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Why This Topic Matters

Commercial payer contracting can materially affect practice revenue, market positioning, and negotiating leverage. Understanding the broad themes discussed in this article can help practices assess whether a payer relationship supports their financial and operational goals.

Article Sections

1. Step 1: Do your homework

   Discusses preparation before entering payer discussions, including understanding the practice’s position and the payer’s priorities. It also addresses the importance of avoiding inappropriate information-sharing during market research.

2. Step 2: Be choosy about who represents you

   Covers selecting a small negotiating team and ensuring the practice presents a professional point of contact for payer communication.

3. Step 3: Be specific about what you’re asking for

   Focuses on clarifying the type of reimbursement request being made and the scope of the request across services or categories.

4. Step 4: Know what your payers are paying you and strategize based on these rates

   Addresses reviewing current payment patterns and building a comparison framework using practice data and payer documentation.

5. Step 5: Calculate the impact on your bottom line

   Explains the need to estimate how a requested change could affect revenue and whether the expected return justifies the effort.

6. Step 6: Figure the impact on your cash flow

   Covers estimating the broader cash-flow effect of a requested rate change by considering frequency and volume.

7. Step 7: Know what happens when you say “no” to a payer’s contract

   Discusses evaluating the consequences of declining a contract and weighing the role of payer mix and business volume in negotiation decisions.