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

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Conducted on Tuesday, September 20, 2022

Recorded event now available

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Course Materials

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.

Description

The past two years have brought many changes to the healthcare industry, impacting the relationship between providers and health plans. Negotiating favorable rates and terms in the new environment is more challenging than ever.

Recent litigation serves as a good reminder about the importance of negotiating managed care contracts, which govern the cost and quality of healthcare services between providers and patients. A recent decision from the California Court of Appeal, San Jose Neurospine v. Aetna Health of California (2020), held a miscoded bill was not a proper basis for the health plan to avoid payment. The court rejected the plan's argument that the provider's technical error precluded the provider from obtaining payment. It is important to anticipate potential areas of dispute when negotiating the managed care agreement, including the resolution of technical errors.

Counsel should carefully consider complex arrangements and take steps to reduce potential exposure for the provider of nonperformance of obligations under the agreement.

Listen as our authoritative panel of healthcare attorneys discusses negotiating managed care agreements with health plans. The panel will offer best practices for providers, examine current trends in contract negotiations, and discuss recent court treatment, key contract provisions, and ways to address common areas of dispute.

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Outline

  1. Key provisions
    1. Definitions of payor, covered services, medical necessity, and standard of care
    2. Provider obligations
    3. Claims submission and reimbursement
    4. Retroactive claim adjustments
    5. Term and termination
    6. Other key provisions
  2. Anticipating areas of dispute
  3. Recent court treatment
  4. 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

Malone, Kevin
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

Mitchell, Gregory
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

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