Wiki PPO contract negotiating/ Whats acceptable?

[lindseyhulley]

Hello,

I am auditing the fees at my Urgent Care and I am noticing that we are being paid below Medicare Rates for our PPO policies for almost every service. To me this seems abnormal. Highly abnormal. I am gathering data but was wondering if anyone had some advice regarding this. I am new to In Network Contracts and would like to know the best way to proceed, as I feel that we are being underpaid by our PPO policies. Thank you.

Lindsey Gallo, CPC

 

[Bombinat]

PPO contracts

Lindsey,

Unfortunately, it is not uncommon. We have a new client that is a big client - $5 billion company. 90% of their contracts reimburse the most billed codes lower than Medicare. We have a managed care negotiator working to update all of the contracts.