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Primary Care Coding Alert

Reader question:

Prepare Wisely for Payer Fee Negotiations

Published on Mon Feb 06, 2012

Question: We're getting ready to begin contract renewal negotiations with one of our payers. We aren't happy with the fees they're paying on some of our services. Do we have to accept a generic fee schedule?Maryland Subscriber Answer: The short answer is "no," you don't have to sign a payer contract and accept the fees they put forth. You have the option to not sign the contract if you're unhappy with your reimbursement.If you contract with a payer and end up with poor reimbursement rates, you'll only burden yourself with hassles.Key strategies: Obtain a specialty-specific fee schedule from the payer whenever possible. Most contracts will attach a generic fee schedule, but this may not provide the valuable information you need regarding your most frequently reported codes.Make sure the fee schedule in your contract is comparable to the reimbursement amounts your believe appropriate for your specialty codes. If a payer offers [...]
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