The Essentials of Payer Contract Management for Medical Billing Success

payer contract management

Have you noticed revenue loss for your otherwise healthy medical practice? Initiating payment contract negotiations might prove helpful. Getting these details right could be the secret to your medical practice’s consistent growth so that you can do more of what you’re passionate about.

PracticeForces shares seven essentials for better payer contract management below to help you improve your medical billing success. If you can master financial measurement in healthcare matters, you can easily assess your revenue cycle to spot payer discrepancies, as well.


#1 Accept the Idea of Negotiations

Physicians will typically accept a current contract as set in stone without a single thought around initiating negotiations. However, payer negotiation is normal and expected, so healthcare providers who want to increase their revenue have to learn the ropes.


#2 Create Data-Driven Arguments

Demonstrating the value of your practice to payers is an essential factor during payer contract management. Use data-driven arguments that display details such as:

  • Your quality of care
  • Cost metrics
  • Google ratings
  • Patient reviews

Showcasing the standard of your service helps payers come on board with paying you more.


#3 Consider the Cost of Living in Your Area

Cost of living is a crucial factor in procuring higher insurance reimbursements. Start by sharing statistics on the cost of living around your medical practice. The payers don’t want to lose your business, so, in most cases, they’re willing to accommodate cost-of-living expenses like rent, staff salaries, and overhead costs.


#4 Request Carve-outs for Certain Services

Asking for carve-outs is effective when it comes to maximizing your medical billing revenue. Be sure to prioritize high-volume services like annual visits when negotiating fee schedules for these carve-outs with higher rates.


#5 Analyze Current Contracts

In most practices, payer reimbursements constitute the majority of the practice’s collections. Still, a lot of practice owners don’t know what’s in their payer contracts, leaving a lot of potential on the table.

Becoming well-versed in your payer contracts requires analyzing them, such as taking a deep dive into the payment history. Look at claims and payments to gain an understanding of reimbursement rates for specific procedures. This is particularly helpful if you’re trying to create a foundation for payer negotiations in the future.


#6 Compare Rates

Always come to the payer contract negotiation table with information that backs up your case, including rates among other payers. If certain payers consistently pay below-market prices, ask them for a raise. Payers with large discrepancies are more likely to facilitate a rate increase.


#7 Analyze Your Fee Schedule

To better understand your payer rates and recognize concerns, take a close look at your fee schedules. Do commercial payers have rates higher than 150 percent of your Medicare rate? You shouldn’t bill less for these payers.

You’ve put a lot into growing and sustaining a successful practice. Personalized patient payment plans and payer contract management could make all the difference to your medical practice’s return on investment. If you’d like a little guidance along the way, contact PracticeForces at 727-202-5429 to chat with the team in Clearwater, Florida.

Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

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