Continuing Legal Education

Advising Providers – The Future of Healthcare Reimbursement (CHICAGO)

January 31, 2014
12:00 – 4:00 p.m. (reception 4:00-6:00 p.m.)
3.75 MCLE hours
Presented by Health Care Law

Chicago
ISBA Regional Office
20 S. Clark Street, Suite 900
(map and directions)

The current changes in reimbursement methodologies have resulted from the desire to control health care costs, many of which have involved moving from fee-for-service as the predominant means of payment to risk-based reimbursement methodologies. This half-day seminar helps you advise your provider clients on healthcare reimbursements and includes over 350 pages of electronic materials for your reference. Healthcare attorneys, in-house council for hospitals, and lawyers advising physician practices – with intermediate practice experience – who attend this seminar will better understand:

  • How healthcare reimbursements are calculated;
  • The different types of payment models;
  • The need for Risk Adjustment in Exchanges;
  • How changes in the reimbursement methodologies have affected insurance and health systems;
  • How providers should plan ahead;
  • The key attributes of contracts from a statistical perspective;
  • How to identify and explain risks to providers;
  • What to do when the contract isn’t producing results; and
  • Much more!
Please Note: Prior to the program, you will receive a weblink via email allowing you to access the course materials prior to the program. You will also receive a copy of the course materials (for no additional charge) when you arrive at the program, but will need to check the appropriate box on the registration page letting us know if you prefer a flash drive or printed course book.


Program Coordinator:
Alice R. Kush, Attorney at Law, Winfield

Program Moderator:
Carolyn V. Metnick, Barnes & Thornburg, LLP, Chicago

 

Agenda

12:00 – 1:00 p.m.  Reimbursement Changes: Definitions and the Physician’s Perspective
Join us for a better understanding of how healthcare reimbursements are calculated, as well as a discussion on the new Payment Models, why Risk Adjustment is so important, and the key questions that must be covered in any risk-based managed care contract. Offered from the perspective of the physician, this segment examines the need for Risk Adjustment in Exchanges, how to evaluate reimbursement based on population (including guidance in obtaining data and reinsurance), the need to be able to terminate contracts, and shadow fee schedules. Questions will be answered at the end of the segment.
Catherine I. Hanson, Whatley Kallas, San Francisco

1:00 – 2:15 p.m.  Reimbursements

  • Relationship Realities
    Gain a better understanding of the real meaning behind industry labels, such as “reimbursement” rather than “payment,” “charge” vs. “price,” and “patient” instead of “consumer.” Learn how these labels obscure the real nature of payer-provider contractual relationships and needs, as well as the payers’ interests and needs in crafting contractual arrangements with healthcare providers to obtain quality, cost-effective healthcare services for health plan enrollees.
    Kathryn Roe, The Health Law Consultancy, Chicago
    Jack Rovner, The Health Law Consultancy, Chicago 
  • Reimbursement: Strategies
    Get the information you need on reimbursement strategies from the perspective of a strategic consultant. Topics include: key contract attributes; the trend toward partnering or collaboration between payers and providers; the role of MSOs for small and solo practices; and important statistical data.
    Steve Young, CPA, Health Scape Advisors, Chicago

2:15 – 2:30 p.m.  Break (refreshments provided)

2:30 – 3:15 p.m.  Drafting and Negotiation: Nuts and Bolts
The new Managed Care Models create new risks and obligations for providers, in addition to the old “traps” found in managed care contracts. This comprehensive overview offers a practical nuts-and-bolts approach to drafting and negotiating contracts, as well as a discussion on what to do when the healthcare provider is not benefiting from the bargain. Learn how to identify and explain risks to providers, propose revisions to contract language, minimize payment risks for providers, identify “Sheep’s Clothing” provisions, and prevent the misuse of rate agreements.
Thomas P. Conley, Arnstein & Lehr, Chicago
Elias N. Matsakis, Holland & Knight, Chicago

3:15 – 4:00 p.m.  Panel Discussion: Contracts That Aren’t Producing
This panel presentation discusses what to do when the contract isn’t producing the anticipated results. Audience questions are encouraged.
Moderator: John A. Roberts, Edwards Wildman Palmer LLP, Chicago
Thomas P. Conley, Arnstein & Lehr, Chicago
Catherine I. Hanson, Whatley Kallas, San Francisco
Elias N. Matsakis, Holland & Knight, Chicago
Kathryn Roe, The Health Law Consultancy, Chicago
Jack Rovner, The Health Law Consultancy, Chicago
Steve Young, CPA, Health Scape Advisors, Chicago

4:00 – 6:00 p.m.  Networking Reception
Compliments of the ISBA Health Care Section Council