Payment Reform
Prescription for a healthier practice: Simplify the claim audit and appeals process
External link will open in a new window.This interactive resource can help reduce the administrative burden by delivering a step-by-step course of action to appeal an underpaid, delayed or inappropriately denied claim. AMA members can access the National Managed Care Contract Database to look up state laws and regulations, which may need to be cited or quoted directly in an appeals letter. Also refer to the issue brief, "Overpayments and underpayments" for additional information.
Prescription for a healthier practice: Understand your contracts
External link will open in a new window.Don't let contracts with managed care organizations intimidate you; gain a better understanding of what they say. AMA encourages physicians to learn more about how a negotiated fee schedule can affect your practice's bottom line by reading "Obtaining, uploading and utilizing your contracted fee schedules," also available on the AMA's Defensible Fee Schedule Toolkit webpage. The step-by-step guide will help you easily and accurately load contracted fee schedules into your practice management system.