Managed Care for Rehab Providers Made Easy: Mastering Contracts and Obtaining Fair Reimbursment / Edition 1

Paperback (Print)
Not Available on BN.com
 

Overview

As the volume of patients who have insurance through managed care networks grows, so does the stress for rehab managers. Spending countless hours negotiating rates, tracking managed care patients, and reading through complicated contract details? Be careful-overlooking any aspect of your managed care contracts could cost your facility thousands of dollars, especially if leads your facility to treat patients at lower reimbursement rates than it deserves. No longer will you sign a contract and cross your fingers! Written by experienced rehab managed care professional, Nancy J. Beckley, MS, MBA, Managed Care for Rehab Providers Made Easy provides expert guidance on assessing how a facility's managed care contracts perform. This book and CD-ROM will also help rehab facilities deal with the challenges managed care networks present, including
• working out contract specifics
• negotiating better rates
• assessing risks
• evaluating contract performance
• credentialing Covering all aspects of managed care to help you plan a strategy that is specific to your market, Managed Care for Rehab Providers Made Easy will walk you through the process of creating new managed care contracts, altering current contracts, and eliminating contracts that are not financially sound for the facility. You'll also benefit from dozens of relevant, time-saving forms, statistics, and other useful tools on the bonus CD-ROM.

Read More Show Less

Product Details

  • ISBN-13: 9781601460417
  • Publisher: HcPro, Inc.
  • Publication date: 7/1/2007
  • Edition number: 1
  • Pages: 151
  • Product dimensions: 7.00 (w) x 8.90 (h) x 0.40 (d)

Table of Contents


A word from the author     vi
Introduction     1
Positioning to contract     4
Analyze current networks     5
Network matrix     10
Referral analysis matrix     13
Competitor's analysis     14
Let's get started     17
Insurance-where it all begins     23
Why manage costs?     24
How did we get here?     25
Insurance and managed care products     30
Medicare managed care     34
Medicaid managed care     36
Workers' compensation managed care     37
The contract     39
Managed care contracts for hospitals     40
Managed care contracts for physicians     41
Managed care contracts for ancillary providers and facilities     42
Legal contract review     43
Duties of the parties     47
Credentialing     49
Utilization review and utilization management     50
Medical records     54
Regulatory requirements     54
Governing authority and dispute resolution     55
Term and termination     55
Notices     56
Miscellaneous     56
Review and approval     58
PPO contracts     58
The silent PPO     59
Hospital contracts     63
What's next?     67
Provider applications     69
Facility application     75
Facility site inspection     76
Credentialing of therapists     77
Challenges and opportunities     80
Rates, risk, & financial analysis     81
Rate setting: Actuarial science     82
Values of copays and deductibles     84
Why managed care organizations want providers at risk     86
Why providers want to assume risk     87
Looking at costs     88
Financial indicators for private practice     88
Rate for physical therapy and rehab reimbursement     94
Capitation     97
Risk protections     100
Types of risk to control     100
Limiting and minimizing risk     102
Other factors and considerations in accepting risk     102
Determining cost objectives     103
Managing the copay, or finding dollars     104
Due diligence & negotiation     105
Negotiation      115
Negotiating tips     116
Assignment and challenges     119
Quality assurance & utilization review     121
Assignment and challenge #1     122
Assignment and challenge #2     126
Quality assurance for rehab providers     126
Contract performance analysis     131
Summary     141
Glossary of managed care terminology     143
Read More Show Less

Customer Reviews

Be the first to write a review
( 0 )
Rating Distribution

5 Star

(0)

4 Star

(0)

3 Star

(0)

2 Star

(0)

1 Star

(0)

Your Rating:

Your Name: Create a Pen Name or

Barnes & Noble.com Review Rules

Our reader reviews allow you to share your comments on titles you liked, or didn't, with others. By submitting an online review, you are representing to Barnes & Noble.com that all information contained in your review is original and accurate in all respects, and that the submission of such content by you and the posting of such content by Barnes & Noble.com does not and will not violate the rights of any third party. Please follow the rules below to help ensure that your review can be posted.

Reviews by Our Customers Under the Age of 13

We highly value and respect everyone's opinion concerning the titles we offer. However, we cannot allow persons under the age of 13 to have accounts at BN.com or to post customer reviews. Please see our Terms of Use for more details.

What to exclude from your review:

Please do not write about reviews, commentary, or information posted on the product page. If you see any errors in the information on the product page, please send us an email.

Reviews should not contain any of the following:

  • - HTML tags, profanity, obscenities, vulgarities, or comments that defame anyone
  • - Time-sensitive information such as tour dates, signings, lectures, etc.
  • - Single-word reviews. Other people will read your review to discover why you liked or didn't like the title. Be descriptive.
  • - Comments focusing on the author or that may ruin the ending for others
  • - Phone numbers, addresses, URLs
  • - Pricing and availability information or alternative ordering information
  • - Advertisements or commercial solicitation

Reminder:

  • - By submitting a review, you grant to Barnes & Noble.com and its sublicensees the royalty-free, perpetual, irrevocable right and license to use the review in accordance with the Barnes & Noble.com Terms of Use.
  • - Barnes & Noble.com reserves the right not to post any review -- particularly those that do not follow the terms and conditions of these Rules. Barnes & Noble.com also reserves the right to remove any review at any time without notice.
  • - See Terms of Use for other conditions and disclaimers.
Search for Products You'd Like to Recommend

Recommend other products that relate to your review. Just search for them below and share!

Create a Pen Name

Your Pen Name is your unique identity on BN.com. It will appear on the reviews you write and other website activities. Your Pen Name cannot be edited, changed or deleted once submitted.

 
Your Pen Name can be any combination of alphanumeric characters (plus - and _), and must be at least two characters long.

Continue Anonymously

    If you find inappropriate content, please report it to Barnes & Noble
    Why is this product inappropriate?
    Comments (optional)