Negotiate Contracts for Your Private Practice Like a Pro Two experts shared tips for how practice owners can ensure beneficial written agreements in a recent ASHA online conference chat. The Leader listened in. Overheard
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Overheard  |   April 01, 2017
Negotiate Contracts for Your Private Practice Like a Pro
Author Notes
  • Renee Matlock, MA, CCC-SLP, is the founder and former owner of Speech Plus PC in Frankfort, Illinois, and the founder of The Private Practice Coach, which provides business coaching to small-business entrepreneurs. renee@theprivatepracticecoach.com
    Renee Matlock, MA, CCC-SLP, is the founder and former owner of Speech Plus PC in Frankfort, Illinois, and the founder of The Private Practice Coach, which provides business coaching to small-business entrepreneurs. renee@theprivatepracticecoach.com×
  • Janet P. McCarty, MEd, CCC-SLP, is ASHA director of private health plan reimbursement. She edited and co-authored several reimbursement guides and contributed to ASHA’s 2016 Coding and Billing for Audiology and Speech-Language Pathology. jmccarty@asha.org
    Janet P. McCarty, MEd, CCC-SLP, is ASHA director of private health plan reimbursement. She edited and co-authored several reimbursement guides and contributed to ASHA’s 2016 Coding and Billing for Audiology and Speech-Language Pathology. jmccarty@asha.org×
Article Information
Practice Management / Professional Issues & Training / ASHA News & Member Stories / Overheard
Overheard   |   April 01, 2017
Negotiate Contracts for Your Private Practice Like a Pro
The ASHA Leader, April 2017, Vol. 22, online only. doi:10.1044/leader.OV.22042017.np
The ASHA Leader, April 2017, Vol. 22, online only. doi:10.1044/leader.OV.22042017.np
Participant: Any suggestions for finding sample school proposals and contracts? The school system I am looking at has never done a contract and neither have I.
Renee Matlock: Ask colleagues to share a contract they have used; check the internet, but always have your contract reviewed by your attorney.
Participant: Our school district has a long-standing contract with a particular private practice in the area, so private practitioners like myself aren’t allowed into the public school domain. Do you have any other examples of where to start looking for facilities to contract with?
Matlock: You can investigate: private schools, charter schools, skilled nursing facilities, other school districts, home health agencies, etc. The sky is the limit if the agency is providing the services you offer.
Participant: When setting up a contract with a school, how do you typically decide on how many hours to provide? Is it based on caseload numbers? Or does the school tell you how many children to see within a certain number of hours? How do you adjust the contract throughout the year to reflect a growing caseload?
Matlock: I usually discuss this with the school administration. They may have high numbers of children needing services, but a limited budget.
Participant: We were surprised to hear that we could negotiate rates with insurance companies. Is this really possible for small private practices or just large health organizations?
Janet McCarty: No, small practices negotiate rates as well. Any provider who is paid for their services should be negotiating a contract that works for them.
Participant: If you want to renegotiate rates after a contract has been in place for years, what strategies would you recommend? I have a number of clients with one private insurance company, but the reimbursement is significantly less than others. I do not want to cancel the contract, but it is important to negotiate higher rates.
McCarty: Have your numbers ready to negotiate. You may need to make a business decision about maintaining a contract that pays low. Do you still get a lot of referrals? Do pediatricians refer to those providers in the plan? Lots to consider.

“Any provider who is paid for their services should be negotiating a contract that works for them.”

Participant: Honestly, I’m a bit intimidated by the idea of negotiating a contract. Do you have suggestions for “first steps” for those of us who don’t have much experience in this area?
McCarty: First steps would be to review your rates against data such as the Medicare Physician Fee Schedule. Knowing that will make you feel good—or make you realize you need to get in there and negotiate a good rate.
Participant: I was contacted about providing services to a little girl in her home. The mother also informed me that her daughter’s preschool/daycare had a provider come into the school for several kids, but they are no longer “hired”; so, they’re looking for a replacement. This woman has not called back to work with the girl individually, so can I contact the preschool myself to express my desire/interest in coming in as the new provider now that I’m aware of that situation? I’ve been hired recently as a contractor for a state early intervention (EI) agency, and I think it would be great to supplement that with also going into the preschool as a contractor, too.
Matlock: Yes, I would contact the administrator and set up a face-to-face meeting to discuss that possibility. It’s a good opportunity for you—excellent supplement to what you are doing with EI.
Participant: Tips for getting past the “brick wall”? I have negotiated a couple of contracts very successfully. They were each a total pain. I was told they “absolutely do not ever” negotiate rates by several different people within the companies each time. There is one company that I was never able to “crack,” whose reimbursement rate is lower. I couldn’t get past the “No, we don’t ever negotiate” response. (I probably spoke to at least five supervisors of supervisors over many months.) I have excellent reasons for negotiating and great numbers to support it; they just flat-out refuse to even entertain the idea.
McCarty: That they don’t negotiate is likely not true. It may depend on the leverage you have in your community. Are you the only SLP in town? Do you have a specialty? A number of criteria plays into it.
Participant: Yes, I am the only private practice in town—in the entire county actually. I am only competing with the hospital, which charges about $400 per visit.
McCarty: It could be a state Medicaid-specific criteria. You might show what you can do, and your outcomes, etc., in relation to service provided by the hospital.
Participant: A friend of mine who successfully ran a private practice for years decided that constantly negotiating with (and filling out the necessary paperwork for) a number of insurance companies took away too much of her time from the “real” work of speech treatment and all the related prep/documentation. She ended up having clients pay upfront and letting them deal with their own reimbursements. While I think this would deter some potential clients, do you have tips/advice on how you could avoid the inevitable time-suck of negotiations/filing paperwork?
McCarty: Many practices do have the patient pay: You provide a superbill, and the patient files. We recommend that way for small practices. But at some point, you may find that to get patients, referrals, etc., you need to sign contracts with health plans. Either way can work; you need to see what is best for you.
Matlock: You could also contract out your billing to an individual or company that would handle this for you.
Participant: Janet, are you saying that one can be a contracted provider but have the patient submit all the claims? I was under the impression that contracted providers needed to submit all claims on behalf of the patient.
McCarty: If you are contracted, you likely need to file the claim. Only if you don’t have a contract can you take the payment, provide the superbill, and have the patient file. Thanks for clarifying that.

“Do the math and know your numbers! Investigate market rates—what are other contract agencies billing?”

Participant: To draw good clinicians, I always want to offer competitive reimbursement. So, when considering all factors in order to negotiate the best rate with a school/facility, how do you calculate a competitive rate for your contractors or providers? Do you have a suggested formula or percentage, or do you just use market rates from sites like Glassdoor to calculate rates?
Matlock: Do the math and know your numbers! Investigate market rates—what are other contract agencies billing? And what costs are involved on your end in providing these services?
Participant: Can you give some examples of demonstrating the value that you, as the provider, bring to the table when negotiating rates with the insurer?
McCarty:Do you track outcomes? I think showing outcomes is one of the best ways to show value. How many sessions does it take to treat a specific disorder in your practice? Payers really like that kind of info, and more and more so. (See “The Proof Is in the Data, URL TK.)
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April 2017
Volume 22, Issue 4