We offer physicians contract negotiation services that will increase revenue for your organization. Most practices never negotiate contracts and accept what the insurance company offers. Insurance contracts have evergreen clauses which mean they continue to roll over year after year, which translates to practices missing out on an additional 5-15% in revenue. Successfully renegotiating your managed care contracts can yield to an increase on revenue for most organizations.
We have established relationships with key people at each organization and have the tools necessary to work with these insurance companies and directly impact your bottom line.
Our process for contract negotiating is as follows:
Step 1: Analyze current reimbursement
We work with the office to identify key payors and also the top 15-20 CPT codes being billed. Once these have been identified, we contact each payor and find your current reimbursement for the codes. We meet with the practice and present the data in a spreadsheet format (see below) and recommend which insurance need to be contacted for re-negotiations.
| Medicare 2010 | Co #1 | # 1 as % of Medicare |
Co # 2 | #2 as % of Medicare |
Co #3 | # 3as % of Medicare |
|
| E&M Codes | |||||||
| 20610 | $79.93 | $85.32 | 106.70% | $85.60 | 107.10% | $75.80 | 94.80% |
| 99213 | $70.19 | $63.74 | 90.80% | $65.47 | 93.30% | $54.63 | 77.80% |
| 99214 | $105.25 | $90.92 | 86.40% | $99.06 | 94.10% | $85.68 | 81.40% |
| 99243 | $140.64 | $128.61 | 91.40% | $143.61 | 102.10% | $127.33 | 90.50% |
| 99244 | $206.66 | $189.59 | 91.70% | $197.07 | 95.40% | $179.20 | 86.70% |
| Hospital | |||||||
| 97110 | $31.78 | $24.78 | 78.00% | $32.81 | 103.20% | $28.74 | 90.40% |
| 97112 | $33.01 | $25.76 | 78.00% | $34.85 | 105.60% | $30.30 | 91.80% |
| 97140 | $29.47 | $23.10 | 78.40% | $37.15 | 126.10% | $27.19 | 92.30% |
| Procedures | |||||||
| 23472 | $1,519.54 | $1,808.78 | 119.00% | $1,735.19 | 114.20% | $1,609.48 | 105.90% |
| 27447 | $1,561.27 | $1,851.44 | 118.60% | $1,765.05 | 113.10% | $1,639.13 | 105.00% |
| 29823 | $635.11 | $749.39 | 118.00% | $757.80 | 119.30% | $690.83 | 108.80% |
| 29826 | $676.83 | $804.85 | 118.90% | $812.47 | 120.00% | $743.56 | 109.90% |
| 29827 | $1,098.55 | $1,315.35 | 119.70% | $1,318.10 | 120.00% | $1,215.24 | 110.60% |
| 29874 | $541.76 | $635.63 | 117.30% | $642.09 | 118.50% | $584.14 | 107.80% |
| Average % of Medicare | 105.32% | 111.07% | 99.10% | ||||
** The numbers and codes mentioned in the table above are for demonstration purposes only and do not represent actual reimbursement amounts.
Step 2: Select insurances for re-negotiations
Once the data has been analyzed by the office, the top payors are selected based on reimbursement rates for contract re-negotiations.
Step 3: Provide information on the practice
When we approach insurance companies for re-negotiations, the most important tool is how your practice adds value to their organization and how you can help them cut costs. That’s what is important them – their bottom line. It is important for your practice to give us as many details as possible about the doctors, the team, and your approach to treating patients. Any data collected on visits and specific procedures helps.
Step 4: Evaluation of existing contracts
This stage goes hand in hand with Step 3. We start the process by requesting copies of current contracts for the selected payors. Once received the contracts are analyzed for any special clause or language that may have been added.
Step 5: Contract Renegotiation
The formal process of re-negotiations is then started. We contact the individual payors to start the discussion. Often there are at least three tiers of managers to negotiate with for final rates.
Timeline
The timeline for the completion of contract negotiations varies by insurance companies and can take anywhere from ninety days to a year. There is constant communication needed between your office and us in order for the contract negotiations to be successful. We may request the president/managing partner of the practice to meet with the insurance company along with our team to address any clinical issues.
You can contact us anytime with questions.