decisionhealth Newsletters, Part B News - 2010 Issue 12 (December)
11 limits you must include in contracts with most favored nation clauses
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Article Overview
This piece is aimed at physician practices, contract negotiators, and health care administrators who manage private payer agreements. It outlines a series of broad negotiation topics related to most favored nation clauses, including payer type, membership size, services, geographic scope, contract term, payment risk, payment timing, related entities, exclusivity, and audit or certification language. The article also emphasizes why these issues matter in maintaining bargaining leverage and financial stability without disclosing the premium article’s specific contract language.
Why This Topic Matters
Most favored nation language can affect how a practice’s reimbursement terms interact across multiple payer contracts. Understanding the major limitation categories helps readers evaluate contract risk, preserve negotiating flexibility, and better assess whether a payer clause is acceptable.
Article Sections
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Overview and negotiation context
Introduces the article’s focus on most favored nation clauses in private payer contracts and explains the general purpose of negotiating contractual limits.
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Recommended limits to MFN clauses
Presents a series of broad limit categories that may be considered when reviewing payer contract language. The discussion addresses payer characteristics, contract structure, payment arrangements, affiliated relationships, exclusivity, and compliance-related provisions.
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Practical caution for contract termination
Highlights a general caution about preserving the ability to end the agreement if the clause becomes too restrictive or financially burdensome.
What You Will Learn
- How MFN clauses fit into private payer contracting
- What broad contractual factors may be considered when evaluating MFN limits
- Why practices may want flexibility in termination and compliance provisions
- What general categories of payer terms are commonly discussed in MFN negotiations
Who Should Read This
- Physician practices
- Health care administrators
- Medical practice managers
- Contract negotiators
- Health care attorneys
- Revenue cycle professionals
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