os,” he said. “So in the private practice of medicine, you can negotiate a little better. Insurance companies want op- tions, and it’s up to us [physicians] to show them the value of keeping doc- tors in private practice.” Mr. Reiner helps physicians con-


duct a thorough assessment of their practices and identify their unique- ness in a particular market. He then puts the information together in a for- mal letter to insurers introducing the practice. Health plans may have a general understanding of the market, “but they don’t really know this neurosurgeon or that cardiologist and what he or she re- ally does,” Mr. Reiner said, adding that cost effectiveness is a “very critical” component. “After all, it’s a bottom- line dollar issue for the payers.” In any size community, physicians


can only boost their clout by build- ing relationships with their managed care representatives, outside of just contracting. “Negotiations are not going to be successful in an adversarial relation- ship,” Mr. Reiner emphasized. Heather Bettridge, associate vice


president of TMA Practice Manage- ment Services, says physicians need to arm themselves with critical infor- mation before the negotiation pro- cess. They should have access to their contracts and an accurate, up-to-date payer contract matrix, which lists per- tinent information for each payer, in- cluding contact information, payment terms, and agreement provisions. “Without the matrix, it will be diffi-


cult to determine if the terms are rea- sonable and if your practice is being paid appropriately,” Ms. Bettridge said. To improve their chances of suc-


cessful negotiations, she suggests that physicians:


• Schedule reminders for all exp- iring contracts to allow sufficient time for the negotiation process;


• Review explanations of benefits to ensure consistent payment in line with the contract;


March 2017 TEXAS MEDICINE 45


CONTRACT NEGOTIATION HELP FROM TMA


TMA’s Take Back the Power: Payer Contract Negotiations seminar will teach you to unleash your negotiation power with health plans, resulting in better contracts and more money for your bottom line. Many physicians feel they can’t negotiate from a place of strength or simply don’t know where to begin. The lessons in this seminar will help empower you to take control. Register online at www.texmed.org/seminars, or call (887) 880-1335.


Seminar topics


• The nuts and bolts of payer contracts; • Understanding common contract elements; • Where to start with negotiations and how to prepare; and • What to ask for and how to do it.


Seminar dates and locations Houston: March 28 and April 5 Dallas: April 18 Tyler: April 19 Fort Worth: April 20 Austin: June 20 San Antonio: June 21 Corpus Christi: June 22 Live webcast: June 20


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