The Managed Care Contracting Handbook ─ Planning and Negotiating the Managed Care Relationship

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 for help.


Decode and analyze reimbursement problems, loopholes, and contract stipulations you are likely to encounter


Learn tried-and-true tricks, tools, shortcuts, and techniques to evaluate agreements


Negotiate contracts that won’t leave you open to unanticipated expenses


Written by Maria K. Todd, a seasoned professional in managed care contracting, this handbook is written for managers, analysts, and finance officers who have the daunting task of negotiating contracts for medical services. It offers an in-depth examination of managed care and its organizations and covers key areas, such as pay-for-performance initiatives, reimbursement methods, contract law basics, and negotiating strategies.
The Managed Care Contracting Handbook offers critical details and strategic information as well as resources on everything from HMOs and PPOs to Consumer Driven Health Plans (CDHP), self-funded ERSIA payers, and Medicaid managed care.
Fully updates the first edition, which was used widely in the U.S. and overseas.
Designed to equip you with the confidence that comes with knowing the right questions to ask and more answers than you are supposed to know, this easy-access resource —



Provides a complete overview of managed care organizations


Covers contract law basics


Presents material that can be used internationally


Discusses Medicaid Managed Care


Offers an operational evaluation of a typical managed care agreement


Includes sample contracts and important checklists, as well as a glossary

Maria K. Todd, PhD, MHA is a professional consultant providing the wealth of her knowledge and practical wisdom to more than 2000 hospitals, physicians, and therapists during the past 25 years. Possessing a depth and diversity of experience matched by few, she has earned a reputation as a peerless expert on managed care. She worked as an EMT and a surgical tech before moving into medical administration and health plan coordination. In addition to degrees in health administration, she is a certified mediator and health law paralegal. A prolific author, she is in constant demand as an award-winning speaker. As a volunteer, she has directly assisted hundreds of senior citizens.

What Is Managed Care?
Managed Care Organizations
All-Products Contracts
Dealing with Self-Funded ERISA Payers in Managed Care:
Employee Retirement Income Security Act (ERISA) of 1974
Medicaid Managed Care
Consumer Driven Health Plans: Contracting Implications
Silent Preferred Provider Organizations (PPOs), Secondary
Markets, and White Space Management: Three Terms That
Translate to Revenue Erosion and Frustration
Single-Case and Continuous-Discount Arrangements
Quality Issues in Managed Care (Pay for Performance)
Reimbursement Methods in Managed Care
Strategic Planning for Renewals and New Contracts:
Understanding the Changing Competitive Environment
Developing Business Rules for Better Contracts
Negotiation Techniques, Tactics, and Strategies
Contract Law Basics
Evaluating a Managed Care Agreement—Step-by-Step
Appendix
Insurance and Managed Care Glossary