Ramifications of Participation Contracts
Emella Steele
HCR 230
October 18, 2014
Myrnell Martin

Ramifications of Participation Contracts
Participation contracts are created that would allow the providers to have an overview of a plan to make a decision on if they will participate in the plan or not. The providers use the plan to see if participation would benefit them financially. An introductory section, the purpose of the contract, services that are covered, responsibilities of physician, obligations of the managed care plan, compensation, and billing guidelines this is how the plan is broken down into parts. What the plan pays, the physician fees are typically higher. The provider may still experience less revenue because the plan brings in more patient, providers also check to see if the plans protocols hinder their judgment in what treatment they give the patient. They can get more exposure, depending on the plans the providers participate with because some plans want the physician name to be advertise through the newspaper, radio, and television. It could increase the revenue for them because this would be an extra benefit to the provider. With a fee-for-service plan, the main problem is preventive care not covered. The patient can see any provider that they would like to visit. The providers are paid for all test and procedure on the patient, and this is another benefit. The most usual or common charges for these procedures and how often the procedure is performed are based on the amount that has to be paid. With the discounted fee-for-service, the physician takes the hit of receiving less money from the plan because they have negotiated at a lower rate. The physician is forced to treat the patients cost effectively instead of doing things that unnecessary, and if the patients is seen more than what is paid for the physician takes on that