By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    HIPPA compliance
    How Medical Office Staff Can Make Your Practice HIPAA Compliant
    October 29, 2021
    Everything you need to know about hyaluronic acid treatment
    Everything you need to know about hyaluronic acid treatment
    February 10, 2022
    Which Mushroom Capsules Are Good for Your Health?
    May 5, 2022
    Latest News
    Ostomy Tips To Be Active And Healthy
    February 8, 2023
    Exploring Healthcare Solutions after Amputation Injury
    February 8, 2023
    What To Expect On A Meditation Retreat In Miami
    February 6, 2023
    Botanical Extracts That Should be on Your Health Radar
    February 5, 2023
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Pharmacists help you
    How A Pharmacist Can Help You
    November 28, 2022
    Response to Austin Frakt
    September 9, 2017
    Medicare by the Numbers
    April 18, 2011
    Latest News
    Why Is a Referenced Based Pricing Tool Necessary?
    February 3, 2023
    Simplifying the Genetic Testing Process: How At-Home Kits are Changing the Game
    January 25, 2023
    9 Hospitals That Have Introduced Green Initiatives
    February 1, 2023
    Why a Health Retreat Can Be the Best Medicine
    January 12, 2023
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Strategies for Payer Negotiation
Share
Sign In
Notification Show More
Latest News
Diagnostic Tools for doctors
7 Essential Diagnostic Tools Used by Doctors
Diagnostics
Ostomy Tips
Ostomy Tips To Be Active And Healthy
Health
nursing career adopt
Ways to Boost Your Nursing Career and Get Promoted
Nursing
advancement in nursing career
5 Ways to Advance Your Nursing Career
Nursing
healthcare workers with gloves
Tips to Keep Health Workers Safe in the Workplace
Hospital Administration
Aa
Health Works CollectiveHealth Works Collective
Aa
Search
Have an existing account? Sign In
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Business > Finance > Strategies for Payer Negotiation
BusinessFinanceHospital Administration

Strategies for Payer Negotiation

Abby Norman
Last updated: 2015/04/15 at 8:00 AM
Abby Norman
Share
5 Min Read
SHARE

“Let us never negotiate out of fear. But let us never fear to negotiate.”

Contents
Getting – and Keeping — Big Payer ContractsKnow Your Organization’s Bargaining PowerUse SWOTCollect and Analyze Your DataThe Break-even PointKnow Your Deal-breakers and Stick To Your GunsKnow Your TimelineInclude the Right PeopleKeep an Eye on Deadlines

― John F. Kennedy

“Let us never negotiate out of fear. But let us never fear to negotiate.”

― John F. Kennedy

More Read

The Technology and Services You Need to Open Your Own Counseling Office

Should Nurse Practitioners Form an LLC?
Maximizing Outcomes Through Effective Patient Engagement Strategies
Robotic Technologies Can Improve Hospital Working Conditions
How to Attract More Clients to your Wellness Business

Getting – and Keeping — Big Payer Contracts

When it comes to procuring and maintaining your contracts with payers, there is perhaps no skillset greater to possess than that of the art of payer negotiation. In today’s healthcare market, there’s not only a need to be informed and competitive, but healthcare organizations need to have a very clear understanding of where they stand amid the competition.

payer negotiations

Know Your Organization’s Bargaining Power

Before you can begin your payer negotiation, you have to develop a clear understanding of your organization’s expectations, abilities and any areas of weakness or vulnerability that could jeopardize the contracts.

Use SWOT

One way of achieving this is through SWOT analysis. SWOT stands for “Strengths, Weaknesses, Opportunities and Threats” all of which are worth exploring within your organization as a means to demonstrate your organization’s readiness for a multitude of undertakings, including entering into new contracts.

Collect and Analyze Your Data

Through SWOT, you can also identify your principles, the overall impact of the current market state on your organization and what the cost is for delivering quality healthcare. Raw data can be collected and subsequently analyzed through utilization reports which will become invaluable as you move through the process of identifying new payors you’d like to engage with, as well as maintaining good relationships with those you already work with.

The Break-even Point

A great source of data may come from your CPT code usage. By tallying up the most used codes and analyzing what you are paid based on the amount billed for each, you can determine your break-even point. This is a financial marker that will be important when you are pursuing new contracts. If you are entering into a new contract with a payor where you will not surpass your break-even point, you may need to reevaluate forging that relationship – and pass on it unless there is another compelling reason for maintaining it.

Know Your Deal-breakers and Stick To Your Guns

When entering into new contracts it’s also vital to know what your bottom line is and what your “must-haves” will be. In any payer negotiation it’s unlikely that you’ll get everything you ask for, so you need to know what are the absolute deal-breakers for your organization; as well as what you may be able to live without.

You’ll want to review the “legalese” of the contract with a fine toothed comb and make sure that you understand everything set forth in the document. If something is unclear or doesn’t seem in line with your discussions, ask for clarification and stick to your guns. You will also want to be certain of your state laws, which will differ (perhaps subtly) from the federal laws. You will also want a clear, itemized list of what isn’t included or covered within the contract payment terms, which will perhaps be one of the most frequently asked questions by consumers.

Know Your Timeline

Another important consideration for such contracts is leaving or renewing them when the elapsed time has passed. Most contracts will have a clause that allows organizations to leave in the first 90-days after the contract is signed, but you’ll want to be certain of that timeframe before signing on. Furthermore, many engage it what is called an “evergreen clause”, which means that there will be an automatic renewal each year without discussion unless one party explicitly states otherwise.

Include the Right People

When you’re reviewing this information, you’ll want to include several key stakeholders in your organization such as your medical director, office manager, your hospital attorney and the coding and billing specialists who will have a keen understanding of those aforementioned CPT codes.

Keep an Eye on Deadlines

At the end of the day, the easiest mistake to make may be all about timing: don’t get so wrapped up in the big picture that you miss your filing deadlines. The time requirement for negotiating this contracts and making a decision may pass by if you aren’t actively aware of your timetable.

Sign Up For Daily Newsletter

Be keep up! Get the latest breaking news delivered straight to your inbox.
By signing up, you agree to our Terms of Use and acknowledge the data practices in our Privacy Policy. You may unsubscribe at any time.
Abby Norman April 15, 2015
Share this Article
Facebook Twitter Copy Link Print
Share
Previous Article Patient Cafe Virtual Meet-Ups for Cancer Patients
Next Article Prepare Your Healthcare Website for Google’s Mobile-Friendly Algorithm Update

Stay Connected

1.5k Followers Like
4.5k Followers Follow
2.8k Followers Pin
136k Subscribers Subscribe

Latest News

Diagnostic Tools for doctors
7 Essential Diagnostic Tools Used by Doctors
Diagnostics February 8, 2023
Ostomy Tips
Ostomy Tips To Be Active And Healthy
Health February 8, 2023
nursing career adopt
Ways to Boost Your Nursing Career and Get Promoted
Nursing February 8, 2023
advancement in nursing career
5 Ways to Advance Your Nursing Career
Nursing February 8, 2023

You Might also Like

healthcare workers with gloves
Hospital Administration

Tips to Keep Health Workers Safe in the Workplace

February 8, 2023
green hospitals
Hospital Administration

9 Hospitals That Have Introduced Green Initiatives

January 20, 2023
saving money in healthcare
BusinessGlobal HealthcareHospital Administration

Best Money-Saving Tips for Health Managers

January 12, 2023
HR staff must deal with divisive views in healthcare
BusinessGlobal HealthcareHospital AdministrationPolicy & Law

HR Must Navigate Polarizing Views in Healthcare Workplaces

January 4, 2023
//

We influence million of users and is the most authentic source of information on healthcare business and technology news.

Quick Links

  • About
  • Contact
  • Privacy
Subscribe

Subscribe to our newsletter to get our newest articles instantly!

Follow US

© 2008-2023 HealthWorks Collective. All Rights Reserved.

Removed from reading list

Undo
Welcome Back!

Sign in to your account

Lost your password?