Managed Care Contracting For Ophthalmology
How To Swim With The Sharks Without Becoming Fish Food
By: Gil Weber MBA
Why This Primer?
Managed Care contract review and negotiations are almost always last on everyone’s list, typically because it’s hard to know where to begin to get traction. And that’s half the battle.
This primer SOLVES that problem for you! It’s a self-help, “how to” guide that trains the reader on what to watch for as well as how to advocate for their practice and/or facility.
Sample Pages
For your reading pleasure, below, I've included links to the Primer's full Table of Contents as well as PDFs for some sample pages. I hope you enjoy them!
Table of Contents
Eligibility
Governing Law
Changing or Eliminating
Assignment
Notifying Patients
Frequently Asked Questions
What about all the “legalese” in Managed Care contracts? How does a layperson understand what’s written in them?
Please see the testimonials. I’ve “translated” contract (Provider Agreement) legalese into everyday vernacular that explains what it all means to you in understandable business terms.
How do I know if I’m even prepared to approach third-party payors to seek renegotiation of our contracts?
Do you provide legal guidance?
Do you give real-life examples of roadblocks put up by third-party payors, and how to get around those?
What about the payment option that includes an hour of consulting support?
Is additional support available no matter which purchase option is selected?
Even if using your Primer sometimes we may not be successful in negotiating or renegotiating a certain contract?
Testimonials
"Just got done reviewing Gil Weber's primer and I cannot say enough good things about his advice and comprehensive knowledge. We've ordered several copies as I want everyone on my administrative team to read it.
If you've never experienced a contract negotiation from scratch you may not appreciate the primer as much, but you will want to now reread all your contracts to figure out what you originally got yourself into. It's an eye opening experience.
If you do not feel you have the time to justify the cost of the primer, rethink your decision. It is worth every penny. The foundation for your understanding is here."- Cambria Krovic
Controller
Ophthalmology Surgery Center
Harrisburg, PA
"Gil, I am impressed. I thought I would have a difficult time getting through it, but you made it very entertaining and informative. This will be beneficial to ANYONE needing to review Managed Care contracts."- Maureen Lynch Yarbrough, OCS
Administrator
Pediatric Eye Consultants of North Florida
Jacksonville, FL
"Your information is not only informative, but tells the administrator *how* to do it."- Maureen J. Tipp, CPA, CMPE, COE
Consultant
Tipp Consulting
Marana, Arizona
(formerly Administrator, Northwest Eye Surgeons, Seattle, WA
"You have done a very comprehensive job in the meticulous writing about what could otherwise be construed as a rather boring topic! KUDOS on a job well done."- Steven R. Robinson, FASOA, COE
Senior Practice Management Consultant
SR Consulting
Ooltewah, TN
"Your Primer was an excellent source of information. It was informative and made learning about managed care contracting very entertaining. We were successful getting Aetna and UHC to the table for discussion about higher reimbursement. Key points encouraged meaningful negotiations resulting in an increase of some of our top codes."- Kristin E. Pegram
Contract and Compliance Manager
Mann Eye Institute
Houston, TX
"I am green to Ophthalmology in general (1.5 years) though I do have an insurance background. Your primer was most helpful, and we were able to negotiate better rates for our clinic and ASC with UPMC, UHC, Aetna, and Cigna... we are very happy with the information we got from your primer."- April M. Sees
Director of Business Services
Ophthalmic Associates
Johnstown, PA
"As a fairly new administrator insurance contracts is an area that I never realized had room for negotiation. With the help of Gil Weber's primer we just successfully negotiated our first insurance contract! Better reimbursements, better appeal time, and paid audits!"- Kim Woodruff, COE
Administrator
Parschauer Eye Center
Sandusky, OH
About The Author
Gil Weber, MBA
Gil Weber has been involved in Managed Care since 1978, every day of that in eye care. He began his practice management and Managed Care career as an optician for a California multi-specialty medical group designing, equipping, and managing three eye care examination and optical dispensing facilities. He was responsible for hiring and training the dispensing staff and for developing personnel policies specific to the dispensaries.
In 1979, long before most of the country could even spell HMO, Mr. Weber started collecting utilization and cost data that in 1981 established an at-risk reimbursement arrangement for the dispensaries. Under this the dispensaries were paid a flat fee no matter the type of spectacle lenses provided under a benefit plan, no matter whether a frame was or was not included, no matter the wholesale frame cost up to the patient’s benefit level.
In 1985 he transferred to the medical group’s HMO parent organization and was appointed as National Director of Vision Care Services. His first task was to research and write for the HMO’s two California plans what he believed were the nation’s first optometric quality assurance protocols for an IPA-based HMO. In 1986 the HMO acquired three other plans and grew overnight from 700,000 lives in 13 states to a little over 2 million lives in 26 states. As a result clinical lab services management was added to his responsibilities.
Ultimately Mr. Weber was responsible for evaluating contracts held between the various states and their vision care and clinical lab vendors, for implementing requests for proposal (RFPs) to bring down costs while maintaining quality and access to care, and to contract for the best rates he could secure.
Since then he has held several other senior level management positions including marketing and contracting duties with a national vision care third party administrator (TPA), consultant to a consortium of West Coast multi-specialty medical groups, consultant and Managed Care trainer for Vision Service Plan’s (VSP’s) national sales staff, and Managed Care Director for the American Academy of Ophthalmology. Since 1997 he has served as a consultant to ophthalmic practices and ASCs.
Over the years Mr. Weber has earned national recognition as a writer, lecturer, and expert on practice management and Managed Care. He is the author of eight books and monographs on practice management and Managed Care, and contributing author to seven others. He has presented more than 100 lectures, workshops, and teleconferences to professional organizations, and published more than 100 journal articles.
In addition Mr. Weber has served as chairman for six Managed Care conferences and as contributing editor for three professional journals. He was honored as the 1996 Adrien and Gladys Drouilhet Lecturer in Ophthalmology at the University of Texas - Houston Medical School, and was awarded the American Academy of Dermatology's 2002 "Golden Triangle Award" for excellence in public education of Dermatology issues. And while working full time he earned an MBA from Pepperdine University in Los Angeles, graduating first in a class of more than 300.
Buy This Primer!
Note: This Primer is only available as a spiral bound hard copy.
Option 1
$175.00
The Primer with Priority Mail shipping included.
Option 2
$275.00
Includes Option 1 and one hour of Gil's consulting time (a $240 value!) to answer your questions.
Instructions
Send a check for $175 USD for Option 1.
OR
Send a check for $275 USD for Option 2.
(either one payable to "Gil Weber, MBA") to:
Gil Weber, MBA
6063 Goleta Circle
Viera, FL 32940
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