这一分析揭示了管理组织的大量少付款项,并记录了追回这些少付款项所需的额外行政费用。
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The truth about managed care: the silent provider discount.

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.

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