Many medical practices are looking for ways to increase payer reimbursement as they adjust to the new health care industry landscape. You may have noticed that some of the latest trends (2013, 2014) have increased the financial pressures experienced by medical practices. The number of Medicaid patients has increased, but processing the claims for these patients is time consuming and Medicaid is known for rejecting claims at a higher-than-average rate. Higher deductibles and co-pays have also made the burden of collection more challenging.
The following are practical ways to increase payer reimbursements.
- Evaluate Your Situation
You will need to assess your payer reimbursements, looking for problem areas. This requires access to data and analytics, which can be best provided by practice management software or an EMR/EHR system tailored to your practice. At the very least, start with a spreadsheet comparing your top 10 payers and your 25 most common current procedural terminology (CPT) codes to see where you are losing money.
You will need to examine the data from the past couple years to identify where you can make improvements when it comes to reimbursements. Are you having problems with claims denial from a specific payer? Are there problems related to proper coding, or the performance of procedures that specific payers do not consider beneficial or necessary, and therefore are not covering?
- Address Internal Problems
Are the providers at your office administering services that aren’t covered? Are they coding improperly or in ways that are resulting in claim denials? Invest in software that checks procedures with policy coverage to limit claim denials. Also, make sure your staff is properly trained on optimal coding.
- Keep Current
It’s important to remain current with processing tools for record keeping, coding, billing and claims. If your software is outdated or no longer supported, you will need to invest in practice management software that communicates with payers and clearinghouses.
- Know Your Competition
Small practices don’t have much leverage with payers, since payers often say things like, “We know there are 75 other providers in your area who will take these patients if you don’t accept our reimbursement rates.” Find out how many competitors you really have, and keep track of your number of referrals, where they come from and what types of referrals you are getting. Keep data on which insurance plans they use.
Look for ways to prove your worth. If you have a reputation for quality service or are a unique practice that offers superior health care services, you need to find a way to document this so you have some sort of tangible proof to bring into payer negotiations. Survey patients and referral partners on satisfaction and quality of services provided, and collect and publish this information so you have some way to prove your worth in the market.
- Negotiate with Private Payers
You can negotiate better reimbursement rates from private payers if you can show your market worth and don’t just accept the first offer. Ask questions about changes in rates for specific codes.
Pay attention to contract expiration dates and make note of the deadlines for requested rate changes. Most payers want to set up evergreen contracts that renew automatically, making you think you can’t negotiate new rates. Read the fine print and find out when you need to initiate a meeting to renegotiate rates. Then ask for short term instead of long term contracts; it’s easier to ask for a small percentage increase in payments every year than to negotiate a 10 percent raise every six or seven years.
Look for areas of the contract to renegotiate that have previously been problematic. For example, you may need to ask for changes in the authorization for treatment process, or perhaps the amount of time allowed for appeal of a rejected claim. If your practice has lost money because of a specific problem, try to shore up against that problem when negotiating the terms of the contract.
Increasing Payer Reimbursements: How MediPro Inc. Can Help
If you want to keep up in this rapidly-changing industry, you need practice management software that will assess your office’s claims filing and processing for you. Talk to an expert at MediPro Inc. to find out what the best software is for this purpose. The payout will be well worth the investment.