Managed Care Contracting

Washington, DC US
October 29, 2018 to October 30, 2018

Participation agreements with Managed Care Organizations (MCOs) overwhelmingly favor the MCO, not the provider of services. Even when an MCO offers reasonable payment terms, standard provisions found in a participation agreement typically permit an MCO to recoup payments made to a provider without notice, force a provider to accept low reimbursement levels in one product as a condition of participation in another, permit MCOs to unilaterally amend the contracts without obtaining the provider’s consent, and implement claims processing practices that deny timely payments for services, including short timeframes for submitting claims, denials of claims without sufficient explanation, and delayed payments.

Many health centers and behavioral health agencies mistakenly believe that they lack leverage with the MCOs to negotiate fair provisions in their participation agreements, overlooking legal protections available under state and federal law. In addition, many health centers and behavioral health agencies fail to position themselves to participate under value-based payment arrangements with MCOs, foregoing potential revenues streams.

This workshop is designed to assist health centers and behavioral health agencies negotiate favorable participation agreements with MCOs. FTLF attorneys will cover topics, including:

  • Preparing for contract negotiations by identifying and assessing potential leverage points, such as regulatory leverage, market power, and competing on value;
  • Evaluating managed care contracts using a team-based approach, considering an MCO’s operational and financial stability;
  • Negotiating strategies and tips to make the most persuasive case;
  • Federal laws and regulations that apply to payments to Federally Qualified Health Centers and to disclosures of confidential health information. 

Please Note: Attendance is limited to a small group of organizations to encourage discussion and focus on the exchange of ideas. 

Target Audience

Health Center and Behavioral Health Executive Teams

Learning Objectives

After this training, attendees will be able to:

  • Identify leverage points to use in negotiating with MCOs
  • Recognize the implications of common legal terms in participation agreements  and confidentiality requirements
  • Negotiate more favorable contract terms in participation agreements
Course summary
Available credit: 
  • 8.75 Certificate of Attendance
  • 10.50 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: 
05/16/2018
Course expires: 
10/30/2019
Event starts: 
10/29/2018 - 8:30am
Event ends: 
10/30/2018 - 12:00pm
Cost:
$1,999.00

Managed Care Contracting

Washington, DC
Monday, October 29, 2018 - Tuesday, October 30, 2018
*This is a draft agenda and is subject to change*

Day 1

Monday, October 29, 2018          
8:30 am - 4:00 pm
8:30 am - 9:00 amBreakfast & Networking
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
  • Value-Based Payment Methodologies
10:30 am - 10: 45 am
Break
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 Decisions
12:00 pm - 1:00 pmLunch
1:00 pm - 2:15 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
2:15 pm - 2:30 pmBreak
2:30 pm - 3:00 pm
Key Terms and Legal Protections Continued
  • Contract Term
  • Termination Provisions
  • Amendments
  • Insurance
  • Indemnification
  • Compensation Exhibits
  • Regulatory Appendices
3:00 pm - 4:00 pm
PART 3: Participating or Forming Provider Networks
 
  • Types of Provider Networks (e.g. IPAs)
  • Accountable Care Organizations
  • Federal Antitrust Law
  • Financial Risk-Sharing Arrangements
  • Clinically Integrated Networks (CINs)
  • Messenger Model Arrangements

Day 2

Tuesday, October 30, 2018          
8:30 am - 12:00 pm
8:30 am - 9:00 amBreakfast and Networking
9:00 am - 10:30 am

Break Option 1: FQHC Payment Protections under Federal Law

OR

Break Option 2: Confidentiality Protections under HIPAA and 42 CFR Part 2

10:30 am - 10: 45 amBreak
10:45 am - 12:00 pm

Break Option 1: FQHC Payment Protections under Federal Law

OR

Break Option 2: Confidentiality Protections under HIPAA and 42 CFR Part 2

For a downloadable version of the agenda, click here.

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

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

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

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]

DIANNE PLEDGIE

As Partner and Compliance Counsel with the firm’s health law practice group, Dianne advises health centers on implementing effective compliance programs and on addressing top compliance risk areas. Dianne counsels health centers and other organizations on developing compliance programs that include the OIG’s seven elements, respond to identified compliance risk areas and reflect the organization’s culture.  Dianne also advises health centers and other organizations on patient privacy and confidentiality, including the HIPAA Privacy Rule and 42 CFR Part 2.  She has experience responding to privacy and security incidents, including determining whether there has been a breach, notifying patients and the government, and creating corrective action plans. [Full Bio]

TED WATERS

Serving as Managing Partner of the firm since 2003, and a member of the Health Law and Federal Grants practices since 1992, Ted is a national authority in the area of federal grants, particularly in the health and community service spheres. He advises clients on all aspects of program requirements, including issues such as cost-based reimbursement, governance, grant administration, cost reporting, and administrative issues and routinely handles challenging issues such as government audits, internal investigations, and litigation. Ted's priority is to help each organization carry out its mission by offering practical, down-to-earth counsel and to ensure that legal challenges do not distract from that focus. [Full Bio]

Conference participants can earn up to 10.5 CPE credits in Specialized Knowledge and Applications.

ADDITIONAL INFORMATION

  • Prerequisites: None 
  • Target Audience: Health Center and Behavioral Health Executive Teams
  • Advanced Preparation: None  
  • Program Level: All
  • Delivery Method: Group-Live 

Feldesman Tucker Leifer Fidell 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.learningmarket.org.

Available Credit

  • 8.75 Certificate of Attendance
  • 10.50 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: 
05/16/2018
Course expires: 
10/30/2019

Price

Cost:
$1,999.00
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Payment:

Available payment methods include check and credit card. Payment for this live training is due 2 weeks before the start of the event. If payment is not received in full 2 weeks 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.