Practices for Effective Managed Care Contracting

Develop a thorough understanding of your current position

Before you even enter into negotiations with your managed care organizations, it’s crucial that you have a thorough understanding of your current position. By thoroughly understanding your current position, you can develop a strong foundation for your managed care contracting strategy. For example, you’ll want to thoroughly understand your current payer mix so that you can adequately diversify your contracting strategy. You’ll also want to understand what contracts are currently in place so that you can take advantage of any in-year contracting opportunities. In short, you’ll want to understand your current position so that you can strategically position yourself for the best outcome.

Negotiate smart in-year contract amendments

In-year contract amendments are an excellent way to negotiate a more favorable reimbursement rate for services provided to patients under your managed care plans. Medicare contractors, including MACs and Regional Offices, are typically open to in-year amendments. However, providers may be less likely to amend their contracts with commercial insurers and Medicaid HMOs. To ensure that you’re negotiating an in-year contract amendment on terms that are most beneficial for your organization, you’ll want to consider a number of factors before beginning the contracting process. First, you’ll want to ensure that you have a strong argument for why you should amend your contract. Next, you’ll want to understand when amendments are most likely to be accepted. Finally, you’ll want to consider the best strategy for negotiating the amendment. Be sure to use contracting software to streamline the contracting process and increase your likelihood of successfully negotiating an in-year amendment.

Have a plan to measure effectiveness of your contracts

Healthcare organizations often use their managed care contracting efforts as an opportunity to experiment with different contracting strategies. While this can be a valuable way to test out contracting strategies and determine which ones are most effective, it’s important to have a plan to measure the effectiveness of your contracting strategies. This will help you determine which strategies are working and which ones aren’t. It will also allow you to adjust your contracting strategies as needed to ensure that you continue to make progress towards achieving your desired outcomes.

MCO provider negotiation checklist

A successful managed care contracting strategy requires careful consideration and meticulous planning. This is why it’s important to use a contracting checklist to ensure that all pertinent information and contracting considerations are covered. This contracting checklist can help you identify the most important factors to consider when entering into managed care contracts. It can also help you identify areas where you may want to make some adjustments in your contracting strategies.