Health plan to alter confusing "fee negotiation agreements"

Organized medicine pressed MultiPlan, which rents PPO networks, to modify a form offering out-of-network physicians quicker pay if they accept a lower rate.

By — Posted Dec. 30, 2009

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The American Medical Association and several state medical societies have pushed a New York-based health plan to make changes to one of its fee negotiation forms commonly faxed to physicians.

According to an AMA practice management alert posted in December, the agreements had been "problematic for a number of physician practices," so the Association and several state societies approached MultiPlan about making changes.

MultiPlan rents PPO networks and routes reimbursements from payers to physicians and hospitals. If a physician falls outside the network that a patient has accessed through MultiPlan, the doctor may receive a "fee negotiation agreement," or "expedited fee negotiation agreement" offering to speed up payment for a given service if the physician agrees to a proposed reimbursement rate.

MultiPlan has been using the agreements for a few years, spokeswoman Susan Mohler said, but she didn't know how many of them go out in a given month or year.

The agreements are faxed, sometimes out of the blue and sometimes after MultiPlan has talked to the physician or practice manager and made a verbal agreement, Mohler said.

If the physician does not agree or respond to the proposal, payment could be reduced anyway as the plan applies "usual, customary and reasonable" rates, plus the payment could come as late as state law allows.

The agreements were reworded to clarify that they don't constitute a contract between the physician and MultiPlan, but rather apply to a single patient visit.

A new accompanying "FAQ" document will help practices evaluate the agreement through clear instructions for rejecting the proposal or limiting the number of such proposals the practice receives. It also indicates where to call with questions.

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