It took two decades for private payor contracts to erode the bottom line: plan on a 2+ year comeback--here's how, Part V.
Parts I through IV of this article series covered getting organized, financial analysis, negotiating strategies, and solutions for a handful of lopsided contract provisions. This last article in the series offers some final contract provisions that if accepted "as is" in the payors' or networks' proposed agreements will afford the payers with too much control over key financial, administrative, and clinical issues related to serving patients covered under the contract. Among those discussed in this article are: medical necessity, confidentiality, term/termination/evergreen, favored nation, products to be included in the agreement, EOB and ID card identifiers, and "drafted jointly" issues. You may not win on all of these, but to not request these changes is an implied acceptance of the agreement terms, perpetuating the unfairness. Ask yourself as you read through this last article, "If my deal-breaker changes are not made, am I ready to walk?" There is no right or wrong answer, but if it is '"yes," then your negotiating power just increased tremendously.
Noyes
Penny
P
Health Business Navigators, 1711 Destiny Lane, Suite 101, Bowling Green, KY 42104, USA. p.noyes@healthbusinessnavigators.com
D032982:Contracts / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D017008:Negotiating; D011216:Practice Management, Medical / Q000191:economics*; D011907:Rate Setting and Review; D015895:Relative Value Scales; D014481:United States