Negotiating with Payers - How does your Practice Manage Contracts and Maximize Them?

Negotiating with payers can have a significant impact on the financial success of your practice. Have you reviewed your contracts and taken opportunities to highlight your accomplishments in patient satisfaction and improved outcomes?
 
Understand the Details in Your Payer Contracts
 
A simple table graph can help you keep track of payer contracts and when you start negotiations. In the graph, note the payers' contract elements for: renewal date, fee schedule revision, termination, timely filing, refund request, denials rate, fee scheduling rating, credentialing and reimbursement performance. It is also helpful to have in the same table the payer mix by charge percentage and payment percentage.
 
As you review your payer contracts, make sure you compare the actual reimbursement to what Medicare would have paid for the same service. Influencing factors in this comparison could include: contract rates or RVU year, modifier adjustments, denials, patient write-offs, payer adjudication flaws, GPCI adjustments and coding errors or unbundling.
 
Armed with data, your practice will be ready when it comes time to begin negotiations for renewal of payer contracts.

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