Managed care contracts impact on the profitability of Urology practices significantly. Urology clinics today face excessive competition resulting in downward reimbursement trends from payers that are limited in number. The scenario puts a lot of pressure on practices to prove their value to the payer. It's important for a practice to know which factors are negotiable in a contract and how to avoid any mentioned unfavorable terms. Any successful contract negotiation exercise would comprise of a realistic self-assessment of the practice, an evaluation of the competition and buildup of an effective negotiating strategy.
Often contract rates are set at a small percentage of Medicare reimbursement with a little room improvement. It’s clever, to begin with the largest payer. Urology care providers also need to assess which procedures and services make up a significant portion of their practice and how do they stand in comparison to their competitors. If your practice performs procedures that your competitors are incapable of providing or if the outcomes of these procedures are better than your competitors, you have the leverage.
Begin with the analysis of reimbursement data from past 3-4 years. Identify the payment issues that reimbursement procedures face when it comes to particular payers. Bringing up these issues at renegotiation tables gives some leverage to care providers. This is also a chance to demand retroactive payment for these claims that faced issues in the past.
It's important that you scrutinize the contents of the payer contract for any terms that seem favorable towards payer. Any terms of the contract that are altered need to be agreed upon by both parties in writing. It is also important to put necessary provisions in place safeguarding both parties by issuing notifications in case changes are made in policy, fees, reimbursement rates and pre-authorization etc. The language of the contract must also state that any changes made by the payer to the contract give providers a chance to renegotiate it.
Urologist must also take a look at claim filing and payment deadlines, ensuring that they have plenty of time to file claims. Justified dispute timelines guarantee that the payments are not delayed indefinitely. Sometimes, contracts come with renegotiation clause that binds the t them to a time window within which the issues must be brought to the table. While it's good to have short one year contract periods, have rate escalating clauses in multi-year agreements are healthy for practice revenues.
It's important for a urology to prove its worth to the payer to gain an upper hand at the negotiation table. It is a smart move to use the data from your office system to portray an efficient image that outdoes the competitors. A wise negotiate is someone who quotes the top rates but knows what's the least he would settle it.
Having a cleverly crafted strategy in place allows Urologists to combat the actions of payers during negotiations. Self- examine your work, market position, competition, fee schedules etc. and try to reach an idea about the value you'll add to the healthcare world.Back