Payer Contract Review

Payer contracting is not easy. Not only do providers need to worry about issues such as varying reimbursement rates, network access and managing hidden clauses, they also need to ensure that they maintain good relationships with the payer when they are negotiating payer contracts. Regardless of practice size, effective healthcare payer contract negotiations are therefore vital to maximize revenue. Our contract review and fee negotiation services are designed to handle the varying goals of both the provider and payer, i.e., providers wanting to deliver quality care to their patients while ensuring business growth and maximized reimbursement against providers wanting to control costs to provide competitive plans to their customers. Our healthcare consultants have the knowledge and skills required to negotiate the terms and conditions of payer contracts to ensure that providers receive the most favorable rates. 

The Challenge

Today’s healthcare payer landscape is diverse and complicated, which is resulting in reimbursement challenges for providers. With the advent of bundled payments, value-based contracts and other risk-based models, the only way to achieve financial goals is by negotiating favorable terms with payers. In this changing regulatory environment, complications therefore already exist. But that’s not where it ends. Providers are working with several payers, which means they need to manage several contracts, which could result in additional obstacles such as:

Different rates for the same or similar services from different payers

Different types of payer contracts such as time-sensitive, evergreen, fixed-term and pricing-based contracts

Different fee schedules and reimbursement requirements across payers

Different contract language and provisions, which are unique to each payer

Home Health Clinical Documentation

Payer Contract Review Services

We understand that proactively negotiated payer contracts and gaining complete visibility into these contracts is extremely important for providers. Payer contracts cover various provisions including reimbursement rates, network access, medical necessity, and provider credentialing. Payer contract optimization is therefore essential so that practices can benefit from increasing revenue during the contract’s term. With the help of our experienced advisors and their data-driven analysis, we strive to achieve higher fee schedules and reimbursements from payer contracts. The contract review and fee negotiation services we offer include:

Comprehensive review of all payer contracts

Market analysis to present comprehensive proposal to payers

Contract language analysis to ensure optimal terms for providers

Identification of strengths, weaknesses, and improvement opportunities

Negotiation with payers to raise reimbursement rates

Identification of threats in unsatisfactory payer contracts

Utilization and payment analysis by payer to compare reimbursements

Preparation of competitive fee schedule analysis to support optimal rates

The 3Gen Advantage

Did you know? According to the Texas Medical Association, providers that do not manage their payer contracts experience an average revenue reduction of 4%, compared to their contemporaries who have strong contract negotiation processes in place. We understand how valuable payer contracting is and have designed processes wherein we review current contracts, identify opportunities and renegotiate with payers to set providers up for long-term success. Still not convinced? Here are some additional reasons to highlight the 3Gen payer contract negotiation service difference.

Frequently Asked Questions of Home Health Coding

Payor contracting not only requires the understanding of each contract in detail, but also staying ahead of regular cycles of contract negotiation and fee schedule changes. We understand how payers operate and help you build successful payer contracts.

With years of experience and extensive expertise, our advisors are well-versed in contract review services across various payers and specialties. We analyze performance, prioritize frequently billed services, and successfully negotiate favorable contracts for our providers. 

We negotiate strong payer contracts, that will not only ensure that providers maximize revenue, but also ensure that they have the necessary resources to deliver high-quality care to their patients.

It’s no secret that negotiating payer contract is a time-consuming process. We handle the paperwork and analyze contracts end-to-end to make the healthcare payer contract negotiations process as seamless as possible for the provider, saving them time and reducing the administrative burden. 

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