Payor Contracts

Abstract

Most pathologists in private practice will negotiate many managed care and other third-party payor contracts during their careers. Some of these contracts may be directly between the pathology provider and the payor, and others may involve an intervening contracting entity, such as a physician-hospital organization (PHO), an independent physician association (IPA), or an accountable care organization (ACO). At times, the pathologist may not have much negotiating leverage with the payor, yet even in these situations, it is important to understand the terms that are offered by the payor and evaluate whether participation in the contract is beneficial. This chapter provides a comprehensive roadmap of the principal contracting components that a pathology provider can follow when evaluating a managed care contract and/or negotiating with the managed care entity.