4 Ways to Improve Payer-Provider Relations in 2015 and Beyond


The physician-patient relationship garners a lot of attention, particularly with the increasing focus on patient-centered care and satisfaction measures.

However, payer-provider relations can be just as important to your practice’s viability. Forming fruitful relationships with the companies that reimburse your claims can mean the difference between getting paid or not.

With that in mind, we’ll reveal four methods for improving the relationship between your payers and your practice.

#1. Establish Clear, Transparent Contract Rules

Medical payer contracts form the foundation of payer-provider relations. Contract rules can drive how the relationship forms and matures.

Before signing on the dotted line, check for well-defined contract terms, and make sure all parties agree to them. This reduces the chances for future disputes, as either party can simply point to the contract if a disagreement comes up.

Also, keep an eye out for  “evergreen” clauses. Payers sometimes sneak these in so contracts automatically renew — unless the practice notifies the payer otherwise. Don’t get locked into contract terms like these that can cause grief later.

#2. Reduce Administrative Burdens

Practice management software does more than save your practice money. Modern technology can cut the administrative burden for both you and your payers. Features like contract rule checks and code scrubbing help you submit clean claims, which keep you from irritating payers by constantly submitting incorrect claims.

Many payers also make provider portals available so practices can check the status of their claims and complete other essential tasks online. The fewer unnecessary phone calls you make to a payer, the more time you both save.

#3. Always Maintain Courteous Phone Demeanor

While we’re on the subject of phone calls, your staff should always conduct payer phone calls in the friendliest way possible, no matter how frustrating the situation. Remember, even with the largest payers, there’s still a person on the other end of the line.

In addition, often your practice will deal with the same individuals when calling state-based payers. If your practice develops a great rapport with these people, they’re more likely to help you when needed. But if they have a reason to dislike your practice, they might provide the bare minimum in terms of assistance.

#4. Outsource Medical Billing & Related Hassles

Outsourcing your medical billing will not improve your payer-provider relations per se, because it eliminates those relationships altogether – which can be a good thing.

When you outsource, the medical billing service maintains the relationships with each payer and takes ownership when conflicts come up. This approach also frees up valuable staff time.

Unless you are running a concierge style practice, you likely depend on payer reimbursements to keep your practice running. Therefore, it’s vital to cultivate a strong payer-provider relationship to make sure your practice has every possible financial advantage.

Salvador Lopez contributed to this post.

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