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a. Payer and Provider agree to negotiate in good faith amendments to the rates established in this agreement, in the event 1) new technology not currently in use at the hospital is introduced, 2) there is a material change in the use of existing services, 3) there is a change in the place of service, 4) there is a coding change that affects the definition of the service, such that there is a material change in the costs non-contemplated by the current rates, or 5) there is new technology that has not yet been assigned an official CPT or HCPCS code by the Coding Committee of the AMA.

b. All such events will be classified as "New Technology."  Such New Technology may include, but is not limited to, inpatient and outpatient services including base costs, supplies, pharmaceuticals, implantables, biologicals, devices, disposable or tissue that have been approved for such use by the FDA or other regulatory agency, as may be required by law and are no longer deemed experimental by a governmental entity, trade association or other generally accepted organization in the industry.

c. Provider shall provide to Payer its good faith estimate of the annual additional costs (the "Aggregate Costs") caused by the New Technology, which may be one event or all of multiple events listed above.

d. Payer and Provider agree to negotiate in good faith to develop fair reimbursement (and a reporting methodology that shall be recognized by Payer’s claims processors in the event that an official CPT or HCPCS code has not yet been established) within 30 days of written notification to the other party. If the parties cannot agree to a mutually acceptable modification to the rates within ninety days after [Date or Time], the party requesting the rate modification shall have the right to submit the matter to mediation in [City, State] in accordance with the American Health Lawyers Association Alternative Dispute Resolution Service Rules of Procedure for Mediation. A certified mediator with at least five years experience with managed care contracting matters shall conduct the mediation. The costs of the mediation shall be borne by the party requesting the rate modification.   (or terminate this Agreement by giving Payer 90 days written notice.)

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With more than 30 years of experience in health care and hospital operations, marketing, and revenue cycle management, Maria Todd wrote the leading industry books on managed care contract analysis and negotiation  written for the medical group and hospital executive audience.   Find this book and others authored by Maria on Amazon.com

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