Eligible for: ACMPE: 1|ACHE: 1|CEU: 1|CME(AAPC*): 1|CPE: 1.2|PDC: 1 Traditional | Intermediate | Analysis * This session is included in the 2025 MGMA Summit education program.
Learn what is popping up in payer contract language and fee schedules and discover effective approaches to negotiating with payers, including new, revolutionary access to payer price transparency data. This session will cover reasons to tackle payer contracts, including intangible benefits. We’ll discuss how to get started, including types of payer agreements, identifying your payer contacts, and gathering the data you need. Gain insights into asking for rates that make up for years without any rate increase, ongoing cost-of-living adjustments, and the only acceptable termination and amendment language for payer agreements. Additionally, get useful tips on avoiding terminology that could negatively affect your practice's finances, such as all product participation requirements, penalties for non-timely demographic updates, and so on.
Learning Objectives:
Point out new language in payer agreements that attempts to control providers, and get more favorable language to use in your commercial agreements
Breakdown real-life examples of payer negotiations, problematic contract language, and how to overcome it to preserve the practice’s strategic growth plan
Learn how to take advantage of previously-proprietary fee schedule information for your competitors in your market, and get great resources for cost-of-living arguments to back-up your rate request
.jpg "Marcia L. Brauchler, MPH, FACMPE, CPC (she/her/hers) photo")