Payor Agreement

(August 14, 2013): In the current repayment environment, single-parent families and medical practices are experiencing a steady decline in reimbursement rates. Unfortunately, with the imposition of Electronic Medical Records, HIPAA Privacy, OSHA and a litany of other regulatory requirements, their overheads and obligations make it more difficult to remain more profitable each year. Health care providers have long accepted that they have very little influence in negotiating contracts with Medicare, Medicaid and other public health programs. But this is not necessarily the case when it comes to private payer contracts. The purpose of this article is to discuss some of the issues you need to consider before signing up or expanding your participation as a provider to a private payor plan. In collaboration with physicians and practitioner groups, we found that very few health care providers have ever read their contracts with the private payer. There are a number of reasons why you should always read a payer contract before signing it or renewing your contract with a payer: once you have completed an analysis of the fees payable, you should now negotiate with the health plan operator. You should first identify an important Payor contact. This is usually your supplier`s representative.

While this person may be encouraged to keep your refund increases to a minimum, they can be a very helpful interlocutor. This person will probably be the person who will make sure that your proposal falls into the right hands. You should then prepare and send a formal letter of proposal for the health plan. In this letter, you should stand out from your competitors and demonstrate the strengths and benefits of your practice. Include what your practice means to the payer and how you are the best provider for health plan members. Make sure you highlight several key factors if they exist: is your specific specialty or specialty not available in certain geographic areas or not provided by your competitors? If such an action is involved, these factors can be important instruments in the negotiation process and are essential to ensure higher repayment rates. If you find that the insurance company is fully refunding a portion of your fees, it may mean that your fees are too low. If so, the payer may be willing to pay more. You may also consider increasing these fees or, alternatively, standardizing all your fees to a convenient and reasonable percentage of Medicare (p.B. 130%).

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