HCPro.com: Managed Care Contracting and Reimbursement Advisor

Managed Care Contracting & Reimbursement Advisor tells you exactly what you must know and do to successfully negotiate the best deal with HMOs, PPOs, and other payors - and get bigger and faster reimbursement!

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August 2008 (Volume 5, Issue 8)	view entire issue

Put these provisions on your managed care contracting hot list
Every managed care contracting director should have a hot list of provisions to check and recheck during contract negotiations. How much unfavorable language you can excise from contracts depends on how much contracting leverage you wield in your market. But with commercial and government payers ratcheting down provider reimbursement, you should at least push back on the most onerous terms. In fact, your influence over your managed care contracts may rest on your improvement of the terms.

Watch your contracts in the wake of 'final' Stark rules
Nearly one year has passed since the final phase of the Stark II law became effective, yet practice administrators, healthcare attorneys, and consultants are still mulling the implications. (For background on the law, which addresses financial relationships between physicians and the hospitals to which they refer Medicare patients, and to view FAQs, visit www.cms.hhs.gov/PhysicianSelfReferral.) CMS did not create new exceptions in the final rule but did make certain refinements that could permit or, in some cases, require restructuring of some existing arrangements.

E-tool: Payer/MCO contract provision samples
Use the following sample language when negotiating key managed care provisions:

E-tool: Sample letter to payer on intention to renegotiate
Send the following both to the most recent payer/MCO representative with whom you have dealt and to the official notice address in your agreement:

Other recently-published articles from Managed Care Contracting and Reimbursement Advisor:

Use lean cost accounting to examine your cost structure

Bridges to Excellence pays bonuses to docs for implementing medical home

Ensure that contracts cover real-time claims adjudication

Build a defensible fee schedule to challenge lowball payer contracts

Use retail clinic referrals to boost your bottom line

E-visit payment promising but not ready for prime time

Think twice before opting out of Medicare

Prepare for contracting challenges during mergers, consolidations

E-tool: Sample letter to payer on intention to renegotiate

E-tool: Payer/MCO contract provision samples

Watch your contracts in the wake of ’final’ Stark rules

Put these provisions on your managed care contracting hot list

Audit your patient financial services department to maximize your managed care reimbursement

Push the envelope when contracting with highly scrutinized payers

Case study: Go electronic on your charge capture process

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