Where We Stand
Section: Insurance
Policy: Third Party Payor Audits

Third Party Payor Audits

OMA should develop contractual guidelines on the factors to be considered by individual physicians in order to arrive at a reasonable charge for physician and staff time devoted to compliance with third party audits and protocols.
Adopted by the interim House of Delegates, 1999.


OMA should solicit periodically from the membership an appraisal of the validity, timeliness, and relevance to actual practice of managed care audits of individual physician performance and an accounting of due process review of the audit results by practicing physicians before publication to plan subscribers.
Adopted by the interim House of Delegates, 1999.


OMA should ask the Oregon Insurance Commissioner to determine whether the major Oregon insurance company managed care organizations comply with the Patient Protection Act in providing periodic, comparative and accurate utilization data for all practicing physicians in the insurance plan.
Adopted by the interim House of Delegates, 1999.

Return to the Where We Stand table of contents.