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Commercial

Private insurance companies and their differing policies, procedures, and payments add complexity to medical practice today. These resources are intended to assist practices in dealing with private payers.

  • Evaluating Payment Contracts - AMA and RAND created two resources to help physician practices when evaluating bundled or episode-based and pay-for-performance agreements. (Note: Accessing these resources may require registration on the AMA site.)
  • Standardized Payer Contract
    This document details what should be included in any contract between a physician and payer. Available to ACP members and requires a login.
  • AMA's National Health Insurer Report Card
    An annual report card of the claims revenue cycle activities of the major commercial insurers and Medicare.
  • Referral Tracking Guide
    One way to ensure a competitive advantage for your practice is to track your referrals and document effective management of your patient population.This guide will help you achieve those goals. Available only to ACP members and requires a login.
  • Health Insurance Plan Referral Chart
    Internists who participate with private insurance plans as primary care physicians (PCPs) often participate with more than one. In making referrals, it can be confusing to keep track of which colleagues belong to which plan.This charg will help you better manage that information. Available only to ACP members and requires a login.
  • Negotiating with Payers to Retain Office Lab Testing
    Sample letters and negotiating tactics to ensure you are successful in negotiating with payers to retain lab testing in your office. Available only to ACP members and requires a login.
  • Electronic Funds Transfer (EFT) Tool
    Providers can now enroll in electronic funds transfer (EFT) with multiple payers simultaneously through this single, secure, online, FREE, process available from CAQH.
  • Understanding Your EFT Payment Options
    Many health plans have moved from paper to electronic forms of payment. During this transition period it is important that physicians, as well as other health care providers, have an understanding of different methods of electronic payment and the financial risks associated with each.

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