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Payer Contract Negotiations Blog Posts

Knowing When to Walk Away from a Payer Contract Negotiations

Patrick Dougherty

Managed care payments provide a significant chunk of revenue for many practices, so it’s understandable that most providers think twice and then some before cutting off any payers due to contract issues or other criteria. While practices should ideally strive for an open, collaborative and cooperating mindset when dealing with their payer counterparts, there are times when it’s best for the practice, and staff who must deal with issues by problem payers, to simply walk away and cultivate other sources of revenue.

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Topics: Payer Contract Negotiations

Successfully Negotiating Payer Contracts for Value-Based Service

Harold Gibson

The reimbursement landscape is slowly but surely moving from fee-for-service to value-based in response to MACRA’s regulations, with their emphasis on quality of care, and the resulting changes in care delivery, as well as billing and coding. Major players such as Blue Cross and Anthem were reported to have paid close to 60 percent of their 2017 reimbursements through value-based contracts, with other payers moving in the same direction.

With CMS’s goal of fully 50 percent of payments coming through value-based contracts by 2018, its Quality Payment Program also moves this forward through incentive reimbursement based on outcomes. Looking ahead, Medicare payments to practices will either be increased or lowered up to 9 percent depending on value-added merits including outcomes.

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Topics: negotiate payer contracts, Payer Contract Negotiations

Strategies for Successful Provider and Payer Contract Negotiations

Patrick Dougherty

Most practices leave the negotiating of contracts to an office manager or medical director. However, even physicians with a hands-on approach to business and who have used various payers for years may not realize that their practice has more bargaining power than they previously thought.  Keep in mind that insurers are responsible in the following order to: 1) shareholders 2) customers 3) contracted vendors (providers). If you want to get better rates, fewer denials and improve your contractual reimbursements, read on:

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Topics: Payer Contract Negotiations

About this blog

A place for physicians and other healthcare stakeholders to share and discover information about everything related to running efficient medical practices.

Established in 2002 by a group of physicians, we are a national provider of medical billing services to group practices, clinics, and individual physicians. We also specialize in provider credentialing, payer contract reviews, and medical coding for a wide range of clients - from solo practitioners to multi-site, multi-specialty practices.

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