Negotiating Managed Care Agreements With Health Plans: Key Provisions, Anticipating Areas of Dispute, Court Treatment
Recording of a 90-minute CLE video webinar with Q&A
This CLE course will guide healthcare counsel on negotiating managed care agreements. The panel will discuss current trends in contract negotiations, key provisions in the agreements, recent court treatment, and practical tips for resolving common areas of dispute.
Outline
- Key provisions
- Definitions of payor, covered services, medical necessity, and standard of care
- Provider obligations
- Claims submission and reimbursement
- Retroactive claim adjustments
- Term and termination
- Other key provisions
- Anticipating areas of dispute
- Recent court treatment
- Practical tips for negotiating key contract provisions
Benefits
The panel will review these and other important questions:
- What are some approaches for providers' counsel in negotiating favorable provisions in managed care agreements?
- What are the most commonly disputed issues during negotiations and ways for resolving them?
- What are current trends in contract negotiations?
Faculty
Kevin J. Malone
Member
Epstein Becker & Green
Managed care organizations trust Mr. Malone to help them understand and navigate their most difficult legal,... | Read More
Managed care organizations trust Mr. Malone to help them understand and navigate their most difficult legal, compliance, and strategic risks and opportunities. He draws on more than a decade of experience working at the highest levels of healthcarehealthcare financing policy and law to help managed care organizations navigate the web of federal and state regulations and program policies governing the health care financing system. Mr. Malone is a go-to lawyer on issues concerning the Mental Health Parity and Addiction Equity Act (the federal parity law), delivery systems for Medicare-Medicaid dually eligible beneficiaries (such as special needs plans and the Programs of All-Inclusive Care for the Elderly (PACE)), and demonstration models for Medicare and Medicaid. He also advises providers ranging in size from large hospital systems to start-up health and telehealth companies on legal and strategic matters involving corporate formation, licensing, and third-party payment and coverage with a particular focus on value-based payment strategies. Provider organizations rely on his experience with managed care organizations and government regulators to develop successful strategies for market entry and growth.
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Gregory R. Mitchell
Partner
McDermott Will & Emery
Mr. Mitchell works with healthcare payors and providers to meet the full spectrum of their managed care and... | Read More
Mr. Mitchell works with healthcare payors and providers to meet the full spectrum of their managed care and reimbursement arrangement needs. He works closely with managed care organizations, insurers, hospitals and health systems, academic medical centers, and other organizations both large and small to negotiate and draft managed care agreements, network participation agreements, and more. Mr. Mitchell is experienced across a variety of arrangements and models, including fee-for-service, value-based care, bundled payment, shared savings and shared loss models, gainsharing and capitation arrangements.
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