Analyzing & Negotiating Managed Care Contracts

Learn How to Negotiate Managed Care Agreements With Confidence and Success

The only Master Class workshop of its kind, nationwide. Now in its 25th year! Over 60,000 participants have rated this course 5 stars on all metrics.

April & October Workshops SOLD OUT in 4 days!

We'll schedule two additional 2018 dates as soon as we receive availability confirmation from the venue.

ABOUT THIS MASTER CLASS WORKSHOP

  • Maintain your professional skills and stay ahead of changes in managed care and contracted reimbursement issues with in-depth and relevant education.
  • Learn from real-world examples, real contract language and bring home a hardbound textbook, software, and additional tools, tips and techniques.
  • Engage in meaningful peer-to-peer discussions and interaction in a small-group setting.
  • Learn from an award-winning, internationally recognized expert and the author of 18 textbooks on healthcare business topics, recognized for industry experience, depth of knowledge, and proven ability to engage participants.
  • Earn up to 21 CPEs and maintain your professional certification or licensure.

Analyzing and Negotiating Managed Care Contracts

Date & Time (Local)
April 17-20, 2018
SORRY SOLD OUT
TU-WE-TH: 8:30a - 3pm
FR: 8a-10:45a
October 16-19, 2018
SORRY SOLD OUT
TU-WE-TH: 8:30a - 3pm
FR: 8a-10:45a
Faculty

Maria K Todd MHA PhD, author of the Managed Care Contracting Handbook, 2nd edition, and 18 other internationally published healthcare business books, is an award winning trainer and international contracting expert. She will clearly explain the various kinds of contracts, reimbursement models, and the margin-eating perils and pitfalls most analysts overlook.

Location

St George, UT

This Master Class workshop is conducted at a 4-diamond resort spa in a spectacular, red-rock and dark sky resort destination featuring year-round warm weather and award-winning golf courses, located just 112 miles north of Las Vegas, and 1/4 mile from Snow Canyon State Park with trails, dunes and vermillion sandstone cliffs, black lava fields, slot canyons and petroglyphs, and proximity to Zion National Park.  Blended naturally into a landscape of vivid red rock cliffs and canyons of southern Utah, Red Mountain Resort has everything you need to relax, renew and rediscover your passion for learning. Canyon Breeze Restaurant features bountiful breakfasts and lunches (included in your registration) gourmet dinners and desserts and unique spirits in the elegant surrounding paradise.

Master Class Summary

Updated for 2018, this Master Class workshop covers an overview of 21 current and evolving MCOs, language analysis and identification of over 150 terms and phrases that increase risk through ambiguity, and how they apply and increase risk in "All-Payer" and "All Product" agreements. Also covers bundled pricing with hands-on exercises and teaches workshop participants how to develop and define bundled case rates and risk mitigation through clearly defined episodes of care, revenue management terms and KPIs help contract analysts push back on troublesome terms related to refunds, chart audits, payment audits, and fee schedule interpretations, complexities of physician reimbursement, capitation, and other issues related to physician contracting and hospital-based physician employment for those new to physician contracting. Physician integration and alignment is addressed for analysts contracting on behalf of IPAs, PHOs, ACOs and MSOs. A new section has been added this year on disintermediation (contracting directly with self-insured employers and labor unions rather than through HMOs and PPOs).

After This Seminar, You'll Be Able To:
  • Feel confident in your understanding of 21 different types of third-party contracted reimbursement arrangements, including how to handle reference based pricing requests
  • Feel more confident about your negotiation skills, tactics and strategies: what to ask for, how to ask for it, and how to leverage brand strength and differentiation
  • Review insurance, HMO, PPO, Medicare Advantage, Managed Medicaid, ERISA and Taft-Hartley plan contracts
  • Maximize reimbursement and minimize medical necessity denials and administrative hassle factors that erode margins
  • Review contracts faster and paperless through the use of the software application provided with course materials
  • Recognize problematic contract terms that impact reimbursement and operations and how to revise and push back with language alternatives from a contract snippet library provided with course materials
  • Reduce surprise one-off and continuous discount arrangements, Silent PPO exposures, plan bankruptcy clawbacks, and medical necessity denials
  • Negotiate capitation, per diem, shared risk, and percentage of charges rates, and adapt your contracted reimbursement strategies according to the offer on the table
Tools and Takeaways

Checklists of contracting and negotiation principles, hard cover textbook, software application that layers on top of MS-Word®, alternative contract language library, USB drive with supplemental reading materials, a sample managed care contract, and a sample direct contract for use in disintermediated negotiations directly with employers and labor unions.

Level:

Intermediate /Advanced; Specialized Knowledge & Applications

Class Delivery:

Live, Hands-on, Interactive, Role Play

Prerequisites:

General knowledge of healthcare reimbursement and contracting principles

Credits:

21 hours if you attend the entire program

 

What's Included

300-page Reference Book

This internationally-published reference book, is required reading at many U.S. and international health administration programs.  You will receive your own hardback copy, signed by the author. Retail value: $96.95

4GB USB Drive

Contains

  • All course slides in PowerPoint®
  • Model worksheets
  • Model checklists
  • Practice contract
  • Glossary
  • Bibliography
  • Supplemental reading materials 
  • Contract Snippets™ ebook - a menu of 70 alternative model language terms and phrases designed to protect your interests in red-line negotiations
  • Managed Care Contract Analyzer. v2.0 - a contract analysis software application (Retail Value $195) to help you use MS Word® to identify problematic contract terms and phrases that impact reimbursement and operations
  • Model contract template for use in negotiations with direct-with-employers arrangements and direct-with-labor union arrangements
Hotel and Resort Amenities
  • Discounted rates at the resort for deluxe king or double room accommodations located on 55 acres of black lava gardens and fragrant mesquite with stunning vistas of the surrounding mountains each with 42” flat-screen, high-definition televisions and complimentary Wi-Fi in rooms and throughout resort
  • Free bicycle check out to explore the area for an early morning ride or to unwind after sitting in class all day
  • Spiral labyrinth and walking trails
  • Complimentary access to indoor and outdoor pools, state-of-the-art Cybex Equipment and cardiovascular fitness center, three whirlpools, yoga sessions
  • Cocktail hour after class on the first day
  • Gourmet, healthful breakfast and lunch buffets and morning and afternoon refreshment breaks
  • Complimentary transportation to and from St George Airport
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