Difficulties of Managed Care Regarding Reimbursement

• Managed care reimbursement entities have great variability in their recognition, policies and procedures for APN reimbursement
• Managed care and reimbursement laws vary greatly from state to state
• Individual contracts have specific, changing restrictions & requirements
• Contracts may have rate reductions & discounts of certain types of care (e.g. telephone consultations)
• Billing procedures are complex and policies change constantly as employers change contracts with providers to obtain best policies
• Referral processes may be complex and require prior authorization
• Patients may be confused and unhappy with restricted list of providers & services
• Providers may feel that the care they provide is being directed by business managers more concerned with money matters that with quality of care