Physicians are often unaware that they may consider negotiating reimbursement rates with insurance companies. After all, health care providers and their networks play an important role in the insurance business. There may be times when reviewing your existing contract helps, such as when there are changes or updates to behavioral health, diagnosis, and cpt billing codes.
In doing so, you could find opportunities to renegotiate a contract with an insurance provider. Depending on the practice, reimbursement rates may differ, even for similar treatments and services. this may result in you being reimbursed less than other practices, which negotiated your original contract differently. a thorough review can also reveal outdated code that is no longer accepted and needs to be updated.
If you’re not happy with your insurance provider’s reimbursement rates, these tips for negotiating rates with insurance companies may help:
understand your role in the network
The more you understand how your practice fits together, the more bargaining power you will have. You will also need to show that you are an asset to the network. cost savings is a way to stand out. be prepared to bring numbers and figures to the negotiating table. Desirable factors include providing scarce specialties in your area, having favorable clinical outcomes, and employing a nurse practitioner who provides less acute care at lower rates.
gather your data
To negotiate a better reimbursement rate, you first need data to support your reasoning. First, list your most common CPT codes and their frequency; this reveals how often you provide a particular service during a specific period of time. billing software can automatically generate reports to avoid time-consuming manual processes.
Identify your top payers, the reimbursement for each code, and the fees for each below. then organize all the data into a graph or spreadsheet for analysis. Codes with the highest volumes and dollar values will generate the highest returns, so focus your efforts here first. another point of negotiation may point to health plans with lower rates or codes that are paid at a much lower medicare percentage than others.
negotiate individual rates
Analyses of your data may reveal individual services for which you may seek to negotiate rates. Payers generally don’t grant rate increases across the board, but you can make your argument that focuses on specific services to the health plan’s provider relations representative, who can refer you to a network administrator or hiring manager. for a new or poorly defined procedure, a medical director may support a payment increase request for their respective code (although they are generally not responsible for negotiating rates).
Whenever proposals or changes are made to the contract, carefully read the plan and its annexes or annexes before signing it. the changes should not, for example, conflict with malpractice coverage. If something is unclear, have legal counsel review the contract.
Psychiatric Billing Associates can help if you need assistance with claims processing, collections, patient billing, or financial reporting for your mental health practice. To learn more about how we can help, call us today at 800-650-6334 extension 947.