Payer Contracting & Negotiation

SINCE 1983, MARIA TODD HAS REVIEWED & NEGOTIATED OVER 15,000 PAYER CONTRACTS

[RIGHT]  THE #1 BOOK IN THE INDUSTRY.  Managed Care Contracting Handbook , 2nd edition written by Maria Todd is like no other book on the market. It was originally designed as self-help training book to help clients navigate the complexities of managed care contracting with insurers and employers. and derive the greatest value from time spent with Maria during one-on-one consulting. It is now available for purchase at all major retail and online booksellers.

Managed Care Contracting Handbook , 2nd edition written by Maria Todd is like no other book on the market. It was originally designed as self-help training book to help clients navigate the complexities of managed care contracting with insurers and employers. and derive the greatest value from time spent with Maria during one-on-one consulting. It is now available for purchase at all major retail and online booksellers.  Denver-based consultant, award-winning speaker, trainer and author, Maria Todd, brings you her best insights and strategies from working on various healthcare, health tourism and international development projects in the USA, Europe, Asia, Latin America and Central America for over 30 years.

As part of her professional work as a consultant, speaker and author, Maria Todd reviews and advises clients on 3rd party payor agreements in more than 115 countries. She provides training and coaching on what to look for, how to decide if the offer is acceptable, and how to perform due diligence on the health insurer or employer-sponsored health benefit program. 

In most instances, authors send book proposal after book proposal only to receive letters indicating no interest in the title or topic.  Maria is the only author in the industry where the international publishers approached to her to write the book for the international audience.  While primarily focused on US healthcare systems and contracting nuance, the book is helpful for any hospital, physician, clinic, ambulatory surgery center or integrated health delivery system, in the USA or abroad.  The chapters in the book cover information about best practices and how to avoid the perils and pitfalls of contracts with health insurers, employers, PPOs, and healthcare buying groups.

 

TRAINING SEMINARS

Maria Todd offers Master Classes and Workshops

Learn payor contract analysis and negotiation from Maria Todd.

Maria Todd frequently presents workshops, Master Classes, webinars and seminars for hospitals, clinics, trade associations, professional societies and also gives guest lectures at medical staff meetings and university programs.  In addition, she often conducts focused, custom training programs onsite for clients including the Cleveland Clinic, Bangkok Dusit Medical Services, the Korean Health Industry Development Group, The Monterrey Health Tourism Cluster, The Republic of South Africa, Opus Dei Health Systems, Adventist Health, Trinity Health (formerly Catholic Healthcare East), Order of St Francis, Gundersen Health, Spectrum Health, Marshfield Clinic, Pediatrix®, Glaxo, Bristol Myers Squibb, Allergan, the Veterans Administration, KCI, Hill Rom, and hundreds of other leading brands in the healthcare industry.

For more than 15 years, she presented her signature two-day workshops for the Healthcare Financial Management Association 4-6 times per year, and was responsible for 5 Yerger Awards for educational programming as program co-chair at the Nevada and Colorado chapters.  She was also designated as a Distinguished Speaker at the HFMA Annual National Institute for five different years. This designation is awarded to speakers who receive high first quartile ratings from the audience on every metric in post program evaluations.  She has received other recognition from IBN Seminars in Malaysia, and from The Turkish Health Tourism Association for her educational programs on third-party payer relations, marketing, business development, branding, contract negotiation and health tourism.

 

PRIVATE, ONE-ON-ONE COACHING

 

Are you a hospital or clinic CFO, healthcare practitioner in private practice or an ancillary healthcare provider or supplier?  Maria Todd subcontracts with providers to analyze and annotate problems and risks for loss in managed care and other contracts and then schedule an on-screen, web conference to go over her findings, recommendations and insights with you.  Private managed care coaching sessions generally run 90-minutes in duration at a cost of $675, plus the hourly fee for the time she spends reviewing the contract offer together with relevant Attachments and Exhibits for you.  She will review the entire contract or will only focus on a specific area of concern.  Many clients also use private one-on-one coaching to plan their contract portfolio strategy, business rules, leverage and positioning reviews, renewal strategies, or to huddle between negotiation meetings. 

 

INTERIM DIRECTOR OF MANAGED CARE

Are you temporarily operating without a Director of Managed Care? Maria can relieve the pressure and clear backlogs.

When time permits, Maria Todd contracts with healthcare organizations to take responsibility for developing and executing payer strategy, contract negotiations, contract performance and administration for hospitals, medical groups and health systems.

Maria Todd has worked for hospitals, health systems, clinics, pharma imaging and other healthcare provider organizations, but also has health law paralegal, and health plan (HMO, PPO, and ASO) provider contracting experience. Her mastery in contracting with self-funded health benefit plans and union programs under ERISA and Taft Hartley Plans is unparalleled in the USA. In addition, she has excellent mastery of third-party liability, motor vehicle accident, Medicare Advantage, Managed Medicaid and workers compensation payor contracting. Maria has an excellent track record winning appeals for wrongfully denied claims for both contracted and non-contracted business, and for managing inappropriate requests for refunds and foreclosing offsets.  She also brings more than 15 years of experience as a successful mediator of payor-provider disputes and claim audits and reviews. Maria is also extremely effective at Silent PPO audit and short-paid claims recovery.

 

CONTRACT ANALYSIS & NEGOTIATION
APPEALS OF WRONGFULLY DENIED PAYMENTS
CHALLENGING PAYMENT REFUNDS & OFFSETS
MVA, WORKERS' COMP & THIRD-PARTY LIABILiTY
CAPITATION & SHARED RISK CONTRACTING
SILENT PPO AUDITS & RECOVERY

Clients appreciate the fact that Maria can immediately step into the role and help with their toughest managed care and revenue management staffing challenges.

She can instantly step in to assist with contracting for value-based arrangements, shared risk, capitation, building and shared savings arrangements, subrogation, in addition to per diem and discounted fee-for-service contracts. She is also well-versed and capable of stepping into a role in an integrated health delivery system in an IPA, PHO, MSO, or ACO setting, and can drive results for integrated care and payment models that align financial incentives to support quality outcomes, patient/ member satisfaction and cost effective care delivery.  Maria Todd has been developing and negotiating successful and profitable bundled case rates for inpatient and outpatient surgery cases since 1995. She has more than 20 years of experience with capitation and risk contracting for PCP and specialty physicians, private medical groups, faculty practice groups, hospital-based physicians, lab, imaging, pharma and health facilities.

Take time to find the right candidate for your organization while Maria maintains order and manages your managed care portfolio. Then, once you've short listed potential candidates, Maria will help you vet their competency, and then help onboard the new hire and get them up to speed. She will remain on standby for the first few months to ensure continuity and consistency with strategy and brand standards.

All that is needed for Maria to begin working is an executed retainer agreement and scope of work, a telephone extension at your organization, and terminal emulation access for remote access to your contract files for the contracts she'll be working on.  When necessary, she will travel to your location to participate in Payer Negotiations and Joint Operating Committee meetings, and can participate in person or remotely in department meetings, Trustee and Board Meetings, vendor meetings when you are contemplating purchases and leases of new technology that must be added to existing contracts and executive briefings and staff training and development events.

Please Note: Maria Todd is neither available nor interested in hiring on as your full-time Managed Care Executive.  Recruiters should not contact her for available positions.

 

Maria K Todd, MHA PhD

Chief Executive Officer
The Mercury Healthcare Companies
600 17th Street
Suite 2800- South Tower
Denver, Colorado USA 80202
mariatodd@mercuryadvisorygroup.com

+1.800.727.4160

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