Managed care organization (MCO) payers, third-party auditors and even the Medicare Administrative Contractors (MACs) continue to ride roughshod over the rules and standards that are supposed to govern their operational interactions with hospitals and health systems. There is no accountability. In addition, language within managed care agreements and provider manuals almost always curry favor for payers, with few to no consequences for poor performance on their side of the contractual relationship. The pitfalls of missing or weak interpretive language in these agreements are a hidden risk, threatening hospital solvency. In addition, there's little to no support from oversight agencies whose responsibility it is to provide independent assistance, ensuring fair and equitable payer/provider relationships.
Moreover, the privatization of Medicare by third-party administrators, coupled with their ability to scoff at the rules of care management and less-than-expected contractual performance, has upended the hospital's ability to provide the very best direct care to patients. With no consequences for reckless disregard of what is best for the patient, managed care payers make care decisions that are supposed to be in the hands of the treating physicians and other clinicians.
This webcast, led by nationally recognized leaders Brian McGraw and Dr. Kendall Smith, will educate you on the best ways to handle payer malfeasance and abuses through an understanding of federal, state and contractual provider protections. They will demonstrate a successful approach that marries together both clinical and legal arguments to support your claims, your documentation and your entitled rights. You'll leave better able to defend your hospital's right to be paid for the necessary care you provide your communities.
Why This is Relevant:
Without a clear understanding of the legal intricacies of the laws, standards and guidelines surrounding medical policies and third-party reimbursement, many hospitals are letting revenue that belongs to them slip through their fingers.
- Identify three clinical-legal areas where providers can hold payers, auditors and CMS contractors accountable
- Use NCQA and/or URAC accreditation standards to compel payer adherence with rapid decision timeframes
- Break down financial classes into payer plan types, and use them moving forward in denial/appeal management
- Ensure that the C-suite is informed and engaged with your payer accountability strategy
- Develop a multi-faceted approach for invoking provider and beneficiary protections in your payment recovery action plan
Who Should Attend:
Chief financial officer, vice presidents of revenue cycle and managed care, physician advisors, utilization review staff and clinical documentation integrity (CDI) staff.
Webcast Access Privileges: Only one login is allowed per webcast purchased. Discounted pricing for additional registrants is available. For more information about webcast pricing and requirements, click here.