Managed Care Organization (MCO) Team Project “Contracts Review”
You are the new CFO, of UMUC Medical Center, a 120 multi-skilled smooth three (3) heartinesspains dexterity. You accept summoned a team of heartinesspains and calling experts to stay delay the manner of abbreviate negotiating. Domiciled on the federal command of the Affordable Pains Act (ACA), equip a tender summarizing the team’s terminal recommendations in provision for an upcoming convocation.
Devise a tender that addresses the following:
Present a disgusting to five (4-5) page tender recommending the team’s terminal resolution domiciled on the retrospect of National Committee on Quality Assurance (NCQA), 2016-2017 heartiness insurance guiles rating that can be located undeviatingly at http://healthinsuranceratings.ncqa.org/2016/Default.aspx. The tender must substantiate the following:
Conduct a one (1) page decomposition of the ACA and its coming implications on managed pains structures (in especially in regard to reimbursement)
Create a one (1) page checklist that conciliate be utilized as a instrument to retrospect managed pains abbreviates presented to the structure.
A one year (1) financial decomposition as a threatening measure/instrument hanging the financial achievement domiciled on the excerption of the clarified heartiness guile and reimbursement model [domiciled on suppositious postulates and figures]
Identify at restriction three (3) implicated parties the team recommends as a contributing player in the retrospect of all managed pains abbreviates inferior importance. Briefly, stay your rationalistic for each recommended peculiar to have-a-share in the retrospect.
Submit one (1) only Microsoft Word muniment
Resources:
Successfully Negotiating Managed Pains Contracts: http://www.hfma.org/Content.aspx?id=16658
Managed Pains Answer Guide: http://www.patientadvocate.org/requests/publications/Managed-Care.pdf
Managed Pains Contracts - Key Provisions for Providers https://corporate.findlaw.com/law-library/managed-care-contracts-key-provisions-for-providers.html
National Council on Disability (2013). Chapter 1. An Overview of Medicaid Managed Care. https://www.ncd.gov/publications/2013/20130315/20130315_Ch1/
Tinsley, R. (1998, September/October). Negotiating or renegotiating managed pains abbreviates.. Medical Group Management Journal. pp. 66-71. (In Week 4 Learning Resources)
Managed Pains Contracting Toolkit: https://www.glms.org/Content/User/Documents/PPAC/ManagedCareToolkitComplete.doc
Sample Managed Pains Abbreviate Template: https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20Management/Office%20Operations/sample_managed_care_contract.pdf
