Submitted by Antonio Arias, MBA, CHBME on Tue, 09/4/2018 - 10:00

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Negotiating with Payers for Better Reimbursements: 3 Tips

Small practices often feel like they have no leverage with payers. But while it’s true that large practices have a lot more power at the negotiating table, independent providers should always make sure their reimbursements are paid fairly – at rates that respect the quality of care delivered.

That said, most payers aren’t trying to “stiff” small practices. They’re simply gauging economics and ROI like any other business. If you can help an insurer realize what unique value your practice brings to their table, you may be surprised at how beneficial it proves to the pay rates (or other expectations) you can secure from a payer when establishing or revising a contract.

It comes down to knowing your worth, and negotiating smart. Here are our top tips for setting rates that support your practice’s success.

Research, Learn & Listen
Just as you have certain expectations on what you should be paid (and what’s too low to accept), payers have unique considerations in mind when they contract with new providers. Which factors are affecting the insurer you’re dealing with?

Pump your payer contacts and industry colleagues for information, and conduct online research to learn a bit about the business pressures facing each payer. And before you ask for higher payment, make sure you know what large provider groups in your area are getting for the same services (as you may learn they’re feeling squeezed, too).

Play All Your Cards
Armed with your research, you should know where your practice can create extra value for the payer. Comb through your incentive-program data to learn where your strengths are, and prepare to bring them to the table.

Maybe you offer strong metrics in areas they’re struggling with – like readmissions, or medication adherence. Or maybe you serve a unique demographic that the payer us expanding to (and that won’t be served by any other physicians in your area, if you pull your participation off the table).

Pivot Your Argument (Wisely)
Ultimately, a payer’s rates are yours to reject… at the peril of your patients. If you have a hard line for walking away (based on your financial assessments), stick to it – and make sure the payer knows how that choice affects your business, and your patient population.

If you have more of a “soft line” because you really need to be in the payer’s network (or else), find other ways to earn value in exchange for your negotiating effort. That might mean a longer contract, an early renegotiating window, extra staff support, a longer window for claims submission, or otherwise.

Negotiating with payers can be easier with a trusted medical billing firm on your side. Contact us today.

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Topics: Practice Management, Medical Billing Company

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