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Ten Tips to Reduce Liability in the Managed Care Organization

1. Maintain an effective utilization management/case management program.
2. Establish an appeals and reconsideration process for both patients and physicians.
3. Maintain consistency with Plan documents and policies.
4. Develop a system to collect aggregate data on utilization, denials, and appeals to identify any potential utilization liability risks.
5. Maintain a comprehensive process for credentialing and privileging practitioners. Do not rely solely on the credentialing and privileging activities of a hospital as the hospital credentials and privileges the licensed practitioner only for those services provided within or under the direction of the hospital.
6. Be careful about what you promise as risks may escalate where performance does not live up to expectations. Negligent advertising may pose an added liability risk.
7. Protect patient confidentiality. Establish information release policies.
8. Design reports to use standardized terminology to avoid miscommunication between departments and providers.
9. Provide for physician and staff education. Areas to cover include medical record documentation practices, communication skills and the importance of systems.
10. Call MICA Risk Management for personalized assistance for your organization.

Risk Management Services Available For Managed Care Organizations

• Department Inservices
• Formal Education Programs and Mock Trials
• New Staff Orientation
• General Topics or Issue Specific
• MCO Employees
• Contracted Providers
• Joint Programs With Hospitals
• Telephone Hot Line Site Audits For Networks or MCO's
• Office Audits For Providers
• Monthly Publications

These services are provided to MICA Insureds at no cost. Risk Management consulting services can also be arranged for non-members. To contact MICA please call 602-956-5276 or 1-800-352-0402.