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WEBINAR 150 Problematic Terms in Managed Care Contracts

January 18, 2019 @ 09:00 - 11:30 UTC-7

Free

Most terms in managed care agreements are ambiguous and pose risks if you fail to clarify and analyze the cost of compliance or performance.

New analysts and negotiators, with well-developed experience analyzing commercial contracts are often caught off guard with the terms and phrases contained within most managed care payer contracts. There are no college level or vocational-technical school courses available to learn the art of analyzing and negotiating for contracted third-party reimbursement. Most of the training is gained by on-the-job experience and mentorship. But what if the incumbent left without passing on the institutional knowledge and job knowledge needed by the new hire? Or what if the provider business owner completed their clinical training with no contract analysis and negotiation course in the curriculum?

This course was created to begin to fill those gaps.

The Terms and Phrases

Over 150 terms and phrases have been identified by our presenter that give rise to risks, costs and jeopardy for breach of contract and financial loss. They aren’t full of legalese either. The ambiguity is in their lack of specificity. If you can’t financially model the performance requirement or risk, how can you know if you will be adequately compensated for your services?

Often, the payment for clinical services appears, on its face, to be potentially profitable. But when you add in the costs of doing business with the plan or the cost of collection activities to finalize payment, you quickly learn that not all contract terms and conditions are created equal. All too often, providers agree to reimbursement as a multiple of some other reference-based reimbursement such as Medicare. This can be financially risky if the contract is not identical in clinical and administrative performance requirements as the comparison plan.

To make matters even more confusing, phrases that relate to measurements or comparisons are impossible to measure and manage if you don’t know the basis of the measurement. These are words such as “adequate”, “timely”, “appropriate”, “material”, “sufficient”, “reasonable” and many others. Understand what to look for, the questions to ask, and how to decide if a change in the language should be negotiated or clarified.

Our Webinar Presenter

Photo of Maria K ToddDr. Maria Todd author of the Managed Care Contracting Handbook, second edition, leads this webinar that introduces the world of managed care contracting for new analysts, negotiators and revenue management staff.  Dr Todd has more than 35 years of experience working with managed care contracts as a provider analyst and advocate and also on the health plan side in provider contracting. She is trained as a health law paralegal and as a mediator of payer-provider disputes. She is a seasoned expert witness having testified in several contract disputes, and brings both clinical and medical group, hospital, ASC and imaging services administrator work experience gained through various roles in her work history. She has helped providers all across the nation to build and launch IPAs, PHOs, MSOs and ACOs. Currently, she assists more than 4000 clients on retainer nationwide, with outsourced contract analysis and negotiation.

Whether you own a small healthcare business (medical or dental practice, physical or occupational therapy, hospice, home health agency, behavioral or mental health practice, DME, orthotics and prosthetics, or work in a hospital or ambulatory surgery center, a reference laboratory, imaging center, or other provider organization) or have been transferred or promoted to the role of analyst or negotiator, or are a new hire, you will take home new insights, and leave with a new appreciation for the inherent risks in popular “all payer” contracts.

Run time: 90-minutes


Please note: When you register, you’ll be asked your name and email address so that we can send you an email confirmation for your registration.

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Details

Date:
January 18, 2019
Time:
09:00 - 11:30 UTC-7
Cost:
Free
Event Category:
Event Tags:
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Organizer

Mercury Advisory Group
Phone:
800 727 4160
Email:
rsvp@mercuryadvisorygroup.com
Website:
https://mercuryadvisorygroup.com

RSVP

Tickets are not available as this event has passed.

Corporate Travel Policy for Dr Maria Todd (effective 31 Aug 2018):

International: Flights in excess of 3 hours’ flying time shall be booked in business class. Short commuter flights (<2h) between key hub airports may be flown in economy seats.

Domestic: Flights in excess of 3 hour’s flying time shall be booked in first class. Short commuter flights (<2h) between key hub airports may be flown in economy seats.

Preferred Airlines: AA, QR, CX, JO, (OneWorld); UA, LH, SA, SQ, (Star Alliance);

Home Airport: SGU (St George, Utah, USA)

Booking Date Reservations: Dates will be confirmed upon receipt of 50% deposit of non-refundable professional speaker fees. In the event your event is cancelled or postponed, you may apply speaker fees deposited on account to another date subject to Dr. Todd’s availability, less a 40% administrative fee.  Please purchase changeable and/or refundable air tickets and hotel accommodation if there is any risk that your event will be cancelled or postponed.

Travel Expense Policy: All travel expenses (air, hotel, ground transfers, car rental, parking, hotel internet service fees, travel meals, visa fees, departure taxes, checked baggage fees, any required travel immunizations and travel/accident and flight cancellation insurance) and/or per diem allowances must be paid by event organizer, at the time of booking and in all cases, at least 30 days prior to departure. No exceptions.