the managed care contracting handbook: planning & negotiating the managed care relationship

ISBN-13: 9781563273698 / Angielski / Twarda / 2009 / 344 str.

Maria Todd

Opis

Demystifying the contracting process, the second edition of this unique work is an essential how to book for those venders involved with the delivery of managed care services. Easy to read and concise this edition provides an updated look at this rapidly evolving area. It offers an in-depth look at managed care and its organizations as a foundation for contracting strategies and covers key issues such as consumer driven health plans, pay for performance initiatives, and contract negotiations. Written by seasoned professional in managed care contracting, it also offers a comprehensive layman's evaluation of a typical managed care agreement, as well as sample contracts and important checklists.

Spis treści

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.

O autorze

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.