When Kevin Barron, vice president of payer relations at University Health in San Antonio, joined Daniel Williams, senior editor and host of the MGMA Insights Podcast, he made clear that success in contracting is rarely about the number on the page. That comes after the contract is signed, and when a practice discovers whether those terms quietly erode revenue over time.

Contract Language Can Erode Everything

For many organizations, negotiation success is measured by rate increases. Barron argues that’s a costly miscalculation.

“A lot of people will focus on rates and they're obviously important,” he said. But, he added, the real danger arrives after the ink dries. Contract erosion happens through operational clauses: prior authorization requirements, medical necessity definitions, documentation standards, and other policy mechanisms that can restrict payment. Over time, those provisions shape reimbursement far more than the fee schedule itself.

Barron doesn’t sugarcoat the timeline. “It may take months to do a contract negotiation, but it will take years to live through what you negotiated.” A short-term win on rates can lock in long-term operational constraints that quietly reduce revenue over time.

“Understanding and talking to all the key stakeholders — making sure you know what’s a priority,” he said, is critical before negotiations even begin. Without that alignment, even well-intentioned contracts can fail in practice.

Integration Beats Silos: Contracting, Auditing, and Operations Must Align

At University Health, Barron’s team operates under a structure that remains relatively uncommon: Contracting, auditing, and contract management all sit within the revenue cycle.

“We fall under the revenue cycle… and his vision for this role… was to be integrated more,” Barron said, referring to Chief Revenue Officer Wala Baniço. That integration ensures there's operational accountability. “Here we live it one way or the other, " he said. "Good, bad, or indifferent, we’re in for the long haul."

One early initiative reshaped how the team understood its role: assuming responsibility for high-dollar claims sitting in accounts receivable for more than seven months. “Our team became fully responsible for them… and it was our job then to collect them.”

The experience exposed gaps between contract intent and operational reality. “It taught me a heck of a lot because all those 20-plus years, all I did was contracts… and then we went to the next payer,” Barron said. That shift forced the team to connect negotiation decisions directly to financial outcomes.

Negotiation Is Relationship Management, Not Just Leverage

The image of negotiation as a rigid standoff doesn’t match Barron’s experience. Instead, it’s a dynamic, relationship-driven process shaped as much by people as by numbers.

“You need to know what your rules are… where are your deal breakers… you need to know the things that you can give on,” he said. But equally important is maintaining balance: “The other side needs to have some wins here and there.”

Barron acknowledges that this balance has become harder as payer organizations consolidate and staffing tightens. “To get the attention of the person you need to deal with… it takes text messages, phone calls, emails, LinkedIn; it takes pretty much anything."

Barron acknowledges that this balance has become harder as payer organizations consolidate and staffing tightens. "To get the attention of the person you need to deal with… it takes text messages, phone calls, emails, LinkedIn; it takes pretty much anything." 

MGMA data backs him up: 41% of billing and claims roles were more than half vacant in 2024, and the AMA found that difficulty negotiating with payers was the top reason physicians cited for leaving independent practice that same year.

Adaptability is key. “If I’m dealing with a person who’s an attorney… they’re quick and to the point,” he explained. “If [you're] dealing with someone who likes to talk about family and stories… you do that, too.”

The reality, he said, is that payer contacts are overwhelmed. “They’re dealing with fires all the time, and they’re usually short-staffed.” 

The Biggest Revenue Leaks Happen After the Contract Is Signed

While negotiations set the terms, Barron sees revenue loss happening most often in day-to-day operations.

“Where do you see organizations leaving money on the table? I think it’s on the operations side,” he said.
That challenge has grown as University Health’s medical group expanded to nearly 900 providers and diversified beyond primary care. “We have many more specialists involved… hospital-based providers… anesthesiologists."

Each specialty brings unique workflows and coding complexities. “For adult congenital heart, for example… it’s not just a clinic visit… you have to make sure you’re looking at the whole longevity of whatever that case is, and it could be years.”

That long-term view requires deeper collaboration with physicians. “I’m spending more time understanding what their key priorities are, what their key codes are,” Barron said. At the same time, physicians entering a large system must adapt as well. “They’re coming from a different scenario… I have to understand how their compensation system works so I can do what I need to do appropriately.”

Underpayments — A Moving Target and Harder to Detect Than Ever

Denials often get the spotlight, but Barron identified a different challenge. “Underpayments are probably one of the biggest issues we’ve got." Unlike denials, he said, they require precise tracking and constant reconciliation.

The root issue often lies in shifting fee schedules. “We end up having to chase down payers for fee schedules because they update schedules,” Barron explained. These updates may stem from CMS changes or payer-driven adjustments, often without clear communication.

Because his team builds every contract into Epic’s Resolute Billing System, discrepancies show up as variances. But even that system depends on accurate data. “If they’ve changed the rate and increased it, it looks like an overpayment… and vice versa.”

Managing that complexity requires constant vigilance. “You’ve got to know what you expect to get paid. You’ve got to monitor it closely and you’ve got to figure out what’s causing [variances],” he said. Sometimes the issue lies in coding, sometimes in payer rules, and sometimes in internal processes. 

AI Is Transforming Contracting — But Experts Still Needed

While many organizations are still exploring AI, Barron’s team is already using it to accelerate core tasks. “I’m using it practically daily,” he said, particularly for contract review and redlining.

“The AI tools… help us redline things in minutes,” he explained. “I had a Blue Cross contract… it was 80 pages. It took me five hours.” He said that with AI-assisted workflows, that same review can now be completed in two or three minutes.

Even so, Barron emphasized that expertise remains essential: “I believe we have to be the experts to be able to interpret what [AI is] doing and make sure you agree with what it’s doing."

The real value is not so much speed but the reallocation of energy. “It’s going to save a lot of effort… [and] allow us to put our time into the relationship with the payer.” 

Purpose Still Drives Performance 

Despite the complexity of payer contracting, Barron returns to a simple but powerful motivator: Purpose.
At University Health, a county-based system, that purpose is rooted in long-term community care. “Our whole goal is to make the mission sustainable… we want to be here 50 years from now,” he said.

That mission shapes how he approaches his work. “The reason you do what you do is really important… it’s the why,” he added. In fact, he keeps that reminder nearby and visible. “I have a little sign… it just says, 'this is my why.'”

In a field defined by contracts, spreadsheets, and negotiations, that clarity provides direction. “If you know why you’re doing what you’re doing, you can do it well… it takes dedication to do this for a living.”

Resources

• Never Split the Difference by Christopher Voss
• Epic Resolute Billing System 
• MGMA Payer Contract Playbook
• MGMA Analyzing Payer Contracts Playbook
• MGMA DataDive (Signature benchmarking resource)
• "The race for more revenue in medical groups: What’s your gameplan?" (MGMA Stat article)
• MGMA Annual Conference | Sept. 27-30 | San Antonio, TX