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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
Maria K. Todd, PhD, MHA is a professional consultant providing the wealth of her knowledge and practical wisdom to more than 2000 hospitals, physicians, and therapists during the past 25 years. Possessing a depth and diversity of experience matched by few, she has earned a reputation as a peerless expert on managed care. She worked as an EMT and a surgical tech before moving into medical administration and health plan coordination. In addition to degrees in health administration, she is a certified mediator and health law paralegal. A prolific author, she is in constant demand as an award-winning speaker. As a volunteer, she has directly assisted hundreds of senior citizens.
What Is Managed Care? Managed Care Organizations. All-Products Contracts. Dealing with Self-Funded ERISA Payers in Managed Care: Employee Retirement Income Security Act (ERISA) of 1974. Medicaid Managed Care. Consumer Driven Health Plans: Contracting Implications. Silent Preferred Provider Organizations (PPOs), Secondary Markets, and White Space Management: Three Terms That Translate to Revenue Erosion and Frustration. Single-Case and Continuous-Discount Arrangements. Quality Issues in Managed Care (Pay for Performance). Reimbursement Methods in Managed Care. Strategic Planning for Renewals and New Contracts:Understanding the Changing Competitive Environment. Developing Business Rules for Better Contracts. Negotiation Techniques, Tactics, and Strategies. Contract Law Basics. Evaluating a Managed Care Agreement Step-by-Step. Appendix. Insurance and Managed Care Glossary.