Rate Negotiations

For years, the healthcare industry has operated on a foundational imbalance of power. When it comes time to review payer contracts or initiate a PPO fee schedule negotiation, large insurance companies hold all the cards—and all the data. Independent practices have been forced to negotiate blindly, often accepting sub-par reimbursement rates simply because they had…

The Independent Provider’s Dilemma As outpatient independent community providers, do you ever wonder if you are really working for the hospitals for free? When we see patients every day, our primary worry is holistic care: Who else does this patient need to see? Do they need a referral to a specialist? Do they need urgent…

“Power in numbers.” It’s the oldest rule in negotiation, and in healthcare, it is often the only way to survive. But not all groups are created equal, and understanding the mechanics of a provider group is the first step to understanding why your reimbursement rates look the way they do, and why your neighbor’s might…

You didn’t go to medical school to become a contract negotiator, yet that is exactly where many providers find themselves. The cycle is exhausting: renegotiating rates every 1 to 3 years, a process that drags on for months and distracts you from patient care. The real problem isn’t just the time it takes; it’s the…