Kevin Dowdy is director of managed care for Meridian Surgical Partners.
Q: Our ASC is currently negotiating our managed care contracts. What are some clauses payors try to include in contracts that we should watch for and fight?
Kevin Dowdy: Any language where the payor has a different timeline as compared to the facility. An example is the facility must notify the payor of payment discrepancies within 90 days while the payor has the right to audit claims up to one year. All timelines must be mutual beneficial.
Make sure the dreaded, "Plan has the right to make changes to the fee schedule upon notice to provider" language is removed. With respect to the fee schedule particularly, but in general, the payor can't have the right to make unilateral changes. All changes must be negotiated prior to notification.
The ASC should fight any termination language that is tied to the renewal date of the agreement. Make sure the termination language can be at anytime upon the appropriately negotiated timeframe. If this isn't done, then the termination period could easily become a year when it should be no more than three months.
Learn more about Meridian Surgical Partners.
Read more guidance from Kevin Dowdy:
- 3 Successful Managed Care Contract Negotiation Tactics (and One to Avoid)
- Two Common Managed Care Negotiation Mistakes
- When to Drop a Payor: Q&A With Kevin Dowdy of Meridian Surgical Partners
Q: Our ASC is currently negotiating our managed care contracts. What are some clauses payors try to include in contracts that we should watch for and fight?
Kevin Dowdy: Any language where the payor has a different timeline as compared to the facility. An example is the facility must notify the payor of payment discrepancies within 90 days while the payor has the right to audit claims up to one year. All timelines must be mutual beneficial.
Make sure the dreaded, "Plan has the right to make changes to the fee schedule upon notice to provider" language is removed. With respect to the fee schedule particularly, but in general, the payor can't have the right to make unilateral changes. All changes must be negotiated prior to notification.
The ASC should fight any termination language that is tied to the renewal date of the agreement. Make sure the termination language can be at anytime upon the appropriately negotiated timeframe. If this isn't done, then the termination period could easily become a year when it should be no more than three months.
Learn more about Meridian Surgical Partners.
Read more guidance from Kevin Dowdy:
- 3 Successful Managed Care Contract Negotiation Tactics (and One to Avoid)
- Two Common Managed Care Negotiation Mistakes
- When to Drop a Payor: Q&A With Kevin Dowdy of Meridian Surgical Partners