How confident are you in the existing provider contract you have with your commercial payers? You might need to think about haggling with your commercial payor if the response is anything than fully satisfied (s).
Although healthcare providers are becoming more assertive in their requests to renegotiate their provider contracts, it can be challenging to decide when and when to become involved.
If you don’t like your contract but aren’t sure how to negotiate, think about contacting a skilled health care provider lawyer to assist you regain control. Healthcare providers who face unfair insurance practices, dispute resolution clauses, and fee schedules can turn to Bryant Legal Group for assistance.
In order for you to concentrate on serving your patients, we fight for you because we are aware of the difficulties that providers face.
We will discuss value-based reimbursement models, when to negotiate your contract, how to bargain effectively, and how to maintain your practice free of legal limits in this post.
When and How to Negotiate Contracts with Healthcare Providers
When you are renegotiating your provider agreements, the circumstances and timing can be quite important. You must have a clear knowledge of the value and position of your own profession in your area in addition to taking the insurance company’s viewpoint and objectives into account.
You can gain the upper hand at the negotiating table and increase your chances of success by timing your discussions well and approaching them with a clear game plan.
Lack of Access to Healthcare Services
You can and should take advantage of the fact that there aren’t many other healthcare facilities nearby if your practice is one of them. If you don’t let them access your practice, they won’t be able to work with you to establish themselves in your community. This strengthens your negotiating position and gives you a great starting point.
Exceptional Specialty Value
Do many other practices in your region perform the same services as yours? If not, despite the fact that there are numerous general primary care options available, you will still be a valuable commodity to an insurance company.
If you are one of the few specialists, you have more negotiating strength and opportunities because insurance firms may profit more from them.
Mutual Commercial Interests
Think about the insurance company’s future plans. You can determine where your interests coincide by closely monitoring business news for the insurance company.
For instance, the insurance firm might turn to you for references if they want to pursue other practices in your region. If you frequently come across any firms they are interested in collaborating with, they might even come to you.
Take advantage of these possibilities to create a contract that benefits both parties.
Advice for Bargaining with Health Plan Vendors
Anything you can do to your advantage before you go to the bargaining table could end up saving your practice a lot of trouble. Although the insurance provider might try to take advantage of you, utilizing these suggestions can improve your chances of succeeding and help you negotiate with confidence.
Perform research
Do your research on the insurance business before entering into talks. Think about its future goals and commercial interests to determine if you concur. You can get a sense of how it feels to deal with a primary care doctor who is part of the health plan’s preferred provider organization vs out-of-network providers by getting in touch with one of them.
Realize your worth:
Recognize how your value can be used while negotiating contracts. Don’t forget that there is a reason why this insurance company wants to work with your clinic.
Be prepared to take on financial risk:
Health care providers can gain an advantage by being flexible with risk. To obtain additional flexibility elsewhere, keep your reimbursement models open-minded.
Do not hesitate to leave:
Even if it appears like a short-term fix, agreeing to a contract that isn’t mutually beneficial will never be helpful to you in the long run.
Consider whether there are any local, state, or federal rules that could affect how the insurance carrier would handle you as an out-of-network provider or reimburse you if you decide to leave.
Employ a knowledgeable health care lawyer:
You can relieve yourself of the responsibility of negotiating by working with a skilled health care attorney. Let a professional assist you in getting what you deserve since you spend your days helping others.
When negotiating your health plan contract, using these suggestions will help you feel less stressed and improve your chances of success. Don’t sign a contract that prioritizes the requirements of your practise over those of the practise as a whole.
Value-Based Reimbursement Models and Health Plans
By deciding to accept some financial risk through a value-based reimbursement approach rather than a fee-for-service model, you can quickly gain flexibility in your contract discussions.
A value-based service model places more emphasis on paying for quality work than quantity. Since they are utilized as performance indicators for their compensation and health insurance premiums, this approach puts pressure on healthcare practitioners to monitor patient outcomes and satisfaction.
Although it has been demonstrated that this model enhances patient satisfaction and decreases overcharging, it comes with a lot of labor and risk for revenue cycle management healthcare professionals. Without a set flat rate, compensation is somewhat contingent on the viewpoint of the patient and recorded data. This means that healthcare workers will have more work and the insurance company will have less.
But by taking this chance, you can improve your negotiating position and win over the insurance provider. Although not all providers will benefit from this option, those who are prepared to take a chance will benefit from some flexibility.
Arbitration vs. the Ability to Sue
Insurance companies frequently include an area known as arbitration provisions in contracts they negotiate with healthcare providers. In order to prevent health care providers from conducting litigation as they see fit, these clauses require them to employ the insurance company’s arbitrator in cases of legal dispute.
High prices:
The insurance company in this instance will pick the arbitrators. Arbitration can be expensive and severely harm smaller providers’ finances.
Inadequate representation
When insurance companies engage an arbitrator, it is ultimately the company’s interests that are being represented, not those of the service provider. Providers are frequently not consulted in the process until after a choice has been made on their behalf and are not given the chance to select their own representative.
Binding judgements
Arbitration verdicts are virtually always conclusive once they have been reached. As a result, providers who disagree with the decision will not have the opportunity to appeal and may find themselves in a difficult situation.
In general, it’s crucial to assert your legal rights throughout negotiations.
Connect with contract negotiation services to renegotiate your contract efficiently.
