Fundamentals of Managed Care for
Medical Practice Managers A new one-day workshop with nationally-renowned managed care trainer, Maria Todd
CALL TO REGISTER 800.209.7263
NEW! The Managed Care Contracting Handbook, 2nd edition ONE-DAY WORKSHOP Author of
Why Should You Attend This Class? Today’s healthcare providers in the USA have a dizzying array of more than 2000 managed care and other payer organizations with which to do business, including, but not limited to: • • • • • •
HMOs and PPOs Exchange Plans Medicare Advantage Plans Managed Medicaid Plans Case Managers Self-insured Employers and their TPAs
• • • • •
Unions Prison Health Services Workers’ Comp Insurers Travel Accident Insurers ACOs, IPAs, PHOs and OWAs
Each of these payer types has different rules, regulations, and contracting objectives. Each one has its own fee schedules, payment rules and regulations, and all kinds of ambiguities and loopholes that can catch providers by surprise and cause denials that can’t be overturned.
No matter what type of healthcare provider you are, or how long you’ve been working in healthcare, if you analyze and negotiate managed care or other reimbursement contracts contract with third-party payers of any kind, you will benefit from attending this class. Before you take on the payers you must first have a contracting strategy that sets the business rules for your organization and gives you a set of rate parameters that will work to cover your care delivery and administrative costs and margins.
Course Outline Introduction to Managed Care Contracting • Managing Managed Care Under Heatlhcare Reform - What You Must Do Now • Key Payer Organizations and Payer Types • Direct-with-Employer Contracting • HMO, PPO, IPA, ACO, Medicare Advantage, Exchanges, Medicaid Assess your current practice and your options • Market Share • Value Proposition • Assessing Negotiation Leverage • Strengths & Opportunities • Weaknesses & Threats • Setting Business Rules Existing Contract Performance • Payer Analysis • Payer Report Cards • Preventing Technical Denials • Preventing Unfair Refund Requests • Strategies for Successful Appeals
Protecting Your Legal Rights & Discounts • Taming the Silent PPO Monster • Find and Eliminate These Perils Lurking in Most “All-Product” Agreements • Closing Costly Loopholes Avoiding Unfavorable Exclusions & Pricing • Must-Know Payer Rules & Regulations • 10+ Payment models • Value-based Reimbursement Building Your Contracting Strategies • Contract Analysis • Profitability • Community Access • Payer Stability • Controlling Access to Discounts • Steerage Formulas • Language Analysis Negotiating for all your options • Deal Breaker Issues • When and How to Walk Away • Exit Strategies • Contract Analysis
• • • • • • • • •
Finding the “Gotchas” Identifying Cost Drivers Requesting Clarifications Negotiating Changes Alternative Language Gathering Data Implementing the Contract Paperless Contract Management Testing the Payment Terms
Playing Hardball: What to Do If Payers So “No” • Lockouts and Terminations • Unfair Business Practices • Antitrust Considerations • Monopsony vs Monopoly • Refusal to Deal • Network Adequacy • Subcontracting • Public Relations • Media Relations • Patient Relations • How to Get Regulators’ Attention Course Wrap Up, Evaluation & Dismissal
BRING HOME THESE SKILLS
WHO SHOULD ATTEND?
COURSE LOCATION & DATES
1.
• • • • • • • • • • • •
Denver CO Sep 12
Perform deeper due diligence on managed care organizations 2. Prevent technical denials 3. Appeal wrongfully-denied claims 4. Prevent unfair refund requests 5. Enhance profitability and competitiveness 6. Bring home lots of model revision language 7. Update your contracting and analysis skills 8. Network with other providers who are looking for similar solutions 9. Increase effectiveness at the negotiation table 10. Learn to initiate and manage amendments to bad contracts 11. Strengthen system and process improvement
Physician Practice Managers PT/OT/ Practice Managers Billers and Coding Staff Dental Practice Managers PHO Contract Negotiators Hospital-based Physician Managers Multispecialty Group Executives Physicians Dentists Orthotists /Prosthetists Consultants Investors
WORKSHOP LEADER AND AUTHOR
MARIA K TODD
Contracting strategy and organizational development (OD) for integrated health delivery systems has been a passion and a pursuit of our workshop leader since 1983. Maria Todd started her career in health administration in the multi-specialty group practice setting, and later designed and developed more than 150 IPAs, PHOs and MSOs during the Clinton Administration. In 1995, McGraw Hill and HFMA co-published her book, The Managed Care Contracting Handbook, and then in 1997, her book, title IPA, PHO, MSO Development Strategies was released. Both how-to books were written to help providers develop reimbursement strategies and design, plan and launch integrated health systems. Each sold more than 4000 copies. Considering there are about 7500 licensed hospitals in the USA, that number is considered a smashing success. In 2009, the sequel to ththe Contracting Handbook was updated and in 2012, her book, Physician Integration and Alignment: IPA, PHO, MSO ACOs and Beyond, was published by CRC | Productivity Press Both are once again, breaking industry sales records. She’s been analyzing and negotiating managed care contracts and practicing organizational development as a facilitator since the 1980s. In 2010, the US Patent and Trademark Office (USPTO) granted Maria Todd the registration of a new term of art, the Globally Integrated Health Delivery System® for her application of the integrated health system concept and operations to the medical tourism and health travel arena. She built the first and only globally integrated health delivery system which combined all the elements of ACO accountability, predictive modeling, case management, provider credentialing and privileging, quality, safety, clinical outcomes and patient satisfaction metrics, telehealth and telemedicine technology applications, electronic medical records, international cloud-based data and privacy security, and TPA operations for provider claims settlement and bill audit. To this, she added a fully-documented system to manage complex and specialized health travel logistics coordination to the mix. Maria has professional work experience as an HMO Provider Contracting Manager, IPA Executive Director, Health Law Paralegal and Mediator, OR Nurse, Multi-Specialty Practice Administrator, Hospital & Surgicenter Administrator, and Care Navigator. As a professional speaker and trainer for various event sponsors, conference organizers, and trade associations, she has presented more educational programs (>2700) in managed care and integrated health delivery systems development than any other presenter in the world. She is also the author of 14 commercially-published handbooks, including: • • • •
The Managed Care Contracting Handbook, 2nd edition Physician Integration & Alignment: IPA, PHO, MSO, ACOs & Beyond The Physician Employment Contract Handbook, 2nd edition IPA, PHO, MSO Development Strategies
Registration Fee:
$459 per person Discounts apply when two or more register together
TIMES: 9:00A - 4:30P CLASS SIZE MAXIMUM 25 Participants DISCOUNTS If your Company’s name is found in the Corporate Discounts section, or if you are a subsidiary of one of those companies, then you are entitled to a $40 discount per registration. You can also receive a discounted per person rate when you register multiple persons at the same time. Call 800-209-7263 for code. This discount cannot be combined with the Reserved Seat Program or In-House seminar offers. REGISTRATION INCLUDES • Course materials on USB • Refreshment Breaks • Lunch • Attendance Certificate
We accept: MC VI AX DS, Check by Mail
TO REGISTER BY PHONE CALL NOW!
800.209.7263
PLEASE NOTE: Registration closes 7 days prior to class or upon sellout - whichever occurs first. Waiting lists will be started in the event we have cancellations. Course location provided with registration confirmation