The moment comes to start examining a payor contract or group of contracts each year. There are many unanswered questions regarding fair rates, term lengths, and whether or not to join or remain on the panel.

All of these are valid inquiries. Are these, however, the only queries to pose? The purpose of this paper is to examine the value of payer contract negotiations planning.

The main goal is to make sure that a group can position itself to get the most out of a certain payor contract. In contract negotiations, there is an adage that goes, "Everything is negotiable." When making preparations for payor discussions, it is crucial to keep this in mind.

The method of planning is also crucial, to sum up. This ought to serve as a representation of the group's standardized decision-making process.

A broad strategy for discussions would proceed similarly through the steps listed below:

Identify

Understanding the group's major concerns is crucial when analyzing a contract for discussions. This establishes the foundation for the investigation and, eventually, the group's contractual goals. Second, it's crucial to pay attention to the current contract's termination clause.

There are instances when terminating before the group bargains makes sense. Money, claims submission deadlines, term and termination restrictions, conflict resolution clauses, and audit clauses are a few of the concerns that need to be raised in the Identify phase. Once more, the process and, eventually, the final agreement will be driven by focusing on the important problems for the group.

The conversion factor should matter a lot to most groups, according to intuition. This is the only portion of the funding that has a more significant effect on anesthesia providers. The OB rate is another area of money to pay attention to.

Whether or not this is of great importance depends on the practice. That will be driven by the local demographics. On OB rates, there are various schools of thinking. The other is base plus time with a cap, while the first concentrates on an OB on a flat fee. Once more, the gang must decide what makes sense to them.

The flat charge schedule is the final financial component. The flat prices mostly have an impact on chronic pain practices, along with femoral and sciatic nerve blocks, arterial lines, CVP, TEE, and Swan-Ganz catheters, to name a few.

The contracts' language frequently goes undetected by groups. There are a few special areas that may be of interest, including the deadline for claims filing, the length of the contract, including renewal and termination clauses, dispute resolution procedures, how underpayments and overpayments are handled, and audits specifically.

Once more, an evaluation of the practice will help to pinpoint the key areas. It is a good idea to have outside counsel to analyze and negotiate any necessary changes to contractual text.

Research

Every wise choice and successful bargaining starts with study. The first identification stage is crucial because it directs attention towards acquiring the informational points for the negotiations.

It is critical to comprehend the practice's size and scope as well as its yield per unit and per case. You should examine payments from the health plan alone, not the patient portion, given the rising trend of high deductible health plans.

The real yield from the payor will be determined by this. Although they make up an increasing portion of how healthcare is paid for, deductibles and copayments will not be the focus of this essay. That aim would be better served by a different article.

Reviewing current practice is another component of research. This covers the internal business procedure for transferring the facility's finished anesthesia records to the billing department or business, and then eventually to the payor for payment.

Spend some time auditing the payor and the practise throughout the research phase to better understand the working relationship. This will be useful when developing the shared trust necessary for successful negotiations.

The manner in which the data is gathered and organized for presentation is one last consideration in the research process. It is crucial to contribute to the justification, or argument, for an increase.

Options

It's time to establish the possibilities for the discussions based on the research phase's findings. The defining of the pie is a crucial negotiation mistake.

Is it irrevocable, or can it be changed? The idea of creating possibilities is covered by Fisher and Ury in their book Getting to Yes. Ask inquiries and look for opportunities to brainstorm on mutually beneficial outcomes between the parties as you're preparing for the real discussions.

Determine the precise needs and desires of the practice. There is a contrast between the two, and that should become abundantly evident as the negotiations go.

The contractual language is another thing to think about at this stage. In particular, now is the moment to choose which clauses correspond to the relationship's actual business functions and which don't.

It's also crucial to remember that many payors publish their provider guides and updates online and demand that participating providers read them (or not to read them, but to sign anyway).

Remembering our earlier advice to consult legal counsel on language, that expert will now be able to aid the group with the contract and the patterns of a certain payor, particularly if that legal counsel collaborates with other anesthesiology groups in the region.

The choice of roles is the last element of this step. This includes who will take part in the negotiations and what position they will hold.

Execution

Now that all of the preparations have been made, the group is ready to start talking. Building trust is a fundamental bargaining strategy. Meeting, discussing the upcoming negotiations, and acting courteously with one another are simple ways to get the negotiations off to the right start.

Utilizing the information at hand is crucial for supporting the case. The opening offer is made once the case has been built. The payor representatives will hold back on how they respond to the offer and presentation. Recognize that they do arrive ready to play as well.

It is common to receive numerous different counter-offers in the early stages of the discussions. Also, have a peek at the pie.

Is the size fixed, or is there room for growth? What other way could the parties cut the pie to their mutual advantage? Does a group have to accept an offer of a certain type? Or, can you think of a more original offer? The baseline that the group will accept has already been established during the planning process.Let’s talk with medical billing experts to maximize your medical practice revenue and to increase your patient retention.