Practice Management Alert

Test your knowledge. Determine how you would handle this situation before looking at the box below for the answer.
Question: I'm the new manager in a billing office. When I asked my employees about our payer contracts, they couldn't respond specifically to most questions. I want to improve the office's familiarity with payer contracts and learn appropriate steps for improving contract negotiations for future contractors. Do you have any tips? Arkansas Subscriber

Answer: Contract negotiation is a crucial step in insurance collection, but most office employees don't know when their contracts were signed or what information they contain. If your office's employees don't know your contracts, you're probably missing out on major payment opportunities. As the manager, you should review your contracts at least every year before renewal, if not more often. Don't count on insurance companies to review the contracts, but you can ask them to do so. At the beginning of the year, you should send a copy of your top 25 procedure and CPT codes to find out what reimbursement they'll offer for those codes each year, and verify that the amount they offer fits your contract's stipulations. Insurance companies may lower your reimbursement without telling you, so let them know you're watching. As for contract negotiations, don't blindly accept a contract. Take a look at it. Redline a specific point even if it concerns minimal money and minimal filing time to let the insurance company know you've sifted through all the details and are fully aware of what it states.

Don't bother spending too much time on a contract that concerns only a few patients. Negotiate only with the big payers, and make sure that when you're negotiating, you have information available from the contract, past payment records and that you've reviewed them.