How to Negotiate claims reimbursement contracts with payers?

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• How to Negotiate claims reimbursement contracts
  with payers?

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How to Negotiate claims reimbursement contracts
with payers?
Money is an important aspect of the healthcare
revenue cycle due to the rising declining rate of
Medicare reimbursement and new value-based care
models. Healthcare organizations should focus on
negotiating claims reimbursement contracts with
payers to optimize revenue cycle
management. Several key factors such as
communication with stakeholders compare expected
and actual revenue yields, evaluate service lines
and understand the organizations financial
position are important for successfully
negotiating payers contracts. Healthcare
organizations should communicate with various
important stakeholders, such as financial
leaders, patient accounting experts, and
physicians. This communication builds a platform
for a successful negotiation. Healthcare
organizations should also focus on developing
actionable strategic direction during an
engagement with stakeholders. Moreover, these
organizations should establish a committee of key
stakeholders not only to discuss actionable
strategic directions but also periodically review
contract portfolios. It is critical for
healthcare organizations to compare expected and
actual yield from contracts. Many contracts
failed to reach expected yield value due to the
high variance between actual and expected yield.
Variance is the difference between actual and
expected yield.
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How to Negotiate claims reimbursement contracts
with payers?
The healthcare organizations should look for an
acceptable variance range before the negotiation
with the payer. The committee should evaluate
actual yield for each contract with the
organizations contractual allowance budget are
aligned or not also, compare actual yield across
different payer contracts. The objective of this
evolution is to minimize the variance in actual
yield across top-tier contracts. The healthcare
organization must assess service lines to
understand the impact of different clinical
services on the contracts claim reimbursement
structure. Another important aspect of
successfully negotiating a payer contract is to
understand the financial position of the
organization. Moreover, Healthcare organizations
should regularly communicate financial goals and
performance with stakeholders which helps the
negotiation team to fulfill the organizations
needs with the payers contract. Apart from key
factors, three rules for negotiating contracts
with payers include defining the baseline
population, developing objectives, and preparing
for changes. These rules must be addressed by
healthcare organizations before negotiating the
contract.
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How to Negotiate claims reimbursement contracts
with payers?
The healthcare organization should identify the
baseline patient population which helps to
understand the treatment of various patient
groups by their providers and the services they
consume. Clear objectives of the healthcare
organization enable them to achieve their
objectives during negotiation. Moreover, these
objectives are expected to share with the prayer
to let them know about the expectations of
healthcare organizations. While negotiating the
payers contract the healthcare organizations
should be adaptable to various changes suggested
by the payer. This enables negotiation teams to
create the best approach to countering these
changes. For long term contracts, both the
healthcare organizations and payers must agree
upon price adjustment.
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