BC Advantage - 2018 Issue 9
Negotiating Payer Contracts
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Article Overview
This article explains how medical practices can approach payer contract negotiations with better preparation and a clearer understanding of their contracting position. It discusses broad review factors, benchmarking against common fee schedules and peer data, managing renewals and terminations, and the importance of properly drafted agreements and legal review. The content is aimed at practice managers, billing leaders, and providers who handle payer relationships and other business contracts.
Why This Topic Matters
Payer contracts affect reimbursement, operational stability, and long-term practice planning. Understanding negotiation points and general contract principles can help practices evaluate agreements more effectively and avoid preventable business and compliance problems.
Article Sections
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Evaluating payer contracts and practice fit
Introduces the idea that payer contracts may be negotiable and discusses the importance of reviewing terms in light of the practice’s overall position and goals.
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Using strengths, weaknesses, and benchmarking
Covers broad ways practices can assess their market position, compare performance data, and use external benchmarks when reviewing payer relationships.
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Fee schedules, reimbursement structure, and renewals
Discusses general considerations related to fee schedules, reimbursement formats, and what to examine when a contract is up for renewal.
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Negotiation approach, termination, and patient notice
Addresses the importance of avoiding unnecessary conflict, following contractual notice requirements, and planning for patient communication when ending a payer relationship.
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Other medical practice contracts and contract basics
Provides a broader view of contract types used in medical practices and explains general contract concepts and the value of legal review.
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Risks of breach and legal remedies
Summarizes general consequences that may arise when agreements are not followed and notes that disputes may lead to legal remedies.
What You Will Learn
- How medical practices can assess payer contracts at a high level
- Why benchmarking is used when reviewing reimbursement relationships
- What types of business considerations commonly come up in contract review
- How broader medical practice contracts fit into overall contract management
- Why attorney involvement can matter when agreements are drafted or changed
Who Should Read This
- Medical practice managers
- Billing and revenue cycle staff
- Physicians
- Healthcare administrators
- Compliance professionals
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