MANAGED CARE CONTRACT ANALYSIS AND NEGOTIATION
Maria Todd brings clinical, administrative, insurance contracting, health law paralegal and dispute mediation experience to help your practice or health facility with third party payer contracting and negotiation.
Since 1983, she's helped over 5000 clients in the USA and abroad with payer contract evaluations, negotiation strategy and stalemates and payer/provider disputes. The likelihood is high that she's already dealt with the problems you're facing and will have several workarounds with most of the third-party payers impacting your bottom line.
Call her today and get started on a solution. 800.727.4160
How Maria Can Help Medical and Dental Practices, Health Facility and other Ancillary Providers
Maria Todd specializes in training and coaching clinicians and hospital managers and executives on the skills, tactics, and strategies needed to negotiate better insurance reimbursement contracts. She does this by teaching them how to differentiate their brands, articulate their brand strength to insurance companies and present their outcomes data to insurers, employers and labor unions during pre-contract negotiations.
She provides a distinct blend of consulting services that combine decades of experience in healthcare marketing and third party reimbursement contract analysis and negotiations with work as a former surgical nurse, health law paralegal, mediator, and experience working on the health plan side as a director of provider contracting.
When readers apply the contracting principles she writes about in her textbooks and blog articles, they increase their reimbursement by about 10–15% in the first year and another 5–10% the second year. When they attend her Master Class workshops, they learn even more about how to pivot, change, and revise their payer contracting strategies by incorporating brand messaging into their mindsets, skill sets, and tool sets.
Find Loopholes and Risks
Learn how Maria Todd protects clients from managed care contract language oversights leveraging decades health law paralegal experience. Continue
Nobody likes being taken advantage of. Healthcare providers of all kinds take on professional liability risks at every patient encounter.
Mitigate the financial risks associated with overly-burdensome administrative requirements, record audits, capitation, shared financial risk and other loopholes in contracts that cause extra work, unfair claim denials, withholds and payment reductions and payment delays.
Denied Claims Appeals
Get What You're Owed
Learn more about how Maria Todd helps clients overturn complicated, wrongfully denied claims.Continue
You've done the work. You did your best for the patient. You were honest. Now that it's time to pay up you've been left out in the cold. Maria has discovered more than 340 reasons why payers try to deny payment unfairly.
If you have been denied payment on a covered service that you believe should have been paid, call Maria's office and set an appointment for a no-cost situation assessment to see if she can help.
Learn how Maria Todd can help you breakthrough payer negotiation stalemates and uncertainty. Continue
Do you need an outsider's perspective on the rates you are being offered for your services? Maria Todd will share insights and experiences from other markets and similar situations.
Often, the best approach is to have her coach you from the sidelines and help with alternative strategies to cope with lowball price offers, rate reductions, and rates that are inadequate to cover costs and margins. But Maria will also step into the negotiation as your advocate and deal directly with aggressive or stubborn negotiators.
Get started with a quick 15-minute call and put an end to your uncertainty.
Mediation & Arbitration
Maria Todd helps providers and their attorneys solve payer disputes leveraging 15+years as a mediator and expert witness. Continue
Does your contract prohibit litigation of troublesome payer/provider disputes? Before you sign your contracts, a conference call with Maria Todd will help you tighten up ambiguities in your agreement that could kill your chances of success in mediation and arbitration on a mere technicality you didn't know could be so critical.
If you are preparing to file a dispute resolution action, ask Maria Todd to pre-review your contract and your compliant to determine your likelihood of success. Perhaps there's another way to settle your third-party payer dispute without the costs and fees of arbitration.
Case Rate Pricing
Maria's extensive experience with decision support, contracting, and clinical experience in surgery helps providers develop bundled case rates for episodes of care. Her approach to value-based care benefits providers, consumers and payers. She has delivered impressive results for hospitals, surgeons, IPAs, PHOs and MSOs on bundled case pricing since the mid 1990s. Continue
Case rate pricing in healthcare reimbursement contracts is risky business. So often, the payer brings offers that are incomplete, or are intentionally worded so vaguely and ambiguously that the provider gets taken advantage of.
Maria's been successfully negotiating fully-inclusive case rates since 1995. Ask Maria Todd to help you respond to these offers with alternative, well-developed, fully loaded, cost-based case rates. She'll show you how to avoid unlimited inclusions and risk exposures by better defining the beginning and ending of an episode of care and contingencies for untoward surgical events.
Lockouts and Terminations
Ask Maria Todd to help you find an alternative approach if you've been locked out of a contract or terminated for no cause. Continue
The trend towards narrow networks are giving rise to provider lockouts and terminations like never before. Providers in good standing for 10 years with no complaints and excellent outcomes are being terminated or locked out of new opportunities to compete or sustain their position on provider panels.
Ask Maria Todd to help determine if there's a way in to new contracts or a way to salvage an existing contract for which a termination letter has been received.
Managed Care Training
Training & Coaching
Maria Todd has been teaching managed care contracting classes for HFMA, MGMA, AICPA, and hundreds of professional development associations since 1989. Now she offers Master Classes, seminars, and webinars on her own.
Classes are offered in St George Utah (112 miles north of Las Vegas), or she can bring the training to your location and lead a custom-tailored, interactive private workshop using your actual contracts as class examples.
Review her onsite training fees and FAQs or call her to learn more and discuss your training needs.
Maria Offers a Complimentary 15-minute Introductory Call
Call or email Maria to schedule a brief discussion so you can explain your concern or situation and see if she can help.
Maria Todd can help you meet a negotiation deadline and complete a review if your contract analyst is unavailable. Continue
Payer market entrances and exits, consolidations, mergers and acquisitions often mean that a healthcare provider will face short deadlines and the risk of being taken advantage of. Maybe your contract analyst just left for a new opportunity or for maternity leave or a serious illness.
Maria will handle the contract language analysis and provide an annotated review and recommended language changes while someone on your staff handles the rate analysis. Often, a contract can be returned to you with annotations and recommendations in about 3 business days.
Employer Direct Contracting
Were You Aware...
Maria Todd can help you negotiate with self-funded employers, healthcare purchasing coalitions, association plans and labor unions. Continue
Self-funded employers and trade and labor unions account for 70% of the non-Medicare/non-Medicaid, third party payers. They contract for PPO “discounts” nationwide but on average, are paying roughly 2.6 times greater than what Medicare pays. Are you getting 2.6 times Medicare for your PPO reimbursements? While some pay less than Medicare and most pay far more, it varies by geography. It helps to know who pays what, to whom and where. That's part of the insight Maria brings to hospitals, ASCs, physician groups, and integrated health delivery systems. This is a compelling argument for building a direct contracting strategy directly with the employer than through a TPA or PPO. You save them significant cash each month and still make more than through the PPO.
PPO networks charge access fees, a fixed cost of a group health plan, of $12-$20 pe/pm. On top of that they pay for claim repricing and claim processing to the TPA that ranges $2-3 per claim, and then an hourly rate for case management, disease management that is in the $125-$200 per hour range. Most hospital PHOs, MSOs, and IPAs, or ACOs, and Integrated health delivery systems can easily charge their discounted fees for service and bundled case rates coupled with a lower admin fee PE/PM than the PPO and save most self-funded groups a ton of cash!
AskMariaTodd to supply the plan administrator contact details for over 210,000 self funded employers and labor union health benefit plans, a fair and uncomplicated model contract template, and walk you through the process of contracting directly with employers and labor unions. After 2-3 of these deals, you'll feel confident and have a portfolio of referenceable accounts that you can use to continue without her help.