Managed Care Contracting

Washington, DC US
May 7, 2019 to May 8, 2019

Many health centers believe that they lack leverage to negotiate fair provisions in contracts with managed care organizations, overlooking legal protections available under state and federal law.  In light of those legal protections, many health centers are actually well- positioned to participate under value-based payment arrangements with MCOs, generating additional revenue for the health center.

This two-day intensive training on managed care contracting offers health center leadership an opportunity to gain insights and develop strategies for negotiating favorable managed care contracts.

Day One focuses on negotiating managed care contracts.  Session topics will address:

  • Identifying and assessing potential leverage points;
  • Common contract terms and favorable provisions;
  • Negotiating strategies and tips; and
  • Participating in financially and clinically integrated networks.

Day Two focuses on payment methodologies, legal protections, and risk areas.  Session topics will address:

  • Payment methodologies from fee-for-service to value-based payment;
  • FQHC payment protections applicable to managed care programs;  and
  • False claims, patient incentives, cost-sharing waivers, and ACO safe harbors.

Bonus: Training intensive includes two guest speaker lunch programs in which other FTLF attorneys will address hot topics in 340B contracting and FQHC PPS litigation.

Target Audience

  • Health Center Executives and Leadership
  • Health Center Controlled Networks / ACOs / IPAs Executives and Leadership
  • Primary Care Association Executives and Leadership

Learning Objectives

After this training, you will be able to:

  • Negotiate favorable managed care contracts
  • Participate in value-based payment arrangements
  • Minimize legal risks under managed care

Course summary
Available credit: 
  • 12.00 Certificate of Attendance
  • 14.40 CPE
    FTLF is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors.
Course opens: 
02/11/2019
Course expires: 
11/08/2019
Event starts: 
05/07/2019 - 9:00am
Event ends: 
05/08/2019 - 4:30pm
Cost:
$1,999.00
Washington, DC
Tuesday, May 7, 2019 - Wednesday, May 8, 2019
*All specific agenda times are subject to change*

Day 1: Negotiating Managed Care Contracts

Tuesday, May 7, 2019        
8:30 am - 5:30 pm
8:00 am - 9:00 amRegistration and Continental Breakfast
9:00 am - 10:30 am
PART 1: P.E.N. (Prepare, Evaluate, Negotiate) Managed Care Contracts
Step 1: Prepare for Managed Care Contracting
  • Contracting Strategy: Know Your Advantage
  • Assessing Regulatory Leverage
  • Assessing Market Power
  • Assessing Timing Leverage
  • Competing on Value
10:30 am - 10:45 amBreak
10:45 am - 12:00 pm
Step 2: Evaluate Managed Care Contracts
  • Contract Review Team
  • MCO Operational Performance
  • MCO Financial Stability
  • How to Read a Contract
  • Prioritizing Issues
Step 3: Negotiate Managed Care Contracts
  • Understanding Negotiation
  • Negotiation Logistics
  • Bargaining over Positions vs. Interests
  • Negotiating Tips
  • Bottom Line Deductions
12:00 pm - 1:00 pmWorking Lunch
1:00 pm - 2:30 pm
PART 2: Key Terms and Legal Protections
  • Scope of Services vs. Covered Services
  • Timing Claiming Rules
  • Prompt Payment and Denied Claims
  • Overpayment Recoupments (and Underpayments)
  • All Product Clauses
  • Cost-Sharing Provisions
  • Regulatory Penalties
  • Access and Appointment Standards
  • Licensure Requirements
  • Credentialing and Delegated Credentialing
  • Prior Authorization / Utilization Review
2:30 pm - 2:45 pm
Break
2:45 pm - 3:15 pm
Key Terms and Legal Protections Continued
  • Contract Term
  • Termination Provisions
  • Amendments
  • Notice Clause
  • Insurance and FTCA Coverage
  • Indemnification
3:15 pm - 4:15 pm
PART 3: Participating or Forming Provider Networks
  • Accountable Care Organizations
  • Types of Provider Networks (e.g. IPAs)
  • Federal Antitrust Law
  • Financial Risk-Sharing Arrangements
  • Clinically Integrated Networks (CINs)
  • “Messenger Model” Arrangements
4:15 pm - 4:30 pmDay 1 Wrap-Up
4:30 pm - 5:30 pmEvening Reception / Happy Hour

Day 2: Payment Methodologies, Legal Protections,
and Risk Areas

Wednesday, May 8, 2019        
8:30 am - 4:30 pm
8:30 am - 9:00 am
Continental Breakfast
9:00 am - 10:30 am
Provider Payment Methodologies
  • Reimbursement Methods
  • Case Management Fees
  • Provider Incentives and Withholds
  • Value-Based Payment: Key Contract Terms
10:30 am - 10:45 amBreak
10:45 am - 12:00 pm
FQHC Payment Rights and Obligations
  • Establishment of a Health Center’s Fee Schedule
  • Section 330 Prohibition on Discounts to Payors
  • FQHC Prospective Payment Systems (PPS) in Medicare and Medicaid
  • Scope of Services under PPS and Scope Changes
  • Initial PPS Rate Setting
  • Payment for Non-FQHC Services
12:00 pm - 1:00 pmWorking Lunch
1:00 pm - 2:30 pm
FQHC Payment Protections in Managed Care
  • Comparability Requirements
  • Supplemental (“Wrap-Around”) Payments
  • Out-of-Network Services
  • Marketplace / State Insurance Exchanges
  • Medicare Part D Legal Protections
2:30 pm - 2:45 pmBreak
2:45 pm - 3:45 pm
False Claims Risks after UHS vs. Escobar (2016)
  • Facility Licensure, Certification, and Enrollment
  • Practitioner Licensure, Certification, and Enrollment
  • Credentialing by Managed Care Organizations
  • Reverse “False Claims” and Overpayments
3:45 pm - 4:30 pm
Fraud and Abuse Risk Areas
  • Patient Incentive Programs
  • Waivers and Reductions of Patient Cost-Sharing
  • ACO Safe Harbors and Exceptions
FTLF Training Center
1129 20th Street NW
Suite 300
Washington, DC 20036
United States
+1 (855) 200-3822
FTLF Training Room

Travel

Hyatt Place Washington DC/Georgetown/West End 
2121 M St NW
Washington, DC 20037
(202) 838-2222

Kimpton Hotel Palomar DC 
2121 P Street NW
Washington, DC 20037
Hotel: (202) 448-1800 | Reservations: (877) 866-3070

The Wink - Washington, DC 
1143 New Hampshire Ave NW
Washington, DC 20037
(202) 775-0800

The St. Gregory Hotel - Dupont Circle 
2033 M Street NW
Washington, DC 20037
(202) 530-3600

Kimpton Hotel Madera 
1310 New Hampshire Avenue, NW
Washington, DC 20036
Hotel: (202) 296-7600 | Reservations: (800) 430-1202

The Embassy Row Hotel
2015 Massachusetts Avenue, NW
Washington, DC 20036
Hotel: (202) 265-1600 | Reservations: (855) 893-1011

The Dupont Circle Hotel
1500 New Hampshire Avenue, NW
Washington, DC 20036
(202) 483-6000

Hilton Garden Inn - Washington DC/Georgetown Area
2201 M Street NW
Washington, DC 20037
(202) 974-6010

Embassy Suites - Georgetown
1250 22nd Street, NW
Washington, DC 20037
(202) 857-3388

ADAM FALCONE

Adam J. Falcone is a partner in FTLF’s national health law practice group, where he counsels a diverse spectrum of community-based organizations that render primary and behavioral healthcare services. Adam counsels clients on a wide range of health law issues, with a focus on fraud and abuse, reimbursement and payment, and antitrust and competition matters. [Full Bio]

Participants can earn up to 14.4 CPE credits in Specialized Knowledge and Applications upon completion of all course requirements.

ADDITIONAL INFORMATION

  • Prerequisites: None 
  • Target Audience: Health Center Executives and Leadership, Health Center Controlled Networks / ACOs / IPAs Executives and Leadership, Primary Care Association Executives and Leadership
  • Advanced Preparation: None  
  • Program Level: All
  • Delivery Method: Group-Live 

Feldesman Tucker Leifer Fidell LLP is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website www.nasbaregistry.org (formerly www.learningmarket.org).

Available Credit

  • 12.00 Certificate of Attendance
  • 14.40 CPE
    FTLF is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors.

Accreditation Period

Course opens: 
02/11/2019
Course expires: 
11/08/2019

Price

Cost:
$1,999.00
Please login or register to take this course.

Registration Instructions

Each registration must be in the name of the individual(s) who will attend. This allows FTLF to communicate important course information to the actual attendee(s), add training materials and handouts to the right account, and properly assign certificates of attendance or CPE credits. 

To register for this training:

  • For yourself: login to your account and register with your personal information
  • For someone else: login with the ATTENDEE’S login information or create an account for the ATTENDEE and register from the ATTENDEE's account
  • For a group: email Learning@ftlf.com to complete group registration

If you encounter problems or have questions Contact us.


Payment

We accept payment by PayPal, credit card, and check. Payment for any live training is due upon registration. If payment is not received in full prior to the start of the event, FTLF reserves the right to cancel your order and deny you entrance to the training.

Cancellation Policy

All cancellation requests must be received in writing at learning@ftlf.com. Requests for refunds will be granted according to the following schedule:

  • Requests received 30 or more days prior to the event will receive a full refund.
  • Requests received between 11 to 29 days prior to the event will receive a 50% refund.
  • Requests received within 10 days of the event start date are not eligible for a refund.

If there are extenuating circumstances regarding your cancellation, please reach out to the FTLF Training Team directly at learning@ftlf.com.