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 the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.