Negotiating Provider Contracts with Payer Health Plans To Your Advantage

Webinar Background, Agenda & Trainer Profile :

Proper reimbursement from private payers is the only way to stay in business considering the continuous rise in expenses on managing your provider setting along with the number of denials on claim reimbursements every now and then. Your future depends on successfully negotiating with your private payer plans, but that is easier said than done. It is vital for providers to understand the key guidelines when negotiating and contracting with these payers. Lack of knowledge often hurts these providers financially. Often times, valid and medically necessary services are denied by health plans because the provider was not a participating or an in-network provider. Along with the advantages, there are also several drawbacks for being a contracted provider. This webinar will help health care providers identify not only the pros and cons of entering into contracts with health insurance companies but also the dos and don’ts of negotiating specific provisions in the payer agreements.  

Here is what will be discussed during this session :

• Provider Contracting: Overview & key terms to comprehend while contracting with a payer in 2023
• Comprehend both the benefits and disadvantages of contracting with payers
• Understand the meaning of key contract provisions
• Distinguish between contractual language that helps vs. that does not hurt
• Learn alternative clauses to achieve the same outcome
• Know when balance billing is permissible
• Identify the reasons for denial to figure out what you can bill the patient
• Negotiate the allowable rates based on your usual and customary or prevailing charges
• Ensure that you are able to fully assert your rights against the 800-pound gorillas
• Recognize the limits of payer negotiations
• FAQs and Resources
  

About The Trainer: Paul W. Kim has over 24 years of health law experience with a uniquely comprehensive understanding of the U.S. healthcare industry. As a former CMS employee, Paul advises clients in all aspects of health law from corporate compliance counseling to reimbursement litigation. He clerked at the Maryland State administrative hearings office, writing decisions for Administrative Law Judges. He worked in the general counsel's office of a national managed care organization and for the Maryland State Medicaid Agency at the Department of Health & Mental Hygiene. Then, prior to entering private practice, he drafted regulations and policies for the Medicare Program at the Centers for Medicare and Medicaid Services ("CMS") of the U.S. Department of Health & Human Services ("DHHS”). Having worked on reimbursement, fraud and abuse, privacy and clinical research issues from the patient, provider, payer and government perspectives, Paul has a unique understanding of the health care industry and an in-depth knowledge of the issues and challenges today clients face.