As a provider, your survival hinges on your ability to maximize reimbursements from managed care contracts and control access to agreed-upon discounts. But money lost at the time of service or through the collection process is often determined well before the patient ever comes through the door. In many cases, that money was lost back when the contract was negotiated. Top Managed Care Contracting Clauses: A Toolkit for Providers contains practical strategies and tools for any organization facing the prospect of negotiating a new managed care contract.
Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.
Managed care contracting is a process that frustrates even the best administrators. However, to ignore this complexity is to do so at your own expense. You don‘t necessarily need to bear the cost of overpriced legal advice, but you do need to know what questions to ask, what clauses to avoid, what contingencies to cover ... and when to ask a lawyer
The dominance of managed care is spreading quickly and risk managers are suddenly faced with major new challenges. With Managing the Risks of Managed Care, the risk manager will learn about risk management challenges in an integrated delivery system. The book also presents expert analysis on issues like contracting, peer review, ethical dilemmas, antitrust and more.
Drawing on the expertise of multi-degreed doctors, and multi-certified financial advisors, Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical PlannersTM will shape the industry landscape for the next generation as the current ecosystem strives to keep pace. Traditional generic products and sales-driven advice will yield to a new breed of deeply informed financial advisor or Certified Medical PlannerTM. The profession is set to be transformed by "cognitive-disruptors" that will significantly impact the $2.8 trillion healthcare marketplace for those financial consultants serving this challenging sector. There will be winners and losers. The text, which contains 24 chapters and champions healthcare providers while informing financial advisors, is divided into four sections compete with glossary of terms, CMPTM curriculum content, and related information sources. For ALL medical providers and financial industry practitioners For NEW medical providers and financial industry practitioners For MID-CAREER medical providers and financial industry practitioners For MATURE medical providers and financial industry practitioners Using an engaging style, the book is filled with authoritative guidance and healthcare-centered discussions, providing the tools and techniques to create a personalized financial plan using professional advice. Comprehensive coverage includes topics likes behavioral finance, modern portfolio theory, the capital asset pricing model, and arbitrage pricing theory; as well as insider insights on commercial real estate; high frequency trading platforms and robo-advisors; the Patriot and Sarbanes–Oxley Acts; hospital endowment fund management, ethical wills, giving, and legacy planning; and divorce and other special situations. The result is a codified "must-have" book, for all health industry participants, and those seeking advice from the growing cadre of financial consultants and Certified Medical PlannersTM who seek to "do well by doing good," dispensing granular physician-centric financial advice: Omnia pro medicus-clientis. RAISING THE BAR The informed voice of a new generation of fiduciary advisors for healthcare
