Many healthcare providers in the USA have been burned by poorly written, poorly negotiated managed care contracts, nonspecific case rates, inadequate training or experience, and a lack of information about costs and the clinical knowledge of the cases.As a former surgical nurse and managed care contracting expert, I guess I've taken for granted the...
Can a Contract Be Assumed Even If You Chose Not to Participate?
Remember the phrase “No good deed goes unpunished”? Take heed and avoid this nasty situation by being meticulous with your managed care negotiation communications. When I assist in the negotiation of a contract together with a client, clients at first describe me as “obsessive” about avoiding oral negotiation communications on clarifications, changes, and acting...
Are Payer Driven ACOs a Deal with the Devil?
Almost all big box health plans are building their own brand of ACO with regional health systems and affiliated physician groups. “ You generally hear that what a man doesn’t know doesn’t hurt him, but in business what a man doesn’t know does hurt. ” — E.S. Lewis As experienced full-time health industry consultants, we build...