Negotiating Reimbursement Rates

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It’s nice to believe that we are solely rewarded for hard work and loyalty. While that might be the case in some instances, it does NOT work that way when it comes to getting reimbursed by your insurance network. 

Commercial payers are not in the business of approaching the practices they work with and offering them more money. Again, it would be nice if this were the case, however we know that is not how this system works. 

If you want to get paid more, you have to be ready to negotiate for higher reimbursement rates. 

There are things that you can do though to prepare yourself to negotiate from a position of strength which will increase your chances of having your rates increased. 

  1. Be Prepared – The first thing you must do is get all of your information in order. This means knowing what specific rate increase you are looking for, concrete data about the services you are providing, and how an increase will help you moving forward. All of this information will help you present a better case. 
  2. Consider Medicare – Medicare might be a good jumping off point for your contract negotiations. If there are rates that have remained the same while there have been increases to the Medicare fee schedule, then your practice could be losing money. Use this as leverage to negotiate for higher rates. 
  3. Demonstrate Your Value – As you are preparing to negotiate you must remember that you must demonstrate what you bring to the table. Otherwise why would the payer consider increasing their rates? Be ready to show how your practice is qualified and the value that you bring to your community. The more that you can show how vital your practice is to your area, the stronger your case for increased rates will be. 
  4. Involve Your Team – Increased rates will have a positive impact on your entire practice. Therefore you should try to get help from your entire team, especially those in leadership positions. Your billers may be able to identify areas where they consistently have problems getting certain services paid. Negotiating payment for those particular services will guarantee previous streams of revenue. Other members of your team will help you provide a deeper context for the data you are presenting as part of your case, such as the value you bring to your community and how your practice has improved since your last negotiations. 
  5. Be Ready To Stand Firm – Last, be ready to stand your ground. If nothing else, your practice will need a cost of living increase to keep up raising costs across the board. However, you have worked hard to build a successful and valuable practice. Your reimbursement rates should reflect that. 

To increase your reimbursement rates, you have to be willing to demonstrate that you have earned those higher rates. Doing the things outlined above will give you the best chance at showing your payers that your practice deserves the higher rates you are looking for. The key is knowing your value and being ready to fight for what you want. 


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