5 Contract Red Flags Costing Your Practice Thousands!

Running a healthcare practice is already demanding, long hours, patient care, staffing challenges. But there’s one area many providers overlook that directly impacts revenue: payer contracts.

Too often, practices sign agreements without fully reviewing the details or comparing them to industry benchmarks. The result? Lower reimbursements, hidden risks, and thousands of dollars left on the table each year.

Here are five red flags to watch for in your contracts:

1. Reimbursement Rates Below Market Benchmarks

If your reimbursement rates are below average for your specialty and region, you’re losing money every time you see a patient. Payers count on providers not knowing the benchmarks. Without comparison data, it’s almost impossible to know if you’re being underpaid.

Tip: Regularly benchmark your rates against national and state averages. Even a 5–10% increase in one contract can add up to six figures annually.

2. Silent PPOs and Hidden Clauses

Some contracts include language that allows payers to share your rates with third-party networks (Silent PPOs). This means you could be reimbursed at lower, unauthorized rates without realizing it.

Tip: Carefully review clauses related to “assignment,” “delegation,” or “downstream arrangements.” These can drastically reduce your payments.

3. Weak Termination Provisions

Contracts without clear termination-for-cause or at-will provisions lock you into unfavorable terms. If your rates are too low or payer behavior changes, you need an exit strategy.

Tip: Ensure your agreements include fair termination clauses that allow you to renegotiate or walk away if necessary.

4. Ambiguous Payment Timelines

Some contracts leave wiggle room in payment timelines. If your agreement doesn’t specify clear payment terms (e.g., 30 days), you could face delays in cash flow.

Tip: Confirm that payment timelines are explicit and enforceable. Slow payments mean unnecessary strain on your revenue cycle.

5. No Out-of-Network Reimbursement Clarity

If patients receive care out-of-network, some contracts fail to define reimbursement policies. This creates confusion and can lead to surprise underpayments.

Tip: Push for clear, fair out-of-network reimbursement terms to avoid costly surprises.

The Bottom Line

Healthcare providers work too hard to leave money on the table. The reality is, payers expect negotiation — but most independent practices don’t have the time, data, or leverage to push back effectively.

That’s where Convisely comes in.

Want to know if your contracts contain these red flags? Book a free 15-minute benchmark review and see how your rates compare to industry standards.