Naya Kehayes, managing principal and CEO of Eveia Health Consulting and Management, recommends hospitals and other providers ask payers these four questions regarding exclusions and restrictions within managed care contracts during negotiations.
1. Are professional service exclusions clearly noted in the agreement (hospital only)?
2. Is the scope of services to be provided clearly defined? Are exceptions properly noted in the contract document itself?
3. Are time restrictions included for billing?
4. Is the payer's use of providers' names appropriately restricted?
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1. Are professional service exclusions clearly noted in the agreement (hospital only)?
2. Is the scope of services to be provided clearly defined? Are exceptions properly noted in the contract document itself?
3. Are time restrictions included for billing?
4. Is the payer's use of providers' names appropriately restricted?
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