Examine new talking points in payer contracts

Many healthcare providers are revisiting the various services they provide and looking to make non-Medicare patients a larger component of their patient mix. That, in turn, puts a premium on commercial contracting.

For providers that are prepared to intensify their contracting efforts with commercial payers, try these tips:

1. Address contract clause and reimbursement rates. The most-favored-nation clause basically says the lowest rate that your facility accepts from any payer is the rate that you will accept with the negotiating payer, notwithstanding that payer’s fee schedule. Remove this clause from contracts altogether, and try to avoid Medicare-based reimbursement in commercial contracts.
2. Increase your negotiating power. Maximize your leverage in contract negotiations with commercial payers by illustrating your worth to them. Adding to or changing your range of services might boost your value to payers and could help you recover from reimbursement cuts that may have hit your main specialty.
3. Maximize the efficiency of your practice’s operations. The efficiency with which you provide any additional services is essential to your financial success. Although you may want to expand the types of services you provide, overall reimbursement rates are going down—so your efficiency is going to be the critical factor for success.

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.