Navigating the Briar Patch: Addressing Regulatory Compliance in an Alternative Payment World
12:45pm - 1:45pmMonday, March 5
Las Vegas - Venetian Convention Center
Alternative payment models involve collaboration between insurers, self-insured payers, third-party administrators, and health care providers, sometimes in ways none of them contemplated when they first began business. As part of deciding whether to participate in an alternative payment model, it is critical all involved parties be familiar with the compliance risks created by antitrust, insurance, and tax laws and understand how to mitigate those risks.
State at least one insurance law or regulation that might affect the choice of relationship in alternative payment model strategies, particularly those devolving risk from the insurer to the provider
Discuss antitrust statutes and regulations that might affect the assembly of provider networks and the negotiation for payment in certain alternative payment models, especially those that do not require the sharing of risk
Share information about restrictions on taxable entities and tax-exempt public entities collaborating to provide patient care and the treatment of the revenue received from such collaborative treatment episodes