Managed Care Contract Negotiations
Feb 19

Sample list of pricing questions to consider

Involuntary pricing transparency isn’t just a concern of the managed care professionals who negotiate contracts with payors. The release of inaccurate data could have a ripple effect on the entire organization, beginning in the patient access area. Consider the following:

1. Does your contract expressly state that your rates are confidential and prohibited from release without your approval?

2. If the payor uses information from an external collection point, and you have an opportunity to review and appeal any inaccurate data, ask that the payor include only the finalized data in its reports about you.

3. Include a clause in your contract that gives you advance notice of the data the payor gathers and reports it publishes, and the right to review and correct any inaccurate information concerning you.

4. Ask for the ability to review and comment on any explanatory materials that accompany the data.

5. Consider publishing your own explanation of the information the payor makes available, explaining its significance and context.

6. If you have enough leverage with the payor, consider a “reverse gag” clause that prohibits any action on the part of the payor that steers or would have the effect of steering patients away from you for those payor products in which you participate.

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →