Ama Policy

Retroactive Assignment of Patients by Managed Care Entities H-285.947

Prompt Payment Deadlines, Risk—Physicians Taking

Our AMA opposes the practice of “retroactive or late assignment” of patients by managed care entities, noting that “retroactive or last assignment” includes: (a) the practice of failing to require enrollees in a capitated plan to select a responsible physician(s) at the time of enrollment; (b) the practice of failing to inform the responsible physician(s) of the enrollment of the patient and the assignment of responsibility until the patient has sought care; and (c) the practice of failing to pay the responsible physician the capitated rate until after the patient has sought care.

Policy Timeline

Sub. Res. 719, A-97 Reaffirmation I-01 Modified: CMS Rep. 7, A-11