Payer Contract Negotiations

Depending on your specialty and healthcare services offered, up to 90% of your revenue may come from private payer (Aetna, Humana, Cigna, etc…). Are you aware that a peer practice down the street may be getting paid up to 30% higher for the same services offered? While we cannot and would not disclose another client’s proprietary information, we can certainly offer comparisons to current comparable or large market offerings. While initial contracts may be non-negotiable, we have had success in increasing reimbursements depending on market saturation and specialty. 

In the practices that we manage on a continuous basis, we undertake a full contract evaluation at least every thirty months. This is the schedule which we advise.

Negotiation projects, when performed effectively, should take approximately 2-3 months for a practitioner group and 3-4 months for a facility. This time-frame allows for appropriate offer-counter-offers to maximize the contracted rates custom-fitted for your organization. We ensure that lab tests/radiography/pathology are covered if your practice offers such services. These are often overlooked but critical aspects of your strategic plan. 
We recommend a contract/fee schedule analysis based on actual rates paid, not percentages of Medicare. Payer contract analysis is something we can perform for you or we can instruct your billing staff. This presents a true and objective status of your payer reimbursements and may serve to dispel some long-held fallacies.

If we find that a payer is unwilling to renegotiate your contract, regardless of our time spent, there is no charge. When you share resources, there are less resources. When you share knowledge, there is more knowledge. Our firm has significant experience in negotiations for all specialties and types of facilities. These include: