Negotiating a health plan contract is one of the most important business moves an independent physician can make.TMA survey data from June 2018 shows that on average, 43% of responding physicians secured changes to contract terms, payments, or both.
Learn about the basics of contracts in the articles below:
The Basic Elements of a Contract
Physician Prices, Fee Schedules, and Managed Care Contract Offer and Acceptance
Is There a Cooling-Off Period for Physician Contracts?
Managed Care Contracting: Contract Evaluation Service
Monitor Payer Contracts to Help Manage Revenue
Payer Contracts Warrant Attorney Review
You CAN Negotiate a Health Plan Contract
Generally, in Texas, a contract modification must meet all of the elements necessary to form a contract at the outset. This means there must be an offer and an acceptance. One party cannot modify the contract terms without the consent of the other, for such a modification would lack the other party's acceptance.
See How Contract Clauses Modify the General Rule
Managed care contracts and regulations can be a jungle of legal language, and physicians who do not carefully pick their way through the various clauses can be in for a nasty surprise.
A Contract Clause That Isn't (But Should Be) in Managed Care Contract
Arbitration Clauses in Managed Care Contracts
Clauses That Survive Termination of Managed Care Contracts
Definitions in Managed Care Contracts
Indemnity Clauses in Managed Care Contracts
Managed Care Contract Provisions Regarding Overpayment
TDI Consent Orders and Managed Care Contract Clauses
Termination Clauses in Managed Care Contracts
Texas Department of Insurance Rules and Managed Care Contract Clauses
The 'Most Favored Nation Clause' of Managed Care Contracts
The Covered Services Clause of Managed Care Contracts
The Nondiscrimination Clause of Managed Care Contracts
To make wise decisions about accepting a managed care contract, you and your practice administrator need a good understanding of how the contract payments relate to the cost of providing services in your practice.
Your Payer Contracts: Money Makers or Money Drains?
Flex Your RVUs
Got Contracts questions? Call or email the Knowledge Center.
Managed Care Contract Guide
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