Practice Management Alert

Key: Maintain good relations with your provider rep You know you should be reviewing your payer contracts every year, and there are likely some contracts you want to renegotiate, payers you would like to begin participating with, or contracts you would like to terminate. If figuring out where to begin leads to anxiety attacks, stop stressing. Just follow these expert tips to ensure you get the most out of every contract your practice signs. Tip 1: Know Whom to Contact Where to start the process depends on the payer you-re dealing with. Insurance companies have different people within the organization who can handle contract renegotiation or new contract writing. "You should contact the insurance company/network to find out who you should renegotiate with. They will give you contact info," says Anne Garrity, medical collector for Alpine Family Physicians in Lake Zurich, Ill. Tip: If you-re not sure whom to start with, try contacting your provider rep first. "With some carriers the provider rep does have some authority to agree to a higher fee, but they are still limited," says Jonathan Devlin, owner of Practice Services in Dalton, Ga. "If you are on good terms with your provider reps, it is helpful." Tip 2: Don't Settle for a Basic Contract Spend time negotiating with the payer to ensure you get the best possible contract for your individual practice. Avoid boilerplate text and cookie-cutter contract models. Standard contracts don't work for all practices. The contract needs to apply specifically to your practice and include information such as your fee schedule, handling of modifiers, multiple surgery discount rates, how long the payer can go back to request refunds, what is considered timely filing, requirements for arbitration, how outstanding claims get paid, and appeal processes. For example: If you contract with a payer who shows you what appears to be a good fee schedule for the few codes shown, but you end up with poor reimbursement because the balance of the codes do not pay well, they don't honor the definition of modifiers, and they seem to "lose" claims all of the time, you-ll only end up with hassles. Obtain a specialty-specific fee schedule from the payer whenever possible along with the other terms, because a contract is a great deal more than the fees. Most contracts include a generic fee schedule, but this may not provide information on the codes you most frequently bill. Tip: See if you can get the new insurer to outdo your best payer. "Before talking money with them, figure out who is your highest-paying insurance company and try to get that fee schedule plus, out of the insurance company you are renegotiating with," Garrity suggests. Remember: When looking [...]