E/M Coding Alert - 2013 Issue 12
Contracts: Weak Contract Negotiations Equal Weak Profits: Sharpen Both With 12 Tips
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Article Overview
This article explains how physician practices can approach private payer contract negotiations more effectively. It focuses on broad contracting topics such as negotiating strategy, fee schedules, claim payment provisions, authorization requirements, payer market position, PPO network arrangements, assignment language, and contract term provisions. The guidance is aimed at practices that want to better evaluate payer agreements before signing.
Why This Topic Matters
Payer contracts can affect practice revenue, administrative burden, and long-term leverage. Understanding the major issues raised in contracting negotiations helps practices identify unfavorable terms and decide whether an agreement is worth pursuing.
Article Sections
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12 expert tips for payer contract negotiations
An overview of practical considerations for negotiating with private payers, including strategy, documentation, reimbursement review, payment procedures, network relationships, and contract duration.
What You Will Learn
- How to evaluate a payer contract before signing
- What broad contract terms are commonly negotiated
- How reimbursement and payment provisions can affect practice operations
- Why network relationships and contract assignment language matter
- How contract timing and termination terms fit into the negotiation process
Who Should Read This
- Physician practices
- Practice administrators
- Medical office managers
- Healthcare billing professionals
- Revenue cycle staff
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