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By establishing organized networks of healthcare providers who commit to provide services at agreed-upon prices, managed care contracting primarily seeks to reduce healthcare costs while preserving or enhancing the quality of care. These agreements specify how providers will be paid for the care they give and establish the operational and financial foundation for them.
A facility's payment for the services it renders is one of the most important parts of healthcare contracting. Reimbursement rates can be capitated (a fixed sum per patient, independent of services rendered) or per-service (fee-for-service). The running expenses of the facility and the standard of care that the patient population requires must be taken into consideration while setting these prices.
Contracts for managed care specify when and how providers must file claims in order to be paid. The precise billing codes must be used, the deadlines for submitting claims, and any fines for incomplete or delayed submissions are all covered in this section. Maintaining a consistent cash flow and lowering the possibility of denied claims depend on a smooth claims procedure.
Contracts for managed care contain performance standards or quality-of-care requirements that providers must fulfil. These criteria could be adherence to treatment plans, readmission rates, or patient outcomes.
Establishing a managed care contract gives facilities access to a patient network that is covered by the MCO. This can bring in a regular stream of patients, guaranteeing stable income and occupancy rates.
As managed care contracts have set payment schedules and agreed rates, they enable institutions to more precisely forecast revenue. This financial stability aids in long-term planning, resource allocation, and budgeting.
Providers who meet or surpass quality-of-care standards are often rewarded under managed care contracts. In addition to better patient outcomes and happiness, this can result in financial incentives and improve the facility's standing in the community.
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