Assuming the surgeon has absolutely no insurance contracts with any of the insurances, you would need to credential the physician with each insurance. Since this physician is a specialist, yes the percentage will more than likely be higher than your general practice physicians. The contracted rate will be negotiated between you (or the contracting manager) and the specific insurances. Of course, an adendum to any existing contracts will need to be drafted and signed by all parties and the new fee schedule loaded to your system (if you're software has that capability). You may also want to consider negotiating an automatic studies list as well with your specialist and the insurance companies. Some specialists are known to bill certain codes frequently and in order to avoid the need to obtain additional auths or referrals for procedures, you can negotiate that the insurance allow only one auth or no additional auth required when certain CPT codes are billed.
I work for an ENT group and we have a few physicians that are subspecialized in Nuero Otology and Laryngology. When we added them to our group, we had to negotiate special contracts with those specific physicians amongst a few of our insurances to pay at a higher rate. For example, with Medica, all of our physicians are cotnracted at 135% of Medicare Locale 4 fee schedule. However, our laryngologist is contracted at 150% of Medicare Locale 4. We loaded our practice management system with the standard fee schedule with Medica, however, every 3 months, we run a special report to capture all charges that were billed under that physician and verify that all codes were paid at the higher rate for that physician under that specific insurance. Any codes that were underpaid, we submit to the provider rep in order to have the claims reprocessed and paid at the correct rate. We can however, load the specialty contract seperately but we would require the offices to remember to register the patient's insurance under that specific insurance code when they saw that physician in order to pull that fee schedule.
For the automatic studies list issue, we currently have 14 ASL's across 14 insurances. Some insurances call them Open Access Codes or All Access Codes. Normally, if we did not have this ASL, we would be required to obtain additional auths for this list of procedures. The list contains anywhere between 50-150 codes. With these ASL's tied into our contract, we avoid the need to obtain additional auths on these codes because we know the physician performs these procedures often. Therefore, when the patient comes to the office, as long as we have an auth to cover that DOS, any procedure performed in the office will not require an additional seperate auth.
Hope this helps!
