An Impactful Proposal Letter – SAMPLE
DATE
PAYER NAME
PAYER CONTACT
ADDRESS
Re: PRACTICE/PROVIDER NAME – TAX ID ##-#######
Dear PAYER CONTACT:
We are contacting you to initiate a renegotiation of our contract fee schedule. PRACTICE/PROVIDER NAME has been providing efficient, effective, compassionate care to the community since DATE OF INCORPORATION and a PAYER network provider since YEAR YOU JOINED THE NETWORK. In the past twelve months, our group provided care to NUMBER OF PATIENTS FOR THIS PAYER SERVED IN PAST 12 MONTHS, receiving $ TOTAL REIMBURSEMENT FOR SERVICES TO PAYER’S MEMBERS IN PAST 12 MONTHS in reimbursement. We have carefully reviewed our existing fee schedule and find that it does not adequately compensate us for providing the high quality care that your members have come to expect and deserve.
PRACTICE/PROVIDER NAME provides comprehensive LIST SPECIALTY (IES) care in COUNTY (IES). Our practice is Medicare Credentialed, accredited by ACCREDITING AGENCY, and has been acknowledged by LIST ANY AWARDS RECEIVED OR LOCAL RATING (SUCH AS TOP PROVIDERS IN YOUR CITY/STATE/SPECIALTY). Our physicians are NAME OF BOARD certified and are recognized leaders in their respective fields. Additionally, we are the only providers in the area performing LIST SPECIFIC PROCEDURES OR FEATURE OF YOUR PRACTICE THAT SETS YOU APART FROM YOUR COMPETITORS, SUCH AS GEOGRAPHIC ADVANTAGE, COMPREHENSIVE/INTEGRATED SERVICES, STRATETIC PARTNERSHIPS W/LABS OR OTHER ANCILLARY SERVICES, ETC.) A complete list of our providers, specialties and service locations are listed in Appendix B to this letter.
We are committed to working with PAYER to provide superlative care to your covered lives, but must do so at reimbursement rates that enable our practice to maintain a superior level of patient care. To this end, we have included, in Appendix A to this letter, a reasonable reimbursement proposal commensurate with the high-quality care that we provide to your members. We look forward to working with you toward a mutually agreeable amendment (contract). We will contact you next week to answer any questions you have about our practice or this proposal. In the meantime, do not hesitate to contact me, if you wish to discuss this matter in person.
Sincerely,
Your Name and Title
C/o Physician name/corporate name
Email: your
Phone Numbers
APPENDIX A
PRACTICE/PROVIDER NAME – TAX ID ##-#######
Fee Schedule Proposal
Key Codes Reimbursement: List your roughly top 10-20 codes that represent s 80% of your revenue with this payer. List your requested rates. If you do not have this information, simply request a 30% increase or another set percentage increase over the current payer fee schedule. We usually recommend 30% since, more often than not, you can expect to get ½ or less of your proposed increase when you finalize.
Other than Key Codes: 30% increase over current fee schedule
(FOR PHYSICIANS) Site of Service / “Facility” Fee: For surgical procedures performed in the office vs. ASC or hospital setting, a Facility Fee of $ (INSERT FEE) shall be applied and paid in addition to the contractual base procedure rate. This section is optional but can be especially useful if you have codes that can be performed in an office vs. facility since it saves the payers money and can create an upside revenue benefit to your practice.
Unlisted Codes: 80% of Billed charges
Pathology, Radiology, Imaging Services, Anesthesia Services, Supplies and Medications: during both surgery and post op visits shall be reimbursed at 80% of billed charges.
Implants and high cost supplies: Reimbursed at (Cost + Shipping Cost) + 10%.
APPENDIX B
List of Providers and Office Locations
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