Payer Negotiations: Why You Need to Review & Report More


Regularly reviewing your contracts and reporting your value to payers will pay dividends when it’s time to negotiate reimbursement rates.

Are you one of the more than 54% of healthcare providers who only reviews payer contracts when issues arise—or never?

If you let your payer contracts gather dust in a filing cabinet, those minor provisions you missed could end up having a major effect on your practice. For the sake of future payer negotiations, spend more time reviewing your contracts and nurturing your payer relationships.

Start by reviewing all your contracts for key dates.

At a minimum, you should be tracking:

  • Expiration: when the negotiated contract is set to expire or auto-renew
  • Change notification: the deadline(s) for notifying the payer of any material changes
  • Early termination: the date by which you’re allowed to terminate the contract outside the renewal anniversary

Why does change notification matter as much as expiration? Because small changes in your contracts can become big problems if you ignore (or forget about) the fine print.

Case in point: A 12-provider practice neglected to review a payer contract until just before it expired after five years. The contract had a built-in annual escalator of 1.5% for three of those years, but to activate it, the provider was required to notify the payer by a set date—and didn’t.

When the provider sought retro-compensation for revenue lost during the first three years as well as the compounded value of the escalator for the remaining two years, they had no legal standing because the terms for change notification were clearly outlined in their contract.

Develop a plan to initiate regular contact with your payers.

Believe it or not, your payers want to hear from you. They want to know what you’re doing to improve the quality of your care, drive value for members, and reduce costs so they can funnel more patients to high-value practices. If you only approach payers during the negotiation process or when you have issues, you risk seeming self-interested and like you only care about increasing reimbursement rates.

And, while it’s true that you do care about increasing reimbursements, it’s important to establish trust and nurture payer relationships as a mutually-beneficial partnership (because it is).

The solution? Once you have a handle on all the dates in your contracts, you can create your own schedule for ongoing contract review and communication with payers. It should include: 

  • A schedule for quarterly (or at least annual) review of each contract
  • A plan to contact your payer representative midway through your contract to report on what your practice is doing to add value for members
  • A timeline to begin renegotiating each contract well before it expires

 By increasing the frequency of your contract reviews and payer communications, your practice will be better positioned to drive volume, negotiate with insurance payers, and continue to provide the best care for your patients.

To learn how Rivet can help you organize, analyze, maximize, and monitor your payer contracts and relationships, request a demo today.

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