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Healthcare billing personnel often begin to view the provider–carrier relationship as an adversarial, often dysfunctional partnership, and improving that relationship may be low on a long priority list of urgent action items. However, the development of a mutually beneficial working relationship that fosters problem-solving can be hugely satisfying for those who attempt contract negotiations. Managed care contracts should formalize respective duties through clear, mutually beneficial contract terms. Further, open, ongoing communication is critical to the success of every contract. We provide extensive negotiation tips for pursuing contract improvements and tools to assist with the ongoing communication regarding contract compliance.
Topic Areas for Contract Negotiations:
Managed Care Negotiation
Negotiating a fair managed care contract has been put forth as close to impossible. However, many negotiators confirm that carriers will make concessions and that the negotiation process can yield a better relationship. However, preparation is invaluable. Here are some starting points. . . .more >>
Negotiating Medical Necessity Contractual Protections
Look especially hard at managed care contractual closes related to medical necessity. Don’t give payers absolute control over shaping treatment decision via medical necessity controls. Here are some valuable suggestions related to medical necessity language. . . .more >>