Catalog Number : cca1748
Title : Managed Care Contracting Compliance
Speaker : Duane Abbey

Webplay Recording Date : 7-12-2011
Webplay Price : $ 200 for two weeks viewing

Target Audience:

• Patient Financial Services Personnel
• Managed Contract Specialists
• Chargemaster Coordinators
• Compliance Officers and Personnel
• All hospital personnel who need to have a better understanding of managed care contracts and association contractual compliance

Webinar Objectives:

• To recall the Managed Care Contracting Features
• To explain the Alternative Payment Arrangements
• To explain the Contractual Compliance versus Statutory Compliance
• To review the Contracting Process for Hospitals and Physicians in connection with the Managed Care Organizations
• To define the Contract Terms and Conditions for Compliance
• Obligations of the Hospital and/or Physicians
• Obligations of the Third-Party Payers
• To review  the typical contract provisions
• To discuss the evolving term and conditions
• To express the need to monitor Managed Care Payment Contracts
• To discuss the resolution of conflicts under Contractual Terms

A few of the Topics that will be covered:

• Overview of Health Care Payment Contracting
  • Terminology
  • Contract Negotiation Process
• Overview of Different Payment Systems
  • Fee-For-Service Arrangement
    • Prospective Payment Systems
    • Fee Schedules
    • Percentage-of-Charges
  • Capitated Models
  • Special Types of Payment Systems
    • Cost Based
    • Hybrid
• The Contracting Process
  • Typical Areas of Concern - Pre-Contract Questionnaire
  • Negotiating and Request For Changes
  • Obligations
  • References to Companion Manuals/Information
  • Modeling Financial Impact
• Monitoring Contract Adherence
  • Revenue Cycle Involvement
  • Addressing Unanticipated Issues
  • Addressing Reimbursement Issues
• Compliance Issues
  • Adherence to HIPAA Requirements
  • Other Rule, Regulations and Laws
  • Possible Legal Review and Assessment
  • Arbitration and Associated Legal Actions
• Filing Claims With No Contractual Relationship

Attendance Certificate:
Upon attending this course you will receive a 1.5 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.