Contract Negotiation Collaboration

Build a foundation for financial stability and successful partnerships.

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Market Contract Comparison

Understand rate baselines to begin payer discussion with confidence.

Contract Management

Manage contract terms, agreements, fee schedules, renewal timelines, etc.

Agreement Scenario Analysis

Model revenue impact of potential fee schedule changes in just a few clicks.

Procedure comparison

Compare contracted amounts per procedure code.

Chargemaster pricing optimization

See where charge prices can be adjusted to align with current or future contractual payments.

The necessary payer negotiation preparation checklist

If you are seeking true change in your revenue this year, you’ll want to commit to a modern technology platform that can assist your journey. A modern platform built with the top issues of today's RCM landscape (not designed forever ago) is less of a disruption than you might think; especially the way it can increase your current revenue overall. To help you pick the right partner, your software should include the following:

Obtain current contracts

Payer document discovery support

Integration with current systems

Assess payer-provider partnerships

Procedure code comparison

Claim analysis for systemic issue discovery

Data-backed negotiation simulation of revenue impact

Overview of maximum, average, median, and minimum allowed amounts

Payer mix comparison

Easy view of all contracted rates simultaneously

Payment variance management workflows

Customizable rules to simplify data visualization

Easy variance explanations for appeal reasoning

Data filtering for manageable workflows

Measured revenue and volume of your services

Determine timing + eligibility for negotiation

Renewal timeline tracking

Easy-view contract terms

Centralized payer contact information

Implement and monitor changes for future negotiations

Historical contracted rate storage

Rate change and revenue impact modeling

Payment terms, escalators, lag time management

Always-on payment variance auditing + detection

Market benchmarking assistance

Responsive, U.S. based support

Contract Management that Makes Smart Cents

You don’t have to renegotiate all of your contracts at once to increase revenue. Start managing your contracts now. If your contracts are set to automatically renew (an evergreen clause), be sure to stay vigilant in understanding if your contracts could be more favorable.

Expected revenue impact of your contract negotiation can vary widely depending on:

Contractual language adjustments needed

Time since last negotiation

Reimbursement configuration

Contracting software used

Assess your payer-provider partnerships

After you’ve obtained all of your contracts and established a communication connection for each payer, you’ll need to assess your payer-provider partnerships. You need to know the insights in your claim data to determine the following:

The volume each payer represents to your practice (payer mix) To gain your due strength with your payers, you’ll need to understand your payer mix. Ken Hertz from the MGMA said there’s no such thing as an ideal payer mix, but he advised that no single payer should represent more than 20% of your revenue.
How your contracted rates have changed from year to year and how those changes have affected your net revenue
The top 10 services you provide as an organization and/or the top 10 services provided by your top providers (things that can make a top 10 highest volume or most time-consuming) are services that need be paid top dollar
The bottom 10 services you provide as an organization (these will be services you can use in negotiations; e.g., we will take this lesser percentage on XYZ services but need to take this higher percentage on ZYX services)
Whether any of your payers’ allowables are currently below Medicare
How contracted rates and individual rates compare
How payer policies are affecting your revenue and if they should be part of negotiation, e.g., Multiple procedure payment reduction (MPPR) paying 100%, 50%, 25% could be 100%, 50%, 50%, or the rates paid for pricing changing modifiers

And with Rivet, you can start preparing negotiations now.

How practices prepare for negotiations through Rivet

"The contract negotiation preparation tools are my favorite part of Rivet, " Shannon Young, Bluegrass Orthopaedics (BGO) business services director said.

"We used to work on a contract negotiation for months, if not longer. But with Rivet we can get negotiation preparations done so much quicker. What used to take 1-2 months can now be done in less than a week. There’s no way we could prepare for negotiations that quickly without Rivet."

At the time of BGO's interview with Rivet, they had 3 contract negotiations in various stages: one just sent, one in progress, and one successfully negotiated.

"We had a consulting firm that did our negotiations for us, but with Rivet we saw better places for negotiation and we could do a better job at preparing for negotiation." “If you're conscientious, ” Young said, “Rivet does anything you need.”
"We negotiated 20% higher than where we had been," said Jennifer Davison, CEO of Vero Orthopaedics.

"We have major negotiation leverage, thanks to Rivet. We were able to go to payers when contracts were up and show our rates side by side. We wouldn't renew with them unless we got better rates and we negotiated 20% higher than where we had been."
“It’s good to know if we are being paid the wrong amount and nobody knows it,” said Peggy Harris, CFO of Pediatric Specialists of Virginia.

“Rivet Payer Performance is where we get the most distinct return on investment. It’s good to know if payers are paying us the wrong amount and nobody knows it.”

Rivet Payer Performance does more than contract negotiation

Rivet Payer Performance simplifies and strengthens payer contract management, negotiation, rate comparison, and contracted rate variance revenue recovery in record time. Model the best terms for a new contract, compare rates to optimize reimbursement rates, and assess claim data. Gain key insights for your claims, your revenue, and your pricing.

Where other software stops, we begin. Optimize your contracted reimbursement now.

FAQ

How do you negotiate with payers?

Negotiating with healthcare payer starts with solid data. You need to show, in clear terms, how your healthcare organization delivers lower cost of care and strong patient outcomes. From there, it’s about being prepared and intentional; setting clear goals before discussions begin, focusing on high-volume CPT codes that meaningfully impact revenue, and building productive relationships with payer representatives. It’s also important to look beyond rate increases alone. Thoughtful proposals (such as streamlining prior authorization requirements, improving turnaround times or clarifying administrative processes) can strengthen the overall agreement and create value for both parties.

When should I negotiate with healthcare payers?

Before reimbursement gaps start impacting your margins. The best time to negotiate with healthcare payers isn't when revenue is already under pressure, it's when you have data that clearly supports your case. The most common and strategic times to revisit payer contract negotiations include the following: when reimbursement rates fall below market benchmarks; when your costs or service mix change; when denial trends or payment variances increase; before automatic contract renewals; or when market conditions shift. Negotiate with healthcare payers when you have clear data, defined goals and a strong understanding of your market position. Proactive contract management, instead of reactive renegotiation, will protect long-term reimbursement performance and margin stability.

Negotiate contracts confidently.

It’s time to prepare for contract negotiation, so that means it’s time for Rivet.

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