Managed Care Contract Negotiations
Aug 26

Deciding what is important to you BEFORE starting a contract negotiation

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.
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 →