Analyzing & Negotiating Managed Care Contracts

The Nation's Only Master Class for Healthcare Providers:
Beginner to Advanced

In this complete masterclass course Students learn how to analyze and negotiate managed care and PPO agreements , raise rates, reduce administrative costs and hassle factors, and lower their risk for denied and late paid claims.

4.95/5

4.95 (39,567 ratings)

46,000+ students enrolled since 1983

Learn How

TO analyze and NEGOTIATE contract language and rates and avoid costly loopholes that arise from oversights and misassumptions

35+ Years

Providing the award winning training courses to over 70,000 Students in the USA & 117 countries

Master Classes with Maria Todd

No other class in the country offers this training.

Updated for 2020, 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.

Maria Todd explains how to develop accurate and transparent bundled pricing. Students practice new skills using hands-on exercises and learn how to develop and define bundled case rates while mitigating financial risk exposures through clearly defined episodes of care. Revenue management tactics and strategies are executed, administrated and managed with clearer terms and measured by KPIs. Maria teaches contract analysts how to tactfully and effectively 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, hospital and ancillary contracting.

Physician integration and alignment, antitrust, antikickback, and other compliance regulations are 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).

Maria Todd eliminates much of the guess work that drives up risk and builds a pathway to prepare and manage risk contracts as part of the change from Fee for Service to Value-based Medicine.

She is available to bring this program to state and regional hospital associations and medical societies or individual medical groups and health systems.

Analyzing and Negotiating Managed Care Agreements® is a powerful, two-day, interactive workshop with the doyenne of managed care contracting. Maria Todd.

Most of her alumnae agree that they knew what they wanted to achieve, but they weren’t sure how to go about getting it.

Managed care payer negotiation is not linear. Payers view the value of a healthcare provider differently than the healthcare provider sees itself. They also push claims cost risks to anyone gullible enough to take it. No matter how diligently you prepare – you will always encounter surprises. Some surprises infuriate you, some frustrate you, and others change your perspective.

LEVELIntermediate /Advanced; Specialized Knowledge & Applications
Class Delivery: Live, Hands-on, Interactive, Role Play
Prerequisites: General knowledge of healthcare reimbursement and contracting principles
CONTACT HOURS: 14 hours, if you attend the entire program

3 Focus Areas

21 Types of Payer Contracts in the marketplace

Trends, examples, lessons learned

Reading the contract to analyze & identify Traps & Loopholes

Locate and neutralize potential financial risk land mines

Learning what to ask, how to ask, and how to interpret the answers you get

Locate and neutralize potential financial risk land mines

Prepare to enter negotiations with confidence and competence

Who Should Attend?

Relative novices and those with lots of experience will benefit from the workshop and will give you a fresh and practical slant that will push you to rethink your habits and assumptions about Payer contract analysis.

Key Takeaways

  1. Feel confident in your understanding of 21 different types of third-party contracted reimbursement arrangements, including how to handle reference based pricing requests
  2. 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
  3. Review insurance, HMO, PPO, Medicare Advantage, Managed Medicaid, ERISA and Taft-Hartley plan contracts
  4. Maximize reimbursement and minimize medical necessity denials and administrative hassle factors that erode margins
  5. Review contracts faster and paperless through the use of the software application provided with course materials
  6. 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
  7. Reduce surprise one-off and continuous discount arrangements, Silent PPO exposures, plan bankruptcy clawbacks, and medical necessity denials
  8. Negotiate capitation, per diem, shared risk, and percentage of charges rates, and adapt your contracted reimbursement strategies according to the offer on the table

Valuable Tools You’ll Bring Back from Class

  1. Checklists of contracting and negotiation principles
  2. Software application that layers on top of MS-Word®
  3. Alternative contract language library
  4. USB drive with supplemental reading materials,
  5. A sample managed care contract, and
  6. A sample direct contract for use in disintermediated negotiations directly with employers and labor unions.

Registration Fee Includes

• 14 hours live, interactive Master Class instruction
• Multiple checklists and templates
• Course slides and materials on USB
• Software application to speed up contract review
• Certificate of Completion

Dress Code

Resort Casual

What to bring to class

Laptop to use your USB class materials (Power outlets will be available.)

Contract analysis requires super-sharpened skills that many people lack. Actually, there are very few places to learn the tactics and strategies to analyze and negotiate shared risk contracts. The stakes are too great to proceed without training. You could use a checklist, but you often, people only use the checklist for what is printed on the paper and completely overlook what is missing that should be included. You have to know what is missing, how critical it is, why it should be there, and what it should say. And that’s exactly what Maria Todd teaches in this Master Class on Analyzing and Negotiating Managed Care Agreements®.

Once you learn HOW to analyze a third-party payor contract, perils and pitfalls you didn’t see before will almost glow from the paper. Your critical thinking skills will improve and you’ll be less likely to overlook a detail that could cost you millions in lost revenues.

Purchase Your Tickets Now

Registration is limited to 50 Students per Master Class

2020 Class Dates

  • March 18-19, 2020  – St George, UT
  • June 10-11, 2020 – St George UT

$795

Save $50 when you register additional employees from the same organization. 

This class is not available for remote participation. You must be present for the live interaction and hands-on learning.  

Need training for the entire department? No problem!

Maria will bring a customized class to your organization for an affordable flat fee including travel costs. To learn more, please call (800) 727 4160.

Follow Maria Todd online

Maria writes articles on managed care and shared risk contracting on Facebook, LinkedIn and on this website