Off-campus Pacific University users: To download campus access theses and dissertations, please log into our proxy server with your PUNet ID and password.

Non-Pacific University users: Please talk to your librarian about requesting this thesis or dissertation through interlibrary loan.

Theses or dissertations that have a specific embargo period indicated below will not be available to anyone until the date indicated.

Date of Graduation

8-2005

Degree Type

Capstone Project (On-Campus Access Only)

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Judy Ortiz, MPH, PA-C

Second Advisor

Jonathon W. Gietzen MS PA-C

Abstract

Context: In order to maintain a viable medical practice, medical providers must understand the various types of health plans and the way in which these plans negotiate their contracts for medical services provided to their members. Although numerous opinions have unfolded regarding how these contracts should be negotiated, there are common, important points between the various insurance companies that will be discussed. Objective: To provide important information to providers on the key elements of negotiating a contract with health insurance companies. Design: Information on contracting will be obtained through the McMinnville Physicians Organization (MPO) and Dr. Michael Jaczko, President of the MPO. The MPO is located in Carlton, Oregon, and provides its member physicians with a basic format from which to evaluate their provider contracts. Additionally, information will be acquired through a search of the current literature. Results: The American Medical Association as well as state and local professional medical organizations are good resources to use when educating oneself about the different aspects of provider contracting. A common theme among the different organizations is that medical providers must be diligent and alert when negotiating a contract for services with a health plan. Conclusion: Providers cannot be expected to know all of the different health insurance plans. However, medical providers must educate themselves on the nuances of provider contracting with health insurance companies, especially since the terminology and language of most contracts are similar. Increasing their knowledge will not only allow providers to receive appropriate reimbursement for services, but also maintain a clinical practice as deemed suitable.

Comments

The digital version of this project is currently unavailable to off-campus users; however, it may be requested via interlibrary loan by eligible borrowers from Pacific University Library. Pacific University Library is a free lender. (Library Use: NL)

Share

COinS