More Revenue, Less Runaround
Payer Contracting Insights for Private Practice Leaders
Effective strategies for payer contracting are essential for independent practices facing declining reimbursements, rising costs, and administrative burdens. Effective strategies help to ensure fair pay, simplify operations, and stabilize revenue. That stability is vital for financial sustainability and the viability of the ownership model itself.
Join us June 22-24 for the 2025 MGMA Focus | Private Practice Conference for expert insights and best practices to communicate your independent practice’s unique value to payers and discover new opportunities in direct contracting to preserve your way of doing business:
What you’ll learn in CON502: “Building Bridges with Employers by Direct Contracting”
- The benefits of direct contracting: Independent practices gain predictable, better reimbursement with minimal administrative hassle, significantly improving revenue cycles, eliminating most patient collections.
- Achieving transparent pricing: Clearly priced, bundled healthcare services are the foundation to successful direct-to-employer contracting.
- Capturing a growing market: More than 100 million Americans now work for self-insured employers, creating substantial opportunities for practices prepared to directly contract.
- Broker relationships: Successful entry into direct contracting often hinges on strong relationships with healthcare brokers rather than employers directly.
- Provider networks: Joining targeted provider networks used by TPAs and care navigators amplifies visibility, but it’s critical to understand who their true client is to avoid misaligned incentives.
- Community-owned health plans: Partnering with direct primary care providers for community-owned health plans offers significant leverage, particularly for local public entities (e.g., municipalities, schools, and county governments).
Did you know?
MGMA members have exclusive access to our new Payer Contracting Playbook — featuring a structured, step-by-step framework for managing the full lifecycle of payer contracts, from initial request and evaluation to negotiation, implementation, and renewal — and Analyzing Payer Contracts Playbook, which helps you understand how to use data analytics, understand critical contract language, and adopt proven post-negotiation best practices.
What you’ll learn in CON103: “The ROAD to Success: Avoiding Potholes During Negotiations”
- Strategic preparation is key: "Contracts not routinely analyzed" is a common pitfall; practices must prioritize regular review and thorough preparation to avoid revenue erosion.
- Knowing your financials: Adjusted collections — not gross collections — most accurately measure how effectively your practice captures contracted revenue, highlighting the importance of thorough financial understanding.
- Administrative burden is negotiable: Practices often overlook administrative burdens during negotiations. Addressing these directly can significantly improve operational efficiency and financial health.
- Clear goals yield better results: You just can’t ask the payer for an increase. You have to provide them specifically what you want. Clearly defined negotiation goals strongly influence outcomes.
- Storytelling engages payers: Effective storytelling about your practice’s value, quality outcomes, and cost efficiency helps create emotional connections and transforms payers into advocates.
- Normalize "no" as a step toward "yes": Hearing "no" multiple times is common, but persistence is essential. "Tenacity wins," Jacobsen says.
Round out your rev cycle education
Help us kick off the start of the conference with a three-hour workshop, “Design Your Strategic RCM Workplan,” featuring Jacobsen and best-selling authors and MGMA consultants Kem Tolliver and Shawntea “Taya” Gordon.
What you’ll learn in CON202: “Maximizing Reimbursements: Digitizing Payer Contracts for Higher Profits”
- Administrative cost crisis: Administrative expenses consume 15% to 25% of total healthcare spend, driven largely by payer processes. Practices can fight back by streamlining these processes digitally.
- Finding hidden losses in payer proposals: Even an attractive payer offer, like an "8% increase," can conceal significant revenue losses if not analyzed against actual utilization data — underscoring the need for detailed scrutiny.
- Granular digitization is essential: Digitizing all aspects of your payer contracts — down to individual CPT codes and contract structures — helps uncover missed revenue opportunities and enables you to negotiate from strength.
- Negotiate from a position of strength: Combining detailed internal data with market transparency allows practices to build credible negotiation strategies and secure meaningful increases, reversing potential revenue declines.
- Quick wins are often hidden: Immediate revenue boosts frequently exist within existing payer agreements — such as overlooked Medicaid or Medicare Advantage terms — without needing extensive renegotiations
- Understanding your Medicare baselines: Many practices misunderstand their reimbursement models tied to Medicare rates, missing nuances like RVU benchmarks or varied locality adjustments, which can significantly impact revenue.
More tools to help your bottom line
Once you’ve negotiated better payer rates, are you making sure you are getting paid accurately? About half of all medical practices audit payer payments at least quarterly, according to an MGMA Stat poll. If this is an area where you struggle, optimize your contract negotiations with MGMA’s Physician Fee Schedule Tool. This updated platform helps you compare fee schedule versions across years, customizing CMS fee schedules by locality and non-Medicare payment rate. Select top procedure codes by specialty, informed by MGMA data. Easily save, export and access custom tables via the web interface.