Ama Policy

Fair Physician Contracts H-285.946

Directories, Fee Schedules, Payment Edits, Termination

Our AMA will develop national (state) standards and model legislation for fair managed care/physician contracts, thereby requiring full disclosure in plain English of important information, including but not limited to: (1) disclosure of reimbursement amounts, conversion factors for the RBRVS system or other formulas if applicable, global follow-up times, multiple procedure reimbursement policies, and all other payment policies;

(2) which proprietary “correct coding” CPT bundling program is employed;

(3) grievance and appeal mechanisms;

(4) conditions under which a contract can be terminated by a physician or health plan;

(5) patient confidentiality protections;

(6) policies on patient referrals and physician use of consultants;

(7) a current listing by name and specialty of the physicians participating in the plan; and

(8) a current listing by name of the ancillary service providers participating in the plan.


Policy Timeline

Res. 727, A-97 Amended by CMS Rep. 3, A-98 Reaffirmed: Res. 814, A-00 Reaffirmation A-06 Reaffirmation A-08 Reaffirmation I-08 Reaffirmed: CMS Rep. 01, A-18