Fundamentals of Managed Care for

Medical Practice ManagersA new one-day workshop with nationally-renowned managed care trainer, Maria Todd

Author of The Managed Care Contracting Handbook, 2nd edition

CALL TO REGISTER800.209.7263

NEW!ONE-DAY WORKSHOP

Today’s healthcare providers in the USA have a dizzying array of more than 2000 managed care and other payer organizations with which to do business, including, but not limited to:

• HMOs and PPOs• Exchange Plans• Medicare Advantage Plans• Managed Medicaid Plans• Case Managers• Self-insured Employers and their TPAs

• Unions• Prison Health Services• Workers’ Comp Insurers• Travel Accident Insurers• ACOs, IPAs, PHOs and OWAs

Each of these payer types has different rules, regulations, and contracting objectives. Each one has its own fee schedules, payment rules and regulations, and all kinds of ambiguities and loopholes that can catch providers by surprise and cause denials that can’t be overturned.

No matter what type of healthcare provider you are, or how long you’ve been working in healthcare, if you an-alyze and negotiate managed care or other reimburse-ment contracts contract with third-party payers of any kind, you will benefit from attending this class.

Before you take on the payers you must first have a con-tracting strategy that sets the business rules for your organization and gives you a set of rate parameters that will work to cover your care delivery and administrative costs and margins.

Why Should You Attend This Class?

Introduction to Managed Care Contracting• Managing Managed Care Under Heatlhcare

Reform - What You Must Do Now• Key Payer Organizations and Payer Types• Direct-with-Employer Contracting• HMO, PPO, IPA, ACO, Medicare Advantage,

Exchanges, Medicaid

Assess your current practice and your options• Market Share• Value Proposition• Assessing Negotiation Leverage• Strengths & Opportunities• Weaknesses & Threats• Setting Business Rules

Existing Contract Performance• Payer Analysis• Payer Report Cards• Preventing Technical Denials• Preventing Unfair Refund Requests• Strategies for Successful Appeals

Protecting Your Legal Rights & Discounts• Taming the Silent PPO Monster• Find and Eliminate These Perils Lurking in

Most “All-Product” Agreements• Closing Costly Loopholes

Avoiding Unfavorable Exclusions & Pricing• Must-Know Payer Rules & Regulations• 10+ Payment models • Value-based Reimbursement

Building Your Contracting Strategies• Contract Analysis• Profitability• Community Access• Payer Stability• Controlling Access to Discounts• Steerage Formulas• Language Analysis

Negotiating for all your options• Deal Breaker Issues• When and How to Walk Away• Exit Strategies• Contract Analysis

• Finding the “Gotchas”• Identifying Cost Drivers• Requesting Clarifications• Negotiating Changes• Alternative Language• Gathering Data• Implementing the Contract• Paperless Contract Management• Testing the Payment Terms

Playing Hardball: What to Do If Payers So “No”• Lockouts and Terminations• Unfair Business Practices• Antitrust Considerations• Monopsony vs Monopoly• Refusal to Deal• Network Adequacy• Subcontracting• Public Relations• Media Relations• Patient Relations• How to Get Regulators’ Attention

Course Wrap Up, Evaluation & Dismissal

Course Outline

BRING HOME THESE SKILLS

1. Perform deeper due diligence on managed care organizations

2. Prevent technical denials3. Appeal wrongfully-denied claims4. Prevent unfair refund requests5. Enhance profitability and competitiveness6. Bring home lots of model revision language7. Update your contracting and analysis skills8. Network with other providers who are looking

for similar solutions9. Increase effectiveness at the negotiation table10. Learn to initiate and manage amendments to

bad contracts11. Strengthen system and process improvement

WHO SHOULD ATTEND?

• Physician Practice Managers• PT/OT/ Practice Managers• Billers and Coding Staff• Dental Practice Managers• PHO Contract Negotiators• Hospital-based Physician Managers• Multispecialty Group Executives• Physicians• Dentists• Orthotists /Prosthetists• Consultants• Investors

COURSE LOCATION & DATES

Denver CO Sep 12

WORKSHOP LEADER AND AUTHOR

MARIA K TODDContracting strategy and organizational development (OD) for integrated health delivery systems has been a passion and a pursuit of our workshop leader since 1983. Maria Todd started her career in health adminis-tration in the multi-specialty group practice setting, and later designed and developed more than 150 IPAs, PHOs and MSOs during the Clinton Administration. In 1995, McGraw Hill and HFMA co-published her book, The Managed Care Contracting Handbook, and then in 1997, her book, title IPA, PHO, MSO Development Strategies was released. Both how-to books were written to help providers develop reimbursement strat-egies and design, plan and launch integrated health systems. Each sold more than 4000 copies. Consider-ing there are about 7500 licensed hospitals in the USA, that number is considered a smashing success. In 2009, the sequel to ththe Contracting Handbook was updated and in 2012, her book, Physician Integration and Alignment: IPA, PHO, MSO ACOs and Beyond, was published by CRC | Productivity Press Both are once again, breaking industry sales records. She’s been analyzing and negotiating managed care contracts and practicing organizational development as a facilitator since the 1980s.

In 2010, the US Patent and Trademark Office (USPTO) granted Maria Todd the registration of a new term of art, the Globally Integrated Health Delivery System® for her application of the integrated health system concept and operations to the medical tourism and health travel arena. She built the first and only globally integrated health delivery system which combined all the elements of ACO accountability, predictive mod-eling, case management, provider credentialing and privileging, quality, safety, clinical outcomes and pa-tient satisfaction metrics, telehealth and telemedicine technology applications, electronic medical records, international cloud-based data and privacy security, and TPA operations for provider claims settlement and bill audit. To this, she added a fully-documented system to manage complex and specialized health travel logistics coordination to the mix.

Maria has professional work experience as an HMO Provider Contract-ing Manager, IPA Executive Director, Health Law Paralegal and Mediator, OR Nurse, Multi-Specialty Practice Administrator, Hospital & Surgicen-ter Administrator, and Care Navigator. As a professional speaker and trainer for various event sponsors, conference organizers, and trade associations, she has presented more educational programs (>2700) in managed care and integrated health delivery systems development than any other presenter in the world. She is also the author of 14 com-mercially-published handbooks, including:

• The Managed Care Contracting Handbook, 2nd edition• Physician Integration & Alignment: IPA, PHO, MSO, ACOs & Beyond• The Physician Employment Contract Handbook, 2nd edition• IPA, PHO, MSO Development Strategies

Registration Fee:

$459 per personDiscounts apply when two or more register together

TIMES:9:00A - 4:30P

CLASS SIZE MAXIMUM25 Participants

DISCOUNTSIf your Company’s name is found in the Corporate Discounts section, or if you are a subsidiary of one of those companies, then you are entitled to a $40 discount per registration. You can also receive a discounted per person rate when you register multiple persons at the same time. Call 800-209-7263 for code. This discount cannot be combined with the Re-served Seat Program or In-House seminar offers.

REGISTRATION INCLUDES• Course materials on USB• Refreshment Breaks• Lunch• Attendance Certificate

We accept: MC VI AX DS, Check by Mail

TO REGISTER BY PHONE CALL NOW!

800.209.7263PLEASE NOTE: Registration closes 7 days prior to class or upon sell-out - whichever occurs first. Waiting lists will be started in the event we have cancellations.

Course location provided with registration confirmation