Eligible for: ACMPE: 1|ACHE: 1|CEU: 1|CME(AAPC*): 1|CPE: 1.2|PDC: 1|PDU: 1 *MGMA is now offering our full conference for AAPC credit via our partnership with ACCME. Please see the event Continuing Education page for more information.
Traditional |Intermediate | Analysis
Attendees will learn what is popping up in payer contract language and fee schedules, and strategies for addressing it with your practice’s payers. In an ever-changing healthcare marketplace, it's interesting to see how payers are attempting to control their provider networks to bring more stability to their bottom lines. However, this can have massive operational and financial ramifications to your practice. For example, if your specialty is considering anything cutting edge, such as office-based labs (OBLs), watch out for limitations on new technology; look for prohibitions on pass-through billing; as well as payers attempting to limit private practice acquisitions through non-assignment clauses. Watch for obligations being imposed on your practice with regard to compliance mandates, such as Medicare exclusion database verification. The speaker will provide actual language from payer agreements that includes all this and more. Plus, she will offer helpful reminders about the traditional language terms that can have an adverse financial impact on your practice, such as notice of material changes, term language lock-ins, all product participation requirements, penalties for non-timely demographic updates.
Learning Objectives:
Point out new language relevant to billing operations that directly and adversely impact revenue.
Distinguish compliance and credentialing requirements imposed in updated language being used by payers, as well as strategies to reduce these unfunded obligations.
Examine examples of new payer contract language that could impede a practice's strategic growth plan in areas such as expanded ancillary services, practice acquisition, new locations, etc.
