Negotiate favorable payer contracts ensuring compliance and optimized rates.
Payer contracts directly impact your practice’s bottom line. Poor contract terms or below-market rates can cost your practice thousands of dollars annually. Our contracting specialists review existing agreements, negotiate better terms, and ensure you’re maximizing revenue from every insurance relationship.
What’s Included:
Contract Review & Analysis:
- Comprehensive review of all existing payer contracts
- Line-by-line analysis of terms, conditions, and provisions
- Identification of unfavorable clauses and hidden penalties
- Payment terms and timely filing deadline review
- Termination clauses and notice period analysis
- Appeal rights and dispute resolution provisions
- Hold harmless and liability protection review
Rate Negotiation:
- Comparison of current rates against Medicare fee schedules
- Geographic and specialty-specific rate benchmarking
- Preparation of rate increase justification documents
- Direct negotiation with payer contracting representatives
- Volume-based rate improvement requests
- Specialty-specific rate schedule optimization
- Annual rate increase negotiations
New Contract Establishment:
- Identification of high-value payers for your patient demographics
- New payer contract applications and proposals
- Contract terms negotiation before signing
- Fee schedule review and acceptance recommendations
- Network adequacy considerations for your specialty
- Strategic payer mix optimization
Fee Schedule Analysis:
- Detailed comparison of contracted rates vs. Medicare
- Service-specific reimbursement analysis
- Identification of commonly performed underpaid procedures
- Geographic adjustment factor verification
- Modifier payment policy review
- Bundling and unbundling rule analysis
Contract Compliance Monitoring:
- Ongoing monitoring of payment compliance with contract terms
- Identification of underpayments and payment errors
- Documentation of contract violations by payers
- Payment variance reporting and resolution
- Audit preparation and support
- Contract amendment tracking and implementation
Renegotiation Support:
- Periodic contract review (typically every 2-3 years)
- Performance data preparation for renegotiation leverage
- Market rate updates and benchmarking
- Contract renewal timing and strategy
- Multi-year agreement evaluation
Contract Documentation:
- Organized digital storage of all contracts and amendments
- Contract summary sheets for quick reference
- Expiration date tracking and renewal calendars
- Historical contract version maintenance
- Easy access for staff reference and audits
Benefits:
- Increase reimbursement rates by 5-15% on average
- Avoid unfavorable terms that penalize your practice
- Understand complex legal and payment language
- Expand insurance participation strategically
- Maximize revenue from existing payer relationships
- Protect your practice’s financial interests
Ideal For: New providers establishing contracts, established practices seeking rate improvements, practices with outdated or below-market agreements