Evaluating Payer Contract Effectiveness Is Continuous

Many physicians believe that payment contract terms are non-negotiable; the truth is any payer is willing to renegotiate your fee schedule if you can save them money.

The reimbursement costs and fees paid for claims are just one aspect of your payer contracts; looking at the whole picture and understanding that you don’t always have to accept the prospective terms can help you increase your income without increasing your workload.

At CodeToolz, We See the Payers as Business Partners NOT the Enemy

In talking about how to improve the physician-payer relationship, first, you’ll have to understand the relationship. This is business.

You are a vendor, and they are a purchaser. The best way to improve that relationship is to be their best vendor. That may be by doing things better, cheaper, faster, or making sure you’re doing things that are important to them. Make yourself an invaluable vendor and they’ll treat you that way.

Evaluating Contract Effectiveness

First, it’s continuous, and you’re never going to be done. By the time you get things renegotiated, you probably must go back and take a look at the ones you did last year or the year before. A few considerations, but not limited to:

• How much does each contract pay as a weighted average percentage of Medicare?
• How do they compare with each other?
• If you are a very busy practice and a small carrier is paying you 20% less than everyone else, then it’s time to negotiate.
• If you haven’t renegotiated a particular contract in 2+ years, then it’s time to negotiate.

You should look at contracts every year, measure them against each other, and measure them against Medicare.

Key Elements of Managed Care Contract Negotiations

Show Your Proven History of Quality: The care you provide your patients can result in fewer hospital admissions, better patient adherence to medication and an overall healthier client base. This level of patient care also cuts costs for payers; your track record and history should be part of the negotiation process, with concessions given to your practice for your efforts to improve wellness and cut costs.

Beyond Dollars and Cents: While the actual monetary terms matter greatly, there are other contract considerations to address. How complex is the claims process and how rapidly will payments be made?

Preauthorization and Claims Workflow: Can you negotiate a faster turnaround time on your payments or eliminate some of the time it takes to get preauthorization for some patients and processes? Reducing these times can speed up the payment process and provide a healthier flow of capital to your practice each month.

Get Top Dollar: Do you truly understand the contract or are there hidden fees or discounts that may not be spelled out in plain language? You only negotiate your contracts once in a while; a third party expert (CodeToolz) already knows what to look for and where you can request changes to maximize the income you generate from your practice.

By Bringing In An Expert, You Can Be Sure That We Will Address All Of Your Practice Needs

If your practice is struggling with existing payer contracts or you want to negotiate a new fee for service fee schedule we can help in a variety of ways:

• Comprehensive contract review
• Contract language analysis to ensure optimal terms for physicians
• Utilization and payment analysis by payer to compare reimbursements
• Working with payers to raise reimbursement rates
• Preparation of competitive fee schedule analysis to support optimal rates
• Market analysis to present comprehensive proposal to payers
• Negotiate participation in additional payer plans in any given market

Summary

, if you’re tired of having to work harder and see more patients just to maintain your , then a look at your could reveal ways to increase your income without increasing your workload. Contact us to set up a consultation and learn what our team of negotiation experts can do to rejuvenate your business and ensure that you get top dollar for your efforts.

The Physician's Advocate in Payer Contracting

Our roots in payer contracting run deep, making CodeToolz one of the most effective payer contracting and reimbursement firms in the country.

Once our team has a clear understanding of what your payer contract contains, we identify strengths, weaknesses, and improvement opportunities and review them with you.

The CodeToolz team excels at negotiating the best possible terms for our physicians and healthcare clients. With a long history of contract negotiation experience and a deep familiarity with both the process and industry acceptable outcomes, our team works hard to get you the best possible outcome from every negotiation.

Let the experts at CodeToolz take your contracting efforts from burden to competitive advantage. The bottom line is that in negotiations, knowledge is power and planning is essential. Contact Us Today! (512) 787-1852

Schedule a Free Consultation / Demo here.