Cardiology Coding Alert

Presented by Steven M. Verno, CMBSI

Thank you, operator, welcome everybody to 'negotiating health insurance contracts.'  Let me start out by saying 1)  I am not an attorney.  I am a practice manager and I am a medical biller and a medical coder and one of things that I do, on a day-to-day basis, is negotiate health insurance contracts from my practices.  I am currently involved with six insurance contract negotiations right now.  I have been doing these for the last several months with these same insurance companies.  So, this is not something that is going to take place overnight or you are not going to get done within a week.  It is going to take months and in some cases maybe up to a year to negotiate a good health insurance contract.  But I just want to let you know, I am not an attorney, I am just like you.  Four Key Steps To Negotiating An Insurance Contract There are some steps that I go through when I negotiate a health insurance contract.  The first step I do is review the insurance contract language.  I go over it line by line to see if there is anything in there that is detrimental to my provider to my practice.  I look to see if there is anything that may be missing.  I look to see if there is any language that needs to be changed or language that needs to be added.  Then I negotiate.  Once I have made the changes, I negotiate the insurance contract language with the insurance company.  There is a give and take in that negotiating period.  This is where I am at right now, is in the negotiating period with these insurance companies because I have already reviewed the language. 

Once you have negotiated the insurance contract language then the next big step is determining and negotiating your reimbursement amount, because this is what you want to be paid once the contract is signed.  If you negotiate a low reimbursement amount, your practice is going to have a lot of headaches.  Your doctors are going to say, 'how come I am not making any money and I have got a contract?'  If you have got a decent reimbursement amount and they are paying you that reimbursement amount then everything is going to go okay.  'I have got some that I negotiated two years ago.  I do not have to go back to that insurance company--they are paying me the decent amount.  I do not have to constantly go back and say why are not you are paying me, how come we are having these problems.'

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