The Managed Care Contracting Handbook: Planning and Negotiating the Managed Care Relationship (Hfma Healthcare Financial Management Series)

As managed care health insurance programs penetrate the healthcare market, hospital administrators, management staff and others responsible for directing or managing hospitals, clinics, laboratories, allied health services and physician practices need to understand the dynamics of managed care. Hammering out a good contract requires that healthcare providers be able to evaluate the strengths and weaknesses of contracts. At the same time, they must also be able to position their organizations in order to attract and maintain managed care contracts that will bring in more patients and generate new business.The Managed Care Contracting Handbook takes the mystery out of the negotiating process by offering readers tried and true techniques, short cuts and necessary negotiating tools. The book begins with an in-depth discussion of managed care concepts and managed care organizations, including a chapter on reimbursement methods, and also discusses Tricare and quality issues associated with managed care. Once familiar with basic managed care concepts, The Managed Care Contracting Handbook offers readers important advice on proposal development, strategic planning, negotiation techniques and strategies and contract law. To help healthcare providers evaluate current agreements effectively, the book also includes an in-depth discussion and analysis of model of a typical managed care agreement.