Negotiating Managed Care Agreements With Health Plans: Key Provisions, Anticipating Areas of Dispute, Court Treatment
Recording of a 90-minute CLE video webinar with Q&A
This CLE course will guide healthcare counsel on negotiating managed care agreements. The panel will discuss current trends in contract negotiations, key provisions in the agreements, recent court treatment, and practical tips for resolving common areas of dispute.
Outline
- Key provisions
- Definitions of payor, covered services, medical necessity, and standard of care
- Provider obligations
- Claims submission and reimbursement
- Retroactive claim adjustments
- Term and termination
- Other key provisions
- Anticipating areas of dispute
- Recent court treatment
- Practical tips for negotiating key contract provisions
Benefits
The panel will review these and other important questions:
- What are some approaches for providers' counsel in negotiating favorable provisions in managed care agreements?
- What are the most commonly disputed issues during negotiations and ways for resolving them?
- What are current trends in contract negotiations?
Faculty
Amy L. Mackin
Attorney
Hall Render Killian Heath & Lyman
Ms. Mackin's practice focuses on healthcare regulatory law for hospitals, health systems, clinical laboratories and... | Read More
Ms. Mackin's practice focuses on healthcare regulatory law for hospitals, health systems, clinical laboratories and other providers. She has a particular interest in managed care contracting, primarily in advising providers in the negotiation and administration of managed care contracts with commercial and governmental health plans. Ms. Mackin has expertise in various reimbursement models, including capitation and pay-for-performance incentive programs. In addition, she has represented providers in contract disputes with payors, as well as in the transition to out-of-network status. Ms. Mackin also advises clients on compliance with federal and state fraud and abuse laws, privacy laws, EMTALA and medical staff matters. She routinely handles physician and other professional service contracting, as well as compliance matters, for health systems.
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Gregory R. Mitchell
Counsel
McDermott Will & Emery
Managed care companies, insurers, hospitals, health systems, physicians, and other payors and providers turn to Mr.... | Read More
Managed care companies, insurers, hospitals, health systems, physicians, and other payors and providers turn to Mr. Mitchell to represent them in managed care and reimbursement arrangements. He assists his clients in negotiating every form of reimbursement arrangement, including fee-for-service agreements, full-risk capitation models, and all other value-based payment models. Mr. Mitchell facilitates the entire arrangement process, from advising on the corporate structures necessary to enter into value-based payment models in each state, to drafting and preparing network participation agreements between IPAs, PPOs, and similar intermediary networks and providers, to drafting and negotiating complex compensation arrangements between payors, intermediary networks, and providers. In addition, Mr. Mitchell has spoken and written on various healthcare topics, including value-based payments, price transparency, social determinants of health, and the ACA’s impact on health insurance and providers. He is a co-editor of the 2021 edition of the American Health Law Association’s Health Plans Contracting Handbook: A Guide for Payers and Providers, and an author of Epstein Becker Green’s Value-Based Payments: A Comprehensive State Survey.
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