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Negotiating Higher Payment Rates

When negotiating insurance payment participation agreements with a healthcare provider, it's essential to ensure that you're receiving adequate compensation for the services you provide to your patients. Negotiating higher payments from insurance companies is possible in certain circumstances. In this blog, we'll explore some strategies that healthcare providers can use to negotiate higher payments from insurance companies.

1. Research the Market

The first step in negotiating higher payments from insurance companies is to understand the market. Are you being paid less than others in the market for service? Maybe you are providing care to a different population than others. For example, you are being paid according to the same fee schedule as other providers, but, because you are serving a lower-income population, you are unable to collect copays like other providers.

Alternatively, are you the only provider of a particular service in an area? Insurers need services in any market where they sell their products. If you are in a scarce specialty, practicing in an area with few other providers, that can also increase your chances of being able to negotiate better rates. Insurers need to weigh the potential customer dissatisfaction of their members having to drive a long distance for care.

2. Demonstrate the Value of Your Services

Pay attention to quality and utilization reports from your insurers. If you are performing at or above your peers, you have more credibility when discussing what it costs to maintain a high-quality practice.

You can provide data to support your claims, such as patient satisfaction surveys or statistics on how your treatments have reduced hospital admissions. When insurance companies see the value in your services, they're more likely to be open to negotiating higher payments.

3. Understand the Insurance Company's Perspective

To negotiate effectively, you need to understand the insurance company's perspective. It's essential to understand the constraints they're working under and the challenges they face.

Many insurance companies are third-party administrators to area employees, so whatever they pay providers is directly charged to the employers. If employers are paying more at your practice than others in the area, they could steer business away from you.

4. Consider Hiring a Professional Negotiator

Negotiating with insurance companies can be a complex and time-consuming process. Consider hiring a professional negotiator to handle the negotiations on your behalf. A professional negotiator has experience and expertise in negotiating with insurance companies and can often achieve better results than you could on your own. In addition, they often have access to data to support the negotiation process.

In conclusion, negotiating higher payments from insurance companies requires research and understanding. By demonstrating the value of your services and considering the insurance company's perspective, you can increase your chances of negotiating higher payments. If you're finding the process challenging, consider hiring a professional negotiator to help you achieve your goals.

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Focusing exclusively in the healthcare arena, The Rybar Group brings in-depth industry knowledge to help clients create solutions designed to identify opportunities for revenue generation, isolate root causes for underperformance, accelerate cash in the door and support long-term margin improvement. The Rybar Group does not dabble in reimbursement and revenue cycle solutions; we specialize in it.  

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