Pub. Date:
Taylor & Francis
The Managed Care Contracting Handbook / Edition 2

The Managed Care Contracting Handbook / Edition 2

by Maria K. Todd


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Product Details

ISBN-13: 9781563273698
Publisher: Taylor & Francis
Publication date: 03/24/2009
Edition description: New Edition
Pages: 300
Product dimensions: 6.20(w) x 9.10(h) x 1.10(d)

About the Author

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.

Table of Contents

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


Insurance and Managed Care Glossary

What People are Saying About This

From the Publisher

"Maria Todd is the most gifted managed care negotiation resource I have ever had the pleasure of knowing. Maria’s vast knowledge is as uncommon as it is welcomed to even the playing field between healthcare providers and payors. Those fortunate providers who take the time to participate in her educational sessions or read her books will undoubtedly achieve unparalleled results."

— Troy D. Roth, Senior Vice President, Revenue Management Strategy, Accuro, A MedAssets Company

"Maria Todd's The Managed Care Contracting Handbook is a must have book for the non-attorney health care professional negotiating managed care contracts for providers. Dr. Todd combines a thorough discussion of managed care contracting basics with helpful hints and practical tools for contracting with all types of payor organizations all with an easy to comprehend style. Dr. Todd brings what could be very dry material to life."

— Ellen E. Stewart, MSHA,JD,FHFMA, Partner, Berenbaum, Weinshienk & Eason, PC Denver, Colorado

"Many organizations struggle to optimize their managed care strategies to achieve operational and financial success. Maria Todd's new book could be the missing keystone to achieve that success. This is a must-read for every hospital executive involved in the managed care process - clinical and financial leaders alike. Clearly and concisely, Maria Todd lays out the background of managed care in all its complexity. Most importantly, she offers proven methods for planning, negotiating, executing, and evaluating managed care contracts that will withstand legal and operational challenges. Maria is well known for her knowledge, good judgment, and commitment to the industry, and her newest book should be used as a key part of any healthcare provider's managed care strategy."

— David Hammer, MBA, MHS, FHFMA, CHFP, Vice President, Revenue Cycle Solutions McKESSON Provider Technologies

"Dr. Todd does a marvelous job at taking the most complex issues of contracting and bringing them down to the level of understanding and simplicity. Using years of real life experiences and making them relevant to our world of contracts is brilliant. It is sad to have Dr. Todd point out how much trouble the insurance industry goes through to make us believe we are getting fair and useful contracts to manage our patients with."

— Lawrence M. Preston, MBA, FHFMA, President and CEO, Professional Medical Consultants, Inc.

"I have utilized Maria Todd’s materials for many of my engagements. She has her finger on the pulse of the managed care industry and is an important resource for my consulting business."

— Catherine M. Zito, FHFMA, CPA, Healthcare Financial Consultant

"As a certified managed care professional, Maria Todd has done it again! The 2nd Edition is even better than before. For example, her process for setting case rates is pure genius! Until I read this section, I didn’t fully grasp the ramifications of setting case rates without the requisite level of detail in the contract. In just a single passage, Maria Todd challenged me to dig deeper into an area in which I previously thought I had true expertise. As form Chair of managed care certification testing for the HFMA, this book is a must-read for improving the professional development of everyone dependent upon managing and negotiating accurate and real-world managed care contracts."

— David I. Samuels, FHFMA, MPA, 2008-09 President-Elect, HFMA/Nevada Chapter, President, EthiCare Breakthrough Solutions, Inc.

"The Managed Care Contracting Handbook should be required reading for ALL hospital managers regardless of the department they manage. The issues and solutions Ms. Todd addresses can mean the difference between barely surviving and successfully thriving for healthcare providers."

— Jackie Hodges, President, HRC Solutions

"I know I can rely on Ms. Todd to clearly define and simplify complex issues. Not only does it help my understanding, but assists me in conveying complicated issues to others. I have consistently found her recommendations and tools to be practical and useful."

— Ed Casteel, Divisional Managed Care Director, Mississippi Division, Health Management Associates

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