Practice Management Alert

There's no sense in taking on an additional payer if the hassle will outweigh the payments, experts say

When you don't understand the claims filing details you'll commit to and the patients you stand to gain by signing on with a new carrier, you risk causing your practice more harm than good.

"If your coffers are full of patients now, don't be so quick in taking on another health plan until you know ALL of the parameters," says Maggie Mac, CMM, CPC, CMSCS, consulting manager with Pershing Yoakley & Associates in Clearwater, Fla. Evaluate the following three main concerns to decide if a carrier contract is right for you: 1. Will we gain many new patients? You must consider what services you provide and the specific patient populations you consequently cater to in order to know whether a new insurance plan will add new patients and increase revenue, Mac says. Of course, you also need to know the patient profile of the prospective carrier's members.

For instance, if you offer services for senior citizens and there are many senior communities and assisted-living centers near your practice, participating with Medicare would boost your practice's patient count considerably, says Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J. Another example would be an ob-gyn practice deciding to participate with a nearby large-scale employer's insurance carrier because the employer hires lots of young female professionals who are likely to be starting families.

Patient numbers problem: If you decide to contract with an insurer that doesn't have many members in your geographic area, you won't be in a good position to negotiate fees and other contract details because you don't represent a big chunk of business for the carrier, Brink says. Also, if you arbitrarily contract with many insurance companies - even though they may only provide you with a few additional patients here and there - you'll be hard-pressed to keep track of each payer's billing policies, she adds.

Bottom line: The best-case scenario for participating with a carrier that will only afford you a few new patients is to negotiate a stellar contract that will make for smooth transactions. 2. Will the carrier be easily accessible? You should find out whether the carrier under consideration has a local office and an accessible medical director, Mac says. In addition, the carrier should offer you a provider representative who's readily available to answer questions and who will come to your office annually to discuss claims filing and contract issues, she adds. "If you can't get problems resolved" quickly and you're forced to conduct all communications via the Internet, you're probably signing on for excessive amounts of hassle. 3. Is the contract good for [...]