Health Profession
publicado em 25/04/2012 às 22h20:00
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Entities deliver proposals to hire professionals to ANS

Text covers issues such as annual adjustments of amounts paid, setting fees and accreditation of medical

 
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In seeking to establish appropriate criteria for hiring doctors by health plan operators, representatives of national medical organizations (the Federal Council of Medicine, National Health Federation and the Brazilian Medical Association) formally submitted to the National Health Agency (ANS), this Wednesday (25), a document with 15 proposals in the category. This paper addresses issues such as paid annual adjustments of values, parameters for setting fees and criteria for accreditation / accreditation of doctors, among others (see below the full document).

The document was tabled at a meeting that took place at the NSA, in Rio de Janeiro, between directors of ANS (Endrigo Antonio Carlos Figueiredo and Bruno Sobral) and representatives of medical organizations Tibiriçá Aloisio (CFM), Márcio Bichara (FENAM) and Jurandir Turazzi (AMB). It was pre-scheduled another meeting for May 14, when discussing the issue again and the Agency shall give its opinion.

According to the vice president of CFM, Tibiriçá Aloisio, it is time to progress in the negotiations. The ANS was receptive and had only a few questions legal matters. We hope that good results can lead to doctors and all Supplemental Health System, he said.

After successful completion of the protest April 25, the national committees guide the State Medical Fee to continue negotiating with the operators of health plans at the local level. An expanded meeting is scheduled for the month of June with a date and venue still to be defined. On the occasion will be an assessment of achievements and developed a schedule of activities for the coming months.

<b> Check out the full document: </ b>

1. All legally constituted medical entity may negotiate with carriers on behalf of their jurisdicionados, without excluding the other one.

2. Necessarily, there will be an annual national data base established for contractual adjustment or additives with a redefinition of the values ​​of the contracted services, according to the criteria established in the annual collective bargaining between the operator and the representation of providers.

& 1 The criterion of minimum wage will amount to CBHPM into force.

& 2 The rate of annual adjustment, when there is no negotiation, it will be fixed by the NSA for the users of health plans.

3. The services provided must be effectively paid within 30 calendar days of submission of the revenue in the first day of each month and in case of delivery of the dispatch of the electronic billing period is 10 days for payment.

4. Late payment will require the operator to pay a fine of xxxx and xxxx restatement of the day.

5. Disallowances will not be admitted for medical procedures that are conducted in Rol ANS or operator or have been subject to prior authorization, and any unauthorized discount.

6. The glosses that may have been made by the operator, which will fit the request for reconsideration, the provider shall be notified in writing signed by the physician auditor with detailed explanation of each case, until day 15 (fifteen) months from the submission of the relevant document collection , and an appeal within 10 days by the provider.

7. Contracts will be signed between the medical providers PF or PJ.

8. Medical professionals can provide their services as individual or legal entity, in accordance with the professional, sealed the embarrassment of migrating from one situation to another.

9. The contract should establish the place of professional care to patients using the service provider.

10. The payments to the provider by the delivery of services in health care facilities should be made directly to the professional provider. Exceptions are cases of doctors employed directly by the Unit.

Sole Paragraph: The service performed between 19 hours and at 7 am on weekdays and on weekends and holidays, without prejudice to above, will be paid in increments of 30%.

11. It is forbidden the accreditation of medical provider, except for fair and reasoned decision, assuring the doctor the right to defense in the operator or another.

& 1 In case of disqualification, the doctor will be notified 90 days in advance and if it is motivated by scaling the network must have the endorsement of the ANS.

& 2 The failure of the lead heading to return to work with all the guarantees and other benefits for the period of removal, which will be considered as effective service delivery.

12. The parties undertake to respect and hold in the contracts, the Code of Medical Ethics and Resolutions supported by law, issued by the Medical Boards.

13. The venue chosen in the contract should be the one on site provision of medical services.

14. The operator will provide the medical providers to provide detailed monthly statement of services, including glosses.

15. Provider Health Plan will provide a direct channel of communication with the medical provider to coordinate the medical provider.

Source: CFM
   Palavras-chave:   Stoppage    Medical movement    NSA    National Agency for Supplementary Health   
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