2015 user conference using data to renegotiation your payer contracts april 25, 2015 presented by:...
TRANSCRIPT
2015 User Conference
Using Data to Renegotiation Your Payer Contracts April 25, 2015
Presented by:
Aimee HeckmanOP 15 Billing Manager
General Session
2015 Office Practicum User Conference
Using Data to Renegotiate Your Payer Contracts
▪ PLAN▪ Track and monitor your contracts
▪ DO▪ Value current contracts by assessing fee
schedules▪STUDY▪ Analyze current contracts in detail▪ Identify contract improvements needed
from payer▪ACT▪ Renegotiate
2015 Office Practicum User Conference
PLAN
Monitor your contracts▪ Keep a master spreadsheet that shows
which contracts are due for review▪ Monitor spreadsheet to determine date
for opportunity to improve your contract
2015 Office Practicum User Conference
PLAN
2015 Office Practicum User Conference
PLAN
Set a Timeline to Renewal
2015 Office Practicum User Conference
DO
Value current contracts▪ Use Office Practicum reports or spreadsheet
software such as Excel or Open Office to create a report to compare procedure codes and payments from each payer
CPT Code 99213Payer 1: $50Payer 2: $60
Payer 3: $70
CPT Code Payer 1 Payer 2 Payer 3
99213 $50 $60$70
99214 $55 $65$75
2015 Office Practicum User Conference
DO
2015 Office Practicum User Conference
DO
▪ Create a second report that compares average dollars deposited per visit from payers
▪ Total the number of visits per insurance company and use that number as the divisor of the total revenue dollars deposited for those visits
2015 Office Practicum User Conference
STUDY
▪ What is right about your current contracts?
▪ What do you still need from the insurance company?
The greater danger for most of us lies NOT in setting our aim too high and falling short; but in setting our aim too low and achieving our mark.
~Michelangelo
2015 Office Practicum User Conference
STUDY
Know your current contract and amendments
▪ Contracted with Self Funded, Leased Network or Insurance Owned Network
▪ Fee Escalators - what % and how often▪ Carve Outs▪ State Laws re: timely payment and timely filing▪ Are you with a Clinically Integrated Network or
ACO whose contracts can replace/void your agreement
▪ Notice required for contract amendments, term and termination
▪ Payment Policies
2015 Office Practicum User Conference
STUDY
Do you want a quality or value based contract?
▪ What is your leverage?▪ Size▪ Low $$ utilization▪ Clinical Quality
▪ Medical Home▪ High Immunization rates▪ Low antibiotic usage▪ Asthma and Obesity
2015 Office Practicum User Conference
STUDY
Value Based Contracts
▪ Vary by geography▪ Can be lucrative▪ Don’t want skin in the game▪ Local Managed Care hurting on HEDIS?▪ Peer group can’t manage and lots of
referrals and hospitalizations?▪ New HIN everyone wants you to use?
2015 Office Practicum User Conference
ACT
Renegotiate
▪ Goal▪ What you want to achieve in your contract▪ What result would THRILL you not just
satisfy▪Bottom Line▪ What you absolutely MUST agree to▪ If bottom line is not met, be ready to walk
away or have a great poker face!
2015 Office Practicum User Conference
Steps to Success
▪ Set your bottom line▪ Consider what the payer needs from the practice▪ How the practice meets those needs▪ Be the first to set the contract offer; Have a plan for
your counter offers▪ We will do this for the payer and you will do this for us▪ Have your data ready! Fee comparisons - Member Facts
- Costs▪ Play smart and confident; Do not appear uninformed or
too aggressive▪ Start with the easiest mark, one that you are sure will be
met with YES or NO▪ Make counter proposals incrementally, do not go
straight to the bottom line▪ Know when to close the deal and push for effective date
as soon as possible
2015 Office Practicum User Conference
Changes You May Wish to Make
▪ Establish spreadsheets or reporting method to track and monitor your insurance contracts
▪ Consider Value Based Contracts▪ Maintain Awareness of Payer needs for
their members
2015 Office Practicum User Conference
2015 Office Practicum User Conference
REFERENCES
For more information on this subject:
Join PPMA and visit the Practice Support page at
http://www.aap.org/practicesupport
Insurance Contractshttp://www.aap.org/en-us/search/Pages/results.aspx?k=Insurance%20contracts
2015 Office Practicum User Conference
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