When you run your own medical practice in California, your top priority is usually caring for your patients. However, you also have to pay attention to your provider contracts. While you know your practice needs these contracts, you may wonder what information you should include.
One important element to include in provider contracts is the fee schedule. This includes a breakdown of all the services a healthcare company will cover, as well as how much these services might cost. This is important for you to know because you typically want to make sure a patient’s insurance will cover your recommended care. Insurance companies may have different fee schedules, so it is important to have a complete breakdown for every company you work with regularly.
Additionally, your contracts need to list out how much money an insurance company will pay for certain services. If this amount does not cover an entire service, your patients may need to pay the difference. Again, this may be different for different companies. It is also a good idea to have a full list of network requirements. Your practice may be eligible to join several different medical networks, so it is important to understand the requirements for each. Additionally, it is a good idea to pay close attention to the language used in this part of the contract, as sometimes the language may give insurance companies more authority to pick a network than you may want them to have.
Sometimes you may experience conflict with one of the insurance companies you work with. In this situation, it is important to make sure your provider contracts list out methods of dispute resolution. This portion of the contract might layout either a mediation process or situations when you may need to take more serious steps. It may sometimes be a good idea to make sure your language in this section does not legally require you to perform certain types of dispute resolutions but instead allows you to use the method best suited for the situation.