Physicians seeking a reasonable alternative to the one-sided contracts offered by some managed care organizations can now rely on a new AMA online resource. The American Medical Association (AMA) today unveiled its new National Managed Care Contract (NMCC) and database to help physicians analyze and negotiate contracts with insurers and help provide relief from unfair corporate business practices.
“The concentrated market power of large health insurers gives them an unprecedented advantage in dictating key aspects of health care to physicians,” said AMA President J. James Rohack, MD. “The AMA’s new resources will be a welcome guide for negotiating fair contracts with health plans angling for an even greater advantage over physicians.”
The NMCC is the first comprehensive managed care contracting resource geared specifically to the needs of physicians. The AMA created the NMCC in an attempt to create model contract language that complies with the managed care laws of all 50 states and the District of Columbia and to comprehensively cover the broad range of physician concerns with managed care contracts. It provides physicians with a valuable frame of reference to compare and evaluate any prospective managed care contract.
The searchable database associated with the NMCC provides physicians with easy access to updated statutes and regulations in all 50 states and the District of Columbia. It covers the managed care contracting process, the managed care contract itself and the business relationship between physicians and managed care organizations after an agreement has been signed.
The NMCC and its database are invaluable tools that can be used by physicians and their advocates to:
· provide alternative language to support contract negotiations with managed care organizations;
· ensure managed care contracts and managed care organizations comply with applicable state legal requirements;
· clarify key contract issues and manage ongoing relationships with managed care organizations;
· assist with legislative, regulatory and legal efforts to reform unfair managed care business practices;
· monitor emerging state and federal legislative and regulatory trends.
AMA members can access the NMCC and database at www.ama-assn.org/go/nationalcontract . The NMCC is not designed to take the place of competent, individualized legal advice. It is one of many tools available from AMA’s Private Sector Advocacy that will help physicians in the generally lopsided negotiations with health plans.