The purpose of managed care plans is to provide benefits, such as health care and medical coverage, to members of the plans for reduced costs. Several of the companies that provide managed care health plans are for profit organizations that work with medical facilities and health care providers. A lot of credit is given to managed care plans for the role they played in holding back the inflation of medical costs in the late 1980s. They were able to accomplish this by decreasing the amount of hospitalizations that were unnecessary, which made providers discount their rates. In turn, this caused the industry of health care to become more competitive and efficient. By looking over managed care reviews and payment reviews, a person can ensure that they are getting the best coverage possible. Instead of doing business with third party administrators and various insurers, providers have the ability to work with preferred provider organizations. Having a good network of providers can aid in the negotiation of favorable fees and revenue recovery from providers, the creation of financial incentives for providers, and the selection of providers that are cost effective. Payment reviews can lead to good payment compliance with a provider. A provider of benefits should be subject to payment reviews. Those receiving benefits, and those acting on behalf of those people, need to be able to keep providers honest.
One of the reasons that healthcare in America is so expensive is because of the significant infrastructure that is required to maintain medical records. There are entire industries that have grown up around the laws regulating the healthcare industry. Contract compliance is one of these areas where there has been significant growth in recent years. But this only scratches the surface. Physicians and doctors also have to hire administrators to deal with managed care review, payment compliance, payment reviews and revenue recovery. Contract compliance is one of the most important administrative tasks for doctors to make sure that their clinics have a handle on. Tort law is the cause of many malpractice lawsuits, but, nonetheless, contract law can also be a significant drain on a doctor’s revenue. For this reason, it is necessary for doctors to exercise the best contract compliance policies to make sure that they are operating within the framework of the laws and performing the services which they have sworn to uphold. Contract compliance will probably only grow more important as we move toward the future. And it is for this reason that outsource contract compliance services are becoming an important part of the healthcare profession.