When you contract with a health plan for your services, you base your deal on the reimbursement you expect to receive from the services you’ll provide under the contract. But when a plan unilaterally removes or "carves out" certain services from your contract and hands them over to an independent specialty provider (sometimes called a carve-out provider), your revenues could be reduced.
The best way to avoid this problem is to convince the plan to agree not to carve out any of your services. Because many plans won’t agree to that, urge the plan to include an antisteering clause in your contract that bars it from steering members away from you and toward the carve-out provider. You’re much more likely to get plans to agree to this compromise, experts say.
This week’s tip will tell you how antisteering clauses can protect providers. Next week we’ll provide a model contract clause that you can adapt and use in your plan contracts.
An antisteering clause can protect providers in the following ways:
This week’s tip was excerpted from HCPro’s monthly newsletter, Managed Care Contracting & Reimbursement Advisor. For more information, click here.