Practices should insist on deleting both direct and indirect hold-harmless language from the plan contract. These provisions are not usually described in the plan participation agreement, but are referenced in the contract, creating a legal obligation for the practice to comply with these policies. The authority to modify these extra-contractual requirements usually rests solely with the plan, unless the provider negotiates the right to review and comment on changes as part of the participation agreement. The practice should, at a minimum, require a 30-day comment period before changes become effective. Moreover, the practice should secure the right to renegotiate the payment rates if the changes have a negative financial impact on the practice.
Some plans offer a volume guarantee in return for accepting capitated fees.
If the minimum isn't set high enough, the plan will probably never have to pay off on the guarantee. You may request that your capitation rate be inversely linked to patient volume. Today, contracts are not standard and physicians need to review every clause together with an experienced attorney to be sure you know exactly what you are getting into before you sign. Savvy negotiations can result in modifying terms so that the managed care plan does not have an unfair advantage in your future relationship. While you may not always be able to negotiate an increase in payment rates, renegotiating other contract terms may represent an equally important benefit to your practice.