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EXTENDED MASTER CLASS

Learn How to Negotiate Managed Care Agreements With Confidence and Success

The only Master Class workshop of its kind, nationwide. Now in its 25th year! Over 60,000 participants have rated this course 5 stars on all metrics.

• Maintain your professional skills and stay ahead of changes in managed care and contracted reimbursement issues with in-depth and relevant education.
• Learn from real-world examples, real contract language and bring home a hardbound textbook, software, and additional tools, tips and techniques.
• Engage in meaningful peer-to-peer discussions and interaction in a small-group setting.
• Learn from an award-winning, internationally recognized expert and the author of 18 textbooks on healthcare business topics, recognized for industry experience, depth of knowledge, and proven ability to engage participants.
• Earn up to 21 CPEs and maintain your professional certification or licensure.

Master Class Summary

This Master Class workshop begins with a brief review of the fundamentals of managed care contracting and quickly moves on to an overview of the 21 current and evolving third-party payer types in the USA.  Maria spends time on language analysis and identification of over 150 terms and phrases that increase risk through ambiguity, and how they apply and increase risk in “All-Payer” and “All Product” agreements. The workshop covers bundled charges with hands-on exercises teaches workshop participants how to develop and define bundled case rates and risk mitigation through clearly defined episodes of care.  A focus on revenue management terms and KPIs helps contract analyst push back on troublesome terms related to refunds, chart audits, payment audits, and fee schedule interpretations. Maria explains complicated aspects of physician reimbursement, capitation, and other issues related to physician contracting and hospital-based physician employment to help analysts new to physician reimbursement contracting. Physician integration and alignment is addressed for analysts contracting on behalf of IPAs, PHOs, ACOs and MSOs. A new section has been added this year on disintermediation (contracting directly with self-insured employers and labor unions rather than through HMOs and PPOs).

After This Seminar, You’ll Be Able To:

• Feel confident in your understanding of 21 different types of third-party contracted reimbursement arrangements
• Feel more confident about your negotiation skills, tactics and strategies: what to ask for, how to ask for it, and how to leverage brand strength and differentiation
• Review insurance, HMO, PPO, Medicare Advantage, Managed Medicaid, ERISA and Taft-Hartley plan contracts
• Maximize reimbursement and minimize medical necessity denials and administrative hassle factors that erode margins
• Review contracts faster and paperless through the use of the software application provided with course materials
• Recognize problematic contract terms that impact reimbursement and operations and how to revise and push back with language alternatives from a contract snippet library provided with course materials
• Reduce surprise one-off and continuous discount arrangements, Silent PPO exposures, plan bankruptcy clawbacks, and medical necessity denials
• Negotiate capitation, per diem, shared risk, and percentage of charges rates, and adapt your contracted reimbursement strategies according to the offer on the table

Tools and Takeaways

Checklists of contracting and negotiation principles, hard cover textbook, software application that layers on top of MS-Word®, alternative contract language library, USB drive with supplemental reading materials, a sample managed care contract, and a sample direct contract for use in disintermediated negotiations directly with employers and labor unions.

Level:

Intermediate /Advanced; Specialized Knowledge & Applications

Class Delivery:

Live, Hands-on, Interactive, Role Play

Prerequisites:

General knowledge of healthcare reimbursement and contracting principles

Credits:

21 hours if you attend the entire program

What’s Included:

The Managed Care Contracting Handbook – 300-page Reference Book

This internationally-published reference book, is required reading at many U.S. and international health administration programs.  You will receive your own hardback copy, signed by the author. Retail value: $96.95

4GB USB Drive

Contains

• All course slides in PowerPoint®
• Model worksheets
• Model checklists
• Practice contract
• Glossary
• Bibliography
• Supplemental reading materials
• Contract Snippets™ ebook – a menu of 70 alternative model language terms and phrases designed to protect your interests in red-line negotiations
• Managed Care Contract Analyzer. v2.0 – a contract analysis software application (Retail Value $195) to help you use MS Word® to identify problematic contract terms and phrases that impact reimbursement and operations
• Model contract template for use in negotiations with direct-with-employers arrangements and direct-with-labor union arrangements

Hotel and Resort Amenities

• Discounted rates at the resort for deluxe king or double room accommodations located on 55 acres of black lava gardens and fragrant mesquite with stunning vistas of the surrounding mountains each with 42” flat-screen, high-definition televisions and complimentary Wi-Fi in rooms and throughout resort
• Free bicycle check out to explore the area for an early morning ride or to unwind after sitting in class all day
• Spiral labyrinth and walking trails
• Complimentary access to indoor and outdoor pools, state-of-the-art Cybex Equipment and cardiovascular fitness center, three whirlpools, yoga sessions
• Cocktail hour after class on the first day
• Gourmet, healthful breakfast and lunch buffets and morning and afternoon refreshment breaks
• Complimentary transportation to and from St George Airport