Are You In or Out?

This panel discussion will bring together two of the healthcare industry’s top experts related to in-network negotiations, Ron Howrigon, and the out-of-network option, Ed Gaines.

From a contract negotiation standpoint, Ron takes into account all aspects of a healthcare entity’s strategic plan:

  • Chargemaster evaluation.
  • Payer mix evaluation.
  • Financial forecasting.
  • What-if analysis.
  • Physician compensation evaluation.
  • Payer contract review.

So what is Plan B if all of the above falls apart—or the plan comes to you “out of cycle” and demands a 30-50% cut in your network rates—then what?

  • Why should you care about out-of-network status?  Let’s look at the recent report from the non-profit organization, FAIR Health. They have one chart that should make you care.
  • The latest CMS data on the IDR process to date: who’s winning, what are they winning and how?
  • What are your ultimate goals for the IDR process?
  • How do you address health plan non-compliance with payment/claim adjudication and other issues?
  • What does the future of the IDR look like once the Texas Medical Association litigation is resolved?  Could Congress come back to address CMS’s failures to enforce the NSA and address health plan non-compliance?