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Are your In Network payer contracts reimbursing at vastly different rates for the same service?

The disparity between payor contracts is intentional and a major part of the payor strategy. In fact, many payors will deliberately change contract terms on a consistent basis to reduce reimbursement conditions at the expense of healthcare providers.


Most payers will contract with providers knowing they have/are:

  • Limited experience with payers

  • A mind-set the payer is always right so the reimbursement rate offered must be all they can get

  • No knowledge of alternate fee schedule options and revert to “fee-for-service”

  • Unfamiliar with contract provision language

  • Carved-out services

  • Claims processing timelines and inquiries

  • Renewal process

At Value-Based RCM our payer contracting experts will provide guidance with tracking and trending reimbursement variations for contracted services by payor. Our healthcare providers quickly benefit from this service, understanding whether they are being compensated fairly and competitively for services using a reimbursement method that fits with the providers objective and gains a better understanding of contract details above the fee schedule.


Value-Based RCM provides:

  • Planning session with providers to identify current contract performance

  • Evaluation of current contract terms and conditions to identify opportunities for improvement

  • Determining future payer contracting and goals

  • Initiating application

  • Subsequent status tracking

  • Credentialing

  • Fee schedule negotiating support

  • Letters of consideration, when applicable

  • Coordinating facility on-site visits

  • Clearly articulating the clinical value propositions defending higher reimbursement and negotiating lesser administrative tasks (i.e., authorizations, medical record requests etc.) as a “center of excellence”.

  • Exploring alternate reimbursement methodologies

To learn more about how Value-Based RCM can assist with determining if your payer contracts are supporting your business effectively contact Teresa May at 954.459.5872 or Teresa.may@vbrcm.com

Updated: Feb 3



What is your Managed Care Contracting strategy? If you struggle to answer this question, you need an advocate to support you.


For most healthcare providers, the key problem associated with managing a wide range of payor contracts lies in the complexity of the process. Most providers are working with several different payors at once, with each contracted payor operating under their own terms.

Are you struggling with any of the following common payer issues?

• Outdated agreements with poor payment terms

• Disparate rates between payors for the same or similar services

• Wide range of regional and national network participation, with specialty panels routinely close

• Ongoing changes to billing requirements for reimbursement with little transparency

• Contract language that is confusing and exclusive to each payor


Value-Based RCM brings decades of experience with managed care contracting and renegotiation.


Our work in more than 20+ states across the nation has enabled us to build relationships with major health plans in multiple regional markets, leading to insights and proficiency we bring to every client engagement.


Value-Based RCM provides:

• Planning session with providers to identify current contract performance

• Evaluation of current contract terms and conditions to identify opportunities for improvement

• Determining future payer contracting and goals

o Initiating application

o Subsequent status tracking

o Credentialing

o Fee schedule negotiating support

o Letters of consideration, when applicable

o Coordinating facility on-site visits

o Clearly articulating the clinical value propositions defending higher reimbursement and negotiating lesser administrative tasks (i.e., authorizations, medical record requests etc.) as a “center of excellence”.

• Exploring alternate reimbursement methodologies



VBRCM's CEO, Dave Worachek, was recently interviewed by Leaders Voice USA where he provided perspective on a number of trending topics related to healthcare and revenue cycle management. Read the full interview here: https://leadersvoiceusa.com/dave-worachek-president-chief-executive-officer-value-based-rcm/