Payer Contracting

Payer Contract Negotiation is a consulting service utilizing a unique process to re
view commercial payer contracts and develop a negotiation strategy for medical practice clients. Good payers are identified for improved business relations through collaboration, poor paying payers are recommended for contract termination, legal issues are cited for correction, payer incentive program opportunities are researched and new contracting markets, such as local self-insured employers, are identified to increase practice volume.

Each engagement generates the following deliverables related to a three part contracting process:

Part I: Payer Strategy Development (Fixed Fee)

  1. comparative summaries of commercial payer contracts to include benchmark measures such as: “% of  practice revenue”; “% of Medicare”; “% of revenue by CPT category” and other industry measures;  
  2. multiple spreadsheets with analytic data  for each contracted payer to determine reimbursement adequacy, business case discounts, carve-out requirements  and payment by CPT code grouping;
  3. payer-specific negotiation strategies based on the above analytics to include tactical and strategic recommendations to yield market-based reimbursement adjustments; 
  4. a client-specific Payer Contract Manual (hard copy and electronic versions) containing contract summaries, signed agreements, payer contact information, legal assessments and analytic reports (as described above).

Part II: Payer Negotiations (Fixed Fee)

  1. chronologies of payer contract negotiations to track progress of payer-negotiation strategies approved in Part I;
  2. identification of new payer revenue opportunities such as provider incentive programs and new product offerings e.g. Health Insurance Exchange products;
  3. additional contracting opportunities with local self-insured employers and “narrow networks”;
  4. new analytic reports based on revenue changes from renegotiated contracts;
  5. Payer Contract Manual updates to include renegotiated contracts and fee schedules.

Part III: (Optional) Payer Relations Maintenance (Hourly Rate or Retainer)

  1. resolution of issues related to contract compliance;
  2. annual review and update of payer negotiation strategies;
  3. collaborative strategic planning for mutual client-payer benefit;
  4. health reform payment updates and client-specific implications.

Payer Contracting Services offer clients both tactical and strategic benefits. For example, favorable fee schedule adjustments have an immediate impact on the client's bottom line. Since there are no variable or fixed costs associated with fee adjustments, all improved revenues add to the client's profit margin. 

Reliance Consulting Group, LLC

3004 Riverstone Trail | Ste. 1000
Atlanta, GA 30339