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
Kevin J. Malone
Member
Epstein Becker & Green
Managed care organizations trust Mr. Malone to help them understand and navigate their most difficult legal,... | Read More
Managed care organizations trust Mr. Malone to help them understand and navigate their most difficult legal, compliance, and strategic risks and opportunities. He draws on more than a decade of experience working at the highest levels of healthcarehealthcare financing policy and law to help managed care organizations navigate the web of federal and state regulations and program policies governing the health care financing system. Mr. Malone is a go-to lawyer on issues concerning the Mental Health Parity and Addiction Equity Act (the federal parity law), delivery systems for Medicare-Medicaid dually eligible beneficiaries (such as special needs plans and the Programs of All-Inclusive Care for the Elderly (PACE)), and demonstration models for Medicare and Medicaid. He also advises providers ranging in size from large hospital systems to start-up health and telehealth companies on legal and strategic matters involving corporate formation, licensing, and third-party payment and coverage with a particular focus on value-based payment strategies. Provider organizations rely on his experience with managed care organizations and government regulators to develop successful strategies for market entry and growth.
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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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