Many physicians and mental health providers are unaware that they can negotiate reimbursement rates with insurance companies. As a vital part of the healthcare system, your practice plays a key role in patient access and outcomes—and that gives you leverage.
Reviewing your existing contracts, especially after updates to CPT codes, diagnostic criteria, or behavioral health billing protocols, can uncover opportunities to renegotiate outdated terms and improve your bottom line.
Why Contract Reviews Matter
Over time, reimbursement rates for the same procedures can vary significantly between providers. These discrepancies often stem from differences in how contracts were initially negotiated. A detailed contract review may reveal underpaid codes, outdated terms, or billing errors that have gone unnoticed.
By staying proactive, you can identify gaps and pursue higher, more equitable reimbursement rates from insurers.
Tips for Negotiating Higher Reimbursement Rates
- Understand Your Value in the Network
To negotiate effectively, you must understand your practice’s role within an insurer’s network. Are you the only behavioral health provider in your area offering a specific service? Do you deliver care with favorable clinical outcomes or offer cost-saving solutions such as nurse practitioner-led care?
Highlighting these value points will strengthen your negotiating position. Insurers are more likely to consider adjustments when they see how your services benefit their members and reduce overall costs.
- Collect and Analyze Your Data
Solid data is essential to justify a fee increase. Start by identifying your most frequently used CPT codes and how often you bill them. Your billing software can generate these reports efficiently.
Then, organize key data:
Most commonly billed codes
Reimbursement rates by payer
Fee schedules and how they compare to Medicare
Focus on high-volume, high-value codes first. These offer the greatest potential return during negotiations. Also, flag any codes paid significantly below Medicare rates, as these can be strong candidates for renegotiation.
- Target Individual Service Codes
Rather than requesting a blanket fee increase, negotiate on a code-by-code basis. Insurers are more open to adjusting reimbursement for specific services, especially if you present a clear business case. Prepare to discuss volume, cost comparisons, and the medical necessity of each procedure.
In cases involving emerging treatments or lesser-known services, a medical director may support the request, even if they’re not the one approving rates. Your primary contact will usually be a provider relations or network contracting manager.
- Review Contract Changes Carefully
Before accepting any new agreement, read the proposed contract and all attachments in full. Ensure the revisions don’t introduce unfavourable clauses, such as conflicts with malpractice coverage or reimbursement terms that limit your flexibility.
If the language is unclear, consult a legal advisor who specializes in healthcare contracts to protect your interests.
Partner with MedRev MSO for Expert Billing Support
At MedRev MSO, we specialize in revenue cycle management for mental and behavioral health providers. Our experienced team can help you with everything from contract analysis and reimbursement strategies to claims processing, collections, and patient billing.
Enhance your revenue and peace of mind with our expert billing services for mental health, therapy, and related specialties.
Call us today at (239) 662-1337 to learn how we can support your practice.