The Managed Care Contracting Handbook: Planning and Negotiating the Managed Care Relationship - Couverture rigide

Todd, Maria K.

Couverture rigide

ISBN 10 : 0786309997 ISBN 13 : 9780786309993

Editeur : Irwin Professional Publishing, 1996

Synopsis

Today's managed care contract arrangements require that the provider understand the mechanics, legal aspects and market share implications of single signature, network-oriented, capitated and discounted fee-for-service payment arrangements. This work provides this information and shows the reader how to: evaluate both payer-proposed and self-authored managed care agreements; position their facility and services to secure and maintain managed care agreements that will yield oportunity for more patients and new business; negotiate a profitable managed care contract using suggested techniques for evaluating the capitation rates provided by prospective payers; and develop a capitation rate from their own data and data supplied by the payer.

A propos du livre

Présentation de l'éditeur

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.

• Decode and analyze reimbursement problems, loopholes, and contract stipulations you are likely to encounter
• Learn tried-and-true tricks, tools, shortcuts, and techniques to evaluate agreements
• Negotiate contracts that won’t leave you open to unanticipated expenses

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.

The Managed Care Contracting Handbook offers critical details and strategic information as well as resources on everything from HMOs and PPOs to Consumer Driven Health Plans (CDHP), self-funded ERSIA payers, and Medicaid managed care.

Fully updates the first edition, which was used widely in the U.S. and overseas.

Designed to equip you with the confidence that comes with knowing the right questions to ask and more answers than you are supposed to know, this easy-access resource —

• Provides a complete overview of managed care organizations
• Covers contract law basics
• Presents material that can be used internationally
• Discusses Medicaid Managed Care
• Offers an operational evaluation of a typical managed care agreement
• Includes sample contracts and important checklists, as well as a glossary

Biographie de l'auteur

Maria K. Todd, PhD, MHA is a professional consultant providing the wealth of her knowledge and practical wisdom to more than 2000 hospitals, physicians, and therapists during the past 25 years. Possessing a depth and diversity of experience matched by few, she has earned a reputation as a peerless expert on managed care. She worked as an EMT and a surgical tech before moving into medical administration and health plan coordination. In addition to degrees in health administration, she is a certified mediator and health law paralegal. A prolific author, she is in constant demand as an award-winning speaker. As a volunteer, she has directly assisted hundreds of senior citizens.

Détails de l'édition

• Éditeur: Irwin Professional Publishing
• Date d'édition: 1996
• Langue: anglais
• ISBN 10: 0786309997
• ISBN 13: 9780786309993
• Reliure: Relié
• Nombre de pages: 300
• Coordonnées du fabricant: non disponible
• Personne responsable: non disponible