Once you’ve scheduled an insurance contract negotiation meeting with payers, you can’t simply breeze into the room without significant preparation. The best way to have the payer accept your terms is to identify any and all leverage you can use in the contracting process, and that’s easier said than done. It requires research and due diligence, along with some great timing.
Check these tips to pinpoint the leverage your practice might have when negotiating an insurance contract with payers.
Evaluate Provider Network Size
If the health plan is in the early stages of developing a provider network in your area, your participation is more valuable because it can help the plan sell its product and increase its membership. As a result, the health plan might be more willing to offer additional concessions during the reimbursement negotiation phase. Therefore, you should know how many in-network providers are in your area. If there are very few, you may have more leverage.
Analyze Your Existing Contracts
Prior to any negotiations, you should conduct a comprehensive assessment and analysis of your existing contracts. You should then develop a contract term sheet, which is essentially a spreadsheet with all the major terms and reimbursement amounts listed. You’ll then evaluate factors such as reimbursement rates, claim processing speed and other items to determine where you stand in all these areas. If you see any areas where the payer has fallen short, use that as leverage. For instance, if they are contracted to pay you in 30 days but the average time to reimbursement is 38 days, that’s worth mentioning.
Point out Your Practice’s Unique Qualities
You should identify and assess your patient demographics, unique services offered, and specialty areas that aren’t common elsewhere in your region to show the unique attributes your practice has that others cannot match. For example, if your practice has the only asthma specialist in a 100 mile radius, tell the payer the number of asthmatic patients within that 100 mile radius to show them how necessary your practice is to these families and how many of them are insured with that specific payer.
Get Letters From Referring Providers
If you get referrals from other providers frequently, ask those referring physicians to write letters to the insurer on your behalf explaining how valuable you are to the medical community and to the patients. If these providers can mention anything unique about your practice, ensure they include that as well. For instance, if you’re the only ophthalmologist performing cataract surgeries using the latest technology, a referring optometrist might write a letter saying they have no one else to refer to since they only want their patients to get the surgery with the most updated technology and you’re the only one that has it, and they trust you implicitly for excellent patient care.
Using these negotiation strategies can go a long way in demonstrating your value to the payer and helping you get better contracts in the end.
There are many more strategies that can allow you to get stronger payer contracts. Join David J. Zetter, PHR, SHRM-CP, CHC, CPCO during his online training, Get Higher-Paying Contracts with Proven Negotiating Strategies. During the 60-minute session, David will share all the tips you need to get better terms during negotiations or renegotiations. Register today!
 | Subscribe to Healthcare Practice Advisor |
| Get actionable advice to help improve your practice’s reimbursement, compliance, and success in this weekly eNewsletter. | |
| |