Are your contracts holding your revenues down?
Physicians right now need to do everything in their power to collect and keep as much of their money as possible. Most offices have never renegotiated their contracts and very few actually renegotiate them on an annual basis. This simple fact could mean that your office is leaving 10-25% of your collections in the insurers' bank. In today's world, that could be the difference in you staying in business v/s deciding to join a hospital.
We strongly recommended conducting a review of the top 5-7 commercial payer contracts on a quarterly basis (or more often) to verify payment accuracy. We often find that the reason behind declining revenues doesn't have to be uncovered – it's right there in plain sight in your payer contracts.
For the negotiations, along with an experienced contract negotiator, we also involve coding/billing department. Often the coding/billing department is left out of these negotiations and they have vital information concerning claim denials, proper use of modifiers, diagnosis, etc. These individuals work daily with the insurance payers and know idiosyncrasies and frustrations of improper interpretations and unclear definitions.
In addition to our contract negotiation services, we also offer contract evaluation services to ensure you understand exactly how you are being paid. Our standard process is to complete a thorough contract evaluation process before beginning any contract negotiation project. We like to ensure, to the best of our ability, that our negotiation services will be able to obtain a substantial enough increase to your insurance rates to justify the expense.
Our Services Include:
Properly review and analyze all current agreements
Evaluate your payer agreements and how they compare to regional market standards
Propose a contracting strategy based on your goals and the current insurance climate
Significant improvement in collections.
Determine whether capitation, exclusivity, or preferred provider status is available with any payers
Consult with payers regarding pay-for- performance measures and what fee schedule works best for the group
Determine if you are losing referrals because you're not participating with certain insurance plans
Develop and implement our plan to renegotiate your insurance agreements
Provide regular updates as we move through the negotiation process.
How Long does it Take?
Should I negotiate the contracts?
If you elect to renegotiate them yourselves, remember that most insurance companies will only provide you with the increase that is due for the current year (2-5%). If you want more, you need to have the tools that will illuminate the added value your organization provides to their members. Remember that you are providing a valuable service to their organization and it is important that you remind them of this often forgotten fact.
In light of the Affordable Care Act and the increased competition among insurance companies, everyone is scrambling to provide more value and service to their members. The value they are most often "finding" is through cutting reimbursements for providers and reducing the member's premium expense. Every penny really does matter to the payers now that customers have the ability to evaluate plan options and price through the exchange. You have to be the group that they do not want to lose, how you show them this will require\ some skill.
Find out what your practice is losing in revenue by not negotiating your contracts. Let our analysts tell you by completing this short questionnaire. We will equip you with the information so you know what to expect when negotiating your contracts. If you feel that you do not have the time to conduct a thorough evaluation and renegotiation, we would be happy to provide you with a quote for our specialized services.