A news program did an expose a few weeks ago about “free” wireless networks. They set up a network in a public place, told users it was free, and saw how many people clicked “accept” on the terms and conditions — which had embedded information allowing the wireless network to take and charge their credit card without their permission.
Are you surprised that few people who joined the free wireless network stopped before clicking “Accept” to read the fine print?
We’re all guilty of this. As long as we know the up-front price, we update software, download new programs, click “Accept” or “Agree” without bothering to read the fine print.
Contract negotiations with payers can go the same way. We focus on the dollar amounts of provider reimbursement, then sign on the dotted line — hitting “accept” without reading the fine print.
And there’s the trap. Because buried in that fine print can be some scary terminology.
- Auditing periods that stretch back several years on claims
- “Lesser of billed charges” language that allows the payer to pay you a smaller sum if your billed charges are not set high enough
- Vague language about the time period for payment of claims
These fine print clauses can cost your practice just as much as (if not more than) lower reimbursement rates.
How can you protect your provider reimbursement rates from the fine print trap?
- Prepare for the negotiation by looking over the previous contract. What did the language read like last time? What policies have cost your practice financially?
- Become educated. Most of us are unfamiliar with some of the complex language used in these contracts. Seek out education to learn what important terms mean and suggestions for alternative terminology in your favor (this is covered in our online, on-demand Blueprint for Success courses)
- Negotiate. Send your initial proposal to the commercial payer representative, including your proposed terminology.
- Don’t hit “accept” automatically! Spend time reading, reviewing and modeling for how their proposals will affect your practice.
- Continue negotiating until you reach an agreement.
- Monitor after negotiations are complete. Make sure the payer is honoring the terms of the contract and that your provider reimbursement reflects it.
Want to learn more? Susan Charkin, our president and founder, has a knack for spotting traps in fine print in contracts. Email us and let’s set up a 30-minute, no-cost, no-obligation meeting with Susan to talk about your contracts. (No fine print needed for this offer).
