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Webinar – Introduction to Managed Care Contracting

November 26, 2018 @ 09:00 - 11:30 UTC-7

Free

In the USA, the world of contracted third-party reimbursement can be daunting

New analysts and negotiators, with well-developed experience analyzing commercial contracts are often overwhelmed by the nuances of managed care and contracted healthcare reimbursements. 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 Payers

Consider that more than 450 accredited insurers and about 210,000 self-funded health benefit plans each define benefits and coverage rules and conditions differently. In addition, there are 50 states and 5 territories, each with their own Medicaid programs. Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. But Medicaid is only one of several Government-run health programs in the USA. The others include:

  • Federal Employees Health Benefits Program
  • Indian Health Service
  • Medicaid / State Health Insurance Assistance Program (SHIP)
  • Medicare
  • Prescription Assistance (SPAP)
  • Military Health System / TRICARE
  • State Children’s Health Insurance Program (CHIP)
  • Program of All-Inclusive Care for the Elderly (PACE)
  • Veterans Health Administration

In addition to the Government administering their own programs, a number of states subcontract the responsibility to administer, pay for and deliver care through a subcontracted panel of vetted providers, organized by many of the same insurance companies and health plans that sell commercial plans. These subcontracted plans are paid by the state and federal government through a capitation (per-member-per month) funding rather than a cost reimbursement system. Therefore, the money is often a fixed amount based on the number of enrolled lives in each payer’s panel. Some of the capitation payment must be reserved to pay reinsurance premiums so that in the event of excess claims cost, the cost of care is covered by a secondary insurer.

To make matters even more confusing, provider organizations such as IPAs, PHOs, MSOs and ACOs are also significant stakeholders in the marketplace. Providers group up to gain leverage and efficiencies in negotiations with payers, and step into the the middle of contract negotiations in some parts of the country. Some require that the network members “delegate” contracting to the provider organization without first determining if the persons working for the provider organizations are competent and qualified to negotiate such complex agreements on behalf of the members of the provider organization. In many cases, they aren’t.

The Basic Concepts and Terminology

Once our presenter has laid the foundation of the payer landscape, she will continue the webinar using a scaffolded learning approach to build on the basic concepts and terminology of managed care and contracted third-party reimbursement. 90 minutes isn’t adequate to learn it all, but you’ll have an excellent start. Continue to learn through other live, interactive webinars we offer from time-to-time as our presenter’s time permits.

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

 


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Details

Date:
November 26, 2018
Time:
09:00 - 11:30 UTC-7
Cost:
Free
Event Category:
Event Tags:
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Organizer

Maria Todd
Phone:
8002097263

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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.