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Medical Practice Reimbursement is Not a Level Playing Field.

The medical practice reimbursement system currently used by payers is not a level playing field for physicians. It’s actually quite an antiquated system and it pays different rates to different size practices and different specialties. National research has shown that the more market power a physician group has, the higher the rates it can receive from private payers. That means that for the same service, the two-physician practice in a rural market is paid less than the 50-physician practice in the next town.

Inequitable reimbursements

The research, conducted by the American Research and Policy Institute in Washington, DC, states that one of the reasons that inequitable reimbursements have grown to the current state is the rate of health system and physician practice consolidations. As large hospital systems increasingly buy up independent practices, they negotiate higher rates. Large health systems can negotiate higher reimbursements for their physicians because they have a larger market share. That leaves independent physicians and small practices out in the cold when competing for good rates.

What is a practice to do? Arm yourself with data- accurate, timely, razor sharp data. It is the key to successfully negotiating every dime from every managed care contract. It is possible to leave the negotiations without leaving money on the table.

Even on a topsy-turvy playing field you can position your practice for optimum reimbursement, however, you will need the following:

1: Make sure your billing staff provides you with:

  • The latest data from all contracts
  • Number of denials
  • Number of appeals
  • Length of time for the appeal

If your current medical billing software does not generate this information, or if your staff can’t extract the data, it may be time to outsource your medical coding and billing functions.

2: Make sure you have leverage walking into payer contract negotiations.

  • Know your contracted rate
  • Know how many times you have been paid less than that rate
  • Know how long it took for you to appeal and receive the remainder of the payment
  • Did you in fact receive the remainder of the payment?

If you current medical billing software can’t arm you with this data, you need one that can. Data is power. Your competitors have these systems. They have the power to negotiate higher rates. You can have that power too.

If you find yourself struggling with all this, stop and call MICI. We are here to help with seasoned experts armed with years of experience. No need to go into battle unarmed. Call us. We can suit you up.

You can read more about this issue in our white paper “Physician Practices- Competition Drives the Need for Efficiency”, posted on our website: http://medicalincome.com/physician-practices-competition-drives-need-efficiency