Private Exchange Provider Contracting: Unique Issues

Event Information
Product Format
Prerecorded Event
60 Minutes
Product Description

All You Need to Know Before Venturing into Private Exchange Provider Contracting

Now that the initial enrollment in public exchanges is over, providers are increasingly focusing on private exchange network contracting opportunities. Since these networks are outside of many of the ACA requirements, it is important to understand how these arrangements differ from public exchange networks, and how providers may need to adjust in order to be able to participate in private exchange contracting.

Yet before venturing into private exchange patient care, providers need to do their homework. First, they need to find out who is sponsoring private networks locally and regionally, and identify the types of patients who are on such exchanges. Since sponsors have greater choice in selecting private network providers, the specific attributes of providers that are more likely to lead to a contract offer need to be known. Compensation formulas and payment terms need to be negotiated. Also, existing managed care contracts may have hidden terms that apply to private exchange patient care.

This program by expert speaker Wayne Miller describes critical differences in public and private exchange provider networks. It will outline diligence to be completed to increase the likelihood of being offered a private network contract. Terms in existing contracts and in new proposals will be specified, that will be critical for successful contracting.

Training Objective:

  • Private vs. public exchanges: what are the differences in provider contracting?
  • Are you automatically included in private exchanges under existing contracts?
  • How payment terms differ in private and public provider agreements
  • ACA and state laws that still apply to private exchange contracts
  • Due diligence necessary before joining a private exchange network
  • Five critical terms that are negotiable in provider contracts

Who Should Attend

  • Hospitals
  • Physicians
  • Practice managers
  • Medical groups
  • Health care consultants
  • Medical practice and facility executives

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About Our Speaker

Wayne J. Miller - Healthcare Compliance Expert

Wayne J. Miller, Esq., is a founding partner of the Compliance Law Group, Los Angeles, a law firm focused on health care industry legal compliance for clients nationwide. Wayne has practiced healthcare business and regulatory law throughout his 30-year career. His firm represents a wide range of healthcare industry clients throughout the nation. He is a frequent speaker for The Coding Institute national teleconferences on healthcare reimbursement, transactional and regulatory...   More Info
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