Many physicians struggle with fee-for-service Payer contract negotiations because asking for higher payments can feel like a pointless effort. Negotiating a successful payer contract is possible for those willing to craft a thoughtful, data-driven argument for why they deserve more money. Physicians think it will be really stressful or may not yield any results. Negotiating payer contractors is often an overlooked option for revenue generation. Reviewing your payer contracts and negotiating them from time to time could ensure the long-term financial sustainability of your practice. In our previous articles, we already have discussed basic guidelines and tips for negotiating payer contracts. In this article, we have discussed additional tips for the same.

Additional Tips for Negotiating Payer Contracts

Make a list:

Target the payers you want to prioritize. Before spending any time trying to contact payers you’ll want to work to identify your top 5-10 payers first. This list would be a good point to start.

Create a connection with a payer:

Once you have identified your top payers, it’s time to connect with a person directly regarding your contract. Communicating with a live person is critical to creating a relationship with your payer where you can build rapport and trust. In turn, this relationship will result in an allyship once it is time for contract negotiations. Begin with calling someone in credentialing, provider enrollment, or network management department. Calls in these departments will likely lead to a conversation with someone who can lead you to the most relevant rep to discuss contracts.

Get the current fee schedule:

The preferred way to get current contact information is by getting an original copy of the fee schedule from the payer. Keep in mind that this can take up to 30 days to obtain from calling/portals. You can also gather this information by looking at the claims history. The downside with this method is that there are adjustments, depending on modifiers and multiple procedures that could impact your allowable from claims.

Find out your value in the network:

Know your ratings on Google, review platforms like RateMDs and ZocDoc, and work to differentiate yourself and bring added value to the payer network. What do you do that the payer would appreciate, outside of how big you are or the revenue you generate? Do you keep people out of the ER? Do you have office hours that patients appreciate? Work to build added value.

Develop a relationship with payers:

Develop a plan to initiate regular contact with your payers. Believe it or not, your payers want to hear from you. They want to know what you’re doing to improve the quality of your care, drive value for members, and reduce costs so they can funnel more patients to high-value practices. If you only approach payers during the negotiation process or when you have issues, you risk seeming self-interested and like you only care about increasing reimbursement rates. And, while it’s true that you do care about increasing reimbursements, it’s important to establish trust and nurture payer relationships as a mutually-beneficial partnership.

All payers are not equal:

The approach you take to obtain contracts successfully for one payer may not work for others, so it’s important that you validate your process. Are you collecting contracts? Are you negotiating? Different payers have different channels, and understanding the best one for each payer is key. As you get more familiar with working with payers, you will begin to see patterns and trends that will make you more effective.

Contracting for different networks:

Many times payer contracts can cover more than one network i.e., commercial (PPO, HMO, POS), Medicare Advantage, and Managed Care (Medicaid). As a result, it’s important that you make yourself aware of how the payer operates with those products. Each payer will treat these contracts differently, so becoming familiar with the language used will be helpful in navigating these contracts. For example, one major payer might have a blanket contract that is in compliance with CMS guidelines, while another major payer has a contract section for commercial payers that overrides Medicare Advantage patients.

Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services. We assist healthcare practices in getting credentialed and reviewing payer contracts with the ultimate aim to boost practice collections. If you are looking for any assistance in provider credentialing/enrolment or payer contracts, email us at: [email protected] or call us at: 888-357-3226.

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