Contracts Review

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You are the new CFO, of UM Medical Center, a 120 multi-skilled level three (3) healthcare facility. You have summoned a team of healthcare and business experts to assist with the process of contract negotiating. Based on the federal mandate of the Affordable Care Act (ACA), prepare a proposal summarizing the team’s final recommendations in preparation for an upcoming meeting.

Devise a proposal that address the following:

• Present a four to five (4-5) page proposal recommending the team’s final decision based on the review of National Committee on Quality Assurance (NCQA), 2016-2017 health insurance plans rating that can be located directly at http://healthinsuranceratings.ncqa.org/2016/Default.aspx. The proposal must identify the following:
  • Conduct a one (1) page analysis of the ACA and its future implications on managed care organizations (in particularly in reference to reimbursement)
  • Create a one (1) page checklist that will be utilized as a tool to review managed care contracts presented to the organization.
  • A one year (1) financial analysis as a predictive measure/tool projecting the financial performance based on the adoption of the selected health plan and reimbursement model [based on fictitious data and figures]
  • Identify at minimum three (3) involved parties the team recommends as a contributing player in the review of all managed care contracts under consideration. Briefly support your reasoning for each recommended person to participate in the review.
  • Share the team’s final review of the contract, UM Medical Center has received for consideration. In addition, provide a final recommendation as to the selection of the primary managed care organization. In addition, discuss whether the contract should or should not be accepted, and the logic for the recommendation. The contract template can be located directly at https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20Management/Office%20Operations/sample_managed_care_contract.pdf )

  Resources:Decoding Managed Care Contracting: https://www.youtube.com/watch?v=9-j-C6n4t50Successfully Negotiating Managed Care Contracts: http://www.hfma.org/Content.aspx?id=16658Managed Care Answer Guide: http://www.patientadvocate.org/requests/publications/Managed-Care.pdf2013 MC Contract Evaluation Guidelines: http://www.acr.org/~/media/ACR/Documents/PDF/Economics/Managed%20Care/2013_CEGuidelines.pdfAnalyzing Managed Care Contracts: http://www.akrongeneral.org/portal/page/portal/AGMC_PAGEGROUP/practicemanagement/AnylzMgmtCrCntrcts.pdfManaged Care Contracting Toolkit: https://www.glms.org/Content/User/Documents/PPAC/ManagedCareToolkitComplete.docSample Managed Care Contract Template: https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20Management/Office%20Operations/sample_managed_care_contract.pdf

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Contracts Review was first posted on December 1, 2020 at 9:35 am.
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