Payor contracting is an interesting topic that can become quite complex. In most cases, this refers to how an individual will be representing individuals, usually with healthcare coverage, and will take on some of the financial risk associated with providing this coverage. If you have ever worked for a business before that provided health insurance, this likely occurred prior to you receiving your discounted policy.
The negotiation process can be very difficult. In a country that does not provide universal healthcare, this is one of the best solutions for assisting those that work in groups. Here are some useful payor contracting tips that you can use if you are negotiating the best rate possible.
Negotiation Tips That Work
First of all, it’s important to understand the language of this type of contracting. You need to know a little bit about the healthcare industry and how utterly complex it is. When you are negotiating for a policy at this level that will cover so many people, having knowledge of terminology is very important. For example, when you are negotiating, they may ask you to accept a specific Medicare rate. Instead of just agreeing, talk to them about what that is and if there is any room for improvement. You should also consider the difference between contracted charges and the charges that will be billed to the insurance. You want to make this as even as possible.
The burden of time frames is also in negotiation point. Once something has been submitted, it needs to be done as quickly as possible so that payments can be dispersed. Finally, ask about any hold harmless clause that may be part of negotiations. Carefully review this before agreeing to sign the contract.
Does This Just Applied To One Plan?
During the negotiation process, when discussing a provider’s arrangement for reimbursement, it’s important to negotiate on behalf of everyone and for the different plans involved. This will include looking at factors such as credentialing, medical necessity, and the different provider networks that will be part of the system. Reimbursement rates will always, so do your best to negotiate an amount that both medical professionals, and those providing the insurance, can agree on. Therefore, it can apply to multiple plans that are available at different price points.
Using these simple strategies, you can easily negotiate something that will work with all parties involved. These payor contracting tips are literally just the beginning of what can be a very long but fulfilling negotiation process.