Mastering Payor Contract Negotiation: Strategic Approaches for Maximizing Reimbursement
Are you looking to enhance your organization’s financial success in today’s complex healthcare landscape? Effective payor contract negotiation is a critical skill that can significantly impact your reimbursement rates and overall revenue. Join our Contracting, Credentialing and Enrollment Expert, David Zetter, CHBC, PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMA, to gain valuable insights and practical techniques for maximizing your negotiation outcomes. David will help you with valuable complete and step-by-step process so you can quickly evaluate your payer contracts, identify hidden opportunities, and negotiate to maximize your reimbursements.
This presentation will communicate what it takes to conduct commercial payor contract negotiations. What works, what doesn’t, what the payors are looking for from in network partners and what preparation is needed to conduct successful contract negotiations. Practice’s success depends on the knowing how you can get the maximum return from these contracts– especially considering that about half of your revenue is most likely tied to commercial payer contract fee schedules. Even slight changes to your current process can result in significant increases in your reimbursement and patient referrals.
During this engaging session, our expert speaker will share their extensive knowledge and hands-on experience in navigating the intricacies of payor contract negotiation. They will equip you with the strategies and tools necessary to advocate for fair reimbursement rates while strengthening your relationship with payors. Whether you represent a healthcare facility, medical practice, or other healthcare organization, this webinar will provide you with actionable steps to achieve better financial outcomes.
Learning Objectives
How to determine leverage in your contract negotiation and what works and what does not
How initial contracting is much different than negotiating existing contracts
Best practices for contract negotiations
Why do you need copies of all contracts and fee schedules
Understand that information is power
What information about your practice is important to communicate in your proposals
Learn what you need to know about the region, competition and about you and your practice
How to determine your value proposition is to the payors
Areas Covered in the Session
Initial Contracting vs. Renegotiations
Issues with trying to negotiate initial contract
Information
Operational Costs
Value Proposition
Health Plan and Strategic Plan
Competition and how to compare
Possible Leverage for Start-Up
Renegotiation
Identifying Leverage: Best Practices
Research and due diligence
Gather copies of all fully executed contracts and all plan fee schedules
Comprehensive assessment and analysis of existing contracts
Evaluation
Reimbursement rates
Claims processing efficiency
Patient access to services
Patient satisfaction
Practice's Needs and Goals
Identify and assessing the patient demographics, unique services offered, specialties, and desired reimbursement rates
Develop Strong Relationships
Regular Dealing
Building a resource list of individuals for ongoing business dealings and contract negotiations strategy
Open communication and meaningful conversations with key decision makers
Building rapport can help foster trust, increase understanding, and facilitate the resolution of potential disputes
Maintaining positive relationships for the future negotiations and contract renewals
Prepare Comprehensive Data & Documentation: Best Practices
Compile and organize comprehensive data and documentation
Research on various insurance companies
Stay updated on industry trends, regulatory changes, and reimbursement rates
Analyzing data to identify trends, cost drivers, and areas of improvement
Use visualization tools
Insurance companies are increasingly focused on quality metrics
Compile and present your practice's quality measures effectively
Commitment to continuous quality improvement
Other Considerations
ERISA Law
Medicare
State Laws
Highlight Cost & Efficiencies
Address Provider Network Adequacy
Leverage Technology and Data Analytics
Engage in benchmarking
Federal and state laws
Initial Communications & Steps
Explain process to the practice
Submit proposal with scope of work
Information & Documentation Request (IDR)
Obtain read-only access to claims data or data dump
Perform analysis on claims data
Perform mini revenue cycle assessment
Complete fee schedule analysis
Complete notations on analysis and assessment
Meet with practice to review findings
Proposal Development
Proposal should be in written format
Approved by practice
Contain all key elements
Make notes of what requested items you would be willing to sacrifice to obtain what you really want
Recognize in advance if you are willing to terminate contract and participation
Include staff in obtaining information
Ongoing Follow-up
Process can be quick or very slow
Not all contract managers operate the same
Have alternative contacts at the carrier to assist
Document all conversations, phone calls, emails, faxes, secure email, and text messages
All communications should end with the next expected communication, date or timeline
Obtain the most important documents in a medical practice
Suggested Attendees
Healthcare CEOs
Healthcare CFOs
Healthcare COOs
Office Managers
Administrators
Billing Staff and Companies
Physicians and Other Providers
Healthcare Consultants
Compliance Officers
Physicians
Nurses
Practice Manager
All Practices
About the Presenter
David J. Zetter, PHR, SHRM‐CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP, is the founder and President of Zetter HealthCare, LLC in Mechanicsburg, PA and has over 30 years of operational and healthcare experience. David is nationally recognized for his presentations and expertise. He is well-versed in regulatory requirements, revenue cycle management, credentialing and contracting, compliance, coding and documentation. He is considered an expert on Medicare, not only by his clients but his consultant colleagues across the country. He has evaluated existing ambulatory care facilities and practices with respect to patient flow, operations, marketing, fee structures, use of ancillary services and financial considerations; developing strategic plans to improve profitability and productivity. His activities in management and compliance include physician practices, IDTFs, hospitals, ASCs, pharmacy, DME and other facility types, including coding and broad‐based regulatory issues. David has also conducted chart audits on behalf of Medicare contractors and Blue Cross/ Blue Shield early in his career, so he has knowledge of what the expectations are from the payers. David’s firm works with healthcare professional clients and facilities coast to coast, in all areas of practice and facility management including start‐ups, buy‐ins, compensation, exit strategies, reimbursement enhancement, practice financial modeling, governance documentation, policy and procedure development and implementation, credentialing and contracting, human resources staffing and management, compliance, coding and chart reviews, physician education and many other areas. David has helped to maximize both profitability and reimbursement of physician practices, facility and ambulatory practices, re‐engineered operational and human resources, and addressed coding and billing issues for providers to curtail fraud, abuse, kickback, OIG, and IRS issues. He is also an original member of CMS’ PECOS Power User Group, CMS Compliance Focus Group and MIPS Design Lean Work Group which provides feedback and recommendations to Medicare’s Center for Program Integrity and Provider Enrollment Operations Group on design and improvements to the PECOS enrollment environment, as well as, NPPES and MIPS and conducts beta testing of the EHR/ HITECH user interfaces and environments at the request of the Office of e‐Health Standards & Services Director. David is also on the CMS contracted team awarded the PECOS 2.0 contract to rebuild PECOS from the ground up. David has conducted practice management, human resource, coding and compliance education and seminars in many states over the past twenty‐five years. David speaks often on a variety of practice management subjects at hospital residency programs, the National Society for Certified Healthcare Business Consultants, the Medical Management Group Association, the American Academy of Professional Coders, AHIMA, Florida Institute of Certified Public Accountants, Florida Medical Society, many other venues and is often called upon by the MGMA, HFMA, DecisionHealth, Part B News, Part B Insider, and many others, to conduct audio conferences and webinars. He has been published in Medical Economics and interviewed and quoted in many publications including Report on Patient Privacy and Report on Medicare Compliance.
Additional Information
System Requirement:
Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to hear clearly
For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com