Health Center Contracting Strategies
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.
- Health Center Executives and Leadership
- Health Center Controlled Networks / ACOs / IPAs Executives and Leadership
- Primary Care Association Executives and Leadership
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
Day 1: Negotiating Managed Care Contracts
Tuesday, June 23, 2020
10:30 am - 5:30 pm
|10:30 am - 11:00 am||Registration 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
|12:15 pm - 12:30 pm||Break|
|12:30 pm - 1:00 pm|
Step 2: Evaluate Managed Care Contracts
|1:00 pm - 1:30 pm|
Step 3: Negotiate Managed Care Contracts
|1:30 pm - 2:00 pm||Lunch Break|
|2:00 pm - 3:15 pm|
PART 2: Key Terms and Legal Protections
|3:15 pm - 3:30 pm|
|3:30 pm - 4:00 pm|
Key Terms and Legal Protections (Continued)
|4:00 pm - 5:00 pm|
PART 3: Participating or Forming Provider Networks
|5:00 pm - 5:30 pm||Wrap-Up and Q&A|
Day 2: Payment Methodologies, Legal Protections,
Wednesday, June 24, 2020
10:30 am - 5:30 pm
|10:30 am - 11:30 am|
Provider Payment Methodologies
|11:30 am - 11:45 am||Break|
|11:45 am - 1:15 pm|
FQHC Payment Rights and Obligations
|1:15 pm - 1:45 pm||Lunch Break|
|1:45 pm - 3:15 pm|
FQHC Payment Protections in Managed Care
|3:15 pm - 3:30 pm||Break|
|3:30 pm - 4:15 pm|
False Claims Risks after UHS vs. Escobar (2016)
|4:15 pm - 5:00 pm|
Fraud and Abuse Risk Areas
|5:00 pm - 5:30 pm||Wrap-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 www.nasbaregistry.org (formerly www.learningmarket.org).
- 13.50 Certificate of Attendance
- 16.20 CPEFTLF 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.
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.
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- 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.
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