Our AMA:

(1) opposes managed care contract provisions that prohibit physician payment for the provision of administrative services;

(2) encourages physicians entering into:

(a) capitated arrangements with managed care plans to seek the inclusion of a separate capitation rate (per member per month payment) for the provision of administrative services, and

(b) fee-for-service arrangements with managed care plans to seek a separate case management fee or higher level of payment to account for the provision of administrative services; and

(3) supports the concept of a time-based charge for administrative duties (such as phone precertification, utilization review activities, formulary review, etc.), to be assessed to the various insurers.

Policy Timeline

CMS Rep. 13, I-97 Appended: Res. 806, I-99 Reaffirmation A-04 Reaffirmation I-08 Reaffirmation I-09 Reaffirmed in lieu of Res. 912, I-09 Reaffirmation A-10 Reaffirmed in lieu of Res. 710, A-14 Reaffirmed in lieu of Res. 711, A-14