Guidance for Negotiating Higher Rates from Payers
Some companies hire an outside consultant to conduct the analysis and negotiations.
(HealthDay News) — Negotiations to increase payment from insurance companies can be extremely difficult, although it is possible to get a payment increase, according to a report published in Medical Economics.
Practices should be aware that dealing with insurance companies involves being prepared with data. Practices should conduct an internal audit, reviewing all current and past contracts and payment records from insurers. The practice should assess information such as how much it makes or loses on each contract, how much business it does with each payer, and how payment has changed over the years; information should be entered into a spreadsheet.
Compiling the information is time consuming and some small practices abandon the process. Other companies hire a consultant to conduct the analysis and negotiations.
According to the report, in cases where fees have not been raised for 5 years or more it could be sufficient to mention this. However, payers often need more persuasion (eg, emphasizing the practices' edge in a competitive market). Practices should prioritize the biggest contracts first and be prepared for a long process.
"If the negotiations are unsuccessful, the practice will have to decide whether to accept what's offered or end the contract," according to the report. "Insurers don't want to lose practices or drive them into joining health care systems with more negotiating clout, so it's usually not in the payer's best interest to push practices to the brink."
- Sweeney JF. Fighting for higher payer rates is worth the effort. Medical Economics. March 10, 2016. http://medicaleconomics.modernmedicine.com/medical-economics/news/fighting-higher-payer-rates-worth-effort?page=0,1. Accessed March 17, 2016.