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Q. What does the term "most favored nation" mean as it appears in many third party payer reimbursement agreements and participation agreements?
A. The most favored nation clause in a third party payer contract simply means that you agree not to charge other payers -this would include patients- a lesser charge for your services than you charge the payer you are contracting with. If you do, the payer you are contracting with may be able to retroactively review your previous claim data and determine that you were utilizing a lower fee schedule for other payers and because of a most favored nation clause, the carrier could potentially seek to recoup dollars paid to you that were over and above any lesser fee schedule your practice may have had in place. This clause is fairly common language in most reimbursement and participation agreements; therefore it will be nearly impossible to negotiate out of the agreement. Best advice is to always create your professional charge on the same basis for all services provided regardless of the third party payer that may be involved. From a compliance standpoint it is the only way to go. |
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