Negotiating Managed Care Contracts

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Managed Care Contracting

Author : William A. Garofalo
Publisher : Jossey-Bass
ISBN 13 : 9780787945817
Total Pages : 0 pages
Book Rating : 4.9/5 (458 download)

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Book Synopsis Managed Care Contracting by : William A. Garofalo

Download or read book Managed Care Contracting written by William A. Garofalo and published by Jossey-Bass. This book was released on 1999-01-06 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Today's heath care marketplace is highly competitive, requiring managed care providers to contract with dozens of insurers to survive. Each of these contracts comes with their its unique terms and conditions-making the contracting process overwhelmingly complex and giving many health care executives major headaches. Written by three of the country's leading health care consultants and attorneys, Managed Care Contracting is the first book to offer executives with no legal background practical, step-by-step advice on how to create winning contracts between health care organizations, payers, and employers. In straightforward language, free of legalese and jargon, this much-needed resource demystifies managed care contracting and prescribes some critical advice for hospital and physician group practice executives. The authors present helpful guidelines for evaluating the various types of managed care contracts and explain the most significant terms and concepts executives are likely to encounter. A treasure trove of information for health care executives no matter what their experience level, Managed Care Contracting Examines how to develop a contracting strategy Reviews the fundamentals of negotiating the contract Frames the key steps in the contracting process Provides a managed care contract negotiations checklist Dissects sample hospital and physician contracts Analyzes the contract risk factors by the type of payment explores the implications of changing financial incentives Outlines the most up-to-date information in the regulatory environment Includes illustrative examples and helpful tables and chartsFor health care executives who are just beginning the complex contracting process and for the more experienced who require the most current information on the topic, Managed Care Contracting provides the knowledge and tools they need to succeed. "Managed Care Contracting is a very timely

Negotiating Managed Care Contracts

Author : Medical Management Institute
Publisher : McGraw-Hill Companies
ISBN 13 : 9780076007059
Total Pages : 180 pages
Book Rating : 4.0/5 (7 download)

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Book Synopsis Negotiating Managed Care Contracts by : Medical Management Institute

Download or read book Negotiating Managed Care Contracts written by Medical Management Institute and published by McGraw-Hill Companies. This book was released on 1994 with total page 180 pages. Available in PDF, EPUB and Kindle. Book excerpt:

The Final Hurdle

Author : Dennis Hursh
Publisher : Advantage Media Group
ISBN 13 : 1599323133
Total Pages : 125 pages
Book Rating : 4.5/5 (993 download)

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Book Synopsis The Final Hurdle by : Dennis Hursh

Download or read book The Final Hurdle written by Dennis Hursh and published by Advantage Media Group. This book was released on 2012-05-15 with total page 125 pages. Available in PDF, EPUB and Kindle. Book excerpt: Get Your Career Off on the Right Track! Everything Physicians Need to Know About Employment Contracts COMPENSATION AND BENEFITS *Dangers of productivity compensation *Common incentive compensation formulas - what needs to be included *Benefits to look out for in addition to your compensation *How to determine if you are "disabled," and how the employer should NOTbe able to make this determination *What the employer can, and can't negotiate as far as benefits *Stark law traps, and how to avoid them RESTRICTIVE COVENANTS *What's really important in restrictive covenants, and what isn't worth negotiating over *Minimizing the impact of a restrictive covenant *How you can be released from a restrictive covenant *Negotiation strategies in buy-outs of restrictive covenants CALL COVERAGE *The language you must have DEFINING WHAT IS EXPECTED OF YOU *Patient contact hours expectations *What flexibility an employer will demand THE TERM OF THE AGREEMENT *Issues with hospital and managed care credentialing, and how to work around them *Grounds for termination *"Without cause" termination issues OTHER ISSUES IN AGREEMENTS TO WATCH OUT FOR *Medical record issues *Assignment of location of service *Budgetary weasel language to avoid *Malpractice issues in common provisions MALPRACTICE INSURANCE *The types of coverage, and the significance when you leave *Need for "tail coverage" *How to minimize the devastating cost of "tail coverage" PRIVATE PRACTICE ISSUES *Time to ownership *Concerns with "guaranteed" ownership *Costs of the buy-in *Methodologies for determining the buy-in, and the pros and cons of each *Why a cheap buy-in may not be in your best interest *What provisions are absolutely vital in regard to future ownership

The Physician's Comprehensive Guide to Negotiating

Author : Steven Babitsky
Publisher : Seak Incorporated
ISBN 13 : 9781892904317
Total Pages : 330 pages
Book Rating : 4.9/5 (43 download)

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Book Synopsis The Physician's Comprehensive Guide to Negotiating by : Steven Babitsky

Download or read book The Physician's Comprehensive Guide to Negotiating written by Steven Babitsky and published by Seak Incorporated. This book was released on 2007-01-01 with total page 330 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Negotiating Managed Care Contracts

Author : Robert D. Keene
Publisher : Practice Management Information Corporation
ISBN 13 : 9781570660931
Total Pages : 160 pages
Book Rating : 4.6/5 (69 download)

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Book Synopsis Negotiating Managed Care Contracts by : Robert D. Keene

Download or read book Negotiating Managed Care Contracts written by Robert D. Keene and published by Practice Management Information Corporation. This book was released on 1994-01-01 with total page 160 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Managed Competition

Author :
Publisher : DIANE Publishing
ISBN 13 : 9780788100260
Total Pages : 120 pages
Book Rating : 4.1/5 (2 download)

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Book Synopsis Managed Competition by :

Download or read book Managed Competition written by and published by DIANE Publishing. This book was released on 1993-07 with total page 120 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pamphlet from the vertical file.

Understanding and Negotiating Construction Contracts

Author : Kit Werremeyer
Publisher : John Wiley & Sons
ISBN 13 : 1394150202
Total Pages : 390 pages
Book Rating : 4.3/5 (941 download)

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Book Synopsis Understanding and Negotiating Construction Contracts by : Kit Werremeyer

Download or read book Understanding and Negotiating Construction Contracts written by Kit Werremeyer and published by John Wiley & Sons. This book was released on 2023-07-19 with total page 390 pages. Available in PDF, EPUB and Kindle. Book excerpt: Understanding and Negotiating Construction Contracts The complexities of construction contracts are made easy with this thorough and readable guide Construction contracts can be complex for both owners and contractors. For contractors, negotiating fair and balanced commercial terms in contracts is just as important as properly managing projects; a properly negotiated contract can mitigate unnecessary risk and unnecessary risk transfer. This, in turn, reduces exposure to financial liability for the contractor and for avoidance of contract claims and disputes. Understanding and Negotiating Construction Contracts provides a comprehensive and readable introduction to the world of construction contracts. Providing, for example, coverage of the four most common types of contracts—lump sum/fixed-price, cost-plus, time-and-materials, and unit-pricing—it promises to reduce uncertainty and allow contractors to enter contractual negotiations with greater confidence to be able to achieve a fair and balanced contract. This updated new edition reflects the up-to-date best practices to understand how to better negotiate the commercial terms and conditions in construction contracts. Readers of the second edition of Understanding and Negotiating Construction Contracts will also find: Updated information on indemnity, insurance, and negotiation An all-new chapter with a contract analysis checklist Real-world examples drawn from small residential, retail, large commercial, and international projects Understanding and Negotiating Construction Contracts is essential for construction professionals and college students studying construction contracts and the liabilities arising out of them.

Negotiating Managed Care Contracts

Author : Medical Management Institute, The
Publisher :
ISBN 13 : 9781583830116
Total Pages : 250 pages
Book Rating : 4.8/5 (31 download)

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Book Synopsis Negotiating Managed Care Contracts by : Medical Management Institute, The

Download or read book Negotiating Managed Care Contracts written by Medical Management Institute, The and published by . This book was released on 1998-01-01 with total page 250 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Renegotiating Health Care

Author : Leonard J. Marcus
Publisher : John Wiley & Sons
ISBN 13 : 1118021576
Total Pages : 514 pages
Book Rating : 4.1/5 (18 download)

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Book Synopsis Renegotiating Health Care by : Leonard J. Marcus

Download or read book Renegotiating Health Care written by Leonard J. Marcus and published by John Wiley & Sons. This book was released on 2011-06-15 with total page 514 pages. Available in PDF, EPUB and Kindle. Book excerpt: Renegotiating Health Care Since the first edition of Renegotiating Health Care was published in 1995, new treatments, technologies, business models, reimbursement methods, and regulations have tangibly transformed the substance of health care negotiation. This thoroughly revised and updated edition of Renegotiating Health Care offers a practical guide to negotiation and conflict resolution in the health care field. It explores why unresolved conflict can hamper any organization's ability to make timely, cost-effective decisions and implement new strategies. The book focuses on the complex interactions between those who deliver, receive, administer, and oversee health care. It defines negotiation techniques and conflict resolution approaches that can improve efficiency, quality of care, and patient safety. Renegotiating Health Care outlines strategies and methods to resolve the myriad thorny issues encompassing the health care enterprise. It should be required reading for students and professionals in health services management, clinicians, leaders, policy makers, and conflict resolution experts working in the health care field. Praise for Renegotiating Health Care "An outstanding book! I learned their principles of meta-leadership while at the CDC and continue to use them at ABC News. This book is a must for anyone in leadership: practical, intuitive, and priceless." Richard E. Besser, MD, chief health and medical editor, ABC News "This book is a must-read to assist today's health professional navigate the ever-changing health care delivery system. Leadership will be the key to success." Pat Ford-Roegner, RN, MSW, FAAN, senior health consultant and former CEO, American Academy of Nursing

Medicaid Hospital Payment

Author : Jennifer Baldwin
Publisher :
ISBN 13 :
Total Pages : 110 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Medicaid Hospital Payment by : Jennifer Baldwin

Download or read book Medicaid Hospital Payment written by Jennifer Baldwin and published by . This book was released on 1991 with total page 110 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Managing Managed Care

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309175054
Total Pages : 394 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Managing Managed Care by : Institute of Medicine

Download or read book Managing Managed Care written by Institute of Medicine and published by National Academies Press. This book was released on 1997-04-21 with total page 394 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.

Cost-Based, Charge-Based, and Contractual Payment Systems

Author : Duane C. Abbey
Publisher : CRC Press
ISBN 13 : 1439872996
Total Pages : 186 pages
Book Rating : 4.4/5 (398 download)

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Book Synopsis Cost-Based, Charge-Based, and Contractual Payment Systems by : Duane C. Abbey

Download or read book Cost-Based, Charge-Based, and Contractual Payment Systems written by Duane C. Abbey and published by CRC Press. This book was released on 2012-08-07 with total page 186 pages. Available in PDF, EPUB and Kindle. Book excerpt: The fourth book in the Healthcare Payment System series, Cost-Based, Charge-Based, and Contractual Payment Systems compares cost-based systems, charge-based payment approaches, and contractually-based payment processes with fee-schedule payment systems and prospective payment systems. Supplying readers with a clear understanding of important background material on the different types of healthcare providers, it covers the basics of cost-based, charge-based, and contractual payment systems. The book illustrates essential concepts with a series of simple case studies—making it ideal for anyone interested in learning more about the specific systems and processes used for payment in healthcare services. It discusses Medicare cost-based payment systems, Medicare payment approaches, and includes an appendix that outlines the various Medicare payment systems. Demystifying contractual language, it outlines managed care contracts and also: Delves into the intricacies involved with adjudication of claims Considers capitated payment systems Addresses healthcare costs and cost-based reimbursement systems Examines charge-based and contractual payment systems Describes where healthcare payment systems are headed in the future Since compliance is inherent throughout the process of providing services, filling claims, and receiving payment, the book examines the range of compliance concerns, including statutory, contractual, and overpayment issues. Using numerous examples to illustrate the processes used for capitated contract arrangements, the book includes coverage of claim adjustment, managed care contracts, and the various combinations of payment systems used by third-party administrators.

America's Health Care Safety Net

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 030906497X
Total Pages : 304 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis America's Health Care Safety Net by : Institute of Medicine

Download or read book America's Health Care Safety Net written by Institute of Medicine and published by National Academies Press. This book was released on 2000-09-04 with total page 304 pages. Available in PDF, EPUB and Kindle. Book excerpt: America's Health Care Safety Net explains how competition and cost issues in today's health care marketplace are posing major challenges to continued access to care for America's poor and uninsured. At a time when policymakers and providers are urgently seeking guidance, the committee recommends concrete strategies for maintaining the viability of the safety netâ€"with innovative approaches to building public attention, developing better tools for tracking the problem, and designing effective interventions. This book examines the health care safety net from the perspectives of key providers and the populations they serve, including: Components of the safety netâ€"public hospitals, community clinics, local health departments, and federal and state programs. Mounting pressures on the systemâ€"rising numbers of uninsured patients, decline in Medicaid eligibility due to welfare reform, increasing health care access barriers for minority and immigrant populations, and more. Specific consequences for providers and their patients from the competitive, managed care environmentâ€"detailing the evolution and impact of Medicaid managed care. Key issues highlighted in four populationsâ€"children with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless.

The Professor Is In

Author : Karen Kelsky
Publisher : Crown
ISBN 13 : 0553419420
Total Pages : 450 pages
Book Rating : 4.5/5 (534 download)

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Book Synopsis The Professor Is In by : Karen Kelsky

Download or read book The Professor Is In written by Karen Kelsky and published by Crown. This book was released on 2015-08-04 with total page 450 pages. Available in PDF, EPUB and Kindle. Book excerpt: The definitive career guide for grad students, adjuncts, post-docs and anyone else eager to get tenure or turn their Ph.D. into their ideal job Each year tens of thousands of students will, after years of hard work and enormous amounts of money, earn their Ph.D. And each year only a small percentage of them will land a job that justifies and rewards their investment. For every comfortably tenured professor or well-paid former academic, there are countless underpaid and overworked adjuncts, and many more who simply give up in frustration. Those who do make it share an important asset that separates them from the pack: they have a plan. They understand exactly what they need to do to set themselves up for success. They know what really moves the needle in academic job searches, how to avoid the all-too-common mistakes that sink so many of their peers, and how to decide when to point their Ph.D. toward other, non-academic options. Karen Kelsky has made it her mission to help readers join the select few who get the most out of their Ph.D. As a former tenured professor and department head who oversaw numerous academic job searches, she knows from experience exactly what gets an academic applicant a job. And as the creator of the popular and widely respected advice site The Professor is In, she has helped countless Ph.D.’s turn themselves into stronger applicants and land their dream careers. Now, for the first time ever, Karen has poured all her best advice into a single handy guide that addresses the most important issues facing any Ph.D., including: -When, where, and what to publish -Writing a foolproof grant application -Cultivating references and crafting the perfect CV -Acing the job talk and campus interview -Avoiding the adjunct trap -Making the leap to nonacademic work, when the time is right The Professor Is In addresses all of these issues, and many more.

Essentials of Health Care Finance

Author : William Cleverley
Publisher : Jones & Bartlett Learning
ISBN 13 : 0763789291
Total Pages : 590 pages
Book Rating : 4.7/5 (637 download)

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Book Synopsis Essentials of Health Care Finance by : William Cleverley

Download or read book Essentials of Health Care Finance written by William Cleverley and published by Jones & Bartlett Learning. This book was released on 2011 with total page 590 pages. Available in PDF, EPUB and Kindle. Book excerpt: Essentials of Health Care Finance stands firmly in its place as the leading textbook on healthcare finance. No other text so completely blends the best of current finance theory with the tools needed in day-to-day practice. Useful for all course levels as well as a professional reference, this text offers a comprehensive introduction to the field. The Seventh Edition has been thoroughly revised to reflect the current economic environment in the healthcare industry, with thoughtful descriptions and ‘real-world’ examples. As the not-for-profit health care sector has increasingly come under attack by legislators seeking new sources of tax revenue, this edition also features a new chapter on assessing community benefits including an examination of the new Schedule H of the IRS 990 form. Ancillary instructor materials for the Seventh Edition have been significantly expanded and updated. PowerPoint lecture slides now include selected examples from the chapters. Electronic versions of many of the charts and tables in the chapters are provided to enable the instructor to re-create and modify existing examples. An expanded set of test questions with detailed answers will be provided for each chapter. New excel spreadsheets for selected chapters will be created to help both the students and the instructors perform a variety of financial analysis tasks with spreadsheet templates. The instructor’s manual has been revised to include key learning points, chapter overviews, and guidelines for class discussion.

A Guide to Managed Care Medicine

Author : William N. Tindall
Publisher : Jones & Bartlett Learning
ISBN 13 : 9780834217652
Total Pages : 322 pages
Book Rating : 4.2/5 (176 download)

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Book Synopsis A Guide to Managed Care Medicine by : William N. Tindall

Download or read book A Guide to Managed Care Medicine written by William N. Tindall and published by Jones & Bartlett Learning. This book was released on 2000 with total page 322 pages. Available in PDF, EPUB and Kindle. Book excerpt: Provides physicians, administrators, and other health professionals with information on managed care, from its history, forms and practices to detailed information on managed care contracting, physician compensation, monitoring, reporting, management, risk, productivity, and accountability. Annotati

Managed Care, Outcomes, and Quality

Author : Steven F. Isenberg
Publisher : Thieme
ISBN 13 : 9780865776876
Total Pages : 374 pages
Book Rating : 4.7/5 (768 download)

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Book Synopsis Managed Care, Outcomes, and Quality by : Steven F. Isenberg

Download or read book Managed Care, Outcomes, and Quality written by Steven F. Isenberg and published by Thieme. This book was released on 1998 with total page 374 pages. Available in PDF, EPUB and Kindle. Book excerpt: The first section leads us through the complicated and risky business of capitation and examines reimbursement in a managed care environment. The idiosyncrasies of managed care contracts are detailed and you will learn how to negotiate with managed care companies. There is a focus on practice profiling and the presentation of an expertise on referral guidelines. The final chapter explores the ethical issues of managed care. In section II you will find a description of outcome research and youseful information for the implementation of outcomes research in community-based office practices. The third section begins with two chapters on improving office efficiency and managing staff in a managed care environment. The next chapter leads us through the important and complicated software selection process for the individual practitioner's needs. A private practitioner offers his insight into managing a medical practice and the section completes with some helpful pointers to avoid malpractice claims. Section IV provides the physicians' response to managed care. The legal issues of mergers and networks are discussed. Several practicing physicians outline their personal experiences in the rapidly changing world of physician network development. The book's final chapter leaves us with an expertise on how physicians can take back healthcare