Your Payer Contracts Are Either Your Greatest Asset or Your Biggest Liability — We Make Them Your Asset
Most physicians accept default fee schedules and never renegotiate — leaving tens of thousands to hundreds of thousands on the table annually. Our negotiation specialists know payer rates, regional benchmarks, and leverage points most practices never access.
What We Do
Before negotiation begins, we conduct a comprehensive analysis of every payer contract — extracting fee schedules, comparing rates to Medicare benchmarks, identifying highest-volume CPT codes, and analyzing contract terms including timely payment provisions, clean claim definitions, and termination clauses.
Using commercial rate intelligence, specialty-specific survey data, and regional market analysis, we establish realistic target rate ranges for each payer. This benchmarking provides the evidence base for your negotiation position — replacing intuition with data.
Every negotiation requires a customized strategy based on your leverage — patient volume, specialty scarcity, quality metrics, cost-effectiveness data, patient satisfaction scores, network adequacy requirements, and the payer's market share goals in your geography.
Our team manages direct negotiation with payer contracting departments — submitting counter-proposals, responding to offers, escalating when negotiations stall. For high-cost procedures, we negotiate carve-out rates separate from base fee schedules.
Beyond rates, contract terms significantly impact your financial position. We review all language for liability provisions — unilateral amendment clauses, audit rights, offset provisions, and termination-without-cause terms. We also track every contract expiration to prevent auto-renewal at unfavorable terms.
What's Included
Contract Analysis
Fee schedule extraction and benchmarking
Market Rate Benchmarking
Regional and specialty-specific data
Strategy Development
Leverage-based negotiation planning
Direct Payer Negotiation
Counter-proposals and escalation
Contract Language Review
Liability and terms analysis
Renewal Management
Proactive renegotiation before auto-renewal
Why This Matters for Your Revenue
Frequently Asked Questions
Typically 3-6 months from initial analysis to executed amendment. Complex negotiations with large payers may take longer.
Small practices often have outdated contracts payers will update. Specialty scarcity, quality outcomes, and network adequacy requirements all create leverage regardless of size.
No. Renegotiation is a standard business practice. Payers prefer to retain network providers rather than face network adequacy issues.
Medicare rates are set by CMS and cannot be negotiated. However, we optimize Medicare Advantage contract rates and ensure proper GPCI locality adjustments.
Most practices achieve 5-20% improvement depending on specialty, current rates vs. benchmarks, and available leverage factors.
Yes. We analyze APM contracts against your quality data and patient panel to determine whether participation is financially advantageous.