Catalog Number : cbba1232
Title : Basic Managed Care Contracts
Speaker : Duane Abbey

Webplay Recording Date : 2-15-2008
Webplay Price : $ 225 for two weeks viewing

Webinar Presenter: Duane C. Abbey, Ph.D., CFP

Webinar Title: Basic Managed Care Contracts

Webinar Version: 3.0

Webinar Level: Basic

Webinar Overview - General

Gain the upper hand in managed care contracting!

Whether you are in the process of obtaining new payer contracts or simply fighting for better rates, you owe it to your organization to attend this Webinar. It will provide you with the knowledge and tools needed to promote your organization's distinctive value in an extremely competitive healthcare services and managed care market.

An increasing amount of health care in the United States is administered though managed care plans. The phrase "managed care" evokes strong, often negative reactions from health care providers. Yet it is important to have an explicit understanding of managed care and particular types of potential ethical dilemmas that arise for health care providers in such systems.

Managed care refers to a variety of techniques for influencing the clinical behavior of health care providers and/or patients, often by integrating the payment and delivery of health care. The overall aim of managed care is to place administrative control over cost of, quality of, or access to health care services in a specific population of covered enrollees.

Learning Objectives Include:

• Review Basic Terminology
• Understand The Alternative Payment Arrangements
  • Fee-For-Service Categories
  • Capitated Models
• Appreciate The Contracting Process For Hospitals and Physicians In Connection With Managed Care Organizations
• Basic Contract Terms
  • Obligations of the Hospital and/or Physicians
  • Obligation of the Third-Party Payer
• Review Typical Contract Provisions
• Understand the Need to Monitor Managed Care Payment Contracts
• Appreciate Compliance Issues Both Statutory and Contractual

The following are only a few of the topics to be discussed:

I. Overview of Health Care Payment Contracting
   a. Terminology
   b. Contract Negotiation Process
II. Overview of Different Payment Systems
   a. Fee-For-Service Arrangement
       i. Prospective Payment Systems
       ii. Fee Schedules
       iii. Percentage-of-Charges
   b. Capitated Models
   c. Special Types of Payment Systems
III. The Contracting Process
   a. Typical Areas of Concern - Pre-Contract Questionnaire
   b. Negotiating and Request For Changes
   c. Obligations
   d. References to Companion Manuals/Information
   e. Modeling Financial Impact
IV. Monitoring Contract Adherence
   a. Revenue Cycle Involvement
   b. Addressing Unanticipated Issues
   c. Addressing Reimbursement Issues
V. Compliance Issues
   a. Adherence to HIPAA Requirements
   b. Other Rule, Regulations and Laws
   c. Possible Legal Review
VI. Filing Claims With No Contractual Relationship

Prerequisites for Participating: Basic Healthcare Payment Systems or equivalent background and knowledge.

Suggested Attendees: All hospital personnel who need to have a better understanding of the health care payment process and the varied payment systems that are used.

Attendance Certificate: Upon attending this course you will receive a 2 Contact Hour Attendance Certificate. There is usually a reciprocal agreement between state associations to allow these to count for each state. If you have any questions, please ask your state association.

Full tuition is refunded immediately on request if the participant has not been sent the program materials and instructions. Once the instructions (including access codes) have been sent, a full refund will be issued only after the program runs and it is verified that the participant did not access the program.