Understanding payer contracts
Practicing medicine often requires physicians to evaluate many different contracts with payers. The terms of these contracts are sometimes difficult to understand, but they can have a major impact on reimbursement and administrative burden. The many factors addressed in payer contracts add to the challenges physicians face in making good business decisions.
Although payer contracts differ, they share some key elements. Understanding common terms and concerning provisions can inform your review of payer contracts and help you look out for the best interests of your practice and patients.
Review the contract’s terms before you sign so you can flag areas of concern and negotiate alternative language.
Understand the impact of proposed reimbursement and negotiate better terms before signing the contract.
Learn more about important factors beyond the contract, such as state laws and contract loading.
* This information is provided for educational purposes only; individual physicians must make independent judgments about payer contracts. The AAD cannot provide legal advice to its members. For specific questions or individual cases, we encourage members to speak with their legal counsel.
