March 03, 2016
Area(s) of Interest: Payor Contracting Payor Issues and Reimbursement Practice Management
The California Medical Association (CMA) has received a number of inquiries from physician practices about how to begin the process of attempting to renegotiate with managed care payors. While CMA cannot give specific legal advice or advise physicians whether they should or shouldn’t sign a particular contract or amendment, there are steps a practice can take to submit a thoughtful renegotiation request.
When submitting a request to open up a contract renegotiation discussion with a payor, best practice is to present a “business case” as to why the payor wants to keep your practice in the network. Failure to present a business case often results in a quick reply from the payor indicating that it is not in a position to renegotiate at this time. To prevent this “auto-reply,” CMA has published a guide to help members present a compelling business case.
“Contract Renegotiations: Making Your Business Case” is designed to help physicians review an existing contract to determine timing of the negotiation, how to identify negotiating leverage and the uniqueness of your practice, how to pinpoint your “bread and butter” codes, how to draft an attention-getting written request for renegotiation, and how to understand what a fee change would mean to your current practice.
The document also includes a sample letter that can be completed and submitted to the payor to request a renegotiation of your contract. The guide is available free to members only on the CMA website.
CMA will also be offering a webinar on this new resource, Contract Renegotiations: How to Get Past &lsquo with a Payor,” on Wednesday, May 4, from 12:15 to 1:15 p.m. It will be presented by Kristine Marck, associate director of CMA’s Center for Economic Services, who has over 25 years of experience in the health care industry.
This webinar is free to CMA members ($99 for non-members).
Contact: CMA's reimbursement helpline at (888) 401-5911 or firstname.lastname@example.org.