Boosting Practice-Payer Collaboration in 2016

January 5, 2016 by Antonio Arias, MBA, CHBME

Topics: Practice Management, Medical Billing Company

Happy New Year! With the dawn of 2016 comes the annual ritual of resolution – personally and professionally. A new year presents a new opportunity for improvement at your medical practice, particularly when it comes to how well you play with others.

Which others? Your payers. Solid payer relations can make a huge difference to medical practice performance, and not just when it comes to bottom-line medical billing concerns. If frustration over processing times, exorbitant fees, improper denials, or underpayments plagued your practice in 2015, it likely spilled over into aspects of managing your practice. Practice-payer issues can decrease employee satisfaction, or even lessen the quality of patient care – making it vital for you to face issues head-on, rather than let them fester.

Seize the new year strong by spending some of January improving payer relations. Prioritize getting treated fairly; while you’ll never earn everything you hope to from insurers, following the steps below can help you get more of what you rightfully deserve.

Cull Your Data: Run the reports necessary to analyze your reimbursement data, payer by payer. Create a spreadsheet detailing pertinent information across encounters: patient, date seen, and codes charged; compared against what the insurance paid (and when), the allowed amount, co-insurance, co-pay, deductible, contractual adjustment, and remaining balance. Should troubling trends emerge, take the data straight to the payer responsible and use it to back up your case about any inappropriate denials, underpayments, or delays that shouldn’t be part of your new year.

Negotiate Your Terms: Use a second spreadsheet to compare contracted reimbursement rates, code-by-code, across your entire payer population. For each code, organize rates from highest to lowest to ensure they’re fairly consistent across the board. Where you see payment rates that are too low, take action to negotiate better terms for the coming year. (Even incremental increases can make a difference to your overall income – especially for your most commonly-used codes.)

Cut Your Losses: Keep in mind that your most problematic payers may not be worth the trouble they cause. Approach the payer data-review process with a mind for ROI; if very few patients in your practice base rely on an insurer that has been giving you grief via underpayments or denials (and is unresponsiveness to your calls for change) it may not be worth keeping them around for more of the same in 2016. 

Set a Stronger Foundation for Success: Start the new year by making sure you have a reachable, verifiable point-of-contact with each and every payer. Then, task a medical billing staffer with starting a dialogue with each payer representative to make sure the lines of communication are open in case of future issues. Make a point of keeping your practice in contact with payer reps who can solve or mitigate your practice’s problems in the coming year. After all – better relations with payers overall begin with better relationships with those in a position to help!

Contracting with a trusted medical billing company can simplify payer relations and make it easier to solve payer problems. Contact us to learn more about the value of working with a results-driven medical billing service!

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