The Affordable Care Act (ACA) will bring about unprecedented changes to health care requirements. Insurers and managed care companies will have to provide more benefits without increasing premiums. Unquestionably, this is going to put extreme pressure on the medical community. If your organization is working through managed care contracting, credentialing or reimbursement issues, we at Lowe & Evander, P.A., are prepared to put our expertise to work for you.
Our lawyers have reviewed more than a hundred managed care contracts for physician groups ranging from one or two doctors to hundreds. This has included some of the largest health care companies in the country, including Aetna, Cigna and Blue Cross Blue Shield.
Our Orlando managed care attorneys are prepared to work on cases involving:
- Contract review: prompt pay, medical records, terminations provisions and Section 641.315 of Florida statutes matters
- HMO, PPO and IPA (full risk or capitated contracts)
- Credentialing application issues
- Collecting money owed from managed care or health insurance companies
- Reimbursement disputes
- Silent PPO issues
Many Florida medical professionals do not understand the subtle differences in products with respect to (illegal) payer clauses and credentialing in managed care contracts. It is absolutely critical to get all documentation reviewed before signing a contract. Many doctors and providers mistakenly think that managed care contracts are boiler plate and cannot be negotiated. Depending on market price, specialty and service, these contracts are negotiable and can be tailored to optimal business process.
Additionally, many doctors do not understand the differences between health maintenance organizations, preferred provider organizations and the details of preferred service plans. They do not know if they are signing a broad contract with a payer, so they have to be careful about silent PPOs.
While many advent of the ACA, many doctors want to do more with less funding and will take on agreements that are not optimal. We are prepared to look for key language in contracts and how to negotiate it out. We will ensure that physicians do not take on plans they do not want, like Medicare advantage or a Medicaid HMO plan, and address all relevant credentialing issues under the ACA.
We also recognize that with the decline in reimbursements under PIP laws, certain medical providers are receiving less and less. We are prepared to look at all reimbursements and contractual issues, calling in specialists as necessary. Our knowledge of Florida outpayer contracts readies for any reimbursement or credentialing issue.
To schedule an initial consultation with one of our Florida managed care attorneys, call (407) 537-0763 or contact us online.