When reviewing contract language for managed care payor contracts, organizations should keep several goals in mind. The contract language scorecard is a tool organizations can adapt to help systematically review contract language for managed care "Payer" contracts and help achieve their goals.

• Talk about the contract language scorecard on the message board 
• Ask our expert a question about the contract language scorecard 

Negotiating managed care contracts can be challenging enough; negotiating behavioral health managed care contracts involves overcoming an extra hurdle or two in order to maximize reimbursement. Employing contracting strategies that protect reimbursement is critical because reimbursement rates for psychiatric care are lower than for medical care.

• Talk about the behavioral health contracting on the message board 
• Ask our expert a question about behavioral health contracting 

Is managed care outdated? Some believe that the term managed care has become outdated, taken on negative connotations and, therefore, should be changed.

• What Does the “Father” of the HMO Think?
• Talk about the potential name change on the message board 
• Ask our expert what they think about a name change 

Although there has been no uniform private payer policy regarding never events, one thing is certain: sooner or later payers will be addressing the issue, which means that hospitals need to be prepared by making sure they understand their obligations and responsibilities with respect to never events.

• Talk about never events on the message board 
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One area that seems destined to see change is the payment system, which many say fosters expense and lowers quality. The specifics are still in the working stages so exactly what these next few years may bring is up in the air , but there are some areas in the current payment system that are ripe for reform.

• How Hospitals Can Prepare for Payment Reform
• Talk about payment reform on the message board 
• Ask our expert a payment reform question 

As providers are faced with increasing pressure to their bottoms lines, the importance of both generating and protecting existing revenue is paramount. The managed care contract audit may help protect revenue.

• Managing Payer Audits
• Talk about managed care audits on  the message board 

Depending upon a provider’s strategic goals, KPIs are used for any number of reasons, from negotiating better contractual terms to tracking negative trends and identifying problem areas. Here are some suggestions.

• A Peek Into One Provider’s KPIs
• David Hammer's Managed Care KPIs 
• Talk about KPIs on  the message board 

Although Medicare’s private fee-for-service option was created in 1997, only in the past few years have health plans that fall into this category experienced rapid growth. What's the future of the plans?

• The Doctor Fix Bill: Going Back to the Beginning 
• Kaiser Family Foundation Medicare Advantage Fact Sheet 
• MedPAC's Report on the Medicare Advantage Program
• Talk about Private Fee-for-Service Plans on  the message board 

Looking out for their own bottom lines, payers issue denials on payment of an insurance claim for a host of reasons, from a lack of medical necessity and preauthorization to inaccurate coding and duplicate claims.

• Is it worth it to invest in denial prevention?

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