managed CARE

Better Contracts.

Maria Todd is the Most Trusted and Recognized Managed Care Contract Analyst and Negotiator in the USA

Author of:

  • 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”.  

meeting facilities in St George, Utah

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.

Self-study options

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.

Hands-On Experience

  • 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.

 
 

[siteorigin_widget class=”SiteOrigin_Widget_Image_Widget”]

“,”after_widget”:”<\/div>”,”before_title”:”

“,”after_title”:”<\/h3>”,”widget_id”:”widget-2-0-0″}}” />[/siteorigin_widget]

Contract Reviews

Find Loopholes and Risks

Learn how Maria Todd protects clients from managed care contract language oversights leveraging decades health law paralegal experience. Read More

[siteorigin_widget class=”SiteOrigin_Widget_Image_Widget”]

“,”after_widget”:”<\/div>”,”before_title”:”

“,”after_title”:”<\/h3>”,”widget_id”:”widget-2-1-0″}}” />[/siteorigin_widget]

Denied Claims Appeals

Get What You’re Owed

Learn more about how Maria Todd helps clients overturn complicated, wrongfully denied claims.Read More

[siteorigin_widget class=”SiteOrigin_Widget_Image_Widget”]

“,”after_widget”:”<\/div>”,”before_title”:”

“,”after_title”:”<\/h3>”,”widget_id”:”widget-2-2-0″}}” />[/siteorigin_widget]

Negotiation Stalemates

Rate Negotiations

Learn how Maria Todd can help you breakthrough payer negotiation stalemates and uncertainty. Read More

[siteorigin_widget class=”SiteOrigin_Widget_Image_Widget”]

“,”after_widget”:”<\/div>”,”before_title”:”

“,”after_title”:”<\/h3>”,”widget_id”:”widget-3-0-0″}}” />[/siteorigin_widget]

Dispute Resolution

Mediation & Arbitration

Maria Todd helps providers and their attorneys solve payer disputes leveraging 15+years as a mediator and expert witness. Read More

[siteorigin_widget class=”SiteOrigin_Widget_Image_Widget”]

“,”after_widget”:”<\/div>”,”before_title”:”

“,”after_title”:”<\/h3>”,”widget_id”:”widget-3-1-0″}}” />[/siteorigin_widget]

Bundled Pricing

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

[siteorigin_widget class=”SiteOrigin_Widget_Image_Widget”]

“,”after_widget”:”<\/div>”,”before_title”:”

“,”after_title”:”<\/h3>”,”widget_id”:”widget-3-2-0″}}” />[/siteorigin_widget]

Panel Lockouts

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

[siteorigin_widget class=”SiteOrigin_Widget_Image_Widget”]

“,”after_widget”:”<\/div>”,”before_title”:”

“,”after_title”:”<\/h3>”,”widget_id”:”widget-4-0-0″}}” />[/siteorigin_widget]

Managed Care Training

Training & Coaching

View 2018 Managed Care Training Courses

Learn about onsite training and Master Class workshops open to industry professionals offered by Maria Todd on a variety of complex managed care topics. Read More

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. 

image of maria todd with contact information

Learn more about working with Maria or inviting her to speak at your upcoming event.

[siteorigin_widget class=”SiteOrigin_Widget_Image_Widget”]

“,”after_widget”:”<\/div>”,”before_title”:”

“,”after_title”:”<\/h3>”,”widget_id”:”widget-4-1-0″}}” />[/siteorigin_widget]

Rush Reviews

Quick Reviews

Maria Todd can help you meet a negotiation deadline and complete a review if your contract analyst is unavailable. Read More

[siteorigin_widget class=”SiteOrigin_Widget_Image_Widget”]

“,”after_widget”:”<\/div>”,”before_title”:”

“,”after_title”:”<\/h3>”,”widget_id”:”widget-4-1-2″}}” />[/siteorigin_widget]

[siteorigin_widget class=”SiteOrigin_Widget_Image_Widget”]

“,”after_widget”:”<\/div>”,”before_title”:”

“,”after_title”:”<\/h3>”,”widget_id”:”widget-4-2-0″}}” />[/siteorigin_widget]

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

Read More on Managed Care Contract Analysis & Negotiation

Healthcare Providers Take Note: Self-insured employers’ 10 favorite buzzwords for 2018…  HOT!

5 Costly Sins of Failing to Maintain Managed Care Contracts Portfolio

How can hospitals cut costs and realize wider margins?

#ManagedCareContracting – Getting Paid for New Services, Technology, Drugs & Supplies

Verbs in Contracts: The Attack of the Silent Margin Killers

What’s UnitedHealthcare up to with this new hospital expense indemnity offer?

Challenging changes to the 340B program lie ahead for many U.S. healthcare providers – What to do now!

Trendspotting in Medical Tourism Supplier Contracting

Contracting for Bundled Case Rates: A Guide for Health Plans & Employers HOT!

Maintain compliance and safeguard assets when outsourcing managed care contract negotiations and contract reviews

Why You Shouldn’t Hire a Managed Care Consultant to Evaluate Contract Rates for Your Hospital or Clinic

U.S. Healthcare Providers Should Prepare for an Expansion of Medicare Advantage Plan Contract Offers in 2018

Strategy: Contracting with Union Health & Welfare Benefit Plans

Read More