You know your payer contracts are the basis of your practice’s revenue but finding the agreements, addenda and rates and then inventorying this information can be daunting.  Attend this session and learn how to push through the first steps toward getting you payer contracts in order and determining which ones and when they can be tackled.

• Gather your current contracts and rates
• Determine which contracts to tackle first
• Create a timeline for each negotiation
• Send notice to renegotiate

So many times a contract gets renegotiated on rates alone.  Lurking in the agreement are a number of terms that can cause a practice administrative and financial nightmares.  Know which state laws that can help and hurt you in negotiating these terms, understand the impact of fully insured vs self-funded plans that are accessing your payer and network agreements, find out what happens if you merge with another practice, how fast you have to submit or how fast they have to pay, how a payer can change your rates, products and other terms without your signature, how silence in an agreement on a particular issue can be detrimental …and much more!

• Identify provisions in a payer/network agreement that need your attention
• Determine how to manage provisions that payers refuse to change
• Propose more favorable alternative language to the payers/networks 

It’s scary, but sometimes the best course of action with a payer or network is to not participate any more with either all of a payer’s products or a specific product. Explore the many factors a practice should consider before making the decision, among them the financial impact, the laws that apply, confidentiality clauses, the population that will be affected and more. And then if you decide it is in your best interest to walk, discover how to you manage and properly initiate the process and minimize the havoc that such a decision can cause for the practice and your patients. Many states have member notice requirements and/or continuity of care laws that will dictate some of the steps you will need to take. Communicate with your patients on their options to continue or transfer to other providers. And brief your staff  on how to handle calls, scheduling, and claims, including payers that send claims payments directly to the patients.

• Discover what factors should be considered before walking
• Initiate the process and manage timelines
• Ensure compliance with contracts and laws
• Minimize havoc for patients and practice

While Medicare already has some bundled payments programs underway, commercial payers also have an interest in working with providers who can package the full spectrum of care for a fixed price for certain high cost procedures and diagnosis… from pre-admission testing, diagnostics, anesthesia, facility (hospital/ASC/Rehab), surgeon, physical therapy, drugs and more. This session provides a broad overview of the structure options, benefits and challenges of these programs. Just a few of the topics covered are how to submit a claim when several TINs are included in the spectrum, how does this work with copays that a member has for specific services, who is the “bundler” or “convener” and who is a partner in the spectrum, who bears the risk if the costs exceed the fixed payment, what if the patient has other conditions that make them too unpredictable for a guaranteed price?… and more.

• Define the services and timeline to include in bundled payment program
• Understand the scope of the financial risk the “bundler” is taking on
• Grasp the practical issues surrounding claims submission and payment disbursement to bundle parties