Revenue impact
Assess proposed rates against the procedures your practice actually performs, rather than relying on a single percentage.
Payer contract evaluation & negotiation
Understand your agreements. Negotiate with a plan.
PPS helps practices evaluate payer agreements, understand reimbursement and build a negotiation strategy around their services and goals.
A clearer view of your agreements
Look beyond the headline rate.
Our contract evaluation combines fee schedules, practice activity and agreement terms so you can assess proposals with a clearer picture of their impact.
Fee schedule clarity
Compare current and proposed schedules to identify changes, tradeoffs and questions to raise with the payer.
Renewal readiness
Review expiration dates, renewal provisions and notice requirements before another decision deadline arrives.
A structured contracting process
Review. Evaluate. Negotiate.
Every practice needs a strategy that reflects its payer relationships, service mix and business priorities.
Develop the contracting strategy
Identify the agreements to review, participation gaps and upcoming renewal decisions. Consider your practice’s strengths, patient access and referral needs when deciding where to focus payer discussions.
Where relevant, review alternative payment arrangements, performance measures and network participation opportunities.
Evaluate contracts and fee schedules
Review existing agreements alongside utilization and reimbursement reports. Weight the analysis toward frequently performed CPT codes to understand how a proposal could affect the practice.
Medicare rates can provide a comparison point. They do not replace a review of the actual payer terms and your practice’s service mix.
Negotiate and follow through
Present the practice’s case, review payer proposals and track revisions. Confirm that the final agreement reflects the negotiated terms, including the fee schedule and effective date.
PPS provides updates through the process. Your team’s input and timely responses help keep decisions moving.
Before you begin
Questions worth asking.
Understand the scope, possible outcomes and commitment before starting negotiations.
Talk to a specialistHow often are negotiations successful?
An increase is not guaranteed. The opportunity depends on the payer, the practice’s services and market position, the existing agreement and the case presented. PPS evaluates the opportunity before recommending a negotiation project and keeps you informed as discussions progress.
What does it cost to negotiate payer contracts?
Scope and pricing depend on the number of agreements, the analysis required and the work involved. Ask PPS for a written proposal that explains the services, fees and any project limits before work begins.
What kind of increase can I expect?
There is no single percentage that applies to every practice. Evaluate a proposal against your actual service mix: a higher rate for one code may be offset by lower rates elsewhere. PPS reviews the proposed fee schedule to help you understand its potential effect on your practice’s revenue.
Should I negotiate my contracts?
A review is useful when an agreement is approaching renewal, rates have not been evaluated recently, your services have changed or participation gaps affect referrals. Start by understanding the current agreement and the value your practice brings to the network. That review helps determine whether negotiation is worthwhile.
How long does contract negotiation take?
Plan for a process that can take several months, rather than an immediate rate change. Timing depends on payer responsiveness, proposal revisions and the practice’s ability to supply information and make decisions. PPS can discuss a planning range for your project and track the next action with you.
Contract evaluation, explained
See how the analysis works.
This earlier PPS video explains how contract value can be evaluated using reimbursement and practice activity. It predates our later software tools; use it as an introduction to the analysis.
Watch the PPS evaluation videoFree resources
Make your next decision an informed one.
Practice startup
Why payer contracting matters
Consider payer participation as part of planning a new practice.
Read the guide → Reimbursement toolsUnderstand Medicare fee schedules
Learn how to use fee schedule information in your analysis.
Explore the resource → Practice planningEvaluate practice viability
Review the relationship between patient demand and payer access.
Read the guide → EnrollmentUnderstand Medicare billing dates
Review enrollment and retrospective billing considerations.
Read the guide →Your next step
A clearer plan for your payer relationships.
Talk with PPS about the agreements and decisions ahead of your practice.