Managed Care Contracts: Medicare and Medicaid Considerations for Providers
Reimbursement and Delegation Challenges, Key Provisions and Anticipating Areas of Dispute
Recording of a 90-minute CLE webinar with Q&A
This CLE course will provide healthcare counsel with a roadmap for drafting and negotiating managed care contracts on behalf of providers. With a focus on Medicare and Medicaid contracts, the panel will discuss current trends in contract negotiations, critical provisions in the agreements and strategies for resolving common areas of dispute.
Outline
- Managed care contracting—current legal trends
- Medicare and Medicaid managed care contracts
- Practical tips for negotiating key contract provisions
Benefits
The panel will review these and other essential questions:
- How have the changes in healthcare and the shift to Medicare and Medicaid impacted the negotiation of managed care agreements?
- What are some proven approaches for providers' counsel in negotiating favorable provisions in managed care contracts?
- What are the most commonly disputed issues during contract negotiations and what are some practical approaches for resolving them?
Faculty
Clifford E. Barnes
Member
Epstein Becker & Green
Mr. Barnes is Co-Chair of the firm's Health Plan Compliance Group. He has been employed by the firm for over 35... | Read More
Mr. Barnes is Co-Chair of the firm's Health Plan Compliance Group. He has been employed by the firm for over 35 years and represents providers, including hospitals, hospital systems, nursing homes, home health, hospice, ancillary service companies; managed care companies, concentrating in Medicare and Medicaid; and nonprofit associations. Mr. Barnes is the Co-Founder of Medicaid Health Plans of America Inc., and currently serves as Vice Chair of the Accountable Care Organization Task Force of the American Health Lawyers Association. He counsels healthcare providers and payors on issues related to mergers, acquisitions, joint ventures, and various forms of contracting, including accountable care organization arrangements, international transactions, antitrust issues, fraud and abuse, and compliance programs Mr. Barnes serves as general and special counsel for post-acute providers, including nursing home, home health, and long-term acute care facilities. He also serves as general and special counsel for managed care companies, including Medicare and Medicaid health plans, and for nonprofit associations, including Medicaid Health Plans of America and the National Medical Association, among others.
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Christian Puff
Atty
Hall Render Killian Heath & Lyman
Ms. Puff works most frequently with provider groups and health systems as well as provider-owned plans. She regularly... | Read More
Ms. Puff works most frequently with provider groups and health systems as well as provider-owned plans. She regularly counsels providers in disputes, such as reimbursement and contract, and provides solutions for overpayment and recoupment issues with provider clients. In addition, Ms. Puff advises on discount and pharmacy benefit program matters with provider-owned plans. Prior to joining the firm, Ms. Puff served as the Chief Operating Officer for CHRISTUS Health Plan, a provider-owned organization with Medicare, Medicaid, FFM and USFHP plans. She brings a unique perspective, having worked for both Fortune 50 health plans and pharmacy benefit managers. In her work with these companies, Ms. Puff performed due diligence for merger and acquisition work; advised on Medicare regulatory matters, Medicare Advantage Plan issues and First-Tier, Downstream and Related Party compliance; and acted as counsel for MAPD plans and freestanding Part D plans, performing as both transactional and regulatory counsel. Ms. Puff currently serves as the Vice Chair of the Managed Care Interest Group in the ABA’s Health Law Section.
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