Contracts and Contracting: A Primer

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Abstract

Purpose/Objectives:

The underlying guiding principles of case management services and practices of the Case Management Body of Knowledge include the following: “Case managers must possess the education, skills, knowledge, competencies, and experiences needed to effectively render appropriate, safe, and quality services to clients/support systems” and “Case management services are offered according to the clients' benefits as stipulated in their health insurance plans (http://www.cmbodyofknowledge.com/content/case-management-knowledge-2). Fulfilling these principles requires that the case manager engage in negotiating and contract execution.

Purpose/Objectives:

This article explores the concepts of negotiation and some of the many ways case managers contribute to the contracting process.

Primary Practice Setting:

Acute care hospitals, individual practice, managed care.

Findings and Conclusions:

Case managers can provide valuable information during the contracting process, in many settings. In the managed care arena, case management can help identify the types of services needed by the population the organization serves. The same understanding of data can assist during the payer contracting process in the acute care setting and ensure that the hospital is fairly reimbursed by third party payers. The independent practitioners will, undoubtedly, face the need to negotiate for themselves as well as their clients.

Implications for Case Management:

The case manager, regardless of the setting, benefits from an understanding of the principles and processes associated with negotiation and contracting.

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