Payers are much important and they need us more than we need them.Payer contract negotiations involve a unnecessary attention and this process is too much discouraging. Payers can pay off in large dividends. These are much essential to your practice.
We have listed payer contract trends which will help you to improve your practice revenue.
Payer contract negotiations involve a unnecessary attention and this process is too much discouraging. Payers can pay off in large dividends. These are much essential to your practice.
We can discuss this in detail; do you have any idea that your fee schedules are for your largest payer or network? Do you remember when they last changed? What about how to find negotiation terms in your contract?
Some practice owners can give answers for these questions, but others need to work on them to get the answers.
Gather all your Contracts and Agreements for all payers
The first step is gathering up all your contracts, and you should start immediately. Expect that this process may take two months to collect all information. Your payer contracts/fee schedules fall into several groups:
- Commercial (BCBS, Aetna, Cigna, etc.)
- Government (Medicare, Medicaid, Tricare)
- Government Replacement (Medicare Advantage Organizations, Medicaid Managed Care Organizations)
- Networks (rented by payers, such as Multiplan, TPRN)
Ensure that you have both current and completed version of documents. Completed means they have been signed by the practice and the payer. Make sure you have any addenda and amendments between the contract’s effective date and the current date.
In case if you fail to find contracts, do not worry. Still you can request duplicate copy of contract from your payer or network. Each payer, however, has its own protocol for requesting fee schedules and contracts. You may need to contact your payers for request guidelines.
Figure out your fee schedules for all your codes
Contracts do not have the fee schedule information. Payers aren’t in the business of broadcasting their fee schedules. Payers are banking on the tedious nature of the negotiations process. Hope that you will accept their terms and conditions without any question.
Gather all codes that you can use and developing a excel sheet for all your code information with modifiers and places of service for each payer product.
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