Payer-Provider Agreements: Maximizing Reimbursement and Minimizing Denials in Value-Based Contracts
Negotiating Favorable Contracts to Improve the Chance of Success in Value-Based Contracts
Recording of a 90-minute CLE webinar with Q&A
This CLE course will provide guidance on structuring payer-provider contracts. The panel will address key provisions to include in both value-based agreements, and any other payer-provider agreement. Topics will include limitations on retrospective review, eligibility and authorization guarantees, and dispute resolution.
Outline
- Key provisions
- Eligibility guarantees
- Authorization guarantees
- Concurrent and retrospective review
- Appeals of medical necessity and administrative denials
- Takebacks and offsets
- Audits
- Value-based arrangements
- The emerging consensus on structuring value-based arrangements
- Best practices in value-based contracting
Benefits
The panel will review these and other notable issues:
- What are the critical provisions that should be included in the payer-provider agreement?
- How does the payer-provider agreement impact reimbursement for healthcare services?
- What are best practices for structuring payer-provider agreements?
Faculty
John C.J. Barnes
Partner
King & Spalding
Mr. Barnes specializes in managed healthcare arrangements. He advises clients on the structuring of risk-based managed... | Read More
Mr. Barnes specializes in managed healthcare arrangements. He advises clients on the structuring of risk-based managed care contracts (including capitation and shared savings arrangements), as well as traditional fee-for-service arrangements. Mr. Barnes also advises clients on contract terminations, network access disputes, and revenue cycle practices. Experienced in managed care contract negotiations, he frequently counsels healthcare clients on federal and state compliance, charity and indigent care, non-contract provider payment, contract termination and transition, business office practices, and other issues. Mr. Barnes often works with healthcare providers and provider combinations in managed-care risk arrangements, helping them to develop efficient, legally compliant business and operational structures.
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Gustavo E.I. Matheus
Member
Anderson & Quinn
Mr. Matheus represents providers of healthcare services in various areas relating to reimbursement and claims denials,... | Read More
Mr. Matheus represents providers of healthcare services in various areas relating to reimbursement and claims denials, managed care, Medicare and Medicaid, network participation and credentialing, revenue cycle, and medical records and privacy. His clients range from single clinician practices, multi-physician groups, allied healthcare practitioners, nursing home facilities and hospital systems. Mr. Matheus enjoys teaching health law topics to students at undergraduate institutions, law schools and in medical school settings. He is a member of the Board of Directors of the Bowie Health Center Foundation.
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