decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Contracts and Contract Negotiations / Overview
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Article Overview
This article explains broad issues to review before entering or renewing a managed care contract. It is aimed at physician practices, administrators, and coding or reimbursement teams that need to evaluate contract scope, included services, practice capacity, and the effect of payer mix on negotiating position. The discussion stays at a high level and focuses on contract structure and business risk rather than coding rules.
Why This Topic Matters
Managed care contracts can affect what services a practice is expected to provide, how resources are used, and how dependent the practice becomes on one payer or hospital relationship. Understanding these issues helps practices assess feasibility and negotiate from a stronger position.
What You Will Learn
- How hospital-linked managed care arrangements can shape practice participation
- Why service scope and excluded services matter in contract review
- How practice capacity and overhead considerations affect contract feasibility
- Why payer concentration and market share influence contracting risk
- How negotiating leverage changes when a single payer dominates a community
Who Should Read This
- Physician practices
- Practice administrators
- Health care attorneys
- Revenue cycle professionals
- Managed care contracting teams
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