12 Questions On Compensation Issues For Hospitals And IPAs Article

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12 Questions on Compensation Issues for Hospitals and IPAs

Critical pieces of the Healthplan Agreement are the Compensation Areas. 12 Questions The Athena Group uses are taken from their booklet. Do you know the answers to these questions for all of your Healthplan Agreements?

Author: Mark Marten

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Typically many hospitals and IPAs struggle to complete managed care negotiations in a timely manner and with the optimum terms possible. Most management teams are already stretched thin and lack the necessary time for proper research and back-and-forth wrangling. As a result, negotiations are often completed late and below market rates.

Like any negotiation, knowing how far the other side will go is the key to successfully negotiating rates and terms. However, because directly comparing rates with other hospitals and IPAs is difficult, another means of obtaining market intelligence is needed. A solution many successful hospitals and IP As use is to hire a third-party negotiator well-versed in the rates and approaches of the various health plans.

Critical pieces of the Healthplan Agreement are the Compensation Areas. 12 Questions The Athena Group uses are taken from their booklet. Do you know the answers to these questions for all of your Healthplan Agreements?

The Athena Group uses extensive contacts, market intelligence and these 129 questions to help hospitals and IPA’s speedily negotiate more favorable managed healthcare Agreements.

1. How much compensation is to be paid and how is it to be determined?
2. Are you comfortable with the payment methodology they are offering? Is it radically different from the payment methodology used by your other contracted plans?
3. If payment is based on coding, which version is used? How quickly will updates be incorporated?
4. Is the plan allowed to withhold payments? How much? Under what circumstances must the plan pay back withholds? What rights do you have if you disagree with the plan's decision to keep a withhold?
5. Does the plan have to account for the disposition of monies it withholds? If so, how (e.g., quarterly financial reports)?
6. What types of incentives or bonuses can you earn? Quality? Outcome? Efficiency? Cost?
7. Do you know exactly what you're supposed to do to earn incentives or bonuses?
8. Are there any incentives for members to obtain their care from you? Are these incentives to use your services at least as favorable as incentives to use other network providers? Do referring providers have incentives (or requirements) to refer in-network?
9. If a member changes providers during a course of treatment, how is compensation allocated?
10. Under what circumstances are you entitled to rate increases?
11. How are rate increases determined? By annual revision based upon a formula such as inflation? By pegging rates to independent factors, rates, or measurements like the Medicare reimbursement rate? By annual renegotiations?
12. Does the plan have the right to "most favored nations" rates?

The Athena Group uses extensive contacts, market intelligence and the booklet "129 Questions To Ask When Negotiating Healthplan Agreements" by Mark Marten to help hospitals and IPAs speedily negotiate more favorable managed health care agreements.

Mark Marten, principal consultant of The Athena Group, has a 25-year track record of successfully negotiating agreements for healthplans and with healthplans. For information about speaking services, consulting services or for quantity purchases of the booklet "129 Questions To Ask When Negotiating Healthplan Agreements", contact The Athena Group at (888) 8-ATHENA or www.AthenaGroup1.com.

Mr. Marten can be reached at:
THE ATHENA GROUP
Managed Care Experts

Mark C. Marten, CHE, PAHM, MBA
Principal
54 Tessera Avenue
Foothill Ranch, CA 92610
Toll free: (888) 8-ATHENA
(888) 828-4362
(949) 584-7247
E-Mail: Mark@AthenaGroup1.com
Web: www.AthenaGroup1.com
FAX: (949) 583-9787

About Author

Mr. Marten has successfully helped Hospitals, IPAs and Surgery Centers in increasing revenues above anticipated levels in healthplan negotiations. Additionally, the negotiations also produced operational efficiencies that assisted the providers in daily operations. Through the Managed Care Contracting Package developed by Mr. Marten, The Athena Group has helped provide the Managed Care Assessments, Contract Negotiations and Strategic Planning needed for successful Healthplan negotiations.

Mr. Marten has over 25 years experience in the Healthcare field. He has held executive management positions with payors and providers over that period of time. He currently is the Principal Consultant for The Athena Group. The Athena Group is a Healthcare consulting firm specializing in Improving Contracting Results for providers,such as Hospitals, IPAs and Surgery Centers. The Athena Group also works with Healthplans in Network Analysis, Market expansions and Competitive Intelligence.

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12 Questions on Compensation Issues for Hospitals and IPAs