Payor Contracting

Become in-network with Medicare, Medicaid,

and Commercial payors and optimize reimbursements

In today’s healthcare payment landscape, every dollar counts. Increasing regulations, downward fee pressure from the government, and decreasing reimbursements have been on the rise and hitting practices hard. Plus, today’s contracting environment is tougher than ever. 

With the potential for declining reimbursements, practices that fail to monitor contracts are likely leaving thousands of dollars on the table. Negotiating contracts and fee schedules annually is essential to optimizing reimbursement and, ultimately, yields a significant return on investment to your organization.

Now more than ever, it’s crucial that you get the most out of your payor contracts and to do that, it’s imperative to negotiate. However, successful negotiation takes significant effort and can stretch a practice’s resources.

Legacy can take all that off your hands. We manage the initial payor contracting, future contract review, reimbursement analysis, and renegotiation on your behalf. And we can efficiently keep up with it, year after year, to maximize your reimbursements and return on investment.

We analyze your current reimbursement against fee schedules and start contract review and negotiations. Our process includes

  • Comparing the overall weighted averages of your healthcare plans.
  • Proposing modifications to health plan contracts (most are evergreen and otherwise automatically renew).
  • Drafting a payor letter that explains the benefits your patients achieve from the care you provide and includes patient satisfaction data, the demographic area you serve, and more.  
  • Preparing for contract negotiation and setting a range that includes an optimum, minimum, and target goal.

Don’t feel forced to accept truly poor contract terms, because you fear rejecting contracts might disrupt ongoing care for some patients, decrease in the number of new patients, interfere in established referral patterns, and result in loss of income. We take those burdens on for you, and payors want to work with us to keep you in-network for their patients.

When you have payor contracts and more favorable terms, you’ll be in a better position to compete and thrive – even in “this age of declining reimbursements.”

What Our Customers Have to Say

Featured Resources

Consulting by the Hour

By legacyconsult | July 20, 2022

Healthcare, Leadership, or Strategic Consulting by the hour.

Featured Article

Contracting

Payor Contracting – It’s a Marathon, not a Sprint

By legacyconsult | February 16, 2017

One of the most common areas the Legacy team sees providers losing money is in their payor contracts. You open your practice, sign your initial contract with the payor for a set fee schedule, then you start seeing patients. Most payors will try to get you to sign an initial two or three-year contract. Each […]

Let us handle payor contracting and credentialing for you and your providers.