Negotiating Managed Care Contracts with MCOs, ACOs and for Health Exchange Products
Tools and Strategies to Maximize Benefits and Avoid Becoming Unlicensed Insurer
Recording of a 90-minute CLE webinar with Q&A
This CLE course will equip healthcare provider counsel with tools and strategies for structuring and negotiating contracts with accountable care organizations (ACOs), managed care organizations (MCOs), and state health exchanges on behalf of providers. The panel will discuss key provisions in these agreements and methods for resolving common areas of dispute.
Outline
- Overview of current legal trends under healthcare reform
- Contracting with ACOs and for health exchange products
- Managed care contracting
- Practical tips and strategies for negotiating key contract provisions
- Definitions of payor, covered services, medical necessity and standard of care
- Provider obligations
- Claims submission and reimbursement
- Avoid becoming an unlicensed insurer
- Retroactive claim adjustments
- Term and termination
- Other key provisions
Benefits
The panel will review these and other key issues:
- How is healthcare reform impacting the negotiation of agreements with ACOs and state health exchanges?
- How should counsel approach contracting with traditional MCOs?
- What strategies are effective for providers’ counsel in negotiating favorable managed care contract provisions?
- What types of disputes should counsel anticipate arising during contract negotiations—and what are effective approaches for resolving them?
Faculty
Kathrin Kudner
Member
Dykema Gossett
Ms. Kudner's practice is devoted to the representation of healthcare providers, payors and biotechnology... | Read More
Ms. Kudner's practice is devoted to the representation of healthcare providers, payors and biotechnology manufacturers in various corporate and regulatory matters. She reviews and negotiates managed care and insurance contracts on behalf of providers, MCOs and commercial insurers. Ms. Kudner is a member of the firm's Life Sciences, Insurance, Public Finance, and White Collar Criminal Defense and Internal Investigations Teams. Prior to her law career, she was an administrator of a medical and dental healthcare system.
CloseNeil M. Sullivan
Partner
McElroy Deutsch Mulvaney & Carpenter
Mr. Sullivan specializes in healthcare and insurance law. Over the course of his career he has served as... | Read More
Mr. Sullivan specializes in healthcare and insurance law. Over the course of his career he has served as Assistant Commissioner at the New Jersey Department of Banking and Insurance (DOBI), in-house counsel at New Jersey’s largest health insurer, General Counsel for a community hospital, and Director of Group Contracts for New Jersey’s largest life insurer. He ranked among the top 15 in NJBIZ’s annual Power 50 in Healthcare in each of 2012, 2013 and 2014.
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