AUDIOCONFERENCE ON TAPE OR CD
Sponsored by “Managed Care Contracting Resource Guide”
presented on November 1, 2006
Are you receiving discounted reimbursement that you never agreed to?
Silent PPO payer arrangements offer patients discounted fees without requiring them to access provider services. Under such arrangements, a third party obtains a database of preferred provider rates from a managed care organization, then the MCO sells or rents its PPO provider network to that third party or insurance broker. The result—the provider involved receives discounted reimbursement—which they never agreed on—from that PPO, instead of the expected out-of-network fees, which are typically higher.
How much money is your facility losing as a result of silent PPOs?
Hospitals must be cautious to assure that only patients entitled to a discount are receiving the negotiated fee. Otherwise, your organization will be extending discounts to individuals and payers who should be paying billed charges in full. In order to achieve this, you must be able to develop a process for ensuring the accurate enactment of particular contracts at hand.
Listen to HCPro's 90-minute audioconference where our expert speakers will help you identify inappropriate discounts and recover the revenue your facility deserves.
Learn key strategies to detect silent PPOs and combat their effects.
Our speakers will illustrate how you must watch for certain language in contracts to ensure that the correct discounts are applied. They’ll also discuss tactics to help minimize confusion on both patients and administrative personnel in hospitals.
Note: This is an intermediate-level program. Participants should have a basic understanding of finance and PPOs.
TAKE A LOOK AT THE AGENDA
- Setting the scene
- How to detect a silent PPO
- Internal communication and audits
- Who leases lists and who buys?
- Clues that suggest silent PPO activity
- Addressing the issue of silent PPOs in contract negotiations and language
- Tips for dealing with silent PPOs
- Case Study - Southeastern Ohio Regional Medical Center
- Implementing a patient accounting process to identify and recover inappropriate discounts
- Internal controls to prevent inappropriate discounts from happening again
- Payer reaction and changed behavior
A question and answer session will follow the presentation.
MEET THE SPEAKERS
Gwen Parrish, is a Managed Care Coordinator at Southeastern Ohio Regional Medical Center. Mrs. Parrish joined Southeastern Ohio Regional Medical Center in 1999. Southeastern Med is a Non-Profit facility located in Cambridge, Ohio and licensed for 171 acute care beds. Her healthcare career began in 1989 at a multi-specialty group practice also located in Cambridge, Ohio. During her time at Southeastern Med she has developed and implemented various initiatives to increase revenue and compliance throughout the facility. In her current position Mrs. Parrish is responsible for contract negotiation and management, payer relations, employer relations and education.
Allan Fine, is a Director in the Life Sciences and Healthcare practice of Navigant Consulting and is also the leader of its medical device practice. He specializes in strategic planning, market analysis, product commercialization and reimbursement strategy, product development, strategic partnering, market research and sales strategy. He has 24 years of healthcare consulting, medical device, pharmaceutical, biotech, provider, managed care and marketing experience. Mr. Fine has assisted manufacturers in designing integrated commercialization strategies from product conception through launch, as well as post-launch marketing support.
BONUS MATERIAL INCLUDED IN YOUR MATERIAL PACKET!
In addition to the expertise and advice presented during this audioconference, you'll also receive a slide presentation of the program materials and tools including:
- Examples of contract clauses
- Lists of words in contracts to watch for
- An example of how to crosswalk payers to contracts
Program materials are provided with PDF links.
WHO SHOULD LISTEN?
Managed care directors, managed care coordinators, PFS manager, revenue cycle director, CFO, patient access director, VP of finance, planning & marketing.
Purchase a tape or CD of the program and listen when you can. It's a perfect training tool for new staff or as a refresher for veteran staff.
Save money when you purchase multiple copies! Ask your customer service representative about money-saving
discounts and bulk orders. Call toll free 800-650-6787 or e-mail
customerservice@hcpro.com.
