Before starting a negotiation with a managed care payer, you must first define exactly what issues are most important to you and your physician practice. Starting a negotiation without doing this first is a complete waste of time in my opinion. So here are a few items you might want to consider:
- Desired reimbursement rate;
- When and to what limit can be made to reimbursement;
- Notification by the payer regarding rate changes;
- Ability of the payer to unilaterally change reimbursement;
- Precise definitions for term and termination;
- Clearly defined rate increases upon renewal (ex. based on CPI);
- Does the contract apply to all of the payer’s product lines;
- Time limit for recoupment of overpayments;
- Time limit for payment.
