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Free checklist

Payer contract review checklist

What to check in a commercial payer contract before you sign or renew. 12 checks, ready to print.

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What's on it

Anesthesia payment depends on details buried in the contract. Check these before you sign or renew.

Payment

  • Conversion factor for anesthesia, and whether it changes each year
  • How time is counted and rounded
  • Whether physical status and qualifying circumstances are paid
  • CRNA payment for non-directed cases (full rate or a percentage)
  • Payment for blocks, lines and other separately billed procedures

Rules

  • Timely filing limit for claims and corrected claims
  • Appeal deadlines
  • Medical necessity policies for MAC
  • How the payer can change policies, and with how much notice

Term

  • Length and renewal
  • How to renegotiate
  • Termination terms

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