Things to consider before re-negotiating rates with current contracted entities:
- Is my current contract equitable and is the plan increasing my encounters?
- Am I getting paid timely?
- Am I getting paid correctly without appeal?
- Is the current model resource intense? (Care Coordination, Authorizations, etc.)
- Are there any new lines of business that need to be carved out since the last contract period? (e.g. Case rates for high-dollar/short length-of-stay procedures vs. per diems)
Things to consider before negotiating rates with new entities:
- What are my costs to perform the services, including resource-intense processes requiring support staff?
- Could I benefit from a shared-risk arrangement?
- Can my expected reimbursement system facilitate a proposal with multiple variables (i.e. multiple stop-loss triggers)
- Does the plan have a good track record for payment?
Things to consider before negotiating with government payers:
- Will fee schedule, APC, ASC, or DRG variants cover my costs?
- Is additional reimbursement or pay-for-performance based upon patient outcome and is my patient population historically compliant with requirements that drive payment?
- Do I have a good compliance program to ensure my team meet all regulatory requirements?
Most importantly:
With margins getting increasingly smaller, can I afford not to have Tenax on my side of the negotiation table?