Payor Contract

Payor Contracting

Are you a new practice or group opening and looking to become in-network with Medicare, Medicare, or Commercial payors such as Cigna, Aetna, UHC, Humana or other Commericial payors?

Do you accept these payors, but reimbursement is below what you feel it should be?

In today’s healthcare payment landscape, every dollar counts—increasing regulations and decreasing reimbursements seem to be the name of the game. Today’s contract environment is tougher than ever. Commercial payor contracting requires a specific skillset for becoming in-network.  In addition, rates are not renegotiated without significant effort.  The government is exerting downward pressure on fees. It’s easy to let payor contracts fall off your radar. And it may be tempting to maintain the status. With the potential for declining reimbursements practices that do not monitor contracts could be foregoing thousands of dollars. Negotiating contracts and fee schedules regularly is essential to optimizing reimbursement and, ultimately, yields a significant return on investment to your organization.

That’s why now, more than ever, it’s crucial that you get the most out of your payor contracts—and to do that, it’s imperative to negotiate. With practice expenses increasing, boosting reimbursement from private payors is one way to stay in business. But successful negotiation is easier said than done.

Legacy can handle the initial payor contracting, future contract review, reimbursement analysis, and renegotiation on your behalf. In order to be effective, this needs to be annual process.

  • We analyze your current reimbursement compared to fee schedules and start contract review and negotiations.
  • Compare the overall weighted averages of all of your healthcare plans.
  • Most health plan contracts are evergreen and will automatically renew unless one party proposes a modification.
  • In preparation for contract negotiation, we set a range that includes an optimum, minimum, and target goal.

Some physicians feel forced to accept truly poor contract terms, because rejecting the contract would result in the disruption of ongoing care for some patients, decrease in the number of new patients, interference in established referral patterns, and loss of income. We take on that burden and most payors want to work with us to keep physicians in-network for their patients.

Providers or groups with payor contracts or more favorable terms will be in a better position to compete and thrive – even in “this age of declining reimbursements.”

Let us handle payor contracting and credentialing for you and your providers.  We can also conduct managed care contract and fee schedule reviews and provide feedback for maximizing revenue opportunities.

Contact Us PM or EHR System Implementation