Meeting Archive:
Disclosure of payment information relative to physician risk arrangements

Meeting Description:

Disclosure of payment information relative to physician risk arrangements


All budget-based payment systems link at least some portion of physician payment to the physician’s assumption of risk for losses or overutilization. For example, in a shared savings arrangement, physicians may share risk of loss with the managed care organization, but in a capitated arrangement, may assume full risk for the utilization of their professional services. Physicians will not be able to monitor and manage assumed risk successfully unless the managed care organization regularly provides physicians with complete and accurate data reports concerning patient utilization, performance with respect to quality and efficiency measures, patient eligibility, etc. Physicians must also receive specific Division of Financial Responsibility Matrices and end-of-year claims reports that will enable them to perform claims and payment reconciliations. This webinar identifies the types of information that your practice will need from managed care organizations to monitor and manage risk, and outlines the rights your practice may have under state law to receive that information.

Date: Tue, Sep 11, 2012
Time: 12:00 PM CDT
Duration: 1 hour
Host(s): AMA Practice Management Center
 Presenter Information
Wes Cleveland, JD

Wes Cleveland is an attorney in the AMA’s Private Sector Advocacy unit. Prior to joining the AMA, Mr. Cleveland served as assistant attorney general in the Office of the Texas Attorney General, an attorney in the Texas Medical Association’s Office of General Counsel, and in private practice in Austin, Texas, where he represented physicians, hospitals, and individual and institutional health care providers.

Mr. Cleveland advocates for physicians on a wide variety of issues related to federal fraud and abuse, antitrust, the Employee Retirement Income and Security Act, and state and federal managed care requirements.