{"id":9813,"date":"2013-10-31T18:00:56","date_gmt":"2013-10-31T22:00:56","guid":{"rendered":"http:\/\/www.poweryourpractice.com\/?p=9813"},"modified":"2025-07-01T10:57:19","modified_gmt":"2025-07-01T10:57:19","slug":"smart-payer-contract-negotiations-make-money","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/smart-payer-contract-negotiations-make-money\/","title":{"rendered":"How Smart Payer Contract Negotiations Can Make You Money"},"content":{"rendered":"

\n

Think of all the payer contracts your practice has to manage. Although they cover many of the same procedures, each payer contract contains a unique set of rules and terminology that affect your practice\u2019s financial well-being.<\/p>\n

Because there are so many, even minimal gains on multiple contracts can provide a huge boost to profitability<\/strong>. So when you\u2019re going into payer contract negotiations or renewals, use the following tips to ensure your practice comes out ahead.<\/p>\n

Look for Evergreen Clauses<\/strong><\/h3>\n

Evergreen clauses are included in the contracts of all types of companies, and honestly, they\u2019re a bit sneaky. These clauses allow payers to renew contracts automatically upon expiration<\/strong>. So, if an expiration date slips by, you could end up stuck with outdated contract terms that don\u2019t meet your practice\u2019s current needs.<\/p>\n

Try to get evergreen clauses<\/a> eliminated from your payer contracts. If a payer refuses, get language written in requiring the payer to provide advance notice that the contract is set to expire. This way, you can terminate the contract and renegotiate if necessary.<\/p>\n

Obtain a Reasonable Timely Filing Date<\/strong><\/h3>\n

Although practice management software<\/a> has made it easier for providers to file claims on time, some practices still incur timely filing claim denials. The problem is that some payers, like Medicare, don\u2019t even allow providers to appeal timely filing denials under normal circumstances.<\/p>\n

Therefore, identify the terminology regarding timely claim submissions and make sure your practice has at least one year from the time treatment is rendered to file claims<\/strong>. Anything less, and you increase the likelihood of receiving an excessive amount of timely filing denials.<\/p>\n

Build Towards Optimum Reimbursement Rates<\/strong><\/h3>\n

It\u2019s difficult to secure substantial reimbursement rate increases all at once. A better way of obtaining ideal reimbursement rates is requesting small increases during each payer contract renegotiation until you reach the ultimately desired rate. Remember, a slight increase on a popular procedure can go a long way toward increasing revenue<\/a>.<\/p>\n

Gauge the Market<\/strong><\/h3>\n

Go online and conduct research to determine if you have any competition in your area. The further the nearest competitor is, the more leverage you\u2019ll have during contract negotiations. Since payers don\u2019t want to lose out on procedures from an entire market, a lack of competitors means you have a better chance of locking in higher reimbursement rates.<\/p>\n

Advanced Notice of Policy Change<\/strong><\/h3>\n

Sometimes contracts include vague legalese that allows payers to change fee schedules without providing advance notice to providers. There isn\u2019t really anything a provider can do about a change if the terminology allows for it.<\/p>\n

That\u2019s why it\u2019s important to negotiate notices of a policy change into your contracts<\/strong>. Demand that the payer provide advance notice to your practice and lets you decide whether or not you agree to the terms. If the terms aren\u2019t favorable, you should be able to terminate the payer contract without penalty.<\/p>\n

Payer contracts are an essential part of the revenue cycle. Unfavorable terms can hurt your practice in both the short- and long-term. So, don\u2019t be afraid to go back-and-forth with payers until ideal terms are reached.<\/p>\n","protected":false},"excerpt":{"rendered":"

Think of all the payer contracts your practice has to manage. Although they cover many of the same procedures, each payer contract contains a unique set of rules and terminology that affect your practice\u2019s financial well-being. Because there are so many, even minimal gains on multiple contracts can provide a huge boost to profitability. So […]<\/p>\n","protected":false},"author":1,"featured_media":32784,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[39],"class_list":["post-9813","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revenue","tag-revenue"],"yoast_head":"\nSmart Payer Contract Negotiations to Boost Practice Revenue<\/title>\n<meta name=\"description\" content=\"When you\u2019re going into payer contract negotiations or renewals, five payer contract negotiation tips will help your practice more advantageous contracts.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/carecloud.com\/continuum\/smart-payer-contract-negotiations-make-money\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta 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