AAPC CEU Approved: This program has the prior approval of AAPC for 1 continuing education hour. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

Course Description:

This presentation will communicate what it takes to conduct commercial payor contract negotiations. What works, what doesn’t, what the payors are looking for from in network partners and what preparation is needed to conduct successful contract negotiations. Practice’s success depend on the knowing how you can get the maximum return from these contracts– especially considering that about half of your revenue is most likely tied to commercial payer contract fee schedules. Even slight changes to your current process can result in significant increases in your reimbursement and patient referrals.

Contracting, Credentialing and Enrollment Expert, David Zetter, CHBC, PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMA, will help you with valuable complete and step-by-step process so you can quickly evaluate your payer contracts, identify hidden opportunities, and negotiate to maximize your reimbursements.

Are you looking to enhance your organization’s financial success in today’s complex healthcare landscape? Effective payor contract negotiation is a critical skill that can significantly impact your reimbursement rates and overall revenue. Join our upcoming webinar on “Payor Contract Negotiation – Proven Strategies to Increase Reimbursement” to gain valuable insights and practical techniques for maximizing your negotiation outcomes.

During this engaging session, our expert speaker will share their extensive knowledge and hands-on experience in navigating the intricacies of payor contract negotiation. They will equip you with the strategies and tools necessary to advocate for fair reimbursement rates while strengthening your relationship with payors. Whether you represent a healthcare facility, medical practice, or other healthcare organization, this webinar will provide you with actionable steps to achieve better financial outcomes.

Learning Objectives

• How to determine leverage in your contract negotiation and what works and what does not
• How initial contracting is much different than negotiating existing contracts
• Best practices for contract negotiations
• Why do you need copies of all contracts and fee schedules
• Understand that information is power
• What information about your practice is important to communicate in your proposals
• Learn what you need to know about the region, competition and about you and your practice
• How to determine your value proposition is to the payors

Areas Covered in the Session

• Initial Contracting vs. Renegotiations
  - Issues with trying to negotiate initial contract
  - Information
  - Operational Costs
  - Value Proposition
  - Health Plan and Strategic Plan
  - Competition and how to compare
  - Possible Leverage for Start-Up
  - Renegotiation
• Identifying Leverage: Best Practices
  - Research and due diligence
  - Gather copies of all fully executed contracts and all plan fee schedules
  - Comprehensive assessment and analysis of existing contracts
  - Evaluation
  - Reimbursement rates
  - Claims processing efficiency
  - Patient access to services
  - Patient satisfaction
  - Practice's Needs and Goals
  - Identify and assessing the patient demographics, unique services offered, specialties, and desired reimbursement rates
• Develop Strong Relationships
  - Regular Dealing
  - Building a resource list of individuals for ongoing business dealings and contract negotiations strategy
  - Open communication and meaningful conversations with key decision makers
  - Building rapport can help foster trust, increase understanding, and facilitate the resolution of potential disputes
  - Maintaining positive relationships for the future negotiations and contract renewals
• Prepare Comprehensive Data & Documentation: Best Practices
  - Compile and organize comprehensive data and documentation
  - Research on various insurance companies
  - Stay updated on industry trends, regulatory changes, and reimbursement rates
  - Analyzing data to identify trends, cost drivers, and areas of improvement
  - Use visualization tools
  - Insurance companies are increasingly focused on quality metrics
  - Compile and present your practice's quality measures effectively
  - Commitment to continuous quality improvement
• Other Considerations
  - ERISA Law
  - Medicare
  - State Laws
  - Highlight Cost & Efficiencies
  - Address Provider Network Adequacy
  - Leverage Technology and Data Analytics
  - Engage in benchmarking
  - Federal and state laws
• Initial Communications & Steps
  - Explain process to the practice
  - Submit proposal with scope of work
  - Information & Documentation Request (IDR)
  - Obtain read-only access to claims data or data dump
  - Perform analysis on claims data
  - Perform mini revenue cycle assessment
  - Complete fee schedule analysis
  - Complete notations on analysis and assessment
  - Meet with practice to review findings
• Proposal Development
  - Proposal should be in written format
  - Approved by practice
  - Contain all key elements
  - Make notes of what requested items you would be willing to sacrifice to obtain what you really want
  - Recognize in advance if you are willing to terminate contract and participation
  - Include staff in obtaining information
• Ongoing Follow-up
  - Process can be quick or very slow
  - Not all contract managers operate the same
  - Have alternative contacts at the carrier to assist
  - Document all conversations, phone calls, emails, faxes, secure email, and text messages
  - All communications should end with the next expected communication, date or timeline
  - Obtain the most important documents in a medical practice
• Live Q&A session

Suggested Attendees

• Healthcare CEOs
• Healthcare CFOs
• Healthcare COOs
• Office Managers
• Administrators
• Billing Staff and Companies
• Physicians and Other Providers
• Healthcare Consultants
• Compliance Officers
• Physicians
• Nurses
• Practice Manager
• All Practices

About the Presenter

David J. Zetter, PHR, SHRM‐CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP, is the founder and President of Zetter HealthCare, LLC in Mechanicsburg, PA and has over 30 years of operational and healthcare experience. David is nationally recognized for his presentations and expertise. He is well-versed in regulatory requirements, revenue cycle management, credentialing and contracting, compliance, coding and documentation. He is considered an expert on Medicare, not only by his clients but his consultant colleagues across the country. He has evaluated existing ambulatory care facilities and practices with respect to patient flow, operations, marketing, fee structures, use of ancillary services and financial considerations; developing strategic plans to improve profitability and productivity. His activities in management and compliance include physician practices, IDTFs, hospitals, ASCs, pharmacy, DME and other facility types, including coding and broad‐based regulatory issues. David has also conducted chart audits on behalf of Medicare contractors and Blue Cross/ Blue Shield early in his career, so he has knowledge of what the expectations are from the payers. David’s firm works with healthcare professional clients and facilities coast to coast, in all areas of practice and facility management including start‐ups, buy‐ins, compensation, exit strategies, reimbursement enhancement, practice financial modeling, governance documentation, policy and procedure development and implementation, credentialing and contracting, human resources staffing and management, compliance, coding and chart reviews, physician education and many other areas. David has helped to maximize both profitability and reimbursement of physician practices, facility and ambulatory practices, re‐engineered operational and human resources, and addressed coding and billing issues for providers to curtail fraud, abuse, kickback, OIG, and IRS issues. He is also an original member of CMS’ PECOS Power User Group, CMS Compliance Focus Group and MIPS Design Lean Work Group which provides feedback and recommendations to Medicare’s Center for Program Integrity and Provider Enrollment Operations Group on design and improvements to the PECOS enrollment environment, as well as, NPPES and MIPS and conducts beta testing of the EHR/ HITECH user interfaces and environments at the request of the Office of e‐Health Standards & Services Director. David is also on the CMS contracted team awarded the PECOS 2.0 contract to rebuild PECOS from the ground up. David has conducted practice management, human resource, coding and compliance education and seminars in many states over the past twenty‐five years. David speaks often on a variety of practice management subjects at hospital residency programs, the National Society for Certified Healthcare Business Consultants, the Medical Management Group Association, the American Academy of Professional Coders, AHIMA, Florida Institute of Certified Public Accountants, Florida Medical Society, many other venues and is often called upon by the MGMA, HFMA, DecisionHealth, Part B News, Part B Insider, and many others, to conduct audio conferences and webinars. He has been published in Medical Economics and interviewed and quoted in many publications including Report on Patient Privacy and Report on Medicare Compliance.

Additional Information:

After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to talk and hear clearly

Can’t Listen Live?

No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: [email protected]

Testimonials:

"This program on HIPAA did a great job providing actionable concepts in a way that updated our team and me, I now know how I will implement the concepts because I already did it in their online seminar, it was easy to ask questions from the speaker at the end of my 60 minutes course"

Melissa Preston, Health Information Management Staff

"David Vaughn covered the material completely and I have a new understanding of when, where and why we need to use an ABN"

Sandie Fowler, Out of Network Billing Staff

"Great presentation. Able to do during the day. Timing was great"

Tina Duffy, Compliance Officer

All tickets include recording of the event.