R$2.400,00
GENERAL INFORMATION
*DISCOUNT NOT CUMULATIVE*
R$ 2,200.00 – Value for CBR/ABCDI Member in good standing
R$ 2,400.00 – Amount for Non-CBR/ABCDI Members
Special condition for multiple registrations.
Ask us how!
In person at the CBR headquarters – São Paulo – SP
30 Vagas disponíveis
Description
In-person - 30 spots per class - 12-hour course
OBJECTIVE
Negotiation opportunities with health insurance companies go far beyond the mandatory annual adjustment stipulated by Law 13.003/14, regulated by RNs 363, 364 and 365.
Because radiology and diagnostic imaging exams are more expensive and more frequent than other types of exams, health insurance companies have focused over the last 20 years on ways to pay less for these exams.
To reverse this situation, we need to understand what these price reductions were and what negotiation strategy we should adopt for each situation, as this strategy may vary depending on the subject matter and the size of the paying source we are negotiating with.
In this module, we will teach you in a practical way how to negotiate effectively with health insurance providers and achieve better results.
PROGRAM CONTENT
- Major Challenge in the Segment;
- Excessive and non-standardized commercial information;
- Negotiation Strategy;
- Financial Impact of Volume-Based Management!;
- Predominant Commercial Management Model;
- Who is the Clinic Negotiator?;
- Negotiator Profile: Resilience and Rhetoric;
- Conducting the Negotiation and Formalization;
- Contracts with Paying Sources;
- First Steps to Reverse the Situation;
- Organization of Business Information;
- Document Organization;
- Cloud-based documents for control and sharing;
- File Name Structure;
- Structure of the Management Folder;
- Tool for Prioritizing the Scheduling of Top Paying Sources;
- Why Create a Scheduling Management Tool?;
- Indicator for Ranking the Best Paying Sources;
- The Filter Tool also applies to Exceptions;
- Daily dynamics to avoid losses.
- Tables of Medical Procedures in Supplementary Healthcare;
- Law 13.003/14 (Contractualization between Operators and Providers);
- Highlights of ANS Resolution 503;
- Highlights of ANS Resolution 512;
- Elimination of the CBHPM's tiered discount rule;
- CMED Resolution on Materials and Medicines;
- Illegality of Submitting Medical Reports to Health Insurance Companies;
- Opinion on Breast and Axillary Ultrasound;
- Indication and Prescription of Tests Using Contrast Agents;
- Presence of a Doctor During Contrast-Enhanced Imaging Examinations;
- Radiologist Can Indicate Tests in the Report;
- Reassessment of Radiological Examinations: "Second Opinion";
- Provider Replacement (RN No. 567);
- Next Steps Regarding Law 13.003/14;
- Contract Checklist to Comply with Law 13.003/14;
- Examples of Abusive Clauses.
- Historical Evolution of the Population – IBGE (Number of Inhabitants);
- Evolution of Beneficiaries of Supplementary Health Plans (ANS);
- IBGE Lives Versus ANS Coverage Rate (City and Region);
- % Growth of Lives ANS (City and Region);
- Evolution of Operators in the Region (City);
- Evolution of Supplementary Health Beneficiaries (Regional);
- Evolution of Operators in the Region (City);
- Evolution of Regional Operators (Regional);
- Claims Situation of Major Operators (Regional);
- Magnetic Resonance Imaging Equipment per Lives ANS by State;
- Computed Tomography Equipment per Lives ANS by State;
- Quantity of Imaging Equipment (Regional);
- ANS Lives by Quantity of Imaging Equipment (Regional);
- Competitor Information (Macro-region);
- Competitor Price Comparison.
- Which reference table? UCO value, Size (version)? Additions or Deflators? ;
- What is the contracted film price per square meter? Is the contract based on CBR or R$? ;
- What is the reference for Materials and Medication? If it's Brasíndice (PF + How many %)?;
- Are we able to charge for the non-ionic contrast agent in CT scans?;
- Does it have all the accredited service units?;
- Does it have all the accredited modalities?;
- Does it have all the accredited procedures?;
- Does it have all the accredited plans?;
- Is the contract already in accordance with Law 13.003-14? Does it have an adjustment index? What is it?;
- Does it have a tiered system? What are the payment methods? What are the rules? Is it in the contract?;
- Do we have negotiated packages? What are the readjustment rules?;
- What is the rule for Doppler ultrasound billing?;
- MRI of the breast (bilateral) already negotiated with TISS standard? What is the cost?;
- Angio-MRI (arterial and venous) and Angio-CT (arterial and venous) already negotiated TISS standard?;
- Do we charge for densitometry in two segments?;
- Do we charge for digital mammograms?;
- Does it have a web service authorization tool? Which one? Is it installed and working?;
- Does it have a payment statement and claim denial in TISS standard XML format?;
- Does it have authorization rules and rules for appealing denials? Is this in the contract?;
- Does it respect TUSS coding and description for all procedures?.
- Application of the Annual Adjustment;
- Paying Sources According to Average Price Index;
- Impact Analysis of Commercial Proposals;
- Setting up the Adjustment Calendar;
- Overview of All Adjustments;
- Multiple Negotiation Strategies;
- Negotiation Opportunities;
- Job involving negotiation of price lists for materials and medications;
- Job for Negotiating the Withdrawal of the Tiered Discount;
- Job involving negotiating the collection of Doppler ultrasound fees;
- Job Description: Negotiating the Values of Breast MRI – Bilateral;
- Job involving negotiation of bone densitometry values;
- Job involving the negotiation of arterial or venous angiotomography scans;
- Job of Negotiating Arterial or Venous Angio-MRIs;
- Job involving the negotiation of interventional exams.
- Job Description: Injury/Nodule Collection - Interventionalist;
- Job of Negotiating the Value of the Primovist Contrast;
- Job for collecting additional charges for spinal CT scans;
- Job involving billing for underarm ultrasound exams with breast ultrasound;
- Job involving negotiation of mammography exams;
- Accreditation Job – US – Endometriosis Research;
- Job Title: Accreditation - Mammography with Eklund Maneuver;
- Job for Authorization and Eligibility via Webservice;
- Job for Payment and Claims Statement.
SPEAKERS
Carlos Moura
He is a Business Administrator with an MBA in IT from USP and an International Human Talent Development Course from the University of Central Florida. With extensive knowledge of the Brazilian diagnostic medicine market, he is an Economic Advisor to the Brazilian College of Radiology and Diagnostic Imaging (CBR), which he represents as a member of the Supplementary Health Information Standardization Committee (COPISS) and the Sector Quality Assessment Technical Committee (COTAQ). He is a partner in Moura Assessoria, a management consultancy in the field of diagnostic medicine. Over the last fifteen years, he has held executive positions in the administrative, commercial and financial areas in the diagnostic medicine segment, among others.
Rodolfo Siqueira
Graduated in Business Administration with emphasis in Information Technology, he has over 12 years of experience in the Brazilian supplementary health market. He held leadership positions in the areas of Market Intelligence, Controllership, Receivables, Commercial and Imaging Diagnostic Management at the fourth largest Diagnostic Medicine company in the world (DASA). He is currently the Manager of Management Consulting for Imaging Diagnostic Clinics, with automation projects, revenue increase and cost reduction, ensuring great results for clients and management training in the health segment.
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