Navigating the Negotiation Process
A quality billing company establishes strong working relationships with dedicated insurance representatives who ultimately grant negotiation requests based on overall practice performance. They weigh several factors, including: how much providers bill to insurance; how much they receive; clean claim rates; and the number of audits passed or failed.
The reps will either accept or decline a practice’s request based on perceived value to their network. An insurer will want to know why patients use the practice and why they should continue working with the practice under a newly-negotiated contract. It is also important to include pertinent clinical information from a physician or director.
A negotiation request should include information about:
• Measures that help keep patient populations healthier
• Procedures that save lives or cut down on hospital admissions
• Expanded office hours that improve access for members
• Practice staff, including physicians, registered nurses, physician’s assistants, etc.
• Facility size and operating expenses - for example, working longer hours incurs overtime costs
• Flat rate services - an urgent care center that gets a flat rate for all visits can request additional reimbursement for expensive CAT scans, MRIs or X-ray
Bottom Line Benefit
Clearly, providers are so focused on patient care and the administration that changing an insurance agreement seems like an added headache. However, practices may be leaving many thousands of dollars on the table if they do not know where to look and are not embracing the need to re-negotiate.
WCH Service Bureau is the #1 billing and credentialing company in the tri-state, New York area. www.wchsb.com