Agreement With Provider

Outdoor activities. Confirm whether the practitioner can provide professional services to third parties outside the contract. For employees, you should generally prohibit such external activities, unless you authorize the activities, and the external services do not affect the practitioner`s obligations arising from your agreement. You may want to confirm that the practitioner is responsible for the security of insurance covering their external activities, which reduces the risk of you being designated as a party to a legal action to ensure another source of recovery. 2.10 Use management and quality improvement requirements: Managed care plans adopt standards and requirements for use management and quality improvement, which aim to promote the provision of quality and low-cost healthcare to their members. When providing the covered services to members, the provider undertakes to comply with the requirements for managing uses and improving the quality of the healthcare program in which each member can participate. These requirements may include, but are not limited to, obtaining pre-authorization or pre-certification prior to transfer or transfer, participating in case management, and coordinating care with other providers. These usage management and quality improvement requirements may include medical records office audits, regular inspections and investigations, case-by-case specific audits, and other simultaneous and retrospective audits performed by SelectHealth and associated management plans. Genital care plans may also adopt physician-approved clinical guidelines and require compliance with those guidelines, unless the patient`s well-being requires otherwise. Managed Care Plan provides the provider with information on these requirements. The provider undertakes to comply with the standards and requirements for managing the use and improving the quality of management care plans and to cooperate with managed Care Plan in order to improve the performance of the Managed Care Plan. 2.14 Switching Provider: According to the procedures established by any managed care plan, the provider or member has the right to require from the respective management plan a change in a particular member`s access to covered services to another provider if the provider and member are unable to establish an adequate and effective provider-patient relationship.

5.06 Exchange of information: the Parties agree to cooperate in the exchange of information necessary to facilitate the implementation of this Agreement, including, but not limited to, the provision of information necessary for compliance with legal and accreditation requirements (e.g..B NCQA/HEDIS – Health Data Employer Information Set; Programs sponsored by the national or federal government). The parties also agree to exchange and communicate information that is essential or likely to be necessary for the defense of one of the parties in respect of a dispute, provided that such information is not readily available from another source and is not contrary to applicable rules or laws on confidentiality or privilege. Compensation. To comply with federal rules, you generally need to ensure that compensation (including benefits, signing bonuses, moving benefits, loan repayments, and anything else you make available to the doctor) is fair market value and does not vary with the volume or value of transfers. You can usually pay the practitioner based on the services provided by the practitioner in person (e.g.B. according to the LFS or a similar methodology). If you`re a group of doctors under Stark, you have greater flexibility in how you compensate group members, for example. B you can also compensate the doctor on the basis of “incident to” or profit-interest services; However, you usually cannot compensate the doctor on the basis of additional benefits that the doctor may prescribe.

For independent contractors, make sure that your remuneration formula is set in advance. do not retroactively alter the remuneration or contract a non-contractual remuneration which is not included in the contract. . . .