Managing Legal Exposure in Radiology — Pre-Conference
Wednesday, October 15, 2008
9:00 am – 4:30 pm
The ABCs of MCOs*
Michael Lowe, Esq.
This program is geared towards attendees who have some basic background in dealing with managed care contracting, negotiation, reimbursement and credentialing matters. This session will focus on the legal review of a managed care contract, with significant emphasis on educating participants on the types of issues that radiology group practices, diagnostic imaging facilities, hospitals, IDTFs, physicians and other radiology providers and billing companies face when dealing with managed care companies, and in particular during managed care contract negotiation, preparation and review.
Mr. Lowe will draw upon and apply what he has learned during more than 12 years in representing health care providers and professionals in matters involving managed care companies and will address areas such as prompt pay laws, silent PPOs, HMO/provider contracting laws, credentialing, reimbursement and other matters. His presentation will include reviewing and discussing the key provisions to be aware of when reviewing and negotiating managed care contracts such as what constitutes covered and emergency services, all product clauses, retroactive denial provisions, termination clauses, key definitions, payment and rates, and other contract issues and provisions. He will actually provide and review a representative, sample managed care agreement with the participants and discuss what to look for in managed care contracts and how to negotiate them. In addition to reviewing and discussing managed care contracting matters, the presentation will focus on how to detect and prevent silent PPOs, how to handle reimbursement disputes with managed care companies and in particular HMOs, and the types of typical state statutes such as prompt pay, continuing care, emergency services, balance billing and other laws which govern health care providers and professionals in their business relationships with HMOs, PPOs and other managed care organizations.
Designed for a smaller group setting in order to enhance the attendees’ learning experience, the presentation will allow for a large amount of question and answer sessions as well.
*Separate fee required
