5 Points on Managed Care Contracts

Managed care contracts can be a headache for any healthcare organization. However, having a plan before negotiations and during live contracts can make a big difference. Here are five points that can make the managed care contract process more endurable.


1. Do the right prep work.
Hospitals and other providers must benchmark contracts against each other, see how all of their managed care contracts compare to others and figure out the financial impacts of each contract, says Kyle Kobe, principal at healthcare consulting firm Equation.

2. Ask the right questions. I. Naya Kehayes, founder and CEO of Eveia Health Consulting & Management, and Scott Becker, JD, CPA, partner at McGuireWoods, explain there are several pertinent questions hospitals and health organizations need to ask when reviewing managed care contracts. In fact, there is a checklist of 96 questions in 23 categories that should be addressed. Some of the questions involve clearly defining payment methods, rate changes and utilization-management structure.

3. Supply payors with meaningful data. Ms. Kehayes, speaking at Becker's 18th Annual ASC Conference in Chicago this past October, added that successful negotiations are also grounded in specific data that is meaningful to payors. For example, useful data could include capital expenditures, variances in payment methodologies, literature demonstrating trends and case mix.

4. Use available resources. In 2010, the American Medical Association unveiled its new National Managed Care Contract database, which allows physicians and other healthcare providers to access updated statues and regulations on managed care contracting and gives a broad range of common physician concerns when it comes to managed care.

5. Train the revenue cycle team to be "pit bulls." Mark Bogen, vice president of finance at South Nassau Communities Hospital in Oceanside, N.Y., says having a persistent teams that understands what needs to be collected will lead to less bad debt and more accountability. This is especially important for managed care contracted, which he says can be very convoluted.

Related Articles on Managed Care Contracts:

The New Health Age: The Future of Healthcare Delivery in America & the Changing Role of Providers

Denver Health CFO Peg Burnette: 6 Strategies to Stay Lean and Mean

More States Turning to Medicaid Managed Care Companies

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