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Rate Negotiations

If you’re a medical or behavioral healthcare provider and have been in practice for quite some time, than you probably know getting a raise is something that isn’t easy to come by. One way to get more money coming into your practice is to get more patients, or you can add additional services, specialty equipment or procedures to your practice.

There is also another way to increase your revenue; if you put in some effort and make sure you have the right people advocating for you — you can get the raise you’ve been desperately deserving. You can go about that through contract and rate negotiations with your insurance payers.

The following are a few steps to help get on your way to that well deserved raise:

  • Step 1 – Locate all your payor contracts and fee schedules.
  • Step 2 – Analyze 1-4 weeks of claim write-offs to determine the following:
    • Are the correct amounts being collected per your current contract and fee schedule?
    • Is the staff writing off claims that are not subject to contractual discounts?
  • Step 3 – You must determine the gross collection ratio for each contracted payer.
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  • Step 4 – For each payer, determine if there are any extra costs to doing business with the payors above and beyond filing a claim and receiving your reimbursements. There are contracts that contain various obligations that a physician must meet; such as abiding by the insurer’s physician manual, providing particular medical services, undertaking medical credentialing with a hospital of their choice, and meeting claim filing deadlines in exchange for payment (these are things you need to know and why reviewing your contracts are critical). This would also include staff time to obtain referrals and authorizations, refiling lost claims, researching denials and refiling improperly paid claims, appeals, time lost due to untimely payment and bad debt associated with large deductibles and copayments imposed by your contracts.
  • Step 5 – Deduct costs from Step 4 from the collections calculated in
  • Step 6 – Using either gross collection ratio or contractual allowances on individual procedures:
    • You will need to put together a report to compare all of your contracts and fee schedules.
  • Step 7 – Determine which contracts don’t have acceptable fee schedules and this will be clear after going through the previous 6 steps.


Since 2003, STAT MedCare LLC has been an expert in Provider Enrollment, Licensing, Rate Negotiation, and other Credentialing-related services.  STAT’s mission is, “Providing Client Services on a foundation of Trust and Integrity.”  We stay on top of teaching, training, and equipping to properly manage the workplace as an industry expert.  STAT has submitted/renewed 250,000+ licenses, submitted more than 10,000 appeals, and renegotiated more than 3,000 contracts. STAT services practices and organizations who are startups, surviving, experiencing (rapid) growth,  or maturing Enterprise clients. Contact our Sales team for a free consultation at 877-887-1784, Ext. 505
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