Maria Todd is the Most Trusted and Recognized Managed Care Contract Analyst and Negotiator in the USA
- The Managed Care Contracting Handbook
- Physician Employment Contracts Handbook
- IPA, PHO, MSO Development Strategies
- Physician Integration and Alignment, IPA, PHO, MSO, ACOs and beyond
- Handbook of Concierge Medical Practice Design
- Handbook of Medical Tourism Program Development
Higher Rates. Fewer Hassles.
Maria Todd has been helping physicians, health facilities and ancillary providers to win better- paying, lower-hassle managed care contracts with insurances companies, HMOs, PPOs, employers, and TPAs since 1983.
How she can help you
Do-it-for-you contracting and negotiation: Maria brings the skills, tactics, and strategies needed to get you better paying contracts. For some clients, she’s hired to “handle it” from requesting new contracts through final execution and implementation. She charges an hourly fee for this service billed in 6-minute increments.
Prices, bundled case rates for surgery and diagnostic testing and price transparency. Come January 2020, hospitals must comply with new Executive Orders that require you to post your fees and contracted rates with health plans for public access and review. Will you be ready? Maria has assembled a rapid response team to help review all the contracts in your portfolio, tease out what needs to be published (and what doesn’t) and they can even build the web page with all the transparency information for you.
Cash pay pricing for self-pay patients. In the USA, insurance contracts and the games played with delayed and allegedly “lost” claims, and all the extra added labor can amount to as much as 28% of revenue to collect your money. Maria will help you design an end-to-end cash pay system for self-pay patients who agree to pay in full on the day of service. All she needs to get started is the project green light and a bit of cost data to get started. She can even arrange no-interest, non-recourse patient financing to help 97% of patients who apply the cash they need to take advantage of this option. And no, the managed care plans can’t demand you offer them these rates, or pay you less. This is a distinctly different “product” than what they buy. If they want the program, the negotiation is on your paper and your terms and conditions, not theirs. Turnkey setup includes pricing formulas, contract templates, program manual, financing, and more.
Add a domestic medical travel program. Patients shouldn’t have to leave the USA to find lower prices on the surgery or diagnostic testing services they want. But if they can’t find your program or it doesn’t yet exist, they may drive right past your front door as they head to the airport and pay 100% cash to a foreign healthcare provider at a price that may be higher than your price. They do this out of ignorance and because they didn’t know you had such an option available to them. Maria is the world’s leading expert and the most prolific internationally-published author on medical travel program development for facilities and medical groups.
Add an inbound international patient program. Many international patients elect to come to the USA from other countries to seek out surgery and confirmation consultations from U.S. specialists and researchers. High-ranking military, government and other prominent citizens often travel to the USA with everything paid for by their government public health insurance program if the services, quality, knowledge, or technology are not present or no trusted in their region. The average case expenditure in these cases is often between $240,000 and $260,000 per episode of care. Want some? Maria shows you how to structure the program or she’ll build it for you and then introduce you to the contracting connection so if your product measures up.
Coaching and Training: If you prefer to learn how to do these things on your own, Maria Todd provides the coaching, Master Classes, and multi-day workshops or group/departmental training to help your team improve and manage contracting internally going forward and lean on her for help when you hit a “bump”.
Maria Todd offers managed care contract analysis and negotiation training workshops in St George, Utah.
Call for details. (800) 727 4160.
- Training is conducted at her location or your location and charged on a flat fee basis per diem. Ongoing support is charged hourly in 6-minute increments. If she travels to your location, travel costs are included in her flat fee quote. If you travel to her location in St George, Utah, training venue costs and lunch for your group are included in the quote, but not air or hotel costs. She will arrange an exclusive discount for hotel stays and shuttle transfers.
If you’ll read the articles she’s published on this website and on LinkedIn, and apply the contracting principles she writes about in her textbooks and blog articles, you can increase your reimbursement by about 10–15% in the first year and another 5–10% the second year. If you attend her Master Class workshops, you’ll learn even more about how to pivot, change, and revise your payer contracting strategies by incorporating brand messaging into your mindset, skill set, and tool set. She welcomes all and encourages self study as much as possible so that you get more out of her training and advise when you call her.
- work experience as a practice administrator, hospital and ASC administrator;
- work experience as a director of contracting at a very large, national HMO;
- training and experience as a managed care dispute mediator and health law paralegal
- a successful track record overturning wrongful claim denials on high-dollar claims
- negotiating direct-with-employer surgical carve out contracts to help employers contain costs
- developing bundled case rates and negotiating surgical bundles with insurers and employers since 1995
- clients that include small solo practices all the way up to large integrated health systems including Cleveland Clinic, and everything in between
- developed more than 450 IPAs, PHOs, ACOs and MSOs since 1991
- transitioned more than 400 primary care and specialty practices to hybrid and cash only concierge membership and direct pay primary care practices (DPC), nationwide.
- former OR nurse, Maria uses her training and experience to power through the development of bundled price surgery case rates.
Maria Todd leverages her insider knowledge from working on the health plan side of provider contracting in the USA and abroad to make you invaluable to insurance plans.
Maria knows what health plans will pay extra for — and what they won’t. She’ll teach you how to differentiate your brand, articulate your unique brand strengths, and what to ask for during the negotiation phase. She’ll supply counter-negotiation options, language, terms and conditions to level the playing field or in some cases, depending on the market conditions, move the advantage to your practice, hospital or service. What’s more, if she believes you’ve already got the best deal, she will explain why and show you other ways you might maximize the contracts you have.
Find Loopholes and Risks
Learn how Maria Todd protects clients from managed care contract language oversights leveraging decades health law paralegal experience. Read More
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.Read More
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. Read More
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. Read More
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. Read More
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. Read More
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. Read More
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. Read More
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.