Certificate Program: Payer Contracting

Most practices know what is required to accomplish due diligence on their contracts but dread the thought of systematically gathering payer agreements and fee schedules, analyzing the findings, and developing and executing a strategy to renegotiate agreements. The challenge of being faced with so many hard-to-find puzzle pieces in the quest to accomplish even the first steps of finding the agreements, amendments and relevant schedules can quickly overwhelm a practice and derail it from its goals. This session will share turnkey processes that will get you headed in the right direction and on task even when obstacles are in the way. The primary focus of this session will be on building your foundation — the gathering, analysis and strategy development stage of your payer contracting project.

This session will set the stage for the content in Session II of the education series: How to initiate a negotiation, what makes your practice special, and how to model and test an offer so that you have a clear understanding of why it is so important to start with a solid foundation.

This session will build upon the contracting foundation established in Part I. Once a practice has tracked down contacts, agreements and fee schedules, the contracting process enters the next phase: Developing proposals and crafting your practice value proposition. The first focus of this session will be on identifying your specific negotiation targets, including identifying top CPT® codes, comparing rates, evaluating proposals and methodologies across your book of business and establishing targets for negotiation. The instructor will then use this analysis to construct proposals, including sample verbiage and recommended strategies. The session will provide insight into the alternative payment model landscape for practices to consider and position as part of the negotiation process. Additionally, this session will focus on developing the practice value proposition, providing templates to use to start the process of articulating the value during the negotiation process. The final focus will include recommended go-forward strategies to integrate the contracting practice into the core financial management strategy.

The concluding session addresses contract monitoring and evaluation. The first hour will be a hands-on workshop demonstrating the Microsoft Excel VLOOKUP function as a tool to analyze payer performance. A sample dataset will be provided for all attendees to manipulate during the session. The session will then demonstrate how to track and analyze payer performance through contract monitoring, providing methods for ensuring that the rates negotiated match payment rates.

NOTE: It is recommended – but not required – that attendees have access to two monitors for the first portion of this session. There is a demonstration, as well as hands-on work.

Penny Noyes, CHC
President, CEO, Founder, Health Business Navigators

Penny Noyes brings four decades of healthcare related experience to medical practices on both the payer/MCO and provider sides of the industry. Since 1999, when Ms. Noyes founded HBN, she has been working with a variety of healthcare-related clients who require assistance with payer contracting and credentialing. She has written and executed business plans, renegotiated managed care agreements, provided market exposure, improved client revenue and increased the bottom line. She is sought after by numerous organizations to provide opinions on hot issues for periodicals and to do educational seminars on the topics of payer contacting and credentialing as she brings her "roll up the sleeves," candid approach to material presented.

Ms. Noyes has held various leadership positions throughout her career in healthcare. She served as Senior Vice President of Business Development for a venture capital backed start-up, U.S. HealthWorks, a practice management company specializing in occupational medicine where she was able to negotiate both improved reimbursement and achieved delegated credentialing with all payers for nearly 100 clinics in 7 states representing nearly $100 million in annual revenue. Prior to that she spent 11 years at Allmerica Financial, an $11 billion insurance and financial services company, where she was an Assistant Vice President responsible for product development of health plans nationwide, as well the contracting and credentialing of 180,000 providers nationwide. While at Allmerica she also led a project related to the development of PHCS in collaboration with 17 other health insurance companies. Earlier in her career she worked at Blue Cross of Massachusetts for 6 years on development and marketing of fully insured and self-funded health plans and HMO products, including some of the earliest Medicare risk-based plans.

Amanda Hilbert
Director, Payer Contracting, Health Business Navigators

Amanda is a graduate of Western Kentucky University and University of Kentucky Law School, J. David Rosenberg College of Law. She has been working at Health Business Navigators since her law school graduation in 2015 and, since that time, has become one of the country’s most seasoned and knowledgeable payer contracting specialists.  As an attorney she is a member of the Kentucky Bar Association and the Bowling Green/Warren County Bar Association, but does not currently engage in private practice nor act in the capacity of providing legal advice. Instead, she has become known for her diligence in the obstacle-ridden process of gathering payer agreements and fee schedules, analyzing  key data and contract terms that have been collected and verified, and turning the new found information into the foundations of successful payer contracting strategies and the associated negotiations, including determining the impact of payer offers and modeling counter offers, as well as reviewing final contracts or amendments to determine if they reflect the negotiated terms.

Doral Davis-Jacobsen, MBA, FACMPE
Chief Executive Officer, Prosper Beyond. Consultant, MGMA

Doral Davis-Jacobsen, MBA, FACMPE, is a Partner at Prosper Beyond LLC, a specialized healthcare consulting firm in Asheville, N.C. Doral is a seasoned healthcare consultant with more than 20 years of experience serving healthcare providers ranging from solo practitioners to large academic medical centers. She is a popular speaker and author, always looking around the corner to help her clients prepare for what's next. Doral is known for assisting practices with next generation managed care contract negotiations, payment reform and revenue cycle. She is a Fellow in the American College of Medical Practice Executives. Doral serves as the Chair for the North Carolina MGMA Payer Contracting Committee 2021. She has written numerous articles on medical practice revenue cycle, managed care contracting and payment reform and is a frequent speaker at national, regional and local healthcare forums. Doral is the co-author of MGMA's book, Transitioning to Alternative Payment Models: A Guide to Next Generation Managed Care Contracting, published in October 2016.

Nate Moore, CPA, MBA, FACMPE
President, Moore Solutions Inc.

Nate Moore, CPA, MBA, FACMPE, speaks, consults, records and writes about business intelligence in medical practices throughout the country. Nate’s book, Even Better Data, Better Decisions: Advanced Business Intelligence for Medical Practices, is an MGMA bestseller. Nate’s consulting focuses on using SQL Server to mine and leverage medical practice data into actionable knowledge.

Nate creates a series of powerful Excel Videos at mooresolutionsinc.com demonstrating how to use Microsoft Excel in a medical practice. Excel Videos have been viewed thousands of times by practice managers across America. Nate also moderates the Excel Users MGMA Community, the online resource for practice administrators to collaborate about Microsoft Excel.