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AMA Releases Revised Model Managed Care Contract
Carol M. McCarthy
410-347-7313
mccarthy@ober.com
On June 10, the AMA released a revised version of its Model Managed Care Contract ("Model"). The AMA released its first edition of this publication in late 1997 to inform and guide physicians and others considering contracts with Managed Care Organizations ("MCOs"). The revised Model details a number of thorny clauses that have become prevalent in MCO contracts since 1997 and discusses additional considerations that physicians should bear in mind when signing a contract with an MCO.
You can download the AMA's revised Model Managed Care Contract from the Internet by visiting:
www.ama-assn.org/ama/upload/mm/38/mmcmsa.pdf.
The table of contents for the Model is inserted below:
AMA Model Managed Care Contract
Table of Contents
Introduction
Model Managed Care Contract
Addendum - Physicians Beware of these Common Managed Care Contract Clauses
Supplement 1 - Medical Necessity
Supplement 2 - Silent PPOs
Supplement 3 - “All Products” Provisions
Supplement 4 - Capitation and Risk
Supplement 5 - Discounted Fee-for-Service
Supplement 6 - Downcoding and Bundling of Claims
Supplement 7 - Coordination of Benefits
Supplement 8 - Late Payment
Supplement 9 - Retrospective Audits
Supplement 10 - Bankruptcy and Other Financial Failures
Supplement 11 - Subrogation
Supplement 12 - Credentialing
Supplement 13 - Patient Record Confidentiality
Supplement 14 - Termination “Without Cause”
Supplement 15 - Mediation and Arbitration
Supplement 16 - Restrictions and Obligations Post-Termination
For more information on contracts with MCOs or the AMA's revised Model Managed Care Contract, please contact one of the following Ober|Kaler health law attorneys:
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Ober, Kaler, Grimes & Shriver
Maryland
120 East Baltimore Street, Baltimore, MD 21202
Telephone 410-685-1120, Fax 410-547-0699
Washington, D.C.
1401 H Street, NW, Suite 500, Washington, DC 20005
Telephone 202-408-8400, Fax 202-408-0640
Virginia
407 North Washington Street, Suite 105, Falls Church, VA 22046
Telephone 703-237-0126, Fax 202-408-0640
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