Payer Contract Management & Negotiation

We support your organization with payer contracting assistance that fits your needs, regardless of the payment methodologies currently popular in your market.

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The reimbursement environment in healthcare is in full-tilt. Value-based reimbursement is swiftly becoming the norm in some markets while fee-for-service reimbursements are persisting in others. At Coker, we want to support your organization with payer contracting assistance that fits your needs, regardless of the payment methodologies that are currently prevalent in your market.

Our approach involves helping clients with:

  • Market analysis. What payment models now dominate your market, and what models are likely to materialize in the near- and longer-term?
  • Contract analysis. Under what contractual terms do you currently operate, and how might they change over time?
  • Payment structure. How competitive are your prices? How would you price services subject to alternative reimbursements, e.g., capitation or bundled payments?
  • Negotiations. Negotiating contracts and fee schedules regularly is crucial to optimizing reimbursement. What can you do to ensure you negotiate fee-for-service or fee-for-value contracts from a position of strength?
  • Understanding the marketplace. Are you aware of all the potential contractors for your services? Who are your major competitors, and how do you differentiate yourself in the market?
  • Transitioning/timing. How do you remain competitive in two distinct business models as the industry shifts slowly from volume to value? When should you leap from one model to another? How long can you keep one foot in both boats?
  • Cost accounting. What cost accounting methodologies work best in healthcare? We believe that time-driven, activity-based, cost accounting will be necessary for many healthcare organizations to know their actual costs of care delivery. Why will this tool be advantageous for future value-based contracts?

Reviewing, renewing, and renegotiating contracts is something your organization should do yearly as a part of effective revenue cycle management. Negotiating for an increase in reimbursement rates will take significant effort, but it is not a process that is unachievable. With the right tools, information, and knowledge, you can be prepared to advocate effectively for your organization.

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