State Exchanges: Opportunities for Provider Contracting

Event Information
Product Format
Prerecorded Event
60 Minutes
Product Description

Know the Prerequisites for Accepting Care Of Newly Insured Patients

With insurance exchanges coming online over the next few months, providers have new contracting opportunities to serve newly insured patients. Some providers may see this change as an opportunity to foray into managed care, while others already have contracts in place and are considering how exchanges will impact their existing deals.

Before venturing into exchange patient care, providers need to do their homework. First, they need to find out which payers will be serving exchange patients. Specific obligations of providers imposed by the payers and/or exchanges 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 exchange patient care.

In this informative medical compliance session, our expert Wayne J. Miller, Esq. will outline considerations for accepting care of newly insured patients. Basically, he’ll outline the steps to be completed prior to accepting contracts for exchange patient care. Wayne will also specify compensation and other terms in existing contracts and in new proposals that will be critical for successful contracting in this new era of exchanges.

Discussion areas with examples:

  • Site Of Service basics
  • Examples of Site choices
  • Defining proper sites
  • Settings: outside office, hospital etc.
  • Special cases, e.g., telemedicine
  • Avoiding liability: waiver via instructions
  • Liability concerns: F&A, Stark
  • Correcting errors: self disclosure
  • Payment significamce
  • Problematic POS billing
  • Medicare Standards
  • F & NF Rate Facilities
  • Carrier advice: liability waiver
  • Overpayment refund (PPACA)
  • STARK fundamentals and potential violations
  • Reminder: State law
  • Antikickback law redux
  • Self disclosure

Who Should Attend? Hospitals, physicians, practice managers, medical groups, health care consultants and 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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