Managed Care Contracting
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Managed Care Contracting
Improve Your Contracting Techniques with these practical tools tips and techniques from Maria Todd
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Direct Contracting Between Hospitals & Employers

Direct Contracting Between Hospitals & Employers | Managed Care Contracting | Scoop.it

Don't miss this class!

 

Direct Contracting Between Hospitals & Employers - 08 Mar 2012, 09:00 AM, The Pinnacle Club by Grand Hyatt Denver Downtown - Denver, CO

 

Spend a day with Maria Todd, America's leading managed care trainer as she shares amazing tools, tips and techniques, contract templates  and covers material that NOBODY else in the country teaches! 

 

Here's what you'll learn:

 

--Build Relationship, Loyalty, and Community Partnership through Value-based Health Purchasing and affiliate steerage

 

--Build loyalty and steerage in order to successfully maximize reimbursements and minimize denials.

 

--Eliminate red tape typically encountered with PPOs and TPAs by contracting directly with self-funded payors

 

--Review a model contract template line-by-line designed specifically for use in direct-to-employer contracts

 

--Take home tools to help with registration, case rate modeling, business development and custom product design strategy

 

--Help employers build cost avoidance and predictability with wellness programs and well-defined case rates

 

--Find new ways to maximize revenues from case management, cost containment, and ancillary services excess capacity

 

--Build programs custom designed for their HSA, HRA, workers compensation, executive health, retiree, and major medical programs

 

--Use a list included in course materials to find individuals and employers operating in your market who are likely to switch to your services as well as the information you need to create tailored, winning proposals (You can buy this elsewhere for $1695!)

 

--Come away with new techniques to handle contract negotiations without overlooking vital details

 

--Grab new market share with a health travel product to capture high-dollar cases from their worksites in other states

 

--Appreciate how healthcare reform may affect all of this going forward

 

--Integrate Pay-for-Performance (P4P)  and HCHAPS bonuses into this non-Medicare revenue strategy

 

--Draw in market share from other regions through domestic medical tourism steerage from contracted employers

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Know how to "push buttons" to get ERISA plans to pay claims

Know how to "push buttons" to get ERISA plans to pay claims | Managed Care Contracting | Scoop.it
For over 30 years, I've built a fabulous career in healthcare consulting and training on managed care contracting, denials and appeals, and revenue cycle improvement. I've helped tens of thousands of healthcare businesses get the money they are owed, and the rates they've negotiated.The most daunting aspect of negotiating all products payer contracts and getting paid has had to be the complexities of ERISA. What is most frustrating to me is how frare it is to find people in the business of healthcare whose job it is to negotiate payer contracts and bring in cash who know enough about ERISA, w
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California Medicaid Acquisition a Sign of the Times, as Managed Care Goes ... - AJMC.com Managed Markets Network

California Medicaid Acquisition a Sign of the Times, as Managed Care Goes ... - AJMC.com Managed Markets Network | Managed Care Contracting | Scoop.it
Blue Shield of California seeks regulatory approval to buy Care1st, which would give the larger insurer a rapidly growing Medicaid plan.
Maria K Todd, MHA PhD's insight:

This deal will make things even more confising for patients and providers when a MediCal patient tells the provider, "I don't have MediCal, I have Blue Shield." It will also create havoc in the revenue cycle if Blue Shield discount start getting applied to MediCal claims in the payment posting process.

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California managed-care pilot program meets resistance - Washington Post

California managed-care pilot program meets resistance - Washington Post | Managed Care Contracting | Scoop.it
Many are confused by attempt to move dual Medicare-Medicaid recipients to new coverage.
Maria K Todd, MHA PhD's insight:

The patients aren't the only ones who are confused. The providers are at a tremendous disadvantage because they are overwhelmed by the volumes of patients, the exodus of many PCPs leaving for concierge medicine, and no time to study these deals before being pressured to sign them.

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New Managed Care Plan Announced for 22 NY Counties - WXXI News

New Managed Care Plan Announced for 22 NY Counties - WXXI News | Managed Care Contracting | Scoop.it
New York Medicaid users with chronic illnesses and disabilities will now have an option for tailored health services that makes it easier to live at home,
Maria K Todd, MHA PhD's insight:

this should be an interesting mini reform for New York.

 

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AskMariaTodd - A Checklist for Physician Integration Projects - Start up

AskMariaTodd - A Checklist for Physician Integration Projects - Start up | Managed Care Contracting | Scoop.it

Here's a tool you can use before you call us to help you build your new IPA, PHO, MSO or ACO. It's written by Maria Todd, the developer of over 300 integrated health delivery groups and author of 2 "how to" books on the subject.

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Negotiating Better Managed Care Reimbursement for Physicians

Managed Care Expert Maria K Todd, author of the Managed Care Contracting Handbook, explains what physicians can do to improve their managed care reimbursement in this short webcast

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PPO Contracting Strategy for Healthcare Providers - Timely Filing Deadline Terms

PPO Contracting Strategy for Healthcare Providers - Timely Filing Deadline Terms | Managed Care Contracting | Scoop.it

I just had my research team complete an assignment that was very revealing about contacting strategies and making use of leverage.

 

A look at the statistics of 2011 contract year PPO terms in our subscriber database from about 4400 acute care hospitals in the nation, (n=4380 unique hospitals) I have to assume that negotiators simply weren't aware of their options or else chose not to exercise them, for some unknown reason.

 

Our database includes terms from hospitals who have subscribed to AskMariaTodd's Managed Care Advice Line™. When a hospital or healthcare provider subscribes, their contracts are loaded into a database to help us answer questions in context in a timely fashion. It also enables us to track and trend 45 unique revenue cycle elements and track and trend payer language across the nation. Rates are NEVER part of the database.

 

While it is pretty easy to negotiate terms that state that the provider may take up to 365 days to submit a clean claim to avoid any timely filing penalties, only 25% of hospitals negotiated "any" terms for that negotiation option. The majority asked for 90 days, max. The mode was "silent" (75%); the median was 90 days, and the range was 30 to 1095 days.

 

Also equally easy, many hospitals failed to negotiate terms that state for the record that when the payer is in secondary position, that the calendar starts when the primary payment is received. Only 2.5% of hospitals bothered to include that term. The consequences could be that the payer denies, penalizes or otherwise reduces the amount owed by some amount - not stated in the contract, because you failed to state the understanding (meeting of the minds) between the parties.  That omission can lead to disputes that may have to go through costly arbitration - with no guarantee of success.

 

Over the coming weeks, we'll be releasing trends and strategies on the research findings for 45 different contract provisions all of which significantly affect the revenue cycle and reimbursement levels.

_____________________________

AskMariaTodd™ offers an annual Managed Care Advice Line™ subscription. The Advice Line subscription rate for 2012 is $1500 for the entire year and allows subscribers to receive up to 5 hours of telephone or email support on contracting issues, suggested and trended language revisions, and negotiation coaching throughout the year. Also included are 3 fee-waived passes for educational webinars that can be used to train staff allowing unlimited listeners (per subscribed hospital).

 

If your hospital or medical group would like to subscribe to AskMariaTodd's Managed Care Advice Line™, please call our customer service department at 800-209-7263. Subscribers who purchase a 2012 subscription before December 1, 2011 will receive the remainder of 2011 at no additional charge.

 

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Managed Care Staff Education

Managed Care Staff Education | Managed Care Contracting | Scoop.it

 Check out Upcoming Training Courses with Maria K Todd, MHA PhD http://t.co/6EEfhAVI...

 

Send your staff for training on contract analysis and negotiation... or compete with those that did!

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Managed Care Negotiators: Isn't it Time You Mastered ERISA?

Managed Care Negotiators: Isn't it Time You Mastered ERISA? | Managed Care Contracting | Scoop.it
Just because a health benefit identification card has a Cigna, BCBS, Aetna or United logo on it, it doesn't mean that the cardholder has "insurance". The majority of cardholders and plan subscribers can have benefits that differ and covered services that are nothing like the others under an "all products" contract.Approximately, 134 million Americans are covered by ERISA regulated medical, surgical, hospital and other health care benefits, of which approximately 70% are covered by about 210,000 employer self-funded health benefit plans.Every month, I receive personal calls
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Apply a Rottweiler's tenacity when fighting ERISA denials

Apply a Rottweiler's tenacity when fighting ERISA denials | Managed Care Contracting | Scoop.it
Part of the frustration for clinics, medical suppliers and health facilities when dealing with Medicare and Managed Care is that they treat the reasons for claims denials as if it is some big proprietary secret.Most PPO plans are actually 30% commercial insurers and about 70% Self-funded health benefit plans operated under ERISA rules. They don't get the luxury of this ambiguity and mystery, but you must know what leverage you can apply, when and how. In this article, I share a few tips on that from my professional arsenal and experience.I have more success in fighting ERISA denials than most
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Power Negotiation Tips from 3 Famous Business Leaders

Power Negotiation Tips from 3 Famous Business Leaders | Managed Care Contracting | Scoop.it
Negotiation is a core aspect in leadership and business. It is both a skill and an art that when mastered can help to competitively position you and bring success to your business.
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Why are So Few Low-Income Seniors Enrolling in Managed Care Plans? - Forbes

Why are So Few Low-Income Seniors Enrolling in Managed Care Plans? - Forbes | Managed Care Contracting | Scoop.it
What if they gave a managed care plan and nobody came?
Maria K Todd, MHA PhD's insight:

Isn't that what is already happening?

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Value-based Purchasing: Highlights for Hospitals

Maria Todd explains the hospital issues related to Value-based Purchasing incentives & penalties under PPACA.
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IPAs or PHOs: Critical Comparison and Contrast

IPAs or PHOs: Critical Comparison and Contrast | Managed Care Contracting | Scoop.it

a White Paper by leading healthcare industry consultant, speaker and author, Maria K Todd, MHA PhD

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Managed Care Contracting for New Negotiators With Maria Todd

Managed Care Contracting for New Negotiators With Maria Todd | Managed Care Contracting | Scoop.it

Register Today! Only 15 seats remain.

 

Managed Care Contracting for New Negotiators - 18 Apr 2012, 09:00 AM, The Pinnacle Club by Grand Hyatt Denver Downtown - Denver, CO

 

Take this three day learining intensive class with Maria Todd, America's leading trainer for managed care contracting and negotiation in a relaxed learning environment. Come in jeans and your favorite sweater, and prepare to roll up your sleeves and dive into the learning with others who are new to contract analysis and negotiation.

 

Learn an easy and effective step-by-step method to perform a thorough analysis of the contract language and reimbursement offers

 

Come away with new techniques to speed up the contracting process without overlooking vital details

 

Bring home tools, tips and resources that the whole department can use - reinforce your learning by training your colleagues

 

Apply your other business skills and education to this new complex managed care and contracted reimbursement system

 

Appreciate how healthcare reform may affect all of this going forward

 

Role Play with the Instructor and Classmates

 

Go through a contract in class using the skills, tools and techniques learned earlier in class

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Knowledge to Negotiate: Subsidiaries and Affiliates

Knowledge to Negotiate: Subsidiaries and Affiliates http://t.co/EgvsUAgB #negotiation...
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Transform Your Organization into Industry Trailblazers

Transform Your Organization into Industry Trailblazers | Managed Care Contracting | Scoop.it

Healthcare providers worldwide must embrace innovation, experimentation and learn how to carry out thorough analysis to develop significant solutions to the challenges presented under U.S. healthcare reform.

 

A simple Visual Basic tool from AskMariaTodd [ContractAnalyzer v2.0 ($149)] can be used to spot more than 170 troublesome words and phrases in a managed care agreement in a matter of seconds.  (MS Word Compatible)

 

More than 3000 organizations are using this tool already. To purchase your copy or learn more about it, please call 800-209-7263

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