Analyzing and Negotiating

Analyzing and Negotiating

Better Managed Care Contracts

A One-Day Program Designed to Improve Your Contracting Skills

7.0 Nursing contact hours have been applied for through the Texas Nurses Association, an accredited approver of continuing nursing education by the American Nurses Credentialing Center''s Commission on Accreditation.

YOU WILL LEARN:

  • An operational understanding of the contracting process.
  • How to improve the contracts you already have.
  • How to enforce your agreements.
  • How to manage underpayments and refund requests and denials.
  • How recently enacted legislation can affect contract terms and conditions.
  • How to identify and troubleshoot problems frequently encountered in the implementation of the contract.
  • Make the most out of what you negotiated.
  • How to develop internal tools that can be used for improving the analytical and management tasks of ongoing participation in the contract negotiations.
  • To develop exit strategies for badly written contracts.
  • What to look out for - When to Say "No"!

Who Should Attend

Medical and Dental Office Managers Hospital Finance Officers Physical Therapists
Billing and Collection Staff Hospital Billing and Collection Staff Occupational Therapists
Psychotherapy and Psychiatric Office Managers Hospital Managed Care Analysts DME Vendors
Chiropractic Office Managers Hospital Decision Support Staff Home Health Suppliers
Podiatric Office Managers Hospital Contracts Management Pharmaceutical Detail Reps
Optometric Office Managers Ambulance and EMS Providers Consultants
Physicians and Nurses Flight for Life Providers CPAs
Dentists Blood Bank Attorneys
Chiropractors Laboratories GI Lab Administrators
Optometrists Imaging Center Managers Sleep Labs
Psychotherapists Hospital-based Physicians Pain Management Physicians
Residency Program Directors Day Surgery Centers CRNA Billing Staff

and others charged with managed care evaluation, contracting and negotiation decisions for hospitals, medical groups, home health, physical therapy and other alternate site providers.

Seminar OutlineThis seminar guides you through the demystification of traditional contract language, and the impact on provider operations and costs. Additionally, the class is led through a demonstration in the development and use of existing Microsoft Office ® applications and techniques to build a contracting “toolkit” to manage the due diligence process necessary for proper contract analysis, ongoing contract management and periodic operational reviews. Students with laptop computers are welcome to bring them to class to work “hands on” as these techniques are demonstrated in class. These tools will then be “take home tools” for use in future contract review.

We''ll go through various paragraphs in typical managed care contracts currently seen throughout the nation and examine the perils and pitfalls just signing on the dotted line. Practicable solutions will be offered, as well as a technique to address negotiation jitters through non-confrontational methods of negotiation. We will earn to identify and dismantle the vagueness of complex managed care contracts with many of the classic and not so-classic problem terms and conditions and “gotchas” frequently encountered in HMO, PPO, Silent PPO and other managed care agreements.

Upon completion, you will feel more adept at the conversion of the boilerplate terms into clearly negotiated objectives, expectations and measurable actions. Whether you have been contracting with managed care organizations for only a few weeks or many years, this class will serve as an in-depth, hands-on and powerful workshop designed to assist you.

1. UNDERSTANDING THE MANAGED CARE CONTRACTING PROCESS

  • The basics in a nutshell

1. Form, structure and content
2. Classic Contract Problems

  • Silent PPO structures: how to work through and around them
  • ERISA contracting concerns
  • Plan bankruptcy concerns and what to do before it happens


Living with the Contracts Already in Place - What to Do - How to Do It

  • Dealing with underpayments, audits, late payments and requests for refunds and denials
  • Mitigating liability in contracting associated with indemnification and hold-harmless issues
  • Evaluating hidden cost escalators in contracts-what they look like and what to do about them
  • Developing a managed care contracting committee: fostering internal and external relationships
  • Managing automatic renewals and fee escalations
  • Enforcing the agreement: dispute resolution options in managed care

2. USING READILY AVAILABLE TECHNOLOGY FOR CONTRACT MANAGEMENT TASKS

  • Examine techniques using existing software you may already have to assist in contract analysis and revision
  • Develop a contract matrix of existing contracts using existing software you may already have for database management applications
  • Develop financial modeling tools for new and existing contracts
  • Develop an “onboard” library of tools, regulations and sample forms on your computer
  • Easy ways to research State and Federal Regulations and Administrative Codes
  • Use your word processor to identify more than 150 problem words and phrases in contracts

3. DEVELOPING A SYSTEM THAT WORKS FOR YOU

  • Evaluate ambiguous words and phrases
  • Develop a strategy for working more efficiently with attorneys
  • Use the Internet and online resources to help with analysis and revision

4. Paragraph by Paragraph Analysis and Practical Solutions

5. Managed Care Profitability - How to Measure it, How to Improve It, When to Get Out

  • Increase profitability by decreasing the terms and performance variables of multiple contracts, standardize contract terms within an organization, practice analyzing various reimbursement models, which can become actual payer reimbursement problems if not negotiated correctly.
  • Exit Strategies for Bad Contracts

5. NON-CONFRONTATIONAL NEGOTIATION STRATEGIES

  • Initiating the dialogue that fosters trust, integrity and veracity
  • Requesting further clarification

Prerequisite
None

Type of Program
Live Group

Content Area
Specialized Knowledge and Application

Faculty
Maria K. Todd, Ph.D., Vice President and Senior Project Manager of HealthPro Consulting, Inc. and author of: The Managed Care Contracting Handbook (1996, McGraw Hill and the HFMA, Chicago) IPA, PHO, MSO Development Strategies (1997, McGraw Hill and the HFMA, Chicago), and The Physician Employment Contract Handbook (1999, McGraw Hill and the MGMA, Chicago).

With clinical, administrative, health plan and paralegal professional work experience, she assists hospitals, physicians and other healthcare professionals on a national basis with managed care contract review (operational/activity-based cost analyses), and specializes in analysis and negotiation of complex, healthcare provider agreements, regulatory compliance (HIPAA), disease management programs, integrated delivery system development, managed care contractual revenue audits and recovery projects.

Dr. Todd often serves the legal community on a national basis as an expert witness. She is a certified mediator specializing in managed care payer-provider disputes. A prolific author, she has had regular columns in Decisions in Imaging Economics, Orthopedics Technology Review and Practice Pointers, a special publication of the American Osteopathic Association. She also serves as an editorial resource to the Managed Care Contracting and Reimbursement Advisor (Brownstone)

Registration:

$229 Single Person

$219 2-4 Registering from Same Organization

$199 5+ Registrants

Registration includes:

Program Admittance

Class Manual

CD of Interactive Tools for After Class Implementation

Healthful Refreshments

Lunch

Parking

Audio CD, MANUAL and Interactive Tools CD Those who cannot attend are welcome to order a digital audio CD, manual and accompanying Tools CD from the program for $229. If you attend the program, a 50% discount will apply to the additional materials. These will be shipped to you after the program has concluded. In order to receive the 50% discount, the materials must be ordered at the same time as registration.