HMO contracting: how to minimize UR liability

Article Abstract:

Hospital contracts with health maintenance organizations must be analyzed to make sure indemnification provisions are included in the hospital's insurance policies. In the case of Corcoran vs United Healthcare, the court found federal law preempting state in claims including improper utilization review. Managed care plans may try to shift liability to hospitals by inserting indemnification clauses in their contracts. Lawyers warn hospitals not to assume responsibility for another institution's utilization review decisions.

Hospital and medical service plans, Interpretation and construction, Contracts, Health maintenance organizations, Indemnity against liability, Liability indemnity

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CEOs: there's no simple cure for billing and pricing woes

Article Abstract:

Hospitals have created a confusing billing and pricing system that is causing a large amount of consumer dissatisfaction. Confusion over pricing would lessen if hospitals streamlined their charge structures, explained to businesses the complex reasons for cost-shifting and keep prices in line with costs. Hospitals need to carefully evaluate all business office functions when trying to improve billing and collection services.

Accounting and auditing, Cover Story

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