Is it time to negotiate your payers' contract?

How to Negotiate your Physician Group or Individual Provider's Contract with the Insurance Payers

Many physician groups or even individual solo practice offices are not happy with their contracted rates or the way they are being reimbursed by the insurance payers? Is it time to negotiate? when is the best time to negotiate your contract?

There is no better time than NOW!

But there are important steps that you need to do before doing so. Negotiating your contract is not only by picking up the phone and calling the insurance payer's provider services department and asking them that you would like to negotiate your contracted fees. Unfortunately, it doesn't work that way!

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​But there are important steps that you need to do before doing so. Negotiating your contract is not only by picking up the phone and calling the insurance payer's provider services department. It doesn't work that way!

Here are my tips: How to Negotiate your Physician Group or Individual Provider's Contract with the Insurance Payers

1. First thing first, do you have a copy of your contract? It's very common the Providers would tell me, they have not seen their contracts or they don't have a copy of their contracts. Oh well, it's time to request for a copy of your contract! Call your insurance payer, look for your Area Network Manager or Network Representative. There should be one assigned in your area! Request to get a copy of your contract;
2. Your contracts should be with accompanied fee schedule or contracted rates. Pay attention to these contracted rates by CPT Code, by Insurance Plan and by Insurance Types!
3. Review your patients volume and the services you have rendered to the Payer's Members? (past 12-24 months)
4. Review your EOBs on how are you getting reimbursed, are the fee schedule being followed?
5. How long have you been contracted with the insurance payer? one year? two years?
6. How's your current payer's volume? (past 12-24 months)
7. How's your patients' satisfaction rates? (it helps when you get good reviews from your patients)
8. How's your patients' outcome?  (again, it helps when you get good reviews from your patients)

You need to present your reasoning why you think its time to negotiate your fees! 
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All of the above, you can present it to the Insurance Payer through the Network Area Manager. Put them all together. Document everything! You can initiate the process by calling, and then by sending a formal letter of intent to renegotiate your contract rates or fee schedule.

Don't forget to involve your billers and coders in this project! Let your patients leave feedback, reviews and about their experience in your practice! All these will surely help get you a better deal.

It's a bit of a process but just be patient and work on it.

Do you need help on how to Negotiate your Physician Group or Individual Provider's Contract with the Insurance Payers?

You should contact us today!