Payer-Provider Agreements: Maximizing Reimbursement and Participating in Value-Based Contracts
Negotiating Favorable Contracts to Improve the Chance of Success in Value-Based Contracts
A live 90-minute CLE video webinar with interactive Q&A
This CLE course will provide guidance on structuring payer-provider contracts. The panel will address key provisions to include in both value-based agreements and any other payer-provider agreement. Topics will include limitations on retrospective review, eligibility and authorization guarantees, and dispute resolution.
Outline
- Key provisions
- Eligibility guarantees
- Authorization guarantees
- Concurrent and retrospective review
- Appeals of medical necessity and administrative denials
- Takebacks and offsets
- Audits
- Value-based arrangements
- The emerging consensus on structuring value-based arrangements
- Best practices in value-based contracting
Benefits
The panel will review these and other notable issues:
- What are the critical provisions that should be included in the payer-provider agreement?
- How does the payer-provider agreement impact reimbursement for healthcare services?
- What are best practices for structuring payer-provider agreements?
Faculty
Adam Falcone
Partner
Feldesman Leifer
Mr. Falcone, based in Pittsburgh, Pennsylvania, counsels a diverse spectrum of community-based organizations that... | Read More
Mr. Falcone, based in Pittsburgh, Pennsylvania, counsels a diverse spectrum of community-based organizations that render primary and behavioral health care services. He advises clients on a wide range of health care issues, with a focus on fraud and abuse, reimbursement and payment, and antitrust and competition matters. Mr. Falcone established the firm’s health care corporate compliance practice, offering proactive counsel to avoid costly legal missteps that can jeopardize vital health services within communities. To that end, he has championed the development of online compliance support services to assist clients in the development of effective corporate compliance programs. Mr. Falcone also conducts internal investigations, defends clients in audit proceedings and negotiates settlements related to fraud allegations.
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Gustavo E.I. Matheus
Partner
Feldesman Leifer
Mr. Matheus represents providers of healthcare services in various areas relating to reimbursement and claims denials,... | Read More
Mr. Matheus represents providers of healthcare services in various areas relating to reimbursement and claims denials, managed care, Medicare and Medicaid, network participation and credentialing, revenue cycle, and medical records and privacy. His clients range from single clinician practices, multi-physician groups, allied healthcare practitioners, nursing home facilities and hospital systems. Mr. Matheus enjoys teaching health law topics to students at undergraduate institutions, law schools and in medical school settings. He is a member of the Board of Directors of the Bowie Health Center Foundation.
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