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Course Details

Course Information
  • smart_display Format

    Live Online with Live Q&A

  • signal_cellular_alt Difficulty Level

    Intermediate

  • work Practice Area

    Health

Date & Time
  • event Date

    Thursday, June 12, 2025

  • schedule Time

    1:00 PM E.T.

  • timer Program Length

    90 minutes

Credit Information

  • This 90-minute webinar is eligible in most states for 1.5 CLE credits.

$297.00
CLE
ALL

This CLE course will provide guidance on structuring payer-provider contracts. The panel will address key provisions to include in both value-based agreements and any other payer-provider agreement. Topics will include limitations on retrospective review, eligibility and authorization guarantees, and dispute resolution.

Faculty

Gustavo E.I. Matheus
Miscellaneous

Mr. Matheus represents providers of healthcare services in various areas relating to reimbursement and claims denials, managed care, Medicare and Medicaid, network participation and credentialing, revenue cycle, and medical records and privacy. His clients range from single clinician practices, multi-physician groups, allied healthcare practitioners, nursing home facilities and hospital systems. Mr. Matheus enjoys teaching health law topics to students at undergraduate institutions, law schools and in medical school settings. He is a member of the Board of Directors of the Bowie Health Center Foundation.

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Adam J. Falcone
Feldesman Tucker Leifer Fidell Llp - Washington

Description

Contracting and renegotiating with payers is a complex process. Healthcare providers must carefully negotiate the terms and provisions in a payer contract in order to maximize reimbursement and avoid claims denials.

Listen as our authoritative panel examines the key provisions to include in the payer-provider contract. The panel will also discuss value-based payment arrangements such as upside/downside risk arrangements and other "shared savings" structures and best practices for structuring such arrangements.

Outline

  1. Key provisions
    1. Eligibility guarantees
    2. Authorization guarantees
    3. Concurrent and retrospective review
    4. Appeals of medical necessity and administrative denials
    5. Takebacks and offsets
    6. Audits
  2. Value-based arrangements
    1. The emerging consensus on structuring value-based arrangements
    2. Best practices in value-based contracting

Benefits

The panel will review these and other notable issues:

  • What are the critical provisions that should be included in the payer-provider agreement?
  • How does the payer-provider agreement impact reimbursement for healthcare services?
  • What are best practices for structuring payer-provider agreements?