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US Physician Practices: Contracting with Payors (health insurance companies), how it works and what are the pain points or issues for physicians - Research Paper Example

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The healthcare market in the United States has been dominated by tremendous growth in managed care and consolidation of the same, both horizontally and vertically. Managed care describes a prepaid health-services plan where physicians are paid their fees for health care services…
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US Physician Practices: Contracting with Payors (health insurance companies), how it works and what are the pain points or issues for physicians
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Download file to see previous pages Historically, health insurers and medical practices accepted the reimbursements offered and signed a signed a multi-year agreement (BBVA Compass Bancshares). Presently, however, primary care and specialty physicians can negotiate their fees if they demonstrate provision of high quality services. The scope of physician /health plan contracting differs in terms their field of expertise, which has seen physicians concentrating in emergency medicine and psychiatry have the lowest rates (Gaynor and Mark 3). Despite this, the basic contract negotiation concepts such as perseverance and concentration of practice protocols still apply. A typical contract-negotiation entails gathering information on all prospective companies and selecting the most appealing according to their consistency on reimbursement. Overhead costs and malpractice liability insurance costs should be considered when setting a policy goal.
The US health care system requires that patients have sufficient funds to cater for their medical fees in both public and private institutions. For this reason, medical and health insurance raises significant concerns towards the provision of universal healthcare services. In relation to this, since a large percentage of American lack health insurance cover, the cost of the services rendered tends to be prohibitive for Americans to receive health services (Huynh 2).
In addition, the US system utilizes, extensively, the use of payment schemes for health services, such as managed care. The scheme has been in use for a long time and has helped in the delivery of services in an efficient manner. However, strain is experienced by the physician for the role they assume in the provision of healthcare services. In addition, most physicians spend most of their time interacting with health plans to facilitate smooth reimbursement process. This translates to massive loss of ...Download file to see next pagesRead More
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