This article provides guidance for Urgent Care leaders on negotiating payer contracts. Tammy Mallow, CEO of Mallow Consulting, shares insights and strategies to secure fair reimbursement rates and favorable terms. Key points include researching payer contracts, building relationships with representatives, preparation for negotiations, reviewing contract offers, and walking away if necessary.
This article provides essential guidance for Urgent Care leaders on negotiating payer contracts. Tammy Mallow, CEO of Mallow Consulting, offers valuable insights and strategies to help providers secure fair reimbursement rates and favorable terms. The content covers the following key points:
Researching Payer Contracts: Understanding the payer’s policies, procedures, and reimbursement rates. Comparing the payer’s fee schedule with other payers in the area. Reviewing claims processing policies, appeals process, and other relevant policies.
Building Relationships: Developing a rapport with the payer’s representatives. Finding individual representatives for more direct contact.
Negotiation Preparation: Being prepared to make concessions for favorable contract terms.
Planning a clear and persuasive script/email supported by data and metrics.
Reviewing Contract Offers: Ensuring that any increase in rates applies to commonly billed codes. Reading the entire contract for potential policy changes or exclusions.
Walking Away from Negotiation: Having a predetermined “walkaway” criteria and script. Complying with termination sections in the contract. Consideration.
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