With the development of technology, the shifting nature of the economy, and new medical advancements, healthcare insurance in the United States is continuously changing. Changes to the terms and coverage of payor contracts are also a result of this.

Reimbursement rates, revenue, and other crucial aspects that affect how clinicians treat their patients are governed by payor contracts.

The bargaining process will also shift as a result of these developments. Negotiating your payor contract is crucial to the ongoing health of your practice because it is already difficult and scary in its own right.

Find out more about the modifications to payer contract negotiation and techniques to help you make the most of them.

Modifications to Payor Contract Negotiations to Pay Attention to

Possibly the present epidemic has brought about the biggest changes in payor contracting. Payors and providers are not exempt from the significant effects of COVID-19, which have affected every single individual, organization, and entity.

Telehealth has been influencing new insurance contracts and contract renewals in the healthcare industry.

The types of agreements between payers and providers will logically follow from the ongoing difficulties brought on by the pandemic. Such effects will probably last for a long time after a vaccine is discovered.

Prior to the pandemic, healthcare providers often anticipated consistently rising patient volumes, broadly available health insurance, and consistent payment for covered treatments.

Value-based payment models between payers and providers were made possible as a result.

But, in the midst of the pandemic, conditions have become more unpredictable, pushing service providers to adjust as best they can. See some of the tendencies you might anticipate here.

Making up for lost income

The new coronavirus's consequences have mostly been felt by providers in terms of both physical and monetary burden.

Medical professionals and other healthcare employees are struggling under hazardous working conditions due to a shortage of personal protective equipment and limited resources.

In contrast, financial figures for the first quarter indicated that larger national insurers were not significantly impacted by the new coronavirus.

Of course, these outcomes might differ from provider to provider and payer to payer, but the majority of providers are experiencing revenue losses. Providers will probably be more aggressive when renegotiating their contracts with payors in order to make up for this lost revenue.

The Protections of Greater Force

In essence, a force majeure clause in a contract allows a party or both parties to be excused from upholding commitments that have been detailed and defined in the contract in the case of an unanticipated occurrence that renders it impossible or impracticable.

This is an earlier legal principle, and given the ongoing negotiations, it could not even apply to COVID-19 (though it may be worth a shot to push for).

But, even if force majeure clauses are not practical, providers can still negotiate contracts that provide them with other safeguards.

Sections that particularly address future pandemics and contain safeguards like faster payments or waiving prior authorizations during a worldwide pandemic may be worthwhile to include at this time.

Let's schedule a demo on prior authorization services to know more.

Security Measures for Shared Savings

Providers receive a portion of any savings under upside-only risk payment agreements if they spend less than a certain amount.

Nevertheless, in order for providers to benefit from those savings, they must meet specific quality standards, which may include a predetermined minimum of community-wide preventive treatments or a predetermined number of cancer screenings.

Although COVID-19 probably delayed a significant amount of money, the virus also caused delays in a variety of services, which means that many suppliers might not fulfill the quality standard.

For some shared saving arrangements (but not all), the Centers for Medicare and Medicaid Services have relaxed these quality threshold standards.

It is worthwhile to request that payers waive quality reporting up until the pandemic is over or to negotiate additional safeguards into the agreement.

Waivers of negative risks

In contrast to upside-inky risk payment, schemes for sharing downside risk require providers to pay into a health plan if expenditure exceeds a certain level but allow providers to share savings if spending stays below that threshold.

Although the majority of providers covered by downside risk agreements won't be liable for COVID-19 claims, many providers want to have that clause expanded to totally waive downside risk agreements in new contracts.

Given the prevalence of deferred services, providers will typically experience medical cost savings; yet, it may still be worthwhile to negotiate a negative risk waiver.