The Art of Negotiating with Health Care Companies

An Essential Guide for Physicians with Dr. Herbert Bravo, MD; Dr. George Rogu MD, CPE, MBA and Jeff Pogany all contributors to P.E.D.S

Know Your Numbers:

Every negotiation begins with a comprehensive understanding of your existing situation. Familiarise yourself with the numbers. Delve into your payment and reimbursement details, review your contracts, and understand your practice's financial aspects. In fact, being complacent about annual increases can spell disaster for your revenue in the long run. Contract negotiation is not a 'once and done' process; constant monitoring and regular revision of your agreements are vital for maintaining financial health.

The P.E.D.S DASH works for pediatricians and any CEO and clinician group looking to know what their data shows.

You can look at our revenue cycle Key Performance Indicators for more information on what numbers are crucial to your success. Then, rank your contracts by the number of patients, accounts receivable, total revenue, and do payer-specific accounts receivable.

The last two steps are the most difficult, and you will need a data analyst to help you compare the “ contract rate” to your insurance allowed for your top 5 codes; also, compare the “ contract rate “ to a national standard such as the medicare payment schedule. Your goal is for all the commercial contracts to be at the same percentage of your national standard and identify high days in accounts receivable ( more than 30) and big accounts receivable as a hassle factor.

If you have a PPO contract with 10% of your revenue at 65% of Medicare, the risk to your practice is that tomorrow, they will be 30% of your practice ( they got the contract with the biggest employer in your market ), and at Medicaid rates, it is unlikely that you can sustain that contract.

The complete podcast edition will air on 2/8/2024 on YouTube or where you download your podcasts.