In a smaller medical practice, negotiating with payers can feel like David with a small slingshot against Goliath. However, even tiny medical practices have a lot to bring to the table when conferring. Whether you’re a larger healthcare organization or a smaller one-doctor practice, you have more to offer when negotiating with payers than you realize.

5 Tips for Negotiating with Payers as a Practice

1. Do your homework before you attempt to negotiate. What concerns might the specific payer have? For example, some insurance companies value keeping hospitalization rates as low as possible. In that case, you should come prepared with data on how your practice works to lower hospitalization rates.
2. Pay attention to your bottom line before you start the discussion. If you don’t know what your absolute bottom line is, you might end up signing a contract that you can’t afford to uphold. Every payer is not a perfect match for every practice, and walking away has to happen in some situations.
3. While negotiating for reimbursement rates might be your top priority, don’t forget that there are other things you can negotiate. If you are unable to get any concessions on rates, ask for ways to streamline the prior authorization process or more favorable terms on the window for resubmitting claims. Many payers who are unwilling to budge on reimbursement rates are open to discussing other aspects of the contract.
4. Know your practice’s value and be prepared to show it. If you are taking part in a quality initiative or accredited by an organization, come prepared with your relevant documentation. Do you practice in a place where there are not many other offices of your type? Do you cater to an underserved patient demographic? Do your patients have a high rate of engagement and preventative care? The many factors that go into making your practice a wonderful place for healthcare all add value to you, even if you have a small patient roster.
5. If you are able to, show a cost-of-living increase in your reimbursements when it’s time to negotiate with payers. It is much more difficult to argue against a slight increase if you can show that your medical malpractice premium just increased 10%, your rent went up 5% and staff health insurance costs also increased. When there are constant cost-of-living increases, an adjustment to reimbursement rates is appropriate.

Get Help Negotiating with Payers with Vetters Enterprises

Vetters Enterprises specializes in practice management, private practice business support and revenue cycle optimization. We can perform in-depth assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.