Contract Negotiation Strategies for Orthopedic Surgeons [Webinar]

 Erika Regulsky Tags: , , , Compliance
  • Home
  • Compliance
  • Contract Negotiation Strategies for Orthopedic Surgeons [Webinar]

Social Shares

BillingParadise Presents

Contract Negotiation Webinar

Contract Negotiation Strategies For Orthopedic Surgeons

posted by Kim Dues for Billing Paradise 24/7

Orthopedic Surgeons Negotiate Your Network Contracts for Higher Reimbursements

As we are all aware, fee schedules from network payors appear to be going down instead of up. Very few insurance companies attach an actual fee schedule to a proposed contract to a healthcare provider.

The majority of insurance companies are now writing their contracts, with payments being stated as a percentage of RVU (Relative Value Units) created by CMS. For example, a contract may read as follows:

a. Reimbursements for services will be at 80% of RVU

A healthcare provider then must review his most used CPT codes in the Medicare Fee Schedule, which is online, and calculate the exact amount he/she will be receiving. An example below is:

a. CPT code 99203 in Dallas, Texas for a participating provider allows $109.62

b. Provider bills $160.00 for this procedure.

c. Reimbursement is 80% of RVU, which has a reimbursement rate of $87.70, leaving the patient owing $21.92 , or the amount to be paid by the patient’s secondary insurance carrier.

An alternative to going over every code to determine what you will be paid is to list your top 25 codes and email to each carrier for their allowable payment amount. The insurance carrier has 30 days to return this information to the biller or the provider.

This is where negotiation of a more acceptable reimbursement comes in to play. Once the contract is reviewed, you or your credentialer, can go back to the insurance contractor and request an increase in the percentage of RVU. Depending on the provider specialty would determine how much of an increase to request.

The request for a higher reimbursement may involve several emails back and forth, and even explanations on why the provider should receive a higher reimbursement (years of practicing, knowledge, specialty, etc), but if the percentages are so low that it tightens your budget to an amount you can’t live with, you need to try at least to negotiate a better deal for you and your practice.

Usually, a provider has to be contracted for one year before asking for an increase. After the first year, the carrier can evaluate how many claims you are running through their system, dollar amounts, referrals, etc. This is part of what they base a renegotiation fee increase.

Specialties like Orthopedics, Cardiology, Pain Management, Neurology, Ophthalmology, Gastroenterology, etc., can negotiate stronger contracts in the beginning based on the reimbursement they are receiving from similar payors.


  • Practice managersPractice managers/owners of orthopedic surgery centers
  • OrthopediciansOrthopedicians
  • Spine care hospitalsSpine care hospitals
  • Orthopedic hospitalsOrthopedic hospitals
  • Orthopedic medical groupsOrthopedic medical groups
  • RadiologistsRadiologists
  • TherapistsTherapists
  • SugeonsSurgeons
  • PodiatryPodiatry


About the Speakers



Kim Dues

Chief of Credentialing & Billing Relations

Credentialing and Billing Relations: Credentialing expert with 60+ years of experience. Has contracted over 3000 providers

Texas Health and Heart hospital and Cornerstone hospital: Kim Dues has contracted over 3000 healthcare providers and has performed privileging for 700 providers, for the Texas Health and Heart hospital and Cornerstone hospital. She has extensive experience in handling the credentialing needs of providers based in Texas.

 Appointment Scheduling using Robotic Process Automation

Subscribe to Billing Paradise Newsletter

Social Shares

I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond Bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.

Get paid Three times faster with our 24/7 medical billing services.

Work with medical billers who understand your EHR's billing process backwards and forwards

Avail Free RCM Audit Worth $2,000! Check out 19 different KPI reports that stops your cash flow.