Health Center Contracting Strategies

June 23, 2020 to June 24, 2020

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: 
  • 13.50 Certificate of Attendance
  • 16.20 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: 
Course expires: 
Event starts: 
06/23/2020 - 9:00am
Event ends: 
06/24/2020 - 4:30pm
Virtual Classroom
Tuesday, June 23, 2020 - Wednesday, June 24, 2020
*All specific agenda times are subject to change*


Day 1: Negotiating Managed Care Contracts

Tuesday, June 23, 2020
10:30 am - 5:30 pm
10:30 am - 11:00 amRegistration and Continental Breakfast
11:00 am - 12:15 pm
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
12:15 pm - 12:30 pmBreak
12:30 pm - 1:00 pm
Step 2: Evaluate Managed Care Contracts
  • Contract Review Team
  • MCO Operational Performance
  • MCO Financial Stability
  • How to Read a Contract
  • Prioritizing Issues
1:00 pm - 1:30 pm
Step 3: Negotiate Managed Care Contracts
  • Understanding Negotiation
  • Negotiation Logistics
  • Bargaining over Positions vs. Interests
  • Negotiating Tips
  • Bottom Line Deductions
1:30 pm - 2:00 pmLunch Break
2:00 pm - 3:15 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
3:15 pm - 3:30 pm
3:30 pm - 4:00 pm
Key Terms and Legal Protections (Continued)
  • Contract Term
  • Termination Provisions
  • Amendments
  • Notice Clause
  • Insurance and FTCA Coverage
  • Indemnification
4:00 pm - 5:00 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
5:00 pm - 5:30 pmWrap-Up and Q&A

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

Wednesday, June 24, 2020   
10:30 am - 5:30 pm
10:30 am - 11:30 am
Provider Payment Methodologies
  • Reimbursement Methods
  • Case Management Fees
  • Provider Incentives and Withholds
  • Value-Based Payment: Key Contract Terms
11:30 am - 11:45 amBreak
11:45 am - 1:15 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
1:15 pm - 1:45 pmLunch Break
1:45 pm - 3:15 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
3:15 pm - 3:30 pmBreak
3:30 pm - 4:15 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
4:15 pm - 5:00 pm
Fraud and Abuse Risk Areas
  • Patient Incentive Programs
  • Waivers and Reductions of Patient Cost-Sharing
  • ACO Safe Harbors and Exceptions
5:00 pm - 5:30 pmWrap-Up and Q&A


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]


Kathy is a Partner in Feldesman Tucker’s health law practice group. In the area of health law, Kathy’s practice focuses on government-sponsored health care programs such as Medicaid, CHIP, Medicare, and the Affordable Care Act, with an emphasis on payment/reimbursement and compliance related issues. Kathy also represents clients in government investigations and audits, litigation before federal and state courts, as well as in administrative appeals with the U.S. Department of Health and Human Services Departmental Appeals Board (DAB) and Provider Reimbursement Review Board (PRRB). She provides reimbursement counseling (including identification, reporting, and repayment of overpayments) with respect to Medicare, Medicaid, and private third-party payors. [Full Bio]

Participants can earn up to 16.20 CPE credits in Specialized Knowledge and Applications upon completion of all course requirements.


  • 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 (formerly

Available Credit

  • 13.50 Certificate of Attendance
  • 16.20 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.


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. 

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  • For yourself: login to your account and register with your personal information
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  • For a group: email to complete group registration

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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/Transfer Policy

All cancellation or transfer requests must be received in writing at Requests for refunds or transfers for in-person events will be granted according to the following schedule:

  • 30 or more days prior to the event, requests for a full refund or a transfer without a fee will be granted.
  • Between 11 to 29 days prior to the event, requests for cancellations will be granted a 50% refund and requests for transfers will be granted, space permitting and subject to a transfer fee.
  • Within 10 days of the event start date, no requests for refunds or credits will be granted. At FTLF's discretion, late transfers may be granted, space permitting and subject to a transfer fee.

If there are extenuating circumstances regarding your cancellation, please reach out to the FTLF Training Team directly at