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How to Negotiate Insurance Contracts to Increase Your Reimbursements

Mar 2, 2018 8:02:00 AM

Between denials and decreasing reimbursements, it may seem inevitable that your private practice will start making less and less money. However, this doesn’t have to be the case.

You can breathe a sigh of relief, because there are ways to increase reimbursements and make more money – without treating MORE patients.

Negotiating payer contracts can be intimidating but it’s necessary if you want to earn more for the valuable services you provide. Dealing with insurance companies and negotiating contracts can be both frustrating and time consuming, but you must always maintain a positive rapport with your payers.

Never allow your frustration to get in the way of finding common ground with your payers. Maintaining a polite, professional relationship will lay the foundation for better reimbursements.

If you’re feeling like some of your CPT codes are reimbursed low from some payers or that your services are worth more from all your payers, there are two effective ways to negotiate higher reimbursements in your contracts:

Focus on CPT codes that get low reimbursement rates

According to this article, some PTs noticed low-ball reimbursement rates for CPT codes they used frequently.

“Run reports to look at the top CPT codes you bill and compare reimbursement with all your insurance contracts. This analysis will help you identify low payments for codes you’re using frequently. The contract may pay a higher fee schedule for certain procedures but if your practice does not perform these procedures, negotiate a higher rate for those procedures performed in your practice.”

Use outcomes data to support your argument

You know you’re providing valuable services, but you’ll need data and numbers to support this argument when it comes to negotiating contracts. “Private practice owners that present objective patient data during payer contract negotiations tend to negotiate better rates—by as much as 3-10%,” (WebPT).

When making the case for the value of your services, use concrete data about the utilization, revenue and expenses of your practice. Also include measurements of quality, patient satisfaction, physician referrals and proof of a strong reputation.

Beware of legal phrases that might not be clear

Payer contracts may be full of confusing or vague words and phrases; don’t let them slip by without asking questions. You never know what you might get locked into.

Some phrases to keep an eye out for are:

  • “Industry-accepted”
  • “Except as otherwise indicated herein”
  • “Hold harmless patient member”
  • “Affiliates and assignments”

This article helps explain what these phrases imply. Don’t be afraid to ask for clarification or do your own investigation into the meanings behind anything you’re unsure of. Your contracts should be clear and without hidden surprises.

You’re not alone in looking for ways to increase your reimbursements. Being an independent is tough, especially when hospitals and major corporations are soaking up higher reimbursements. Did you know this is something you could be doing as well?

You could tap into national insurance contracts right now AND remain independent. The tips above are helpful and they will help you get paid more for your services, however, this will only go so far.

You’ll eventually hit a wall where you can’t negotiate any higher, reimbursements will get cut again, and your overhead and expenses will continue increasing.

But before we get any more gloom and doom, there is an answer to this challenge! A larger PT network of independents are working together and negotiating as a larger group with FYZICAL. Click here to request more information.

Written by FYZICAL

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