Payer contracts are the foundation of a healthcare facility’s financial health. These agreements set your reimbursement rates for patient services—and even small changes in those rates or policies can impact your bottom line. That’s why regular reviews of your payer agreements are essential.
But how often should you review your contracts? What key areas should you focus on during the review?
Let’s walk through the ideal timeline for payer contract reviews, what triggers a contract reassessment, and how expert support can help you get more value from every agreement.
Why Reviewing Contracts Matters
Over time, healthcare regulations change, patient needs evolve, and reimbursement trends shift. If you keep the same contracts while the industry changes, you could miss out on higher rates or end up stuck with outdated terms.
Regular reviews help you:
- Ensure your reimbursement rates remain competitive
- Catch changes in payer policies or fee schedules
- Identify hidden costs or unfavorable terms
- Maintain compliance with payer and regulatory guidelines
These reviews are especially important for behavioral health providers, who often face unique restrictions and lower baseline reimbursement rates.
How Often Should You Review Payer Contracts?
While there’s no one-size-fits-all answer, most healthcare organizations benefit from reviewing their contracts at least once a year. However, some situations call for more frequent evaluations.
Recommended Timeline:
- Annually: A full payer contract review should be part of your yearly financial planning.
- Before Contract Renewals: Start reviewing contracts at least 90–120 days before their renewal date. This gives you time to negotiate or terminate if needed.
- After Service Changes: If you add new services, specialties, or locations, your existing contracts may no longer reflect your current offerings.
- After Major Payer Changes: If a payer updates its policies or fee schedules, it’s time to reassess the terms you agreed to.
- During Mergers or Acquisitions: Facilities undergoing ownership or structural changes should always re-evaluate contracts to avoid conflicts and revenue disruptions.
Each of these moments is an opportunity to assess whether your agreements still serve your goals—or if it’s time for change.
What to Look for During a Payer Contract Review
Not all contract reviews are equal. When taking a closer look at your agreements, focus on terms that affect your revenue, operations, and long-term growth.
Here’s what to check:
- Reimbursement Rates: Are your rates competitive based on your location, specialty, and peers?
- Fee Schedules and Payment Timelines: Are payments timely and accurate?
- Denial Policies: Are claim denials increasing? Is there a clearly defined appeals process in place?
- Contract Language: Are there vague terms or automatic renewals that limit your flexibility?
- Outdated Clauses: Have changes in state or federal laws made any terms non-compliant?
A detailed review reveals not just where you are—but where you could be with better contract terms.
How AT Contracting Solutions Can Help
Reviewing contracts is time-consuming and often complicated, especially for busy facilities managing multiple payers. That’s where our team at AT Contracting Solutions steps in.
We provide professional insurance contract negotiation services and ongoing payer contract management so providers can focus on delivering care—not sorting through legal fine print.
Our services include:
- In-depth payer contract reviews to identify weak points and lost revenue
- Market analysis to compare your rates with current benchmarks
- Contract renewal tracking and deadline management
- Strategic negotiation support to improve your contract terms
- Compliance checks to avoid costly errors or penalties
With our help, providers stay one step ahead of their payer contracts and gain a stronger financial footing.
Stay in Control of Your Payer Agreements
Health insurance contract negotiations don’t just happen once—they’re part of an ongoing strategy. The more often you review and adjust your agreements, the more control you have over your revenue, operations, and patient access.
Contact AT Contracting Solutions today to schedule a comprehensive review of your current payer contracts and learn how we can help you get the most out of every agreement.
