Learn How to Negotiate Managed Care Agreements With Confidence and Success
The only Master Class workshop of its kind, nationwide. Now in its 26th year! Over 70,000 participants have rated this course 5 stars on all metrics.
This Class is offered in St George, Utah at the 5-Diamond Inn at Entrada at Snow Canyon.
Make your hotel reservations and prepay through our office to save 20% on hotel advertised rates.
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.
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.
Intermediate /Advanced; Specialized Knowledge & Applications
Live, Hands-on, Interactive, Role Play
General knowledge of healthcare reimbursement and contracting principles
21 hours if you attend the entire program
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
- All course slides in PowerPoint®
- Model worksheets
- Model checklists
- Practice contract
- Supplemental reading materials
- 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
Hotel and Resort Amenities
- Continental Breakfast
- Lunch each day
- Free WiFi in your room
- Access to the fitness center, pool, pickleball, tennis, golf and spa