Managed care contracting is a process that frustrates even the best administrators. However, to ignore this complexity is to do so at your own expense. You don’t necessarily need to bear the cost of overpriced legal advice, but you do need to know what questions to ask, what clauses to avoid, what contingencies to cover ... and when to ask a lawyer for help.Written by Maria K. Todd, a seasoned professional in managed care contracting, this handbook is written for managers, analysts, and finance officers who have the daunting task of negotiating contracts for medical services. It offers an in-depth examination of managed care and its organizations and covers key areas, such as pay-for-performance initiatives, reimbursement methods, contract law basics, and negotiating strategies.
Acknowledgements
Introduction
Chapter 1 : What Is Managed Care?
Chapter 2 : Managed Care Organizations
Chapter 3 : All-Products Contracts
Chapter 4 : Dealing with Self-Funded ERISA Payers in Managed Care
Chapter 5 : Medicaid Managed Care
Chapter 6 : Consumer Driven Health Plans: Contracting Implications
Chapter 7 : Silent Preferred Provider Organizations (PPOs)
Chapter 8 : Single-Case and Continuous-Discount Arrangements
Chapter 9 : Quality Issues in Managed Care (Pay for Performance)
Chapter 10 : Reimbursement Methods in Managed Care
Chapter 11 : Strategic Planning for Renewals and New Contracts
Chapter 12 : Developing Business Rules for Better Contracts
Chapter 13 : Negotiation Techniques, Tactics, and Strategies
Chapter 14 : Contract Law Basics
Chapter 15 : Evaluating a Managed Care Agreement—Step-by-Step
Appendix
Index
