Navigating Insurance Contract Negotiations: A Practical Guide for Neurologists

Abstract

Effective negotiation with health insurance payers is crucial for neurology practices to maintain financial sustainability and optimal patient care. This paper outlines strategic approaches to payer negotiations, emphasizing the importance of clearly defining practice strengths, understanding market conditions, and leveraging detailed contextual data to counter incomplete or misleading payer analytics. Specific considerations discussed include customer service efficiency, claims management, provider–payer relationships, clinical management policies, contract terms, and fee schedule clarity. We present actionable negotiation strategies illustrated by a case study, highlighting tactics such as targeted utilization reports, social media advocacy, and data-driven reimbursement proposals. Additionally, practical advice is provided on managing payer interactions, addressing common administrative inefficiencies, and strategically limiting patient volumes when negotiations stall. This structured negotiation approach empowers neurologists to effectively align clinical value with payer objectives, ensuring fair reimbursement and enhanced practice viability.

Keywords

payer contract - managed care negotiations - utilization data

Publication History

Article published online:
30 May 2025

• References

• 1 Incident To Services & Supplies | CMS Centers for Medicare & Medicaid Services (CMS). Medicare Physician Fee Schedule (MPFS). 2025 . Accessed April 28, 2025 at: https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/advanced-practice-nonphysician-practitioners/incident-services-supplies
• 2 Pilotfish Technology. X12 EDI Interface Engine. Pilotfish Healthcare Integration,. 2025 . Accessed April 28, 2025 at: https://healthcare.pilotfishtechnology.com/edi-x12-interface-engine/
• 3 American Academy of Neurology. Coding Resources. 2025 . Accessed April 28, 2025 at: https://www.aan.com/practice/billing-and-coding
• 4 Hinton E, Raphael J. 10 Things to Know About Medicaid Managed Care. Kaiser Family Foundation. 2025 . Accessed April 28, 2025 at: https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/
• 5 Centers for Medicare & Medicaid Services. Physician Fee Schedule. CMS. 2024 . Accessed April 28, 2025 at: https://www.cms.gov/medicare/payment/fee-schedules/physician
• 6 Medicare Payment Advisory Commission (MedPAC). Report to the Congress: Medicare Payment Policy. March 2025 . Accessed April 28, 2025 at: https://www.medpac.gov
• 7 Medicare Payment Advisory Commission (MedPAC). Aligning fee-for-service payment rates across ambulatory settings. 2023 . Accessed April 28, 2025 at: https://www.medpac.gov/recommendation/ambulatory-surgical-center-services/