Beyond the rate schedule: 20+ contract provisions that could break your deal

Rates aren’t the only part of a payer or network contract with substantial impact on your practice. Savvy practices know that there are 20 or more terms buried in a contract where concession can be (and are) won, no matter the size of your practice. Some common clauses if left unaddressed will undermine the speed or level of your reimbursements. Others will determine how burdensome it is for your team to deal with the payer year-round. In this session, you’ll learn to spot the important ones including…

• "Timely Payment" – what the absence of language or reference to state law really means and how to fix it.
• "Timely Submission" – how claims can be denied if you don't try for longer timeframes.
• "Amendments" – don't give the payer rights to change the terms without your written consent.
• “All Product” – which forces you to accept patient types that just plain aren’t good for your practice (at rates that can differ from what you’ve negotiated).
• “Recoup Through Offset” – which could cut off your cash flow without warning.
• “Hold Harmless of Patient” that could have you footing the bill when an employer goes belly-up. 
• Plus, dozens more red flags you'll need to change if you want a winning contract.

Take-home tool: Sample red-flag language that payers commonly include, with alternative redline language to improve your position.

Refreshment break

Practice! Practice! Practice! – How many contract problems can you spot?

In this wrap-up exercise, you’ll have the chance to practice what you’ve learned so that you return home revved up and ready to tear through your new or existing contracts and pinpoint ways to improve them. We’ll share sample contracts – feel free to jumpstart your ROI from this conference by bringing a real contract from your own practice to work through – and we’ll all see who can spot the most opportunities to replace problematic language. Plus, role-play how you’d lobby to get more balanced language that the payer cannot reasonably refuse. How many deal breakers will you fix?

Workshop adjourns