Question

Please post 500-word response. Thank you!

There are many websites that discuss how to negotiate a good managed care contract. When negotiating the fee schedule, how do physician offices/hospitals know if they will obtain a good financial outcome (reimbursement) when they enter into negotiations for a managed care contract? What data do they need to investigate have ready as they enter into these negotiations. Consider any data elements that would come into play with regard to setting and negotiating per diem rates, bundled rates, billed charges, carve out diagnoses or procedures, ets.

Answer 1

To negotiate a good managed care contract first we need to have the understanding of the terms of contract like,
-capitation
-direct cost
-fee for service
-fixed cost
-health mainteanance organization
-incremental cost
-indirect cost
-single sevice care out
-variable cost etc.

Before negotiating ,we must get the data from network participants regarding the reimbursement.and also be sure of,
*know the market value,competition.
*calculate the raw cost,profit and negotiation rates.
*understand the terms of negotiation.
*get the copy of agreement regarding the negotiation.
*must know when to walk away from the negotiation without damaging the business.
*managed care contract must include the how long payer has to pay a clean claim.
*contract must also include the method of resolving the conflicts arised in managed care contract.