The first question I ask every physician practice is: Do you have a copy of all of your payer contracts? I can tell you that the answer I usually get is……NO! This is a major problem – how can you know what/how your practice is supposed to, and not supposed to, be paid if you do not have your contracts? Along with this, if you want to carve out particular services that are unique to your practice and area, you must have access to your payer contracts.
Now that I have your attention, you are probably on a mission to request a copy of the contracts for your practice. I commend you for that, but let me warn you, even if you call your payer and request the contract – it will take them a very long time to get this information to you. Why? Because it is not in their best interest. So with this said, start now, and keep fighting for them.
A medical practice must think about the following points when negotiating, and re-negotiating, their contracts: (I encourage you to create an Excel spreadsheet that allows you to keep all insurance information in an easy to read and accessible format.)
- · Once you get your contracts review them word for word – once you get used to their format you will figure out which areas you can skim and which areas require close attention.
· Know negotiation deadlines – all contracts have them but many practices overlook them. Be sure to create a column in the spreadsheet that has this information. This will allow you to work your contracts in order and decrease much stress.
· Remember: Without you there is no insurance company. I try to stress to groups that an insurance company is only as good as the doctors that accept them. Keep this in mind when fighting for proper, and fair, reimbursement rates.
· Know your geographical area and know your competitors. You have to think of your practice as a business – not just as a provider of health care. It is important to know how many groups with the same specialty as your practice are in the area. You also want to know what insurance plans they accept.
· Know the percentage of patients in your practice that are from each of your payers. This is helpful in two ways – first it gives you a sense of which contracts you want to re-negotiate first. Secondly, it acts as a powerful bargaining chip when a payer knows you have a large percentage of their patients.
· Know how much each payer reimburses for your office visits, and common procedures and services – and compare them to other payer reimbursement rates, as well as Medicare’s fee schedule. Even if you do not accept Medicare, all of your payer fee schedules are based off of the Medicare fee schedule. On top of that, if you have a payer that is paying you well, it gives you a base point of what you would like to achieve from your other payers.
· Stop the fear – if a payer’s reimbursement rates are not even meeting your costs – DROP THEM! Many times that is enough to get them to re-negotiate with you! Remember what I said earlier: Without you there is no insurance company!
There are many tricks to the trade in negotiating with insurance companies. We are having a webinar hosted by an experienced insurance negotiator on 10/19/09 – Join us! Holly knows the tricks and she is ready to SHARE!
Until next time……