Payer contracts are vital for your medical practice’s revenue and are the foundation of our healthcare system. Negotiating a more favorable payer contract will help you improve your income potential, allowing you to provide better care to your patients.
However, payers don’t necessarily reward loyalty with better payer contracts. That’s why you should create a negotiating strategy before the renewal deadlines. It will help you maximize the revenue and save you from countless headaches along the way.
Read on to learn how to negotiate payer contracts with more favorable terms and how to find professional help for payer contracts, credentialing, and payer enrollment in Houston, Texas,
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Collect and Analyze Data
Data is the most critical tool you can use to identify unfavorable contracts and renegotiate better terms. The best way is to involve your coder and locate payer-specific barriers to getting paid. For instance, if a payer refuses to pay a certain code, you can ask for it to be included in the next contract to increase your revenue.
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Set Minimum and Optimum Target Goals
Once you discover the most frequent codes and how many times you’ve billed them to each payer, it is time to compare the data with the actual reimbursement you received. To better understand each contract, you can determine your weighted average costs, compensations, and break-even points.
Then, you need to set minimum target goals that need to be met and optimum targets that reflect the terms you would like to negotiate. Doing this will help you identify unsatisfactory proposals and give you better grounds for negotiations.
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Create a Value Proposition
If your practice reports favorable data, you should ask for better terms and reimbursement rates. In addition, you can leverage vital indicators of increased productivity or unique services, such as the higher volume of patients seen annually, extended hours, working on weekends, telehealth services, an additional office location, or a change of location to an area with a large group of insured people.
You need to identify a clear value proposition and explain how it benefits your patients, your practice, and the health plan. That increases your chances of negotiating more favorable payer contracts.
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Understand the Terms and Verbiage of Your Payer Contracts
Understanding your payer contracts is the first step toward negotiating better terms. You should familiarize yourself with the verbiage and read each contract carefully. There are often hidden terms that can harm your practice, which is why the best idea is to hire a professional to help you go over everything. That way, they can point out all problematic areas and recommend better solutions.
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Don’t Be Afraid to Play Hard Ball
Negotiating more favorable terms for your practice often requires more aggression than most people are comfortable with. Most “friendly” requests simply don’t get the desired results, as you usually receive a response that a payer is not negotiating terms at that time.
You should push for negotiations and use all legal tools to get the terms you want. It’s vital to know where you stand and set realistic expectations. Don’t be afraid to say no if the contract doesn’t benefit your practice.
Where to Find Help for Payer Contracts, Credentialing, and Payer Enrollment in Houston, Texas?
If you are not sure how to approach payer contract negotiations, don’t worry. Peregrine Healthcare can help you analyze your practice’s data, set targets, and leverage your position to negotiate better terms on your payer contracts. We have vast experience assisting medical institutions to boost their revenue through effective contracting strategies. Click here to contact Peregrine Healthcare and gain the upper hand in payer contract negotiations.
