Contact Us
Sign In / Sign Up for FREE
Go to advanced search...

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

Comments (0) Cite this document
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…
Download full paperFile format: .doc, available for editing
GRAB THE BEST PAPER91.2% of users find it useful
US Physician Practices: Contracting with Payors (health insurance companies), how it works and what are the pain points or issues for physicians
Read TextPreview

Extract of sample "US Physician Practices: Contracting with Payors (health insurance companies), how it works and what are the pain points or issues for physicians"

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
Cite this document
  • APA
  • MLA
(“US Physician Practices: Contracting with Payors (health insurance Research Paper”, n.d.)
Retrieved de
(US Physician Practices: Contracting With Payors (health Insurance Research Paper)
“US Physician Practices: Contracting With Payors (health Insurance Research Paper”, n.d.
  • Cited: 0 times
Comments (0)
Click to create a comment or rate a document

CHECK THESE SAMPLES OF US Physician Practices: Contracting with Payors (health insurance companies), how it works and what are the pain points or issues for physicians

The Power of Pain: How Pain Shapes Us

...? Philosophy    Topic:  The Power of Pain: How Pain Shapes Us Instructions: Ethics of Health Care  Book - Scarry, Elaine. (1987). Thebody in pain: The making and unmaking of the world. New York: Oxford University Press.  After reading the work, write and submit a 5 to 7 page, double-spaced report (using APA style, 6 th ed.). Your report must include the following:  an analysis of the topic addressed in the work in terms of either  its significant historical, political, legal aspects and health policy implications  OR  its humanistic or social significance  a summary and...
5 Pages(1250 words)Term Paper

Psychology: Professional Limitation

3 Pages(750 words)Essay

Legal Issues with Physicians

...? Legal Issues with Physicians No: Legal Issues with Physicians Introduction Study of the healthcare legislation of the United States of America indicates many aspects relating to Tort law, contracts, antitrust, insurance, and so on. The figures of 1990 show that the United States of America spent around 500 billion USD on healthcare in a year, which, of course, is more than 11 percent of GDP. During the years 1991 to 2012, noticeable increase in the expense on the health programs has been witnessed. As per the predictions of CMS, the expenses may further grow by 7.3% yearly. This year USA will spend 3.1 trillion USD on...
7 Pages(1750 words)Term Paper

US and Canadian health insurance

...US Health Insurance vs. Canadian Health Insurance Health insurance in the United s is failing patients and physicians alike. In this country 37 million uninsured face economic barriers to care, and the health of many suffers as a result. The "corporatization" of medical care threatens professional values with an unprecedented administrative and commercial intrusion into the daily practice of medicine. Competitive strategies have also failed their most ostensible goal--cost control. In contrast, Canada offers a model of a national health insurance plan that provides universal and comprehensive coverage, succeeds at restraining health care inflation, and does little to abrogate the clinical autonomy of physicians in private practice... . The...
5 Pages(1250 words)Essay

Insurance Practices

...that ' Serious problems can arise in each of these areas that can make a health care liability claim even worse than imagined' (Thornton). Aggravating factors that work to increase claims are the cost of continued healthcare to treat or remedy the problem under discussion and the potential loss of earnings for the plaintiff. (Bell). In some cases the rocketing level of claims awarded have driven healthcare insurance companies out of certain states because they cannot afford to do business in those circumstances. Only revised state legislation capping the level of claims made has allowed them to return and resume business with the healthcare organizations in the area....
3 Pages(750 words)Essay


...resource that offers detailed information on how and when vendors should respond to all federal contract solicitations worthy $25000 or more (Longley, N.d). US General Services Administration (GSA) establishes and administers the largest government –wide contracts with the government agencies ordering goods and services directly from the GSA schedule contractors. Municipalities, counties, states and federal agencies have huge needs which can be fulfilled by our company thus it paramount to remain vigilant of the government contracts whether they are advertised in the daily newspapers or websites such as FedBizOpps or each arm of...
4 Pages(1000 words)Term Paper

Insurance companies Finances

...of insurance premium fall under different ‘classes’ and these classes have different eligibility criteria. Properties with risky factors or having disputed issues, and properties specially protected are not generally eligible for the class ratings. For these types of cases, insurance premiums are specially rated. The rates used are specifically for those assets which are determined by physical inspection. The method of class rating is based on the assumption that the future losses to be insured will be determined largely by some sort of factors. The major classification factors in homeowners insurance include construction material, age...
5 Pages(1250 words)Coursework

How to address the pain points

...ESSAY: BUSINESS By This paper delves in analysis of the Tuckmans Stages of Team Development and the pain points that the IncredibleApps Company faces in their production. The report as well gives the pieces of advice that can better the productivity of the Company. It is therefore important to note that this is a report on the company. Considering the stages of team development, as discussed by Tucksman, the members ought to have put on board at the formation stage. They were to be aware of what they were producing and the team was to be committed in the production process. This therefore means that they never worked in reference to the...
1 Pages(250 words)Essay

Physician Assisted Suicides

...on physician-assisted suicides in different parts of the country on how standardized physician-assisted suicide will be beneficial to the health care sector. The paper will discuss the arguments that have been put forward for and against physician-assisted suicide. The paper will make a conclusion on why the federal government should consider legalizing and regulating the practice since it is beneficial for patients suffering from extreme suffering due to life-threatening illnesses. Thesis statement: the federal government should legalize physician-assisted suicide Arguments For Physician Assisted...
7 Pages(1750 words)Essay

Function of Bile in Fat Digestion and Absorption

1 Pages(250 words)Essay
sponsored ads
We use cookies to create the best experience for you. Keep on browsing if you are OK with that, or find out how to manage cookies.

Let us find you another Research Paper on topic US Physician Practices: Contracting with Payors (health insurance companies), how it works and what are the pain points or issues for physicians for FREE!

Contact Us