Payer-Provider Agreements: Maximizing Reimbursement and Participating in Value-Based Contracts

BARBRI

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.

Description

Contracting and renegotiating with payers is a complex process. Healthcare providers must carefully negotiate the terms and provisions in a payer contract in order to maximize reimbursement and avoid claims denials.

Listen as our authoritative panel examines the key provisions to include in the payer-provider contract. The panel will also discuss value-based payment arrangements such as upside/downside risk arrangements and other "shared savings" structures and best practices for structuring such arrangements.

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

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