C189 - Business Strategies for Payer Negotiations and/or How to Go off the Grid

Event Time: Thursday April 26, 2018 1:00 pm to 3:00 pm
Topic(s): Practice, Policy, and Ethics, Business of Neurology
Director(s): Joseph Fritz PhD
Description: The rising cost of compliance with government regulations, time-consuming insurance documentation requirements, declining reimbursements, and increasing overhead threaten the sustainability of physician practices. Payers face similar pressures, with increasing cost of pharmaceuticals, hospitalizations and diagnostic services, limitations on premiums due to regulations and member or corporate affordability, and uncertainty in government subsidies. Solutions must be found in practice efficiency, ensuring dollars are spent where needed, reducing administrative expense, and preventing fraudulent activity. Faculty will give an overview of the existing payer landscape, highlighting both provider and payer concerns, discuss business and clinical metrics that can be used to guide and improve reimbursement models, and review strategies and implementations for non-mainstream financial models, such as bundling and capitation, subscription plans, and other sources of revenue.
Completion Message: Participants should be able to understand practice revenues, expenses, and quality markers that can be used to improve practice profitability, as well as position for payer negotiations; identify new revenue opportunities; establish and use key performance indicators for their practices; enhance work flow to maintain fiscal health; use benchmarking to enhance their practice; know how to determine which payers are creating an administrative drain on their practices; identify possible fraud internally within the practice; and understand how to evaluate and implement new financial reimbursement and risk-sharing management models, such as accountable care organizations; understand opportunities and risks associated with alternative payment models.
CME Credits: 2
Core Competencies: Practice-Based Learning and Improvement, Systems-Based Practice

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