Payer contracting is the heart of what we do at Healthcents, and we have over 20 years of experience negotiating new contracts with payers on behalf of medical practices, medical device / DME companies and ancillary providers across the United States. This experience has allowed us to fine tune our process, and we have developed a list of “best practices” for contracting. This list is broken down into three categories: Prepare, Negotiate, Monitor. Each step in the process is important, and should not be skipped if you want to successfully negotiate the maximum reimbursement for your contracts. If you’d like to know more about ways to increase your payer reimbursements, our white paper is available for free.
Step 1: Prepare
- The first step to a successful payer contract negotiation is to evaluate your top codes and figure out which ones are driving revenue. Perform SWOT analysis for payer fee schedules and your practice, and benchmark against Medicare and payers to determine patterns of under-reimbursement. If you don’t have software to easily and quickly do this, we suggest RevolutionSoftware, our software tool that can help you easily analyze and identify your top codes, calculate revenue differences based on volume between different payers, and benchmark and analyze reimbursements by CPT code.
Step 2: Negotiate
- Once you have prepared and are ready to negotiate, you need to write and deliver a highly impactful proposal letter to a contracts manager at the payer. Establish a relationship with the contracts manager, and follow up regularly in order to keep the payer “on the hook.” When you get a response, evaluate payer proposals and look for ways to optimize counter offers, don’t take “no” as an answer and be ready to escalate at the right time. You need to be thorough and review the contract(s) for language that affects reimbursement.
Step 3: Monitor
- Stay on top of your contracts by monitoring payments and renegotiating within the appropriate timeframe. Doing your due diligence will help you avoid paying for mistakes later, and keep everyone happy!
Payer contracting can be tough, and often can require a team to be successful. If you don’t have the time or people-power to devote to staying on top of it, let us help. Our team can provide you with whatever you need to ensure well-negotiated contracts, from training your staff, or managing the entire process from start to finish for you. We can help medical practices, medical device/DME companies, or ancillary providers of ANY size make money through payer contract negotiation. Contact us today to see how we can help!
To further assist you in your contracting efforts, please click our free white paper here about 3 techniques to analyze and increase your reimbursements. You have nothing to lose, it is free and will help you. If you would like to discuss your payer contracts, please send me an email and I’ll be happy to assist. For more information, please contact: Steve Selbst, firstname.lastname@example.org or 831-455-2174. For general information or questions, please phone us at 1-800-497-4970 or send an email anytime to email@example.com. We look forward to hearing from you and are glad to provide information that helps you as a provider to run a more profitable practice / company.