Managed Care Contracting Handbook

Managed care contracting is a process that frustrates even the best administrators. However, to ignore this complexity is to do so at your own expense. You don’t necessarily need to bear the cost of overpriced legal advice, but you do need to know what questions to ask, what clauses to avoid, what contingencies to cover ... and when to ask a lawyer for help.

• Decode and analyze reimbursement problems, loopholes, and contract stipulations you are likely to encounter
• Learn tried-and-true tricks, tools, shortcuts, and techniques to evaluate agreements
• Negotiate contracts that won’t leave you open to unanticipated expenses

Written by Maria K. Todd, a seasoned professional in managed care contracting, this handbook is written for managers, analysts, and finance officers who have the daunting task of negotiating contracts for medical services. It offers an in-depth examination of managed care and its organizations and covers key areas, such as pay-for-performance initiatives, reimbursement methods, contract law basics, and negotiating strategies.

The Managed Care Contracting Handbook offers critical details and strategic information as well as resources on everything from HMOs and PPOs to Consumer Driven Health Plans (CDHP), self-funded ERSIA payers, and Medicaid managed care.

Fully updates the first edition, which was used widely in the U.S. and overseas.

Designed to equip you with the confidence that comes with knowing the right questions to ask and more answers than you are supposed to know, this easy-access resource —

• Provides a complete overview of managed care organizations
• Covers contract law basics
• Presents material that can be used internationally
• Discusses Medicaid Managed Care
• Offers an operational evaluation of a typical managed care agreement
• Includes sample contracts and important checklists, as well as a glossary